Tag Archives: Pain

Straight, No Chaser: Got Hemorrhoids?

Genital/Urinary, Gastrointestinal, , , , , , , , , , ,

 Bath reading

Yes, you do.  I can hear you now.  Aww, doc!  Why are you talking about this first thing in the morning?  Well, a lot of you have them 24 hours a day, so now is as good as a time as any.  I know this topic is a pain (no pun intended), but you should consider reading this before your next bowel movement.
Let’s talk about hemorrhoids, and we’re gonna make this simple.
1. What are they?  Hemorrhoids are swollen veins either inside (internal hemorrhoids) or outside (external hemorrhoids) the anal canal.  It’s not uncommon for people to have both types at the same time.  You should wonder if you have them if and when you experience pain, bleeding and itching to the perianal area.
2. Why do you get them?  It’s all about pressure.  The blood that is circulating to the skin near the anus finds itself in outpoutchings when you strain and stretch the skin while having a bowel movement.  Pregnancy is another time when hemorrhoids become common.  I’ve literally seen hemorrhoids form before my eyes during the straining of childbirth.  The table is set for that in advance, as the pressure of the last two trimesters on the pelvic vessels also causes development of hemorrhoids.  The same goes for the obese.  Plus, you sit too much.
3. How can I prevent them?  You should start with ensuring that you’re eating a high fiber diet (fruits, vegetables and whole grains), exercising and drinking a lot of water.  Becoming constipated and having to strain is a sure way to developing hemorrhoids.  Does anyone remember Al Bundy from Married with Children?  Notice how he always took a newspaper to the toilet?  That’s the other part of prevention.  Allowing your bowel movements to occur on their time-table without you straining keeps you without hemorrhoids.
4. How can I treat them?  The problem with hemorrhoids is they hurt, and hurting causes a vicious cycle.  Because they hurt (and bleed), you don’t want to have another bowel movement.  If you’re not having bowel movements, chances are you’ll get constipated.  If you get constipated, you’ll have to strain and endure pain.  And the cycle continues…  So, in order to break the cycle – WASH yourself (like the young lady in the lead picture).

  • Water (sitz bath)
  • Analgesics (pain medication, either topically or by mouth)
  • Stool softeners
  • High fiber diet

5. How will your physician treat them?

 hemorrhoid

Treatment in an emergency room setting is largely dependent on whether or not the external hemorrhoid has developed a blood clot (as shown in the lead picture).  These are the type that are especially painful and are called thrombosed external hemorrhoids.

  • Non-thrombosed internal hemorrhoids usually are initially treated conservatively as described above.
  • Sometimes internal hemorrhoids will need to be tied off with a surgical band, eliminating the blood supply to the hemorrhoid and forcing it to shrink or fall away.  Alternatively, the tissue around the internal hemorrhoid may be surgically scarred (ouch!) to the same effect.
  • Thrombosed external hemorrhoids need to have the clot removed.  This is done by the physician with a particular type of incision.

By this point, you should be thinking “I’ll take the prevention!”.  Trust me, that’s the correct choice.
As an emergency physician, I’m even more concerned about the possibility of something else being wrong.  Given that 10 million Americans are walking around with hemorrhoids anyway, that rectal bleeding could be due to something else, such as rectal, anal or colon cancer.  You may receive additional examinations specifically to rule out those considerations (they may involve tubes, probes and/or scoping).  Feel free to ask if you really want details.
Feel free to read this again as motivation during your next bowel movement.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2015 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: The Treatment of Arthritis

Musculoskeletal System, Orthopedics/Bones, Medical Treatment, Geriatrics/Elderly Care, , , , , , , , , ,

arthritisrx

The thing about treating arthritis is you’d better do it. If you’re not lucky enough to have a form that readily responds to treatment or if you didn’t get early treatment, your arthritis will progress and create an incrementally worse situation for you. Given that we’re discussing arthritis, we’re talking loss of mobility somewhere, maybe in your legs or hands, and pain.
The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause often cannot be cured.
Treatment considerations for arthritis fall into three general categories: lifestyle changes, medication and surgery. Let’s review each.
Lifestyle
The best time to enact lifestyle changes is before you’re struggling to return to normalcy. Exercise is a lifelong habit that will improve the quality and extend the quantity of your life. For starters, exercise maintains and improves muscle tone. It also strengths your bones and cartilage. This will reduce pain, fatigue and stiffness over the long term.
Exercise should include a tolerable level of aerobic activity, flexibility exercises to sustain your range of motion and strength training to maintain and improve your muscle tone. Physical therapy is another component; massage, heat and ice application, splints and other treatments are important in maintaining blood flow, mobility and positioning as stiffness and deformity increase over time.
Medication
Using medication for arthritis is a very delicate act. Many if not most arthritics are aging and may have other medical issues. Medications in these settings have risks for side effects and drug interactions, including kidney, liver and heart damage, stroke, ulcers and bleeding. Any medications should be coordinated with your physician. Typical over-the-counter (OTC) medical regimens begin with acetaminophen, then move to NSAIDs (non-steroidal anti-inflammatory agents such as ibuprofen, aspirin or naproxen).
When OTCs don’t work, your doctor may prescribe medicines, including steroids and other medications called biologics, immunosuppressants and DMARDs (disease-modifying anti-rheumatic drugs). These drugs all are effective in certain patients but can have serious side effects.
Surgery
Surgery is an option if and when other therapies haven’t worked and if the patient is healthy enough to have it. There are two primary options. Arthroplasty rebuilds the joint, and joint replacement starts from scratch.
Let’s start back where I’ll always hope you start: prevention. Here are some lifestyle change tips for holding off the onset of arthritis or slowing down its advance.

