FAQ Category: General

That’s a good question because it is possible to give too much of a blood thinner, or anticoagulant. When your doctor wants to give you an anticoagulant, he or she needs some tests done to see how long it takes for your blood to clot. There is a set amount of time that is considered to be normal. If the blood clots too quickly, this can cause blood clots inside your body that can cause severe damage, even death.

Once the doctor has determined that you do need an anticoagulant, then he or she has to decide what type to give you. Once you have begun to receive the anticoagulant, you will get blood tests frequently to monitor how effective the medication is. If your blood still takes longer than normal to clot, the doctor may increase your dose of anticoagulant. If your blood takes too long to clot, the doctor will lower the dose. Sometimes, there may be many dosage adjustments, sometimes they’re rarely needed.

When you stand and walk around, your leg muscles encourage the blood in your legs to move around, to circulate. Because the legs are at the lowest part of the body, your heart needs help getting the blood moving. When someone has had surgery and is lying in bed, the legs aren’t actively encouraging the blood to move around, so it can be sluggish. Because it’s moving more slowly, it can clot more easily.

This is one reason why people who are bed ridden are encourage to move about as much as possible and doctors and nurses push people to get out of bed as soon as it is physically possible.

Fibromyalgia is a disease that is getting a lot of attention from researchers. It’s still very much a mystery as to what causes fibromyalgia and what fibromyalgia causes.

Studies have shown that people who live with chronic pain, of any cause, can see some changes in their cognitive abilities. With fibromyalgia, the people don’t only have pain, they live with fatigue, difficulty sleeping, and often depression and/or anxiety. So, researchers have been looking into how this all affects the brain.

The latest research is showing that yes, people with fibromyalgia, do have difficulty with doing certain types of tasks. If this will worsen or not, they’re not really sure.

Psoriatic arthritis is an inflammatory joint disease. It affects a small percentage of people who have psoriasis. Psoriasis is a chronic, inherited, skin disease. It is inflammatory but not infectious. There are well-defined patches of red skin called plaques that are covered with a silvery scale. Some patients are especially bothered by itching and, occasionally, pain from dry, cracked, encrusted lesions.

Psoriasis usually starts in adults between the ages of 20 and 30. The arthritis may not occur for up to 20 years after the first signs of psoriasis. The disease can occur in children, usually between the ages of 9 and 12 years.

About 20 per cent of the patients with psoriasis also develop arthritis of the joints. Psoriatic arthritis occurs more often in those with severe psoriasis. It tends to progress slowly. For most of those affected, it is more of a nuisance than a disabling condition.

Standard treatment of mild psoriatic arthritis starts with antiinflammatory drugs and topical skin creams. There are several commercially available skin creams that seem to give short-term relief of itchy, scaly skin. Lotions or sprays containing zinc pyrithione may be helpful. Zinc pyrithione is a zinc compound, (a metal, not an herbal treatment).

To relieve the itching, some patients use vaseline, salicylic acid preparations, urea-containing topical ointments, oatmeal baths, and emollients. Topical agents with corticosteroids should be used sparingly because of the incidence of side effects that have increased with the use of the superpotent fluorinated preparations. Only weak preparations, such as 0.5 per cent or 1.0 per cent hydrocortisone, should be used on the face, groin, or other sensitive areas (e.g., underarms, front of forearms, belly).

When looking for an effective topical cream for psoriasis, don’t be swayed by advertising. Check with your physician first. He or she will be able to recommend one that has the most evidence to support its use.

Methotrexate (MTX)is a drug used in treatment of cancer and autoimmune diseases such as psoriatic arthritis. It acts by inhibiting the metabolism (break down and use) of folic acid. This affects DNA synthesis and inhibits reproduction of rapidly growing cells, such as the prolific keratinocytes in psoriasis. Methotrexate also has an immunosuppressant effect, tempering the inflammatory response.

The use of Methotrexate with psoriatic arthritis hasn’t been studied in depth. It appears to work well with joint symptoms from arthritis, and to a lesser extent with the skin lesions of psoriatic arthritis. As with all medications, the goal is to benefit from the positive effects of the drug with the least amount of side effects.

Possible side effects can include anemia, increased risk of bruising, nausea and vomiting, dermatitis (allergic skin reaction), and diarrhea. A small percentage of patients develop hepatitis and liver impairment. Liver biopsies have shown a tendency in psoriasis patients to have a fatty liver that may put them at risk for liver problems. Likewise, patients with psoriatic arthritis who abuse alcohol may not be good candidates for the use of Methotrexate.

