Time for another edition of Writer’s Block, where we highlight the best medical, health and fitness writer’s from across the Internet:

Grand Rounds 4.50 is up at A Chronic Dose and the theme is all about education. If you’re heading back to a classroom this time of year or know someone who is, this selection of posts should appeal to you.

Change of Shift is up at Nurse Ratched’s Place. Once again MJ has assembled the very best posts from the nursing and healthcare bloggers while simultaneously managing to relate everything to a pulp fiction theme. Needless to say, she is very creative. Check it out and don’t blame me if your glasses steam up.

Then you might want to check out The Carnival of Total Well-being - hosted by Ecopolitan Living. This carnival is all about ways in achieving total well-being for cosmopolitan dwellers.

Next, we have a newcomer in the mix with The Aromatherapy Blog Carnival hosted by Aroma-essence. Here you’ll find numerous articles on aromatherapy, essential oils, health, fitness, healing, and alternative medicine.

That’s it for this week. Enjoy!

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Sept 6, 2008

Sciatica and Epidural Injections - Risks and Side Effects

So far in this series we’ve discussed what epidural injections are, what they are not, and how to determine if you are a candidate for the procedure.

What we haven’t discussed are the risks and potential side effects that go along with getting these injections.

Since we all want to be informed consumers, let’s first take a look at the risks involved with epidural steroid injections.

There is Always a Risk

Every form of medical intervention involves risks and potential side effects.

There are risks involved with simply taking an aspirin or over-the-counter cold remedy. There are even risks associated with taking vitamins and herbal supplements especially when you’re taking them for medicinal purposes.

So it should come as no shock that there are risks that you need to be aware of before you decide to undergo a series of epidural steroid injections. Here are the main ones:

Infection

There is always the risk of infection whenever you undergo an invasive medical procedure. With an epidural injection, your doctor will be puncturing the skin and injecting medication into the lumbar region of your back.

Fortunately, serious infections from this procedure are rare (less than one tenth of a percent) and minor infections only occur in about 2% of all patients.

Dural Puncture

A dural puncture sometimes does occur, however this is also extremely rare. When this does happen, it can result in a headache that normally clears up in a couple of days. If it doesn’t, there is a simple procedure called a blood patch that your doctor can use to stop the leak.

Bleeding

Bleeding caused by the injection is also extremely rare and usually only occurs in patients who have a bleeding disorder.

Nerve Damage

Whenever you stick sharp objects into your body, there is always the possibility that some nerve damage can occur. This might be the result of a nerve coming in direct contact with the needle or from one of the other risks mentioned above such as an infection. Again, this is extremely rare, but something you should be aware of just the same.

What are the Side Effects

In addition to the risks mentioned above, a small number of patients will experience some form of side effect from the medication. These are usually temporary - lasting no more than a day or two - but can include one or more of the following:

• Increase in lumbar pain
• Headaches
• Facial redness or warmth (flushing)
• Anxiety or mood swings
• Sleeplessness
• Fever
• High blood sugar
• Brief reduction in immunity

The only long-term side effects associated with corticosteroids appear to be the result of excessive or prolonged steroid usage - not due to the limited number of injections we’re talking about. These included such things as stomach ulcers, cataracts, osteoporosis and arthritis.

Again, these disorders have only been shown to occur in people with long-term use of corticosteroids and not to people who merely undergo epidural injection for sciatica. In other words, they don’t really apply to this discussion.

Who Should Not Get the Injections

Lumbar epidural steroid injections should not be performed if you have any of the following:

1. Bacterial infection
2. Bleeding problems
3. Back pain due to a tumor or infection
4. High blood pressure
5. Diabetes

In addition, you should not get the injections if you are pregnant, if you are allergic to the medication, or if you are on blood thinners such as aspirin or Plavix.

Cover All Your Bases

As always, be sure to inform your primary care physician that you are considering this procedure so that you can discuss any medical conditions that might affect the outcome. Then be sure to inform the doctor performing the injections about any of these conditions.

He or she will attempt to minimize the risks and potential side effects by administering the lowest dose possible. And will also be more than happy to discuss everything we’ve discussed here and answer any additional questions you have in more detail.

Next time we’ll wrap this series up by going over exactly how the procedure is performed and what you can expect to happen the day you go in for the shots. (That is unless I think of something we haven’t covered yet.)

So stay tuned,
Dean

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Yes indeed folks, it’s time once again to see what everyone is talking about in the health, fitness and medical blogosphere…

Grand Rounds is hosted this week by Rural Doctoring with a nice Shakespearian theme. As usual it contains the best in online medical writing.

