Toe walking in children

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Walking on the toes or the balls of the feet, also known as toe walking, is fairly common in children who are just beginning to walk. Most children outgrow it.

Kids who continue toes walking beyond the toddler years often do so out of habit. As long as your child is growing and developing normally, toes walking is unlikely to be a cause for concern.

Toes walking sometimes can result from certain conditions, including cerebral palsy, muscular dystrophy and autism spectrum disorder.


Toe walking is walking on the toes or the ball of the foot.

When to see a doctor

If your child is still toe walking after age 2, talk to your doctor about it. Make an appointment sooner if your child also has tight leg muscles, stiffness in the Achilles tendon or a lack of muscle coordination.


Typically, toe walking is a habit that develops when a child learns to walk. In a few cases, toe walking is caused by an underlying condition, such as:

  • A short Achilles tendon. This tendon links the lower leg muscles to the back of the heel bone. If it’s too short, it can prevent the heel from touching the ground.
  • Cerebral palsy. Toe walking can be caused by a disorder of movement, muscle tone or posture caused by injury or abnormal development in the parts of the immature brain that control muscle function.
  • Muscular dystrophy. Toe walking sometimes occurs in this genetic disease in which muscle fibers are unusually prone to damage and weaken over time. This diagnosis might be more likely if your child initially walked normally before starting to toe walk.
  • Autism. Toe walking has been linked to autism spectrum disorders, which affect a child’s ability to communicate and interact with others.

Risk factors

Toe walking out of habit, also known as idiopathic toe walking, sometimes runs in families.


Persistent toe walking can increase a child’s risk of falling. It can also result in a social stigma.

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Causes The most common cause of HUS

result for Hemolytic uremic syndrome (HUS)

The most common cause of HUS — particularly in children under the age of 5 — is infection with certain strains of E. coli bacteria. E. coli refers to a group of bacteria normally found in the intestines of healthy humans and animals. Most of the hundreds of types of E. coli are normal and harmless. But some strains of E. coli cause diarrhea.

Some of the E.coli strains that cause diarrhea also produce a toxin called Shiga toxin. These strains are called Shiga toxin-producing E. coli, or STEC. When you are infected with a strain of STEC, the Shiga toxin can enter your bloodstream and cause damage to your blood vessels, which may lead to HUS. But most people who are infected with E. coli, even the more dangerous strains, don’t develop HUS.

Other causes of HUS can include:

Other infections, such as infection with pneumococcal bacteria, human immunodeficiency virus (HIV) or influenza
The use of certain medications, especially some of the medications used to treat cancer and some of the medications used to suppress the immune system of organ transplant recipients
Rarely, HUS may occur as a complication of pregnancy or health conditions such as autoimmune disease or cancer
An uncommon type of HUS — known as atypical HUS — can be passed down genetically to children. People who have inherited the mutated gene that causes this form of HUS won’t necessarily develop the condition. But the mutated gene might be activated after exposure to a trigger, such as an infection, the use of certain medications or a chronic health condition.

Risk factors
The majority of HUS cases are caused by infection with certain strains of E. coli bacteria. Exposure to E. coli can occur when you:

Eat contaminated meat or produce
Swim in pools or lakes contaminated with feces
Have close contact with an infected person, such as within a family or at a child care center.
The risk of developing HUS is highest for:

Children 5 years of age or younger
Adults 65 years of age or older
People who have a weakened immune system
People with certain genetic changes that make them more susceptible to HUS
HUS can cause life-threatening complications, including:

Kidney failure, which can be sudden (acute) or develop over time (chronic)
High blood pressure
Stroke or seizures
Clotting problems, which can lead to bleeding
Heart problems
Digestive tract problems, such as problems with the intestines, gallbladder or pancreas
Meat or produce contaminated with E. coli won’t necessarily look, feel or smell bad. To protect against E. coli infection and other foodborne illnesses:

Avoid unpasteurized milk, juice and cider.
Wash hands well before eating and after using the restroom and changing diapers.
Clean utensils and food surfaces often.
Cook meat to an internal temperature of at least 160 degrees Fahrenheit.
Defrost meat in the microwave or refrigerator.
Keep raw foods separate from ready-to-eat foods. Don’t place cooked meat on plates previously contaminated by raw meat.
Store meat below produce in the refrigerator to reduce the risk of liquids such as blood dripping on produce.
Avoid unclean swimming areas. Don’t swim if you have diarrhea.

