FAQ Category: General

Methicillin-resistant staphylococcus aureus (MRS) infection can be either community-acquired (contracted anywhere outside of a hospital or clinical setting) or nosocomial (contracted in a hospital or similar setting). Community-acquired MRSA is becoming more and more common in our society. Many people have MRSA but don’t know it because it’s not causing any problems. However, if you have a weakened immune system or you are living with a chronic illness, like diabetes, you could end up becoming quite ill because of the infection.

Nosocomial infections are transmitted and contracted within the hospital. That means the patients are being exposed to the MRSA through visitors, staff, equipment, or other patients. In this setting, proper hand washing and sterilizing techniques would cut down on the spread of MRSA. Because people in the hospital are there because they are ill or injured, their body is stressed, making them more vulnerable to developing an infection if they’re exposed. This makes the spread of MRSA very serious.

Methicillin-resistant staphylococcus aureus (MRS) is a bacteria that has developed into one that can resist many of the antibiotics that we have available. Many healthy people have MRSA on their skin or their mucous membranes (such as the nose) and as long as you’re healthy, there’s nothing to worry about. However, people with chronic diseases, the elderly, the very young, or those with weakened immune systems can become seriously ill as a result of the infection.

MRSA is transmitted very easily between people, which is why most hospitals and clinics have strict guidelines for treating people with MRSA infections and to protect other patients from becoming infected.

The best way to prevent becoming infected or by preventing the spread of infection if you do have it is by frequent and thorough hand washing. If you wash your hands after every time you touch your nose or mouth, for example, you would cut down the risk of spreading the bacteria.

If you have MRSA, it is important that any healthcare professional (doctor, nurse, dentist, emergency technician) know this so they can take the proper precautions and lower the risk of spreading it even further.

Health care professionals are trained to conduct a pre-rehab assessment on all Workers’ Compensation patients. The idea is to 1) help identify patients who may have trouble getting back to work despite rehab and 2) create a plan of care just for you to improve your chances of getting back to work.

In order to do this, the questions they ask have been previously tested to determine reliability. Studies have shown that two stable predictive factors of return-to-work can be used. These include employment status at the start of your rehab program and amount of sick leave used in the last one-year before entering rehab.

Questions like the one you were asked help get at this information. The therapist relies on your self-assessment and self-report as much as on the results of formal tests given. It’s not an indication that he or she doesn’t believe in you.

Studies show that workers off the job more than three months have less of a chance at getting back to work compared with those who recover and return-to-work in the first three months after developing a musculoskeletal disorder. The level of pain intensity and constancy are especially predictive of a poor result.

In order to avoid disability, a rehab program geared toward a worker’s skills needed on the job is often advised. A physical therapist trained in work recovery performs a test to find out the worker’s specific weaknesses and work-related needs. A common way to do this is to conduct the test you mentioned — a functional capacity evaluation (FCE).

The FCE is a series of 25 standardized tests designed to test a worker’s physical capacity. The therapist compares the job tasks required with the patient’s current ability to do that work. Activities such as lifting, bending, and carrying objects are included. Job demands (for your job) are the standard used to rate your actual work ability.

Once the pre-treatment test results are in, the therapist uses them to figure out what you will need in a rehab program to get you ready to return to your full job duties. Once you start this process, if you have any doubts about the ability of the program to restore you to your job, let your therapist know. A cooperative patient who is willing to work consistently on a return-to-work program has a better chance of successful re-entry into the job market.

It is well-known that exercise reduces pain and improves function for patients with osteoarthritis of the hips and knees. Study after study has shown how something as simple as walking can offer a low-cost yet effective solution to joint pain.

As you have discovered, getting patients to buy in to the idea isn’t always so easy. For many, they have never established a habit of exercise even before they developed arthritis. Many are overweight or even obese. A lack of lifetime activity contributed to the obesity and now makes starting an exercise program more difficult.

Sometimes folks need a jumpstart. They seem to do better if they sign up for a series of classes with other people in their same situation. The psychosocial benefits of seeing others accomplish the goal of weight loss and/or increasing activity can help.

Sometimes, they need someone to teach them the importance of exercise and show them what to do. If your community has a senior-citizen center, Council on Aging, or YMCA, there may be programs of this type already established.

If not, then a short series of appointments with a physical therapist could be another way to approach this problem. The therapist can assist in providing education about the disease process, why exercise is so important, and find the right exercise program that both suits and motivates your mother to stick with it.

