Marilyn Covers The Medical World With a Passion

Peripheral Nerve Blocks for Joint Surgery

Posted on December 30, 2010 by Marilyn • 0 Comments

It’s’ not exactly a new idea, Peripheral Nerve Block has long been used in obstetrics,  but in the last  8-years this type of anesthesia has grown up, become more sophisticated and that makes it definitely worth talking about –  especially if you’re about to undergo joint replacement surgery of any kind.    In fact, according to the American Academy of Orthopedic Surgeons, nearly 600-thousand Americans undergo total knee replacements every year.  Another 200-thousand receive new hip joints.

The Total Knee Replacement

 

 

Orthopedic surgery has always had a brutal and dangerous image.  Read More

Filed Under: Surgery

VERTIGO

Posted on November 26, 2010 by Marilyn • 2 Comments

(Benign Paroxysmal Positional Vertigo – BPPV) 

That dizzy feeling

We’ve all done it as kids – spinning around and around and then stopping to get that dizzy feeling.  We’d stagger around, fall down, and giggle like crazy because the room kept spinning even though we were standing still.   We didn’t know our self-induced vertigo was the result of our inner ear’s balance system getting out of whack.

Why does it happen?

That balance system is called the labyrinth and it’s located within three semicircular canals.  According to Dr. Douglas Chen, an expert on hearing and nerve disorders of the ears, hold nerve endings and fluid that tells your body where it is in relation to gravity- something like a gyroscope. Read More

Filed Under: Conditions and Diseases

Get Those Vaccinations

Posted on October 27, 2010 by Marilyn • 0 Comments

Think about it.  We protect our homes and cars against damage and destruction with insurance, and most of us pursue added protection of our automobiles with oil changes and other routine maintenance.   But a lot of us fail to protect ourselves against certain destructive diseases and conditions with immunizations.   Sound familiar?    Think it’ll never happen to you?  Why take the chance?  Every year thousands of Americans die from illnesses that are easily prevented with a simple shot.    Here is a rundown of the vaccines you need and why.

Pneumococcal Polysaccharide Vaccine

If you are 65 and older you should have this vaccine.   This once-in-a-lifetime shot protects you against 23-types of streptococcus bacteria, including those that cause serious disease.   For kids age five and under the Pneumococcal Conjugate Vaccine is recommended.   Pneumococcal disease is the leading cause of vaccine preventable illness and death in the United States.    Once easily controlled with penicillin and other antibiotics, some strains of the streptococcus bacteria don’t respond to those treatments.  That makes prevention even more critical.

Who is at risk? Read More

Filed Under: Conditions and Diseases

Gallbladder Disease – Stone and/or Inflammation

Posted on October 11, 2010 by Marilyn • 2 Comments

The attack

It’s one of the most uncomfortable feelings I’ve ever experienced.  A kind of gnawing, chewing ache in the upper right part of my abdomen near my rib cage that radiated to my back between my shoulder blades.   I had the most common symptom of gallstones.   Many say it feels like a heart attack.   I will agree with that.

Symptoms that come and go

The odd thing is that you can have one attack and never have another.   Or, as in my case, the symptoms come, disappear for a few years and then return.  My first attack hit one day in 2005 after eating ice cream.    I couldn’t sit down, lie down, walk upright, or take deep breaths.  I also tried Motrin.   Nothing worked.  An hour later the pain was gone – until February, 2010.   After a week of on-again-off-again mild discomfort – doctors call it biliary colic – severe pain woke me up at 4:30 a.m. Sunday morning, Valentine’s Day.   By the time I got to the emergency room the pain had passed.  Still, I had to be checked out.   A sonogram revealed my gallbladder was full of stones.   Apparently,  I had passed one through the bile duct.

More than a momentary nuisance

As I said, my pain lasted about an hour.  However, it’s important to mention that pain lasting several hours is indicative of a more serious condition.   For example when a stone blocks the bile duct for a long time it can cause:

  • fever, chills,
  •  nausea and vomiting,
  •  rapid breathing,
  •  yellow skin (jaundice)
  • dark urine,
  • light colored stools,
  • sudden drop in blood pressure
  • severe pain in the upper right abdomen. 
  • Patients face the potential of a torn gallbladder and gangrene. 

THE MESSAGE HERE:  SEE A DOCTOR IMMEDIATELY.

The location of the pain relates to the location of the gallbladder.  This small pear shaped organ sits just under the right lobe of the liver.    The bulb of the pear faces to the front while the stem or common bile duct points toward the back.  So if a stone gets stuck in that duct – or even if it passes through the duct the pain is felt through to the back between the shoulder blades and/ or behind the breastbone. 

