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Doctor's Consultation  by Dr. Iain Corness


Saturday, October 13, 2018 - October 19, 2018

Tonsillitis – a rite of passage?

I lost my tonsils when I was three years of age. I can still see the anesthetists hairy arms through my tears as I was restrained on the trolley. I won’t claim PTSD (Post traumatic stress disorder) but I think my parents could have got me better prepared. A lot of promises of ice cream would have helped.

I thought about tonsils as a friend just had her tonsils out. This is nothing extraordinary as most of us got our tonsils yanked when we were about three years old. However, my friend who has children of her own is obviously a little older than a toddler.

Tonsils are interesting little (or in some cases, not so little) glands. They live in the back of the throat and can become acutely infected, which we call Acute Tonsillitis, or can carry a low grade infection for many months or even years, known as Chronic Tonsillitis.

The infecting organism is also of interest and can be a Virus, or Chlamydia, or bacteria such a Streptococcus or Staphylococcus, Mycoplasma, Fungi or Parasites. Another interesting snippet is that the most likely organism varies with the age of the owner of the rotten tonsils. In the 2-7 year olds it is Haemophilus influenzae which is the culprit, while in the 8-14 year olds it is Staphylococcus aureus and after that it becomes a mixed bag.

With an acute tonsillitis you will often hear the child’s voice change, and when you look inside the mouth there will be two “strawberry” shaped masses in the back of the throat. They will even have little white follicles on them, like strawberries. They can get so big that they will even meet in the midline, displacing the uvula, the little ‘clapper’ that hangs down in the center. Pain radiating up to the ears is another frequent symptom, and the younger ones can run temperatures over 40 degrees C which is a worry for most Mums and Dads. Another symptom of an acute attack is bad breath, so if Junior can knock over the cat with one breath, have a look at his tonsils!

An appropriate antibiotic settles the acute attack fairly quickly, but it is very necessary to make sure the child takes the full course of medicine. With the more chronic attacks, the pain is less, the temperature is less, but the patient does not feel well, and antibiotic treatment is usual. Of course, it is necessary to identify the causative organism, and a tonsillar swab is usually taken to identify the nasty little blighter. It is also important to treat the other symptoms, such as pain and the elevated temperature, and paracetamol is the drug of choice for this.

When I was a child (in the days of hardship before ballpoint pens and cellophane paper) one good attack of tonsillitis was enough to have you prostrate under the surgeon’s knife, but these days we are a little more circumspect. With more than 10 acute attacks in 12 months we would recommend tonsillectomy, or if there was a continuous low grade chronic infection, again the advice was to yank the offending organs.

I am sure my friend will feel better after having her chronically infected tonsils removed - after she has got over the acute effects of surgery!

Ice cream helps.

Update Saturday, October 6, 2018 - October 12, 2018

They walk amongst us!

Following on from my article on blood groups came a “scientific” paper to claim that people who are Rhesus negative are descended from Aliens. This is nonsense and very poor application of statistics. However, DNA testing applied correctly can turn up some startling results.

Let’s begin with some medical facts: Bruises on a child’s body are often considered proof that a baby has been battered. A visible bruise on the buttocks, the shape of a hand and five fingers is almost ‘undeniable’ proof. In fact, there was a very celebrated instance of a GP in the UK having discovered that so many of the Asian babies in the practice were showing signs of being ‘battered’ that the children’s welfare people were called in and an enormous number of children taken away. However, the highly observant GP was wrong!

In Thailand, and the rest of Asia, a new-born baby with the ‘handprint’ bruise is very common, while child abuse is not common at all. The problem, or rather the condition, relates back to Genghis Khan and the Mongol hordes. It is a wonderful piece of folklore and also a fine example of applied genetics.

Let’s look at the folklore first, and you are going to have to dig very deep to get this tale anywhere else! A Mongolian baby, called Tanujin, was born just over 1,000 years ago, but did not breathe. His father, in desperation, held his new-born son upside down and smacked him severely over the bottom, so much so that the baby drew breath and lived, but carried the life giving bruise for the rest of his days. That baby later became Genghis Khan (which means King of the Earth), and by the time he died in 1227 he was the ruler of a large chunk of it, including the area which later became known as Thailand.

History has chronicled that the Mongol hordes raped, pillaged and annexed countries from China to Persia. Famous cities were captured and looted such as Tashkent, Baghdad (still a good place to stay away from, thanks George) and Bokhara. The Mongols conquered northern India and Afghanistan. In 1222, they defeated the Russian and Bulgarian armies. At the time of Genghis Khan’s death, his empire stretched from China’s Yellow River to the Dnieper, in Russia.

And now back to some interesting folklore. The descendants of Genghis Khan also showed the hand-shaped bruise on the buttocks, beginning with his four sons Ogdai, Jagatai, Juji and Tule, who were given one quarter of the empire each after their father died. They in turn passed on this ‘trademark’ and so this continues till today. If your “Luk Krung” children have the sign of Genghis Khan, called Mongolian Blue Spot, you can claim descent from the warrior king. However, there is quite a number of you, so I think there won’t be much left in Genghis’ estate by today.

Now Mongolian Blue Spot, as a clinical condition, is well documented, and I came across figures suggesting that at least one Mongolian spot is present on over 90 percent of Native Americans and people of African descent, over 80 percent of Asians, over 70 percent of Hispanics, and just under 10 percent of fair-skinned infants (Clinical Pediatric Dermatology, 1993). The distribution was followed through with DNA testing.

Medically we describe Mongolian Blue Spot as flat bluish to bluish gray skin markings that commonly appear at birth (or shortly thereafter) and scientifically they are called congenital dermal melanocytosis. They appear commonly at the base of the spine, on the buttocks and back. The medical text books also warn that occasionally Mongolian Blue Spots are mistaken for bruises and questions about child abuse arise. Obviously a text book that the UK GP did not read! Mongolian Blue Spots are birthmarks, not bruises.

So, for all of you with children with a peculiar blue birthmark on their bottoms, or for those interested in checking friends and neighbors (or the young ladies dancing in the chrome pole palaces), it seems fairly positive that the lineage is verified. You really have found descendants of the man who conquered more of the world than Alexander the Great. And guess what – my children have it too!

HEADLINES [click on headline to view story]

Tonsillitis – a rite of passage?

They walk amongst us!