In the end, it’s still her decision. Not everyone does what the evidence shows works for their problem. Adult children of older (aging) adults are often frustrated by their parents’ lack of interest in self-care. These can be difficult problems to solve. Patience and gentle persistence may pay off but you should be prepared if they don’t gain the results you had in mind.

There have been many attempts by scientists to answer this question. So far, the mechanisms of leg cramps remain a mystery. Clearly, leg cramps at night are more common than cramps during the day — and not just because people are more aware of such things at night (i.e., less likely to notice while busy during the day).

Electrodiagnostic testing of the muscles in people with leg cramps shows that the motor units to the muscles begin to fire over and over without being asked to. This type of involuntary repetitive firing of the motor unit can cause muscle cramps. But what causes the involuntary repetitive firing? This also remains unknown.

There has been some suggestion that the motor units are abnormal. This makes some sense since leg cramps are more common in older adults and we know that we lose motor neurons as we get older. But it doesn’t explain all the other cases in younger adults.

The fact that this symptom is more common at night might help scientists find an answer. Possibilities right now include a change in hydrostatic (water) pressure in the calf muscles from lying down for hours. The resulting shift of fluids then causes the motor neurons to fire repetitively, a condition referred to as hyperexcitability.

But again, this doesn’t explain daytime leg cramps. So, some experts suggest it is the result of many factors that converge in one person at one time. And those factors might be different for different groups of people. More studies are needed to find out if this is the case — or if there is some other explanation for leg cramps.

As your physician has suggested, there are some specific causes of leg cramps. But after all the testing, many patients come up empty-handed. There just isn’t a clear cause with an effective treatment method. For you, if you do find that it’s medication-related, then a change in meds can help. Some people find relief with other treatments such as acupuncture, massage, or physical therapy.

More and more older adults are in need of a total hip revision surgery. Nearly 18 per cent of all total hip replacements done in the United States have to be revised at some point. Current estimates are that in the next 20 years, the need for total hip revisions will increase dramatically.

So how come there’s such an increase in the number of revision operations required? And what can be done to prevent this from happening? Studies show that the relative number of revision operations hasn’t really increased. It’s more the fact that more adults are having their first hip replacement and more of those are being done at a younger age. If patients outlive the life of their implant, then revision surgery is needed. Or if there are complications from the first surgery, a revision replacement might be needed.

As you have heard, there is a shortage of surgeons who perform a primary (first time) hip replacement operation. Joint replacement revision is a subspecialty all of its own. The procedure is difficult and complex.

Surgeons aren’t being reimbursed adequately by Medicare. So while the number of older adults needing this operation is on the rise, the number of surgeons available to perform the procedure is on the decline. That presents an interesting dilemma for all concerned.

If revision surgery is going to be a fact in the near future, then what can be done now to head it off at the pass? Some suggest building more high-volume orthopedic specialty hospitals. Studies show that there are fewer complications when a surgeon performs the same operation on a larger number of patients.

Specialty centers of this type would draw more patients and attract more physicians with a subspecialty practice in revision hip replacements. With fewer complications, costs could be contained. Preventing infection, dislocation, or fractures of the bone around the primary implant could go a long way in protecting the implant and reducing the need for revision surgery.

What else can be done about the possible imbalance between supply and demand of specialty surgeons? One natural solution to the problem has already been provided. More non-U.S. trained surgeons are filling surgical positions.

Some suggest putting an end to fee reductions proposed by Medicare. Instead, Medicare reimbursement for primary and revision surgeries must be increased. Otherwise, surgeons will turn to other types of surgeries that pay better just in order to stay in business.

Surgeons have also cited high legal costs of malpractice claims as a deterrent to performing these procedures. Surgeons who perform more than 100 hip and knee replacement operations each year have a much higher risk of being sued for complications such as nerve injury, leg length difference, infection, damage to blood vessels, and implant/joint dislocation. What can be done to reduce complications and the risk of litigation?

Experts suggest developing and using evidence-based guidelines for standard of care, patient safety, reducing complications, and managing patient expectations at the time of the surgery. Added together, these steps represent best-practice procedures for both hospitals and specialty centers. The final result might be total decreased costs as a result of reduced hospital length-of-stay, fewer complications, and fewer revision operations.

What you are referring to is called the patient-provider interaction, which certainly is a part of why people feel better after massage. There’s no denying that simple, human touch has value and benefit. There’s also the placebo effect — the person expects to feel better and so he (or she) does feel better.

But massage does have a physiologic effect on the soft tissues such as skin, muscles, and tendons. Applied properly, massage can increase blood circulation to these structures and wash away toxins or byproducts of cellular metabolism.