The August edition of The Pain-Blog Carnival is up at How To Cope With Pain. Lots of great reading on the subject of health and pain management.

The 31st edition of the Medicine 2.0 Blog Carnival is up hosted by Michelle vs the Med Student. Check out all the posts and news about the world of medicine 2.0 and health 2.0.

Also, check out the Carnival of Healing hosted this week by Your Joyous Life. Here you’ll find a collection of health and fitness related blog posts focused on alternative medicine.

Finally, don’t miss the Carnival of Improving Life hosted by Improved Life. Here you’ll find numerous articles on improving your life and furthering your career. Subjects include finances, fitness, nutrition, productivity, relationships, personal growth, and general health.

That’s it. Enjoy!

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August 30, 2008

Neck Pain Goes Back to Class

Speaking of neck pain, it’s back to school time again and you know what a pain in the cervical region that can be.

Needless to say, I never cared much for the world of academia so at this time of year I’m want to recall immortal words of Chuck Berry:

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“Up in the mornin’ and out to school,
The teacher is teachin’ the Golden Rule.
American history and practical math,
You study ‘em hard and hopin’ to pass.
Workin’ your fingers right down to the bone,
And the guy behind you won’t leave you alone.”

“Ring, ring goes the bell,
The cook in the lunchroom’s ready to sell.
You’re lucky if you can find a seat,
You’re fortunate if you have time to eat.
Back in the classroom, open your books,
Gee, but the teacher don’t know how mean she looks.”

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Well, mean looking teachers aside, it turns out all that book learning just might be good for something after all. At least where neck pain treatment is concerned.

Heat Proven to Halt Pain

We’ve all known since the beginning of time that the application of heat appears to sooth away aches and pains, but up until now that so-called “knowledge” has been strictly anecdotal. We could demonstrate it and experience it for ourselves, but there was no real proof that the phenomenon was anything more than just the result of the placebo effect.

That is until I came across a press release this summer from London’s University College stating that researchers there have discovered scientific proof that heat alleviates pain.

Dr Brian King, of the UCL Department of Physiology, led the research that found the molecular basis for the long-standing theory that heat, such as that from a hot-water bottle applied to the skin, provides relief from internal pains, such as stomach aches, for up to an hour. [1]

Dr. King goes on to explain:

“The heat doesn’t just provide comfort and have a placebo effect - it actually deactivates the pain at a molecular level in much the same way as pharmaceutical painkillers work. We have discovered how this molecular process works.”

If heat over 40 degrees Celsius (104F) is applied to the skin near to where internal pain is felt, it switches on heat receptors located at the site of injury. These heat receptors in turn block the effect of chemical messengers that cause pain to be detected by the body. [1]

In the past it was easy to speculate that heat therapy seemed to work simply because it made us feel good and thus made the pain more bearable.

Add to the fact that the pain relief was only temporary, furthered the assumption that the effect was merely psychological and not really real. However, Dr. King’s research gives us physiological evidence that supports our past personal observations.

The team found that the heat receptor, known as TRPV1, can block P2X3 pain receptors. These pain receptors are activated by ATP, the body’s source of energy, when it is released from damaged and dying cells. By blocking the pain receptors, TRPV1 is able to stop the pain being sensed by the body.

Scientists made this discovery using recombinant DNA technology to make both heat and pain receptor proteins in the same host cell and watching the molecular interactions between the TRPV1 protein and the P2X3 protein, switched on by capsaicin, the active ingredient in chili, and ATP, respectively. [1]

And so we see that even the temporary aspect can be demonstrated at the molecular level.

What does this all mean for the future of pain research? Dr. King goes on to give his opinion on the matter…

“The problem with heat is that it can only provide temporary relief. The focus of future research will continue to be the discovery and development of pain relief drugs that will block P2X3 pain receptors. Our research adds to a body of work showing that P2X3 receptors are key to the development of drugs that will alleviate debilitating internal pain.” [1]

Not Just Anecdotal Any More

This, of course, means the physical therapists have been correct all along in their use of modalities such as heat and ice when treating back and neck pain. It also confirms what you and I have observed time and time again, that the relief only lasts a short while.

For those of us who prefer not to use pharmaceuticals if they can be avoided — and don’t mind settling for a temporary solution — this is interesting research and a chance to finally point to something other than anecdotal evidence.

So, if you don’t want to take a pill and all you’re looking for is something to help you get to sleep at night. Try applying a hot water bottle or one of those commercial heat packs just before bed.

It may just do the trick.