The fix – surgery

The gallbladder is not an essential organ.  It is just a holding sack for bile produced by the liver to aid in digestion.   Gallbladder removal is one of the most common surgical procedures performed today – especially on women.  Even during pregnancy, doctors say, there is very little risk to mother and baby.  The primary advantages:  It gets rid of the gallstones and prevents gallbladder cancer.    Unless there is a reason to do an open belly procedure, most surgeons remove gallbladders through four tiny incisions.  If there are no complications patients can go home a few hours later.

 Of course, there are non-surgical treatments.  Your doctor can advise you on what is best for you.   I never wanted to feel the pain of gallstones again, so I happily, eagerly went through outpatient laparascopic surgery in March of this year.  The only side effect – if I can call it that – is that large and or fatty meals are evacuated within a half hour.  Sooner or later that should dissipate.   It’s a small price to pay for permanent relief.

Few will be bothered

90-percent of gallstones never cause symptoms at all.    The stones themselves take a long time to develop and doctors tell me it takes about eight years for symptoms to appear – if they appear at all.  

Resources if you want to know more:

Filed Under: Conditions and Diseases

Treating Lung Cancer

Posted on October 6, 2010 by Marilyn • 0 Comments

Stereotactic Body Radiation Therapy

Radiation therapy – long the gold standard in the treatment of cancer – has changed for the better.   Instead of blasting a wide area with radiation that can damage surrounding tissues, doctors now use a sophisticated technique that delivers precise high doses of radiation to isolated tumors in the brain, bone, liver, and most recently the lungs.   It’s called Stereotactic Body Radiotherapy or SBRT and for lung cancer patients like John DeAngelis it’s proving to be a life-saver. 

 

A patient pulled back from the brink

 John DeAngelis will tell you he always fought the big sharks to save the little fish – did it many times over.    He was a civil trial lawyer until he encountered an opponent he couldn’t beat.    Emphysema: a lung disease commonly found in smokers.  The tiny air sacs in the lungs get stretched out of shape and break down.   Inhaled air can’t escape the lungs so new air can’t get in.   Imagine the desperation of that.   Today, DeAngelis is tethered to an oxygen tank.  And, that’s not the worst of it.   When chronic bronchitis and a persistent cough settled in, John says “I tried everything to correct the problem.  Nothing worked.”    He became one of 11-million Americans with Chronic Obstructive Pulmonary Disease – COPD – a disease that robs them of their breath, their energy, and ultimately their lives.   Then the ultimate insult struck in February, 2009 – a cancerous tumor in his left lung.                                   

The good news:  it was very early.  The bad news: emphysema ruled out surgery.  “Every doctor I saw said the same thing; the emphysema is  too diffuse, too spread out in the lungs.  Surgery was out of the question.”   John says he “wasn’t keen on surgery anyway.   I told my doctor to make me comfortable and leave me alone.  I have a living will that says I don’t want any heroic measures.  I’m not afraid to die.”

Stereotactic Body Radiation Therapy (SBRT) a life-saving alternative

As it turns out John, like so many other lung cancer patients who can’t endure surgery, had an alternative that could save him from death.  That relatively new radiation therapy I mentioned earlier called SBRT.    In fact, it is so precise it can zap a tumor without damaging or destroying the surrounding tissue.  Radiation Oncologist, Dr.Tom Colonias explains that “innovations in CT scanning allows doctors to see a patient’s lungs as they move with each breath.  “While the patient is on the table we can make calculations and adjustments.  We can actually map the lung area and guide ten to twelve beams of radiation precisely at the tumor.

 

Potential Side effects of SBRT

 High dose radiation directly to the spot with 90-percent chance to locally control the tumor at the site, that’s what SBRT can do with just one to five days of treatment. .   Standard radiation therapy calls for roughly 30-days of treatment and provides only 30-percent chance of local control of the cancer.    While the side effects of SBRT are also lessened they are not totally erased.   Fatigue seems to be the main complaint.   John DeAngelis remembers he “was so tired at the end of therapy there were times I could barely get out of my car.  In fact, it took almost a year to get back to feeling like I had any energy at all.”   Other potential side effects are persistent cough, feeling short of breath when exercising, rib fracture and red, dry, flaky, itchy skin at the radiation site.   Despite aggravations that came with his treatment, John has reaped the benefits.  His lung tumor has been in remission for the last 18 months.   And, that is good news.   Dr. Colonias says the return of cancer usually happens within two to three years of treatment.  If all holds true the chance of John’s recurrence of lung cancer is minimal.    A note of caution:  this treatment does not relieve his emphysema.