The net effect is to reduce pain, restore normal movement, and facilitate relaxation. Total body relaxation has the ability to reduce stress hormones and improve a sense of well-being. Most of these benefits can be derived to some degree through exercise and general movement. Yoga, Tai Chi, Qi Gong, acupuncture, and traditional aerobic exercise has similar effects but certainly doesn’t feel as nice or as soothing.

It’s likely that if people spent any amount of time in self-care through diet, staying hydrated, and engaging in exercise, there would be improved health benefits. Adding a massage in there can’t hurt and there’s evidence it will likely help in many ways.

When doctors are studying, they learn the various ways to diagnose and treat patients. For many illnesses and disorders, doctors have found that certain methods and treatments work better for others. Also along the way, they’ve learned that some treatments don’t work at all, may make the situation worse, or may cause other problems.

To keep doctors up to date on what treatments work best and what the general consensus is, many specialties have come up with guidelines that should be followed in order to provide the best care possible. Because every patient is different, these guidelines are not written in stone, however, they are recommended. If a doctor wants to choose another method of treatment, he or she usually has a good reason for straying from the guidelines.

If anything goes wrong during a particular treatment, experts will look to see what treatment was given and if recommended guidelines were followed.

Overuse of antibiotics has caused a problem with bacteria getting resistant to the medications we have. However, giving prophylactic antibiotics, antibiotics that prevent infection from happening in the first place, is a different situation.

Over the years of providing certain types of treatments or surgeries, doctors and researchers learn what common complications occur and they work to prevent them. One common complication of different types of surgeries is infection. Infection in the spine, for example, can cause serious complications, so it’s important to do everything you can to avoid this.

Other than the standard sterile techniques and good surgical technique, one way to prevent infections that are common to the surgery is by treating the patients to prevent the bacteria from settling in to begin with. These antibiotics must be the right ones for the particular type of bacteria they are trying to prevent from entering and they are only to be taken for the set prescribed time.

Before air bags were invented, seat belt use was clearly shown to reduce injuries during motor vehicle accidents. That’s why so many states enacted a mandatory seat belt law. Your state may have this law in place, which would put an end to the argument immediately.

But if you don’t have a mandatory seat belt law, here are some things we know from recent safety studies. Studies show that the use of combined seatbelt and air bags on passengers in the front seat of automobiles has reduced the number of deaths and bodily injuries. The use of an air bag without a seat belt results in more cervical (neck) spine and thoracic (upper back) fractures.

The use of an air bag with the seatbelt produces more spinal fractures. But the severity of the fractures is less. Patients with spine fractures are more likely to be wearing only a seatbelt. Those who wear a seatbelt and have air bags that deploy have fewer spine fractures. The number of spine fractures reported among patients who used only an air bag is equal to those who used no safety measures (no seat belt and no air bag).

Statistical analysis of available data shows that seat belt use alone increases the risk of spine fracture. The combined use of a seat belt and an air bag reduces the risk of cervical and thoracic spinal fractures but does not affect the number of lumbrosacral fractures. Using just an air bag (without a seat belt) increases the risk of a severe thoracic fracture.

Based on the results of current studies, drivers and passengers are encouraged to wear their seat belts even when the vehicle has air bags installed. The risk of a spine fracture (and especially a severe one at that) is less with both safety measures in place. The use of seat belt alone or air bag alone is not advised.

Over the years, as antibiotics have become more common, the bacteria they target have adapted to avoid being killed by the medications. While some aren’t successful, some are and they are the bacteria that some people may call super bugs. One such bug is called MRSA (methicillin-resistant Staphylococcus aureus). When people contract an MRSA infection, it can be very difficult to treat because the bacteria is resistant to most antibiotics.

When an infection sets into the bone, it is also quite difficult to treat because of where it is and how far the infection may have progressed before it was diagnosed. By combining an antibiotic-resistant infection with the difficulty of treating a bone infection, it is possible that some people may end up with such a severe illness that they may face amputation.

The best way to prevent MRSA infection is the same way to prevent any type of infection – wash your hands and wash your hands often. Most people don’t wash their hands properly. When washing:

Use running water and soap.
Wet your hands and lather up.
Rub your hands together, covering all surfaces and paying attention to between your fingers, your thumb (often forgotten) and under your nails.
Wash for at least 20 seconds.
Don’t turn the tap off yet.
Dry your hands with a clean or disposable towel.
Turn off the tap, using the towel, and dispose of it.

Rheumatoid arthritis is a chronic disease that can affect many parts of the body. Joints are the most painful but there can be cardiac involvement, skin problems, kidney disease, vision changes, and neurologic problems.

