martes, 21 de abril de 2009

Operar o no operar de amígdalas. That´s the question

Operar a un niño siempre es motivo de preocupación para los padres. Lo que me llama la atención es que no temen a la intervención en sí sino a "la anestesia". Cuando les recomiendo una intervención - o un especialista lo hace- siempre les explico lo siguiente para que sepan por dónde nos movemos. Yo clasifico a las operaciones en:
  1. Urgentes: los padres no pueden decidir. Hay que operara ya o el niño puede morir, por ejemplo, una apendicitis.
  2. Semi urgentes: los padres pueden buscar segundas opiniones pero tienen un tiempo limitado porque si no se realiza el órgano queda descompensado y una intervención tardía no obtendría ninguna ninguna mejora. Tal es el caso de las cardiopatías congénitas o malformaciones de riñón.
  3. Nada urgentes: no hay una fecha determinada. Se puede realizar, en teoría, más pronto o más tarde e incluso posponer durante años. Algunas de estas intervenciones mejoran algo en el organismo que a la larga se traduce en una mejor calidad de vida (fimosis, adenoides/vegetaciones, amígdalas o hernia umbilical).
Pues bien, las intervenciones a las que los padres son más remisos son sin duda la de adenoides/vegetaciones y amígdalas. Pero no tienen miedo a la operación sino a la "anestesia" y por este motivo la retrasan o se niegan a hacerla. Hay niños que da pena verlos con cara de "bobalicón" por respirar mal debido a una hipertrofia amigdalar o adenoidea.

Un fenómeno que yo ya había apreciado en la consulta es que algunos de los niños operados subían de peso e incluso se "pasaban". La causa no está clara pero son niños que durante años han hecho un sobreesfuerzo para poder respirar: la respiración es ruidosa por la noche, tienen mal aliento y sed al levantarse, duermen intranquilos cambiando de postura continuamente. En cuanto se intervienen duermen como angelitos-no roncan- y no tienen ninguna dificultad para tragar. En un estudio reciente de la revista Pediatrics unos médicos holandeses demostraban que cuando se operaban de adeno-amigdalectomía entre los 2 y 5 años se asociaban a un aumento de peso e incluso obesidad.

A muchos niños no se les mejora el paso del aire y están flacuchos, se les deforma la cara y, al crecer, pueden ser roncadores de campeonat, tener sueño durante el día, dormirse conduciendo o tener problemas cardiovasculares

40 comentarios:

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Dr.Santi:
Es verdad que los padres tienen sobre todo miedo a la anestesia. Suelo comentarles que, estadisticamente, es mucho más peligroso el viaje en coche hasta el hospital que la anestesia, y parece que les tranquiliza ..... algo.
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Playing bingo needs more than luck or skills and techniques, contrary to what most believe. Bingo, just like any game of chance, comes with rules and regulations that players should observe. Being a player comes with responsibilities and etiquette.

Winning the Game

The moment you figured out you won, you must immediately yell BINGO, and it should be loud enough for the floor walker to hear. The pot money shall be given to the winner once their winning card is confirmed. Well, in winning or once you know you just won, the most important thing is that you shout the winning word BEFORE the time elapses. If the game proceeds and the next number is mentioned and you failed to shout "Bingo", your winning card is disqualified. Therefore, this is the rule you must know.

There may be cases when there are two winners, and in this case the pot money shall be divided equally among the winners. Supposing there are two winning cards, the two winners will share half the prize money.

Bingo Game Rules

Bingo rules are basically the same no matter in which Online Bingo hall you play. But still it's good if you know these rules by heart. If it is your first try, then ask for handouts and inquire from pros regarding the game rules. Nonetheless, the ideal thing to do if you have questions is to ask the floor walker and not the person seated beside you. You should clarify things and doubts before the game starts because asking too many questions as the game proceeds could well distract you. This guideline also applies to those who are newcomers at casinos, those who play roulette for the first time.

Bingo halls demand an age limit of 18 years old. If you are below this age, you are prohibited to play. Some bingo houses ban alcohol inside, so players aren't supposed to take liquor nor drink it inside the venue. Smoking may also be restricted inside the venue, as there are designated smoking sections.

Take note that some Bingo houses don't allow food but some do, so it basically depends on the venue. Policies vary among different venues. For instance, some bingo halls allow reservation of cards, while others don't allow it. Some allow people to leave the venue in the middle of the game, others forbid it. But there are general policies observed in all bingo houses, such as disqualification of tampered bingo cards. There is no way you can get away with a tampered card because the walkers are adept at identifying authentic cards from tampered ones. You could be banned from a bingo establishment if proven liable of tampering a card. Hence, you should play honestly.

Interestingly, some venues offer special bingo games for kids although some halls don't allow players to have companions while playing. Suppose you bring kids with you, don't let them run around the venue and bother other gamers. They should behave well whilst you play and the game proceeds. Play quietly and don't recite the numbers you desperately want to come off because you'll be much of a disturbance if you do. Decorous playing is expectant of all players, even those who play roulette at casinos. Also, having a valid identification is important because you don't know you might win and need to present credentials.

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