  • If you are overweight, do what you can to slim down. Weight loss significantly reduces joint pain in the legs and feet.
  • Eat a healthy diet full of fruits and vegetables. Among other things, a rich supply of vitamin E yields benefits you’ll need. Also eat foods rich in omega-3 fatty acids (e.g., salmon, mackerel, herring, flaxseed, canola oil, soybeans and soybean oil, pumpkin seeds, and walnuts).
  • Sleeping eight to 10 hours a night and taking naps during the day can help you both prevent and recover from flare-ups more quickly.
  • Avoid staying in one position for too long.
  • Try stress-reducing activities, such as meditation, yoga or tai chi.
  • Avoid positions or movements that place extra stress on your sore joints.
  • Change your home to make activities easier (e.g., grab bars in the shower, the tub, and near the toilet).
  • Consider capsaicin cream over your painful joints. Typically expect improvement after three to seven days if it’s going to help.

If and when you develop arthritis, it’s going to be a tough time. Get ahead of the challenge and take care of yourself in advance. Feel free to ask questions or leave comments.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

From the Health Library of SterlingMedicalAdvice.com: "My tooth hurts. Is it dry socket?"

Dental, Medical Treatment, , , , , , , , , ,

dry socket(1)Dry_socket2

Ok.  Some of you are thinking “What is dry socket?”. Anyone who has ever suffered from it knows it all to well.  This as well as so many other dental conditions are best dealt with by appropriate hygiene (brushing and flossing) so it never gets to this point. But when it does…
‘Dry socket’ is another name for alveolar osteitis.  This is an extremely painful condition of the mouth that usually occurs within a week (say 2-5 days most frequently) after you’ve had a tooth extracted. Normally a small clot forms to protect the exposed bone.  Anything you do to cause the loss of this protective clot can lead to inflammation and sometimes infection of that bone.
Treatment involves mostly addressing the pain. Your dentist will likely rinse the socket to eliminate any offending particles and apply a medicated dressing. Prescription pain medications often are given. These measures pretty promptly bring relief, so if your pain after having had an extraction seems especially severe, get in for an evaluation promptly.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your Friends on WordPress, and we can be found on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Straight No Chaser: Got Hemorrhoids?

Genital/Urinary, Gastrointestinal, , , , , , , , , , ,

hemorrhoid Bath reading

Yes, you do.  I can hear you now.  Aww, doc!  Why are you talking about this first thing in the morning?  Well, a lot of you have them 24 hours a day, so now is as good as a time as any.  I know this topic is a pain (no pun intended), but you should consider reading this before your next bowel movement.
Let’s talk about hemorrhoids, and we’re gonna make this simple.
1. What are they?  Hemorrhoids are swollen veins either inside (internal hemorrhoids) or outside (external hemorrhoids) the anal canal.  It’s not uncommon for people to have both types at the same time.  You should wonder if you have them if and when you experience pain, bleeding and itching to the perianal area.
2. Why do you get them?  It’s all about pressure.  The blood that is circulating to the skin near the anus finds itself in outpoutchings when you strain and stretch the skin while having a bowel movement.  Pregnancy is another time when hemorrhoids become common.  I’ve literally seen hemorrhoids form before my eyes during the straining of childbirth.  The table is set for that in advance, as the pressure of the last two trimesters on the pelvic vessels also causes development of hemorrhoids.  The same goes for the obese.  Plus, you sit too much.
3. How can I prevent them?  You should start with ensuring that you’re eating a high fiber diet (fruits, vegetables and whole grains), exercising and drinking a lot of water.  Becoming constipated and having to strain is a sure way to developing hemorrhoids.  Does anyone remember Al Bundy from Married with Children?  Notice how he always took a newspaper to the toilet?  That’s the other part of prevention.  Allowing your bowel movements to occur on their time-table without you straining keeps you without hemorrhoids.
4. How can I treat them?  The problem with hemorrhoids is they hurt, and hurting causes a vicious cycle.  Because they hurt (and bleed), you don’t want to have another bowel movement.  If you’re not having bowel movements, chances are you’ll get constipated.  If you get constipated, you’ll have to strain and endure pain.  And the cycle continues…  So, in order to break the cycle – WASH yourself (like the young lady in the lead picture).

