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Dr. John: Hole in the heart, extremity nerves

10:00 AM, Dec 18, 2013   |    comments
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KUSA - Dr. John Torres from Premier Urgent Care answers your questions every week. If you have a medical question for Dr. John, send it to mornings@9news.com and make sure to have Ask Dr. John in the subject line.

Question #1
I sponsor a 14 yr-old girl in Colombia. A few months ago she had an emergency appendectomy. Afterwards, they gave her a complete physical. In a recent letter, she said she had a small hole in her heart that would have to be fixed. She is a little apprehensive. Is this something that can probably be taken care of by going up from the abdomen or leg? I know the information isn't a lot, but it doesn't sound like something that would be considered an emergency here.

Answer
The hole in her heart is known as either a ventral septal defect or atrial septal defect. It's basically just that, a hole in the tissue separating the two sides of the heart. Normally this tissue keeps blood that already got oxygen from the lungs from mixing with blood that still needs that oxygen. But when someone has a hole in this part of the heart this blood mixes and can cause other health issues. Usually it is found and repaired in very small infants here in the US. How it gets fixed depends on where the hole is, how big it is and how good of a shape the heart is. If it's small it can sometimes be taken care of by placing a catheter in a leg blood vessel, feeding it up towards the heart and placing the device that will close the hole. If the hole is too big though an open heart type surgery might be done instead. After either surgeries patients usually recover well and typically do well from then on out.

Question #2
I lived in Alaska years ago and was told in a first aid class the nerves in the fingers, toes, and ears of babies and toddlers are not well developed. These children don't react to severe cold the way older kids and adults do. So they can get frostbitten very quickly if they are out without hats or mittens or boots. It should be simple common sense to cover them up, but it is amazing how many little tykes we see with no hat or mittens or boots. Thank you. Margaret

Answer
It is true that children are more sensitive to the cold than adults are but try and tell them that. They usually want to go outside in the snow and cold and don't always dress well for it, so that's where we come in. One of the things we learn early on in medical school is that children are not simply small adults so they react to things including the cold differently than we would. Because they have a bigger body surface area than adults and less muscle mass they can lose heat quicker and have a harder time making it up so can drop their temperature fairly rapidly when out in the cold. This is especially true if they are wet or if it's windy. They also don't necessarily pay attention to early signs of hypothermia or frostnip so can quickly get in to trouble. That's where we, as adults, come in. It's important we make sure they have enough clothes on for the given conditions. Coats, gloves and hats are important to ward off the weather but not something they always want and don't work well if they are left on the sidewalk. Also don't assume they are reacting to the cold the same way you are. Keep a close eye on them and make sure they take breaks from time to time to come inside and warm up a bit.

(KUSA-TV © 2013 Multimedia Holdings Corporation)

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