Unfortunately, not everyone with lung cancer can benefit from SBRT.  Dr. Colonias says “SBRT is risky for anyone with a lung tumor larger than 5-centimeters, or if the tumor is more centrally located because there are so many blood vessels located in and around the larger airways.

More than 200-thousand Americans are diagnosed with lung cancer every year.   Dr.  Colonias adds that “only 20-percent are discovered in the early stages with a good percentage of these patients not able to tolerate surgery.”  Basically that means roughly 10-percent could benefit from SBRT.

Source:  

Tom Colonias, MD   Director of Lung Program, Department of Radiation Oncology

 Allegheny General Hospital, Pittsburgh, PA.    412-359-3400

Filed Under: Cancer

Bloodless Medicine

Posted on September 22, 2010 by Marilyn • 2 Comments

What do you mean I need surgery?

Like a lot of folks I fortunately sailed through my childhood and young adult years without serious injury, disease, or surgery.  So, I never dreamed I would ever need surgery – until recently.    Trust me, the older you get the more likely you will need an operation of some kind.   I’ve now had two in as many years.   Thank God both were elective.  A total knee replacement in 2008 and gall bladder removal in early 2010.    

 As a medical editor I’ve watched all types of surgeries over the years without so much as a quiver.   After all it was to help the patient, right?   Ah, but when it was my turn it was a different matter. The very thought left me hollow.  My stomach did little flips, my hands turned cold, and tiny beads of sweat rolled down my back.    Everything in my head said NO!  What was I worried about?   Certainly not my surgeon and anesthesiologist, both are excellent at what they do.    My concern was blood.    I didn’t want any.  I’m not alone.

Blood transfusion?  No way

 When you check into hospital for surgery, one of the things you are asked is whether you will accept a blood transfusion.   Without hesitation I said “absolutely not.”   It’s not my religion.  I’m not a Jehovah Witness whose faith forbids blood transfusions even in the face of death.  I just know the risks associated with donated blood:  Hepatitis, HIV and other diseases, pulmonary complications, slower healing, longer recovery even death.  And since I was having elective surgery, I had the choice to refuse.   I and every patient who refuses a transfusion can thank Jehovah’s Witnesses.

Bloodless surgery and conservation

 Their religious beliefs forced physicians develop ways to perform surgeries without blood transfusions.   That trend began in 1962.    Today, the approach to bloodless medicine and surgery is state-of-the-art and in demand by mainstream patients who hear their doctors say ‘the best blood is your own’.    What a change in attitudes.    Doctors who once thought donated blood was necessary now offer their patients ways to save their own blood and avoid transfusions.

Dr. Jan Seski, a gynecologic oncologist here in Pittsburgh, Pennsylvania, is a pioneer and leader in bloodless medicine.   He got involved back in the 1970’s while completing his fellowship at M.D. Anderson Cancer Center in Houston, Texas.  In 1981 he brought a bloodless technique to Pittsburgh. Ten years later he opened the Oakland Infusion Center which offers patients facing open heart, orthopaedic and cancer surgery a wide range of blood conservation methods.

Dr. Seski, like most physicians, doesn’t pooh-pooh donated blood.  In certain situations it has value.   However, he’s quick to add “it’s a good thing to avoid blood transfusions if you can, not just because of the risks involved with transfusions but the expense.”   Hospitals pay approximately two-hundred dollars per unit.  Tack on disease testing and blood typing and patients will pay roughly one-thousand dollars per unit.  Depending on the treatment some patients can go through five or six units of blood.  In severe trauma cases and liver transplantation it is not unheard of for patients to receive 70-units or more.  You do the math.

Save every drop

So hospitals and doctors alike are doing what they can to recycle a patient’s blood and limit the amount of blood lost after surgery.  

* Pre-operation preparation – Patients can plan ahead and collect their own blood for use during surgery.

* Drugs can boost blood levels before surgery.

* Blood Cells can be salvaged and blood can be diverted or looped during operations.

* Doctors can limit post-surgery blood draws – patients can lose a pint of blood a week from drawing blood

*Micro-sampling techniques for lab tests to preserve patients own blood is available in some hospitals.

* Post-operative anemia can be corrected with Intravenous Iron and High doses of the growth hormone, erythropoietin, to make bone marrow produce red blood cells or prevent anemia caused by blood loss

Unfortunately, not all hospitals are alike.  It’s up to you, the patient, to refuse blood transfusions before surgery – if that’s what you want.  And, to ask your doctor what, if any, bloodless techniques he or she can provide.  With the demand for bloodless medicine and surgery on the rise, chances are good that you can get what you need without donated blood.