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Expect : Coronary bypass surgery

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Before the procedure Coronary bypass surgery

If your coronary bypass surgery isn’t performed as emergency surgery, you’ll likely be admitted to the hospital the morning of the surgery.

During the procedure

Coronary bypass surgery generally takes between three and six hours and requires general anesthesia. The number of bypasses you need depends on where in your heart and how severe your blockages are.

For general anesthesia, a breathing tube is inserted through your mouth. This tube attaches to a ventilator, which breathes for you during and immediately after the surgery.

Most coronary bypass surgeries are done through a long incision in the chest while a heart-lung machine keeps blood and oxygen flowing through your body. This is called on-pump coronary bypass surgery.

The surgeon cuts down the center of the chest along the breastbone and spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped with medication and a heart-lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel, often from inside the chest wall or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is redirected around the narrowed part of the diseased artery.

Other surgical techniques your surgeon might use include:

  • Off-pump or beating-heart surgery. This procedure involves doing surgery on the beating heart using special equipment to stabilize the area of the heart the surgeon is working on. This type of surgery is challenging because the heart is still moving. It’s not an option for everyone.

  • Minimally invasive surgery. A surgeon performs coronary bypass through small incisions in the chest, often with the use of robotics and video imaging that help the surgeon operate in a small area. Variations of minimally invasive surgery might be called port-access or keyhole surgery.

After completing the graft, the surgeon will restore your heartbeat, disconnect you from the heart-lung machine and use wire to close your chest bone. The wire will remain in your body after the bone heals.

After the procedure

Expect to spend a day or two in the intensive care unit. The breathing tube will remain in your throat until you are awake and able to breathe on your own.

Cardiac rehabilitation often begins while you’re still in the hospital. You’ll be given an exercise and education program designed to help you recover. You’ll continue with monitored programs in an outpatient setting until you can safely follow a home-based maintenance program.

Barring complications, you’ll likely be discharged from the hospital within a week. You still might have difficulty doing everyday tasks or walking a short distance. If, after returning home, you have any of the following signs or symptoms, call your doctor:

  • Fever
  • Rapid heart rate
  • New or worsened pain around your chest wound
  • Reddening around your chest wound or bleeding or other discharge from your chest wound

Expect a recovery period of about six to 12 weeks. If you have your doctor’s OK, you can return to work, begin exercising and resume sexual activity after four to six weeks.

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An X-rays is a quick, painless test that produces images of the structures inside your body — particularly your bones.

X-ray beams pass through your body, and they are absorbed in different amounts depending on the density of the material they pass through. Dense materials, such as bone and metal, show up as white on X-rays. The air in your lungs shows up as black. Fat and muscle appear as shades of gray.

For some types of X-ray tests, a contrast medium — such as iodine or barium — is introduced into your body to provide greater detail on the images.

Why it’s done

X-ray technology is used to examine many parts of the body.

Bones and teeth

  • Fractures and infections. In most cases, fractures and infections in bones and teeth show up clearly on X-rays.
  • Arthritis. X-rays of your joints can reveal evidence of arthritis. X-rays taken over the years can help your doctor determine if your arthritis is worsening.
  • Dental decay. Dentists use X-rays to check for cavities in your teeth.
  • Osteoporosis. Special types of X-ray tests can measure your bone density.
  • Bone cancer. X-rays can reveal bone tumors.