Anyone taking Methotrexate for a long period of time should have liver studies done to monitor for liver damage.

Natural bone graft material (either donated from the patient or taken from a bone bank) has been the gold standard for the treatment of fusions and bone defects for many, many years. But bone bank grafts aren’t always available. And there have been problems with autogenous (bone donated to yourself) bone grafts.

Bone graft material is used whenever there’s a need for extra bone to support a fracture site or defect in the bone. It’s easily available (taken from the patient’s pelvic bone) and inexpensive. And it is bone inductive (fosters bone growth) to provide structural support to the damaged area.

The downside is that the graft site can be painful for a very long time. In some cases, infection can delay recovery. Patients often report difficulty walking due to the pain. And the combination of pain and impaired walking result in loss of function.

To avoid the major and minor complications of bone graft, scientists are exploring the use of bone substitutes. Studies show collapse and resorption of the bone is less likely with bone substitutes. It is an acceptable replacement for bone graft material.

In fact, it appears to be a better choice. It is stiffer, offers more support, and holds up better under load compared with autogenous bone graft. There is also less sideways shifting or subsidence (sinking down into the bone matrix) of the healing bone with bone substitute materials.

Guarding your body where you have pain is an instinctual reaction for many people. This is because they want to protect the body from any further pain or from pain returning. So, if you have pain in your stomach, for example, when someone approaches you to examine it, you may, unconsciously, take your hand and put it protectively over the area – guarding it from pain.

You may have heard about the 2003 death of a college football player (Ricky Lannetti at Lycoming college) from Methicillin-resistant Staphylococcus aureus (MRSA, pronounced mersa) infection.

MRSA is a bacterium responsible for difficult-to-treat staph infections in humans. It’s resistant to a large group of antibiotics including penicillin and cephalosporin drugs. That makes it a dangerous infection that can spread, even causing unexpected deaths in children and young adults. When it’s acquired outside the hospital or institutional setting, it’s referred to as community acquired MRSA or CA-MRSA.

This young man’s death brought the disease to everyone’s attention. CA-MRSA starts as a simple skin infection. If it’s found early enough, it can be treated successfully with antibiotics. But if it’s undetected or ignored, the infection can become much more serious. Osteomyelitis (bone infection), necrotizing pneumonia (death of lung tissue), and sepsis (blood infection) can develop as a result of MRSA.

Athletes may be at increased risk because of the close quarters they share in locker rooms. They are at increased risk if they share personal items such as towels, sports drinks, or shavers. This is true for any group of people (athletes or otherwise) in similar situations. Prison inmates, homeless people, men who have sex with men, and even children in day care centers are susceptible to the spread of MRSA.

Efforts are being made to reduce this risk in all sports settings. Special anti-MRSA soaps have been developed. Players are being taught to take a full shower with soap after each workout. Education about NOT sharing personal items is a key area of prevention.

The showers, exercise equipment, and other areas athletes come in contact with must be disinfected on a regular basis. Those in charge of laundry should be instructed to use hot water and a hot dryer when washing the uniforms. There is a risk that the clothes will shrink, but this will help kill bacteria.

Anyone with a skin infection (especially one that is open, oozing, or draining) must have proper wound care and coverage of the site. Any lesions that can’t be covered will put the athlete on the bench until healing occurs.

The team physician must work with the coaching staff and athletes to ensure that antibiotics (when prescribed) are taken in the proper way. The appropriate antibiotic must be chosen. The correct dosage must be prescribed. And the athlete must take the medication as instructed. Many people stop taking the drug as soon as the most recognizable symptoms are gone. This type of drug-taking is one of the main reasons bacteria have become resistant to certain antibiotics.

There are many new challenges for partners facing the prospect of a chronic, painful condition such as osteoarthritis. One of the biggest stumbling blocks is communication. Patients may not feel confident in their ability to explain their pain or other symptoms. Partners may overestimate, underestimate, or misunderstand their spouse’s pain, distress, and level of disability.

There has been some suggestion that treatment intervention for rheumatology patients include training in the area of effective communication. Each member of the couple must feel confident and comfortable expressing his or her concerns. The communication process must be open and nonjudgmental with listening and acceptance of each person’s thoughts, feelings, and experiences.

Communication skills training can help reduce distress between partners. It can also help the partner become more supportive and better able to assist the patient during painful episodes. Since there is often a tendency to hold back in starting conversations, such training could provide couples with the opportunity to grow in this area.