Information sources:

Dr. Jan Seski, Director, Oakland Infusion Center – 412- 621-2888

Center for Bloodless Medicine and surgery 412-359-8787 www.bloodlessmedicine.org

Filed Under: Surgery

Tinnitus, Help and Hope

Posted on September 6, 2010 by Marilyn • 1 Comment

If you’re among the more than 50-million Americans driven to distraction by Tinnitus, a condition marked by constant ringing, roaring, or static like buzzing in the ears, there is good news for the roughly 12-million severe sufferers.   I’m talking about hearing aids that do more than enhance sound.  

Hearing aid manufacturers have been working feverishly on digital solutions to tinnitus which can be so annoying, so irritating it makes many consider ending their lives.  According to Clinical Audiologist, Julie Hobbs “It doesn’t matter what the cause of the tinnitus might be, even if you don’t have a hearing problem, these aids can block the noise that can threaten quality of life and mental stability.”  

Cutting edge help 

The newest cutting edge digital wonder is the Widex Mind 440 Series.  It combines a traditional hearing aid with relaxing Zen tones.   Hobbs says “there are five different programs that offer random bell-like sounds that coincide with your heart rate.  The programs can increase or decrease the speed and loudness of the tones, even add or lessen static white noise, whatever it takes to achieve the most comfort for the patient”.  

They are expensive, about thirty-five hundred dollars each.   If you choose the smallest aid you will also need a remote to make the adjustments.  So figure another three-hundred-fifty dollars for that.   The good news:  you can try before you buy.    The Widex Company, a well-established hearing aid manufacturer, offers a one month trial period.  No relief, no money.  

One woman’s story 

Georgette Kropelak-Smith of Leechburg, Pennsylvania is one of the first in this area to try the Widex Mind Unit.  Immediate relief brought her a joy and peace of mind she hadn’t felt in several months.    But she can remember two years ago when she felt that her head was stuck inside a New York subway tunnel, “I thought the constant roaring noise in my ears was caused by my sinuses because it eventually went away.”  The 56-year old computer worker now believes her problem stems from the weeks of powerful chemotherapy she received to fight breast cancer around the same time.    

By early 2010, the roar in Georgette’s ears was replaced by a high-pitched whining noise that never, ever goes away.  It’s worse at night or in quiet rooms.  She saw several doctors.  Some told her to just live with it.  She tried several treatments she thought would help, including medication for a sluggish thyroid gland, acupuncture, and breathing exercises to calm herself.    Nothing brought total relief. 

Finally diagnosed with tinnitus in February she at least she knew she wasn’t crazy.    But ‘knowing’ didn’t stop the noise, the anxiety, the depression.    She says “the constant whining grates on my nerves, robs me of sleep, and nearly drove me to suicide”.    Now, a small dose of Xanax lowers the whining noise and another medication called Prestique eases my anxiety and depression.  But it’s the Widex that really lets me cope.”  

Pricey relief 

Georgette’s relief didn’t come cheap.  Seven-thousand dollars all told.   But she feels “it’s worth the money because it helps me keep my sanity when I get real nervous.”   Sometimes the tones get on her nerves but she can turn them down – or off.   “It’s a very flexible system that may not work for everyone.  It depends on the individual but since you have a free month it’s worth a try.” 

Georgette’s admits her days – and nights – aren’t perfect.  Some are good, some bad, but she takes one day at a time, “I manage to keep busy taking care of my farm and the six horses that I board.  Busy is always better.” 

Other ways to help 

ReSound makes an aid that uses white noise but no tonal music.    Another is made by Neuromonics.   Audiologist, Julie Hobbs says “This device is very much like an Ipod with four tracks of music; two classical, two New-age.   In fact, it’s a two-step system.  The first has static or white noise mixed with the music.  Patients use it two-to-four hours a day for six weeks.   Hobbs says that tinnitus is a brain issue and the “theory is to turn up the volume of music enough to relax the brain’s limbic system.  Once the brain is relaxed the white noise is removed.  Patients continue to wear the aid for another 16 weeks”.    Cost: approximately five thousand dollars for testing and the device. 

 Hobbs says the Neuromonics system is “being used by the VA to help veterans returning from the wars in Iraq and Afghanistan.”    It’s free through the VA to the men and women who serve in the military and patients with traumatic brain injuries.   They are also given a trial period because the system doesn’t always help. 