The course of RA can vary considerably from mild to severely disabling and is difficult to predict. It appears that adults today with RA have less severe symptoms and less functional disability than even 10 years ago. This positive trend and more favorable course of disease may be attributed to earlier diagnosis. Results are better with a shorter duration of symptoms at the time of diagnosis and more aggressive use of drug therapy.

When only the joints are involved, the rheumatoid arthritis is not life-threatening. Having severe wrist involvement can reduce function but it does not reduce life expectancy. Still, there are people who would trade a few years of life for less pain and improved quality of life.

If your pain is not being controlled with medications and conservative (nonoperative) care, then surgery may be indicated. Your rheumatologist and health care team (physical therapist, surgeon) can also help guide you in making this decision.

Myofascial Pain Syndrome (or MPS) is a term used to describe one of the musculoskeletal conditions characterized by chronic pain. It is associated with trigger points (TrPs). TrPs are tender points in the muscles. Sometimes they are referred to as hyperirritable nodules within a taut band of muscle. When pressed, these points trigger a painful response. When palpated by the examiner, the tissue is very tight. Sometimes a knot is felt within the muscle.

Despite many studies looking for a way to reliably diagnose trigger points and myofascial pain syndrome, there isn’t one test everyone can use with the same results. As you experienced, the same palpation can be done but with varying degrees of pressure.

Most examiners follow the nail blanch method of testing for trigger points. They use the amount of pressure it takes to cause the examiner’s own nailbed to turn white when pressed against the examiner’s own palm. Some say they use the amount of pressure it takes to indent a tennis ball.

Certainly, pain or tenderness will occur if enough pressure is applied. The clinician who is examining a patient for trigger points will use the digital palpation test along with a few other guidelines. They will feel for that taut band and knot in the muscle. Most people with true trigger points report with a painful response with very little pressure. It doesn’t take much to reproduce their painful symptoms.

Fibromyalgia syndrome (FMS) is a noninflammatory, nonarthritic condition. It’s characterized by generalized aches and pain in the joints and muscles. Most people with fibromyalgia say that even tender touch can set off their symptoms.

Patients with FMS also report many other symptoms along with their musculoskeletal distress. This can include headaches, intestinal problems, poor sleep at night, sense of swelling in the hands or feet, and anxiety/depression to name just a few.

Most people with fibromyalgia syndrome have tender points in the same spot on both sides of the body. There are nine possible places where tenderness can be palpated for a total of 18 when you count both sides. Anyone with 11 of those total tender points along with other associated signs and symptoms is likely to have fibromyalgia.

Fibromyalgia syndrome (FMS) is different from myofascial pain. FMS is considered a systemic problem. The nervous system and its communication pathways with other systems seem to be off kilter. That’s why the multiple tender points are accompanied by a cluster of signs and symptoms from many other systems.

Myofascial pain syndrome (MPS) is more of a local condition. Only the muscles are involved. Any muscle group can be affected. There can be one or a dozen painful points called trigger points (TrPs). Whereas myofascial pain syndrome has TrPs, fibromyalgia syndrome has tender points.

Both disorders cause aching muscle pain and tenderness. Both have similar local histologic (microscopic cellular) changes in the muscle. Painful symptoms in both conditions are increased with activity. However, fibromyalgia is more of a generalized aching. Myofascial pain is more localized (you can put your finger on it and reproduce the symptoms).

Fibromyalgia is also very similar to chronic fatigue syndrome (CFS). There is a mix of symptoms that are the same for both. However, chronic fatigue syndrome focuses on fatigue, whereas fibromyalgia syndrome focuses on pain. Many people have more than one of these three conditions at the same time. For example, it’s possible to have fibromyalgia AND myofascial pain syndrome. Or, a patient may have fibromyalgia and chronic fatigue syndrome. Most people with myofascial pain syndrome just have the one condition.

A large study at Mayo Clinic polled over 1,000 patients with fibromyalgia. Only about 15 per cent were smokers. If tobacco use were a risk factor for developing fibromyalgia, a larger portion of the group would be expected to be smokers.

On the other hand, there’s no evidence one way or the other that exposure to tobacco products (as a user or from second hand smoke) is a risk factor for fibromyalgia. Some other studies have linked back pain with smoking. But even this association isn’t consistent. There are studies with equally conflicting results showing no link between tobacco use and back pain.