  • Water (sitz bath)
  • Analgesics (pain medication, either topically or by mouth)
  • Stool softeners
  • High fiber diet

5. How will your physician treat them?  Treatment in an emergency room setting is largely dependent on whether or not the external hemorrhoid has developed a blood clot (as shown in the lead picture).  These are the type that are especially painful and are called thrombosed external hemorrhoids.

  • Non-thrombosed internal hemorrhoids usually are initially treated conservatively as described above.
  • Sometimes internal hemorrhoids will need to be tied off with a surgical band, eliminating the blood supply to the hemorrhoid and forcing it to shrink or fall away.  Alternatively, the tissue around the internal hemorrhoid may be surgically scarred (ouch!) to the same effect.
  • Thrombosed external hemorrhoids need to have the clot removed.  This is done by the physician with a particular type of incision.

By this point, you should be thinking “I’ll take the prevention!”.  Trust me, that’s the correct choice.
As an emergency physician, I’m even more concerned about the possibility of something else being wrong.  Given that 10 million Americans are walking around with hemorrhoids anyway, that rectal bleeding could be due to something else, such as rectal, anal or colon cancer.  You may receive additional examinations specifically to rule out those considerations (they may involve tubes, probes and/or scoping).  Feel free to ask if you really want details.
Feel free to read this again as motivation during your next bowel movement.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress

Straight No Chaser: Myth Busters Edition – Migraine Headaches Fact vs. Fiction

Medical Treatment, Health Prevention, , , , , , , , , , , , , , ,

headache

There are 30 million migraine sufferers in the U.S. alone.  Women are thrice as likely to have them, but both sexes have to address the issues raised by them.  Here are some important facts regarding migraines and myths surrounding them, based on questions I’ve actually been asked.  And yes, regarding the lead picture, I refuse to say she’s lion.

Myth #1: I can’t help if I get migraines.  They’re hereditary, right?

There are a few things about being predisposed to having migraines I want you to know.

  • If you have one parent with migraines, there’s a 50% chance you’ll have them.
  • If both your parents have migraines, there’s a 75% chance you also will.
  • 4 of 5 migraine sufferers have a relative with migraines.

These facts represent a predisposition.  In order to have migraines, you must have triggers that will set off the migraine.  That’s a vital consideration in your effort to prevent, reduce and effectively treat your migraines.

Myth #2: This is a woman’s disease.  They stress out more and are more emotional.  That’s why they get headaches.

It is true that there is a strong hormonal component to migraines, particularly regarding estrogen and progesterone.  In fact, the incidence of migraines between the sexes is pretty equal until puberty.  Migraines are increased during pre-menstruation, when hormone levels are high.  Menopause may ease migraines.    All of this said, men still get migraines as well because of the presence of other triggers.  It certainly does not appear to be true that women suffer stress at a disproportionate rate sufficient to claim it as more of a trigger in women than in men.  Both sexes’ stress responses include release of substances that expands blood vessels, causing migraines.

Myth #3: My migraines won’t get any easier as I get older.

Along the same lines as Myth #2, diminished hormone production that accompanies aging may help explain how most migraine sufferers have less frequent and less intense migraines after age 40.  Because of hormonal fluctuations during perimenopause, this reduction may not be seen.

  • Most people who get migraines have fewer headaches and their headaches aren’t as strong once they hit 40. However, this may not be the case for women going through perimenopause. If hormones are a trigger for a woman’s migraines, then she could have more headaches during the period around menopause.

Myth #4: Once I’m diagnosed with migraines, only narcotics will help.

First of all, trigger identification and prevention is vital.  Migraine trigger management and treatment is a topic unto itself, but I’d like to point out a few important considerations.

  • Think triggers first and last.  The list of triggers includes foods (think chocolate, alcohol, aged cheese and caffeine; results vary with the individual), cold, stress, smoking and certain medications.  Alterations in mealtimes, exercise and sleep patterns must be monitored as well, these tend to exacerbate migraines.  Migraine sufferers are advised to maintain a headache log to identify triggers as things occur.
  • A special comment about caffeine: It helps some people, but for others it’s a migraine trigger, particularly if you’re a heavy user.  If you don’t drink many caffeinated beverages, one may help if you’re having a less than severe migraine.  If you’re taking enough in to create a caffeine dependency, overnight withdrawal may be enough to trigger a morning migraine.