Oh, and a nice YouTube video might help take your mind off things…

References:

1. Press Release: Heat Halts Pain Inside The Body, University College London, July 5, 2006
http://www.ucl.ac.uk/media/library/heatandpain

2. BBC News: Heat ‘blocks body’s pain signals’
http://news.bbc.co.uk/1/hi/health/5144864.stm

3. SCHOOL DAYS - Chuck Berry
http://www.youtube.com/watch?v=DHG5-GxI_Es&NR=1

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Once again, it’s time to sit back and enjoy the week’s best in medical, health and fitness blogs.

Grand Rounds is hosted this week by Kerri Morrow of Six Until Me. This week’s theme had to do with the evil Dewey Decimal System. As usual, GR contains an excellent collection of the best in online medical writing.

Next, Change of Shift is up over at Emergiblog. Once again Kim has assembled the very best posts from the Nurse bloggers.

Also be sure to check out the Total Mind and Body Fitness Blog Carnival #63 hosted by FitBuff. This week there are a variety of articles to help you improve your health, wealth, family, nutrition, and work.

And don’t forget to check out the Carnival of Healing hosted this week by Key Business Partners. Here you’ll find a collection of health and fitness related blog posts focused on alternative medicine.

That should be plenty to keep you busy. Enjoy!

Dean

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August 23, 2008

The First Step in Repairing Herniated Discs

In my previous post, we discussed my hypothesis that inactivity and compressive loading are the main culprits that lead to herniated discs.

Naturally, there may be other contributing factors such as age, smoking, poor diet, and external trauma that also play a role in the degenerative process, but I believe they are secondary causes at best.

In this post we’re going to continue the discussion by taking a close look at just how the disc is put together.

After all, in order to understand disc degeneration in general — and herniated discs in particular — we need to know a little bit about the object we’re dealing with. If we’re going to attempt to repair this problem, we first need to understand what it is we’re actually trying to fix.

Fortunately, for our purposes, we can keep things pretty simple and I promise to hold the medical speak to a minimum.

A Little Refresher Course

You’re probably already familiar with the anatomy of the spine but just in case things have gotten a little rusty here’s a quick rundown of the major players.

The Spine

The spine is made up of 24 segments of bone we call vertebrae. These bones are stacked one upon another like round blocks. Between each segment is an elastic membrane we call a disc. At the rear of the round blocks are two sets of joints known as facet joints.

The Facet Joints

The facet joints act as a hinge between the vertebrae above and below. It is this series of hinge points running the full length of the spine that allows us to bend in all directions.

The facet joints are of the ball and socket type and at the point where each ball is in contact with its socket is a layer of cartilage that acts as a bearing surface. These joints are enclosed in a membrane called a capsule, which is filled with a lubricating fluid called synovial fluid.

The Spinal Canal

A channel between the round blocks of the vertebrae and the facet joints contains what we commonly call the spinal cord.

In reality, the spinal cord only travels from the base of the skull down through the cervical and thoracic vertebra. Once it reaches the lumbar region, it branches into a multitude of nerve roots that resemble a horse’s tail.

The Ligaments

The entire structure of the spine is wrapped in a sheath of ligaments which run vertically, horizontally and crosswise totally enclosing the entire package like a suit of armor.

Our Old Friend the Disc

The intervertebral disc is basically made up of two parts and is often compared to a jelly donut. This donut-like structure is porous much like a sponge and (when healthy) is filled with fluid.

The center of this disc contains a jelly-like sack called the nucleus that — along with the fluid in the disc itself — acts like a hydraulic shock absorber.

The outer portion of the donut is called the annulus and is a series of concentric rings of fibrous connective tissue that surrounds the nucleus much like a ring of forts built one inside the other.

The top and bottom of the disc are capped with more of this fibrous connective tissue and these caps are called end plates. It should be noted that the end plates are strongly attached to the vertebrae above and below making it virtually impossible for the disc to slip.

Why Would a Disc Fail?

That’s a good question because in order for a disc to rupture, the nucleus has to break through all of those tough fibrous rings we just talked about. This soft squishy sack of jelly which has about as much penetrating power as well, a soft squishy sack of jelly, has to break through ring after ring of what should be some of the toughest ligament fibers in your entire body.

How is this possible?

In the next installment, we’ll answer that very question, so stay tuned. In the mean time, I’ll give you a little hint: it has to do with moisture. (Don’t you just love cliffhangers?)

Till then,
Dean

References:

1. Orthogate, Lumbar Disc Herniation (eOrthopod) Friday, 28 July 2006

2. Nelson, B. The Herniated Disc: New Concepts and Treatments. Physicians Neck & Back Clinics [2005]

3. McGill, S. Low Back Disorders, Evidence-Based Prevention and Rehabilitation, 2nd Edition. (p. 44-47) Human Kinetics (2007)

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