In that same Mayo Clinic study, smokers with fibromyalgia had more intense pain but not more tender points. The tender points are the hallmark finding that is diagnostic of fibromyalgia. More studies are really needed to evaluate the relationship between tobacco use and fibromyalgia. For example, do smokers (or tobacco users) respond to treatment for fibromyalgia differently than nonsmokers (faster? with different treatment?)? Do smokers with fibromyalgia have a harder time quitting smoking (or quitting using tobacco)?

For now, we know that tobacco use is linked with worse symptoms in patients with fibromyalgia. It is always advised that patients should quit smoking. Patients with fibromyalgia should be encouraged to enter a tobacco-cessation program not only to reduce pain but also for their overall better health.

Smoking (tobacco use) has been shown to increase pain intensity among patients with chronic pain. Fibromyalgia is a condition with chronic musculoskeletal pain. A recent study from a well-known clinic (Mayo Clinic Fibromyalgia Treatment Program) clearly showed that tobacco users (smokers) did have much higher pain levels compared with nonsmokers.

They did not find a greater number of tender points in smokers with fibromyalgia compared with nonsmokers. But the pain intensity was greater in fibromyalgia patients who were smokers compared with the nonsmokers.

How and why does tobacco use increase pain intensity? Scientists think that tobacco increases substance P in the cerebral spinal fluid. Substance P helps transmit pain signals. At the same time, smokers have lower endorphin levels (natural pain killers).

The results of the Mayo fibromyalgia study were consistent with other studies linking smoking with pain (e.g., low back pain), more severe symptoms from other musculoskeletal disorders, and loss of function. The smokers with fibromyalgia were also more likely to miss days of work.

It is always advised that patients should quit smoking. Patients with fibromyalgia should be encouraged to enter a tobacco-cessation program not only to reduce pain but also for their overall better health.

If you’ve recently been diagnosed with fibromyalgia, it may be necessary to get control of your symptoms through medications and other forms of treatment before launching into an exercise program. Exercise is extremely important and a key feature in the successful treatment of fibromyalgia. But you may have to ease into it gradually.

Many patients seek the help of a physical therapist who understands the nature of fibromyalgia and how to deal with it. Pool therapy may be a good place to start. The warmth of the water combined with the buoyancy helps reduce muscle tension, tenderness, and pain. In time, a dry land component can be added to include aerobics, endurance training, and flexibility.

Pain can flare up in fibromyalgia patients with any amount of physical exertion. That’s why it’s important for your physician and physical therapist (as well as any other team members) to work together with you to find the best combination of treatments that will ease your symptoms and improve your function.

When flare-ups occur (whatever the reason), exercise can be modified but shouldn’t be stopped. Your therapist will help you figure out how to do this. The therapist may add other modalities to your program such as biofeedback and relaxation training, ultrasound, or electrical stimulation.

At the same time, complementary care such as massage therapy, acupuncture, hynotherapy, and balneotherapy (bathing) can help reduce pain, improve function, and restore a sense of well-being. Don’t give up when things don’t seem to be improving.

It takes time to find the right program of therapies that work with each patient. And even then, the physical, emotional, and psychologic needs of individuals change over time. This may mean your treatment program for fibromyalgia may have to change too. Don’t let this push your panic button. Ride each new situation out like a wave. Symptoms will ebb and flow over time. Find what works for you, stick with it, and be prepared to modify or tweak your program as needed.

Fibromyalgia is the cause of widespread body pain that is usually accompanied by many, many other symptoms as well. It’s considered a nervous system problem. The entire nervous system and its connections to and communication with other systems has been identified as the key area of pathology.

Over the past 20 years, advances have been made in understanding this condition and what causes it. But so far, there doesn’t appear to be one single reason why the nervous system goes haywire. At the present time, it looks like there can be biochemical abnormalities, neuroendocrine abnormalities, and possible genetic influences.

We know that patients with fibromyalgia feel sensations like touch and temperature (hot and cold) louder and longer than people who don’t have fibromyalgia. Normal sensations feel uncomfortable or even painful to them. And the awareness of those sensations lasts longer than in other folks.

Stress seems to have a role in fibromyalgia. Symptoms are certainly aggravated or made worse by emotional, psychologic, or physical stress. There’s some evidence that communication between the hypothalamus, pituitary, and adrenal glands is altered in patients with fibromyalgia. The proper functioning of these three areas is essential to a normal response to stress that doesn’t lead to physiologic dysfunction.

There is more and more scientific evidence everyday that emotional stress and belief systems play a key role in all health problems. This may be especially true for chronic pain problems. More and more treatment programs are addressing these issues through patient education, cognitive and behavioral therapy, and complementary therapies such as hypnosis or acupuncture that address the mind-body connection.