Friday 16 November 2018

Dear Dr Nina: My daughter's broken arm has healed - but she's still suffering

Photo posed
Photo posed

Q: My 10-year-old daughter broke her arm playing football last year. It was a bad fall where another girl pushed her - accidentally, probably - but there was a lot of drama around it as the other girl's mother made a big deal about it and my daughter ended up having to answer questions from the coaches about how it happened and was she being bullied. She wore a cast for two months and the doctors were pleased by how well the break had healed and that was that. However, these days she frequently complains now about pain in her arm and she even has said that she doesn't want to do sports at school because it hurts. Is it possible that the arm is still sore or is this all in her head?

Dr Nina replies: The majority of arm fractures heal quickly and well in an otherwise healthy child, but if your daughter is complaining of pain, I do think it's important that any physical cause is ruled out first. If the pain is stopping her taking part in all activities, even those outside school sports, then a physical cause is more likely. If pain only occurs when attending school sports, I would explore other causes.

If all is well physically, then I think it is important to explore any psychological pain. Her pain may reflect being distressed or having her life disrupted by her injury and the stress surrounding it.

Anxiety-related disorders are very common in Ireland, affecting up to one in eight people. Anxiety can make you feel on edge, unable to relax, sleep or eat, along with physical symptoms such as nausea, palpitations and chest pain.

Counselling or talking therapy are probably the best places to start. Cognitive behavioural therapy can be especially helpful for anxiety disorders. There are counsellors who specialise in children and adolescents.

Your GP may recommend practitioners in your area. Other good places to search are psihq.ie (Psychological Society of Ireland) or iacp.ie (Association of Counsellors and Psychotherapists).

Lifestyle is important. Regular exercise has been clinically proven to reduce stress levels and help anxiety. So getting back to even 30 minutes gentle exercise daily is important.

Eating well will also help. Regular unprocessed meals will help keep blood glucose levels stable. Healthy fats are good for the brain and mood.

Disrupted sleep can be a symptom of anxiety. Have a proper wind down time and keep the bedroom cool, dark and quiet. These will help promote good, quality sleep.

Mindfulness is a state of open active acceptance of the present. Although originally based in Buddhist principles, it has evolved to become part of the mainstream treatment of psychological issues.

Those who are mindful maintain an awareness of their thoughts, feelings, surroundings, sensations and environments. It also involves acceptance of our feelings and emotions and not necessarily looking for a right or wrong in these. Mindfulness has been shown in numerous studies to be beneficial to both physical and mental health.

There are some excellent self-help books even for children. You can get many of these in your local library. The HSE has a list of recommended books and your GP can advise you of these.

Despite huge media campaigns as regards mental illness, there remains a stigma attached to it. Physical symptoms, which are socially more acceptable, may predominate. Children especially may not realise the psychological basis for their condition. Their symptoms are genuine and real and they will often worry a lot about the cause.

The first step is talking to your daughter, exploring her anxieties and concerns. Reassure her that her pain is treatable and that addressing it will hopefully be a first step on her road to health.

Q. I recently had a scan which showed up, to my surprise, that I have a gallstone. I have never had any symptoms or problems. Do I need to do anything about it?

Dr Nina replies: The gall bladder is a pear-shaped gland that sits below the liver in the right side of the abdomen. It stores a substance called bile, which helps us digest fats in our diet. Gallstones form when liquid stored in the gallbladder hardens into pebble like material. They can vary in size from small bits of grit to as large as a golf ball. People may have one or several gallstones. Gallstones are very common and are thought to occur in 10 to 15pc of the adult population.

Women are twice as likely to develop gallstones as men. They are more common in those over 60. High oestrogen conditions such as pregnancy, the contraceptive pill or using HRT increase the risk. Obesity is a major risk factor for gallstones, as is a diet high in fat and low in fibre. Conversely, fasting and rapid weight loss can also increase the risk. Gallstones may run in families and are more common in those with diabetes.

When gallstones act up, they cause pain, usually in the upper abdomen. This may be felt in the back or in the shoulder also. These attacks often follow fatty meals. If there is a blockage or infection in the gallbladder the pain may last longer. There may be a fever, nausea and vomiting, pale-coloured stool and jaundice (yellowish colouring of the skin and eyes) may occur. These symptoms usually require admission to hospital. 

Gallstones only require treatment if they are symptomatic. Despite the fact that so many people have gallstones, it is estimated that every year only about 1pc to 4pc of these will develop symptoms related to them. If you had the scan because of bouts of abdominal pain, then treatment may be warranted, but if your gallstones are not causing any symptoms, it is perfectly OK to let them be.

 

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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