With any new diagnosis, there’s a certain period of adjustment that takes place. Give your parents a few weeks (to months) to sort things out on their own. If you still have concerns, suggest contact with a social worker or counselor. Even one or two sessions of counseling can help improve communication, potentially improving patient outcomes as well. With a little outside help, your father may feel better mentally and physically.

An aneurysm is an abnormal thinning and dilation (or ballooning) of a blood vessel. It can occur wherever major blood vessels are located. Major arteries in the brain and the aorta (major blood vessel from the heart down to the legs) are two of the most common places aneurysms occur.

Ninety-five per cent (95%) of aortic aneurysms occur just below the renal artery (to the kidney). This type of aneurysm is called an abdominal aortic aneurysm (AAA).

Risk factors for aneurysms include obesity, high blood pressure, atherosclerosis, and trauma. Many people are born with a congenital aneurysm. They don’t know they have an aneurysm until they either develop sudden symptoms or it’s found when imaging studies such as CT scans or MRIs are done for some other reason.

Aneurysms aren’t always treated. Studies show that the mortality (death) rate is just as high with surgery as without. A brain (cerebral) aneurysm can cause a stroke if it bursts. Surgery is more likely for this type of aneurysm.

When surgery is done, the aneurysm is removed and the blood vessel is repaired. A metal clip is placed around the base of the aneurysm. Sometimes coil embolization is done. Using a catheter, the surgeon inserts small, flexible microcoils into the aneurysm. The body responds by forming a blood clot around the coil blocking off the aneurysm. The coils can also be used as packing to fill the aneurysm, thus preventing a rupture.

When things settle down, you may want to find out where your sister-in-law’s aneurysm is located. Once you know this, it will be easier to get information about the treatment and prognosis. Many advances have been made in the diagnosis and treatment of aneurysms in the last 10 years. We hope your family member will have a successful outcome.

Many types of tissues and organs can be donated and therefore transplanted. Tissue transplants include the heart, lungs, liver, pancreas, kidneys, intestines, skin, bone and bone marrow, umbilical cord blood, veins, soft tissues, heart valves, corneas, and eyes.

There are different types of tissue transplants. Allograft (also known as a homograft) transplant occurs between individuals of the same species (e.g., human to human). Autologous transplants are within the same individual (e.g., skin graft from leg to hand; blood or bone marrow for own use later). Xenogeneic (heterograft) transplants are between individuals of different species (e.g., pig to human).

Human allograft donor tissue is recovered from bodies after death in operating rooms, hospitals, morgues, and funeral homes. There are guidelines for when and how this is done. But there have been some problems with contaminated tissue. The adverse effects on the patient receiving the donated tissue can be severe (even life-threatening).

For this reason, scientists are working to create bioengineered skin, bone, ligaments, tendons, and articular cartilage. These are already available in some clinical settings. For example, in some cases, it is possible for the surgeon to take healthy plugs of bone (or cartilage) from one site, multiply the cells in culture, and later place them into a lesion or hole in the same patient. This stimulates new, healthy bone to form and fill in the defect.

Getting the bone up to the strength needed to bear full loads remains a challenge. Developing bone substitutes may be a way around this. A variety of materials such as natural and synthetic polymers, ceramics, and composites are under investigation.

In order to make this work, growth factors, proteins, and other materials needed for bone healing must be present. These substances must be removed from healthy bone and mixed with the bone substitute in order to stimulate the formation of new bone cells.

Although rare, there have been a few reports of HIV transmission from allografts (donor tissue). The first case was in 1988. A patient receiving donor bone for a spinal fusion developed HIV as a result of a contaminated tissue sample.

Now we have special testing of blood and tissue to prevent this from happening. As a result, there is a risk of about one in 1.6 million that HIV transmission can occur from a tendon transplant. This translates into the potential for one person receiving a musculoskeletal allograft over a two-year period of time to get HIV from the graft.

It’s more likely that hepatitis will be transmitted via tendon allografts. Again, the risk is small but the concern is great because of the potential adverse effects. To help reduce the risk of this complication, the FDA has required nucleic acid testing for HIV/HCV. As of August 2007, all new tissue donors must be screened and pretested.

Although tissues cannot be screened for West Nile virus, yet, donor blood can be tested. Updated processing techniques are needed along with regulations requiring all tissue banks to screen, process, sterilize, store, and distribute allografts in the same way. This will help ensure public safety and prevent life-threatening adverse reactions.

Most dance injuries affect the musculoskeletal system. Sprains, strains, tendon problems, and stress fractures in the back and legs from overuse are the most common. Most of the injuries are minor and do not require time off. Injuries are not always reported and/or treated.