  • Lung infections or conditions. Evidence of pneumonia, tuberculosis or lung cancer can show up on chest X-rays.
  • Breast cancer. Mammography is a special type of X-ray test used to examine breast tissue.
  • Enlarged heart. This sign of congestive heart failure shows up clearly on X-rays.
  • Blocked blood vessels. Injecting a contrast material that contains iodine can help highlight sections of your circulatory system to make them visible on X-rays.


  • Digestive tract problems. Barium, a contrast medium delivered in a drink or an enema, can help reveal problems in your digestive system.
  • Swallowed items. If your child has swallowed something such as a key or a coin, an X-ray can show the location of that object.

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Robotic surgery

Robotic surgery, or robot-assisted surgery, allows doctors to perform many types of complex procedures with more precision, flexibility and control than is possible with conventional techniques. Robotic surgery is usually associated with minimally invasive surgery — procedures performed through tiny incisions. It is also sometimes used in certain traditional open surgical procedures.

About robotic surgery

Robotic surgery has been rapidly adopted by hospitals in the United States and Europe for use in the treatment of a wide range of conditions.

The most widely used clinical robotic surgical system includes a camera arm and mechanical arms with surgical instruments attached to them. The surgeon controls the arms while seated at a computer console near the operating table. The console gives the surgeon a high-definition, magnified, 3-D view of the surgical site. The surgeon leads other team members who assist during the operation.

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Why it’s done


Surgeons who use the robotic system find that for many procedures it enhances precision, flexibility and control during the operation and allows them to better see the site, compared with traditional techniques. Using robotic surgery, surgeons can perform delicate and complex procedures that may have been difficult or impossible with other methods.

Often, robotic surgery makes minimally invasive surgery possible. The benefits of minimally invasive surgery include:

  • Fewer complications, such as surgical site infection

  • Less pain and blood loss

  • Quicker recovery

  • Smaller, less noticeable scars


Robotics surgery involves risk, some of which may be similar to those of conventional open surgery, such as a small risk of infection and other complications.

Is robotic surgery right for you?

Robotics surgery isn’t an option for everyone. Talk with your doctor about the benefits and risks of robotic surgery and how it compares with other techniques, such as other types of minimally invasive surgery and conventional open surgery.

Robotics surgery may not be available at medical centers in your geographic location.

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Atrial flutter ablation

Atrial flutter common, easy to treat – Sterling Journal-Advocate

Atrial flutter ablation is a procedure to create scar tissue within the right upper chamber of the heart in order to block the electrical signals that cause a fluttering heartbeat.

Atrial flutter occurs when your heart’s electrical signals tell the upper chambers of your heart (atria) to beat too quickly. The goal of atrial flutter ablation is to stop the incorrect electrical signals and restore a normal heart rhythm.

Why it’s done

Doctors use atrial flutter ablation to control the signs and symptoms associated with atrial flutter. Atrial flutter ablation may restore a normal heart rhythm, which may improve your quality of life.

What you can expect

Atrial flutter ablation is performed in the hospital. You’ll receive a medication called a sedative that helps you relax.

Once the sedative takes effect, a small area near a vein in your groin or neck is numbed and catheters are inserted into the vein. Your doctor carefully guides the catheters through the vein and into your heart.

The catheters are equipped with electrodes that are used to record your heart’s electrical activity and to send electrical impulses. Your doctor uses this information to determine the best place to apply the treatment. For atrial flutter ablation, the treatment is applied to the right upper chamber of the heart.

Special catheters are used to transmit electrical energy (radiofrequency ablation) to the target area, damaging the tissue and causing scarring. In some cases, this will block the electrical signals that are contributing to your atrial flutter.

Atrial flutter ablation typically takes two to three hours. Afterward, you’ll be taken to a recovery area where your condition will be closely monitored. Depending on your condition, you may be allowed to go home the same day or you may spend a night in the hospital.

Your doctor will schedule follow-up examinations to monitor your heart. Most people experience an improvement in quality of life after atrial flutter ablation. But there’s a chance that atrial flutter may return. In these cases, the procedure may be repeated or you and your doctor might consider other treatments.

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