Relief for less  

Not everyone with tinnitus needs such high-tech help.   Most can find relief in noise interrupters that cost around a hundred dollars or less.   Search www.sound-oasis.com . However, before you go looking for products get a proper diagnosis by an otolaryngologist, a physician who specializes in ear and hearing problems.    He or she will then be able to help you find a solution to your problem.  You don’t need to suffer anymore. 

INFORMATION ABOUT TINNITUS:  American Tinnitus Association:  http://www.ata.org/

About the Widex Mind System:  Pittsburgh Ear Associates at Allegheny General Hospital – Julie Hobbs, Clinical Audiologist bhaudio4431@aol.com   

http://www.widex.com/ 
http://www.neuromonics.com/ 
http://www.gnresound.com/ 

Filed Under: Hearing Issues

Diabetes and the Brain

Posted on August 21, 2010 by Marilyn • 2 Comments

Type 2 diabetes is a bad disease any way you look at it.  When the body becomes resistant to the hormone insulin or when the pancreas stops producing enough insulin, high glucose levels in the blood quietly attack every organ of the body, robbing physical health and eventually life.  

According to neurosurgeon Peter Jannetta, doctors “know the mechanics of the disease and what puts us at risk; excess weight, genetics, but no one knows the primary cause.”  His groundbreaking discovery published in the journal, Surgical Neurology International may change that.

The Brain Connection

A neurosurgical pioneer, Dr. Jannetta says “he has found a link between a compressed or squeezed artery at the base of the brain and type 2 diabetes mellitus”.  These findings come after 35 years of observations during brain surgeries for other conditions and diseases.

In this newly published 10-year study and follow-up of 10-patients, Dr. Jannetta and his colleagues * found that relieving the pressure on a vessel in the right rear lower part of the brain called the medulla oblongata gave seven of those patients significant control of their diabetes.  One patient could stop his medications altogether.  The team found that the operation “worked better in patients who were at normal weight or who were overweight with a body mass index of 32.  It did not help obese patients.”   

The medulla oblongata is the lowest part of the brain that extends into the spinal cord.  Its job includes respiration, circulation and the autonomic reflexes including pancreatic function.  What you can’t see in this image are the arteries and nerves that run on each side.      Micro-vascular decompression involves slipping a protective pad between those arteries and nerves.  Decompressing the right side helps control diabetes, the left controls hypertension (high blood pressure).    

So, what is most important  here?  Dr. Janetta says these study patients are the first to have improvement of their diabetes without weight loss, a change of diet or a change in activity which means arterial  deterioration may be the culprit in diabetes and not sugar”. 

One patient’s story

John Horrell of Ligonier is one of the first 10- patients to have micro-vascular decompression 10-years ago.   He’s 71 now and doing very nicely, his diabetes well controlled on two pills a day.  Back in 1997 it was a different story.   John “was taking several medications but they just didn’t work very well”.  No matter what he did he says “his blood sugar was out of control.”

He wasn’t really surprised by the diagnosis that came after several tests.  “I worked construction so I was never overweight and while my parents never had diabetes,  my Dad’s sister did have it and my brother was diagnosed in 1997 when he was just 40”.   

When John heard about Dr. Janetta’s micro-vascular decompression trial he admits he didn’t jump at the chance.  Understandably John wasn’t too keen on the idea of any type of brain surgery and neither was his family.  However, after he talked to a friend who had successfully undergone the procedure he decided worth the try.  Today he’s not cured, but his blood sugar is well controlled with a good diet and a minimal amount of medication.  He has no regrets and is quick to say “If I had to do it over again, I would be the first in the operating room.”

What is micro-vascular decompression?

Micro-vascular decompression involves placing a protective pad between the nerve and the compressed or squeezed artery in the brain.  Dr. Janetta has performed more than 6-thousand such operations.   He is considered the preeminent authority on diseases associated with vascular compression of the cranial nerves including: Trigeminal Neuralgia, Hemifacial spasm, Vertigo, Meniere’s disease, and Spasmodic  Torticollis.  

So, what’s next?  Other researchers must duplicate the study on a larger number of patients.  That will take a bit of time.  But when it’s all over Dr. Janetta believes those studies will agree with him, that “micro-vascular decompression of the right cranial or vagus nerve and the medulla oblongata – may offer some  patients with type 2 diabetes better control of their blood sugar”.

Want more MVD information?  Contact:  Dr. Peter Jannetta, Vice Chair of Academics –  Allegheny General Hospital Department of Neurosurgery pjannett@wpahs.org

Need information about Diabetes:  www.Sciencedaily.com

Filed Under: Diabetes