Patients must become their own experts on how and when you use different medications.

  • I hope you and your primary care physician have discussed and have you focusing on your abortive medications.  These medicines can stop further progression of migraines if used early enough at the first sign of a migraine.
  • Painkillers have consequences.  As tolerance to and dependence on narcotics develop, withdrawal symptoms become more prominent.  Rebound headaches are a major component of these symptoms.  That’s a vicious cycle that doesn’t have a happy ending.  It’s important to note that your health care professionals do appreciate there is a difference between being drug seeking and drug dependent.

Myth #5: Migraines really don’t cause problems beyond the headaches, right?

Wrong.  If you have migraines, take special care to ensure you have a healthy heart and a low risk for strokes.  Refer to the Straight, No Chaser archives (or just type in the search engine to the right) for information on stroke recognition and heart attack recognition.  If you’re a female and have migraines with aura (certain warning symptoms that precede you migraine like nausea, dizziness, light sensitivity, and seeing zig-zag lines), your heart attack risk climbs by over 90% and your stroke risk more than doubles (increases by up to 108%).  The presence of migraines without aura also raises the risk of heart attack and stroke but by lesser amounts.

As per routine at Straight, No Chaser, the message is simple, but execution is key. Prevention is protection, and knowledge is power.  Check back this afternoon for life threatening causes of headaches, and feel free to send questions and comments.  Take good care.

Straight, No Chaser: Back Pain to The Future

Orthopedics/Bones, Neurology, , , , , , ,

lower-back-pain-causes-2
Over 40 million Americans suffer from various forms of chronic low back pain. We must work really hard.
Lower back pain is a tricky subject for an emergency physician. The lower back is a source of many life threatening emergencies, which I’ll discuss in a separate post, but for now, as always let’s give you some information to help prevent and address your routine back problems. Let’s start by understanding what the back’s trying to accomplish and how you help or hinder that process by your actions.
Remember the back is the major weight-bearing apparatus of the body and it connects the upper and lower body. It twists, turns, pulls and bends. It contains many vital nerves and muscles.
Let’s point at four situations that produce or exacerbate your back pain:
1. Bad form (born with or otherwise acquired):

  • Spinal problems you were born with can predispose you to and outright cause all manner of back difficulties. Any machine works better if well-built.
  • Obesity puts a significant strain on your back in various ways. Given that most people don’t build up their back muscles, sprains and chronic pain are quite easy when you’re front-loaded. Pregnancy produces a similar strain on your back.

2. Strains
Have you ever heard that it’s easier to lift with your legs than your back? Well, I’d never think so based on the habits of many patients, but it’s true. The lower extremities are much stronger than your back. One of the problems with back strains is once it gets weak, it gets worse. Muscle spasms, pain, more strains and protruding discs all become more likely.
3. Fractures
A broken back is no fun. A weakened back bone (vertebrae) may collapse on its own if diseased (e.g. cancer, age, arthritis, infection), it may become fractured or may be injured with significant trauma. Those with osteoporosis have this happen more commonly. These broken bones may compress spinal nerves. You may even get shorter.
4. Arthritis and Normal Deterioration (aging)
There are other forms of arthritis beside degenerative joint disease (osteoarthritis, which we all get as we age), but the resulting pain, warmth, redness, swelling and limitation in motion all forms lead to reduced function and pain that can continue for the remainder of one’s life.
Here are a few clues to help you hone in on whether your back pain requires emergency attention:

  • Direct blow to your back
  • Fever and new onset back pain
  • Loss of control of your bowel movements or bladder function
  • New onset back pain after age 65
  • Numbness and tingling in both of your legs
  • Nighttime back pain
  • Sudden sexual dysfunction
  • Weakness and/or loss of motion or sensation in your legs
  • Weight loss and new onset back pain
  • Work related back injuries

What can you do to prevent or reduce the pain at home?

  • Learn and practice good posture. Sit when you can. Keep your back straight and shoulders back. When you stand, find something upon which to prop one of your feet, like a stool (think Captain Morgan).

CaptainMorgan

  • Learn the correct way to lift (bend at the knees, not at the back – every time). If you have pain, avoid bending, stretching and reaching if avoidable.
  • Wear low-heeled shoes whenever you can, ladies!
  • Learn how to stretch your back.

LBP exercises

  • Maintain a healthy weight, and exercise to strengthen your abdomen and back (your core)
  • Sleep on your side. Try a pillow between your knees.
  • Walk. Did you know walking is the best (and easiest) exercise for your back?

I’ll be back later (no pun intended) with your questions and more.