The result is that many dancers suffer from more than one injury at a time. The rate of reinjury is also high. Identifying risk factors among your dancers may be the first step. Educating dancers about their personal risks and how to reduce them is important.

For example, practicing and/or performing for more than five hours a day and more than five days a week increases the risk of injury. Eating disorders, menstrual dysfunction among females, and dissatisfaction with work add extra risk.

Anyone with a history of previous injuries is also at increased risk for reinjury. Fatigue, dieting, stress, and tension are other risk factors that have been identified. Helping dancers find ways to care for themselves and cope with stress is important. Early intervention to avoid dancing through their injuries may help reduce the severity of injuries.

And there’s also some evidence that reducing injuries helps build company morale. This can only help improve satisfaction and foster better coping mechanisms.

Although very graceful with controlled movements, dancers are also athletes who overtrain and overuse their bodies. This can lead to an increased risk of musculoskeletal injuries. In a recent review of all studies done on dancers between 1996 and 2004, most injuries were musculoskeletal affecting the soft tissues of the back and legs.

More than 80 per cent of professional dancers will suffer some type of injury during their career. On any given day, the prevalence of injuries among professional ballet and modern dancers can be as high as 70 per cent. Almost half of all ballet and modern dancers report pain caused by chronic injuries.

Sprains, strains, tendon problems, and stress fractures from overuse are the most common. Most of the injuries are minor and do not require time off. Many dancers suffer from more than one injury at a time. Injuries are not always reported and/or treated.

Dancers report finding the most help for their injuries from physical therapists. But they do receive care from other specialists as well. They may see a primary care physician, massage therapist, acupuncturist, chiropractor, or osteopathic physician. Studies suggest that injury prevention and management may reduce total number of dance injuries and the related costs. And dance company morale was improved when there were fewer injuries.

Musculoskeletal injuries are an important health issue for dancers in all settings and at all skill levels. There is a need for more research in the area of dance medicine. A physical therapist specializing in dance injuries could bring valuable information in the study of effective prevention and treatment of this type of injury.

You’re correct, the Hoffmann sign is a very simple test that requires nothing but the doctor’s finger and the patient’s hand. To do this test, the doctor or nurse taps the patient’s nail on the third or fourth finger. Normally, nothing should happen. However, if there are problems with the neurological system, the test will be positive and the patient will involuntarily bend, or flex, the end of the thumb and index finger.

Of course, this is just one test of many that are done and diagnosis isn’t made just on the results of the Hoffmann sign.

Many diseases and syndromes are named after the doctor or scientist that either first identified it or first documented it in medical literature. Since anyone could be in that position, some of the names are from doctors who have difficult to spell or say names. Many times, some diseases don’t have a person’s name attached but this happens over the course of time. For example, amyotrophic lateral sclerosis (ALS) is often called Lou Gehrig’s disease.

Other problems, such as schwannomas are also indirectly named after people. A schwannoma is a tumor that comes from a cell called a Schwann cell. This cell, discovered by the researcher Theodore Schwann helps protect the nerve cells. So, when researchers discovered that there were tumors that could come from this cell, they chose to call them schwannomas.

The most common way to test for osteoporsis is using dual energy Xray absorptiometry (DEXA) scan. This is a special Xray that measures bone density.

That’s a good question and one that has been brought up in the research community before. It is easiest to test medications and treatments on men because there is always the concern of pregnancy in adult women. Of course, the bodies of both men and women are different, so it would stand to reason that there could be difference in how a medication is absorbed or how much of a medication is needed.

Arthritis is really a general term that refers to different joint problems. Rheumatoid arthritis is an autoimmune disease, a disease where the body attacks itself for unknown reasons. This type of arthritis can attack any joint, but is most common in the hands and wrists. The joints become swollen (inflamed) inside, making them swollen, red, and warm to touch.

Osteoarthritis is often called the wear-and-tear arthritis because that is what usually causes it. The linings in the joint wear away with time, causing pain in the joint. The most commonly affected joints are the knees, hips, and spine. Finally, septic arthritis is a completely different type. This happens when the fluid in the joint becomes infected. This causes fever, and pain and swelling in the joint.

A recent study of healthy males estimated a 15 percent reduction in forces on the buttocks when falling onto 4.5 cm. closed cell foam. This may be enough to lower the threshold for fracture. The reduction in force was 20 percent for 7.5cm foam, and 24 percent with 10.5 cm thickness foam padding.