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Muscle Strain: Should You Treat It With Hot Packs Or Cold Packs?

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Applying an ice pack to a muscle strain.Along with blisters and sprains, muscle strains are among the most common afflictions for active persons in the outdoors. Common medical dogma is to use the “RICE”  approach for sprains and strains of—rest, ice (application of cold), compression, and elevation.

This is more applicable to sprains (e.g., an ankle sprain) than to strains, because the sprained body part is usually a limb (ankle, knee, wrist)
that is amenable to this approach. Strains more often involve larger muscle
groups, such as those in the back, chest, thigh or abdomen, or difficult-to-approach areas, such as the neck or groin.

Prevailing theory for treatment of a muscle strain is that one applies external cold for 24 to 48 hours, and discontinues it after 72 hours, at which time one begins application of external heat. The rationale is
that swelling (from leakage of blood and tissue fluid) and inflammation prevail in the first two days, and that after three days, one wishes to increase local circulation and augment reabsorption of the fluid that has collected. There is some science to this, and these recommendations have been around for as long as I can recall. Read more »

This post, Muscle Strain: Should You Treat It With Hot Packs Or Cold Packs?, was originally published on Healthine.com by Paul Auerbach, M.D..

When Patients Attack: Is Self-Defense Legally Dangerous?

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Sideways Shrink posed a great question recently in a comment on my post “When A Thick Skin Helps.” The question was whether or not physicians are allowed to hit a patient who tries to assault them.

Certainly, physical assaults on patients are not the standard of practice in psychiatry or any other medical specialty. Psychiatrists do undergo some training about physical management of violent patients: I remember in residency we had to get trained in “take down” and restraint procedures. As a group we practiced applying pressure point joint locks on each other in order to make a patient break a grip on us, and to do two person restraints to hold someone immobile until security could arrive. None of this involved any “Crouching Tiger, Hidden Dragon”-type kung fu moves, there was no kicking or hitting or loud kiai karate yells. There was a lot of talk about the importance of being as least forceful as possible. Frankly, I’m not sure how much of that I would have remembered if I had ever been in a position to have to use it. The few times when I was actually assaulted by patients the incidents happened so fast there really wasn’t anything I could have done. (OK, so the little manic lady who hit me with a stuffed dog really couldn’t count as an assault, and she was already restrained in a geri-chair to begin with.)

But the real question is: will a doctor get into trouble for defending him or herself? Read more »

*This blog post was originally published at Shrink Rap*

Can You Catch Genital Herpes When There Are No Lesions?

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The answer might seem obvious, but I get this question often in clinic. In particular, patients want to know if genital herpes is contagious even if they or their partner is not having an outbreak.

The answer is yes. Genital herpes is a common sexually transmitted disease and is highly contagious. Although the risk of infecting someone else is much higher if you’re having an outbreak, it is still possible to transmit the virus, called HSV, even if you have no symptoms. About 1 in every 6 adults has genital herpes.

Once you have herpes, there is way to cure it. It is common to have recurring outbreaks especially in the first year, but in most people these lessen over time.

The only way to ensure you won’t get herpes is to abstain from sexual contact or to be in a monogamous relationship with a partner who is not infected. Wearing a condom can reduce the chances of infection, but it’s still possible to be transmitted. Taking anti-herpes medication such as acyclovir can reduce the amount of virus and minimize the risk of transmitting it.

April is STD awareness month. If you’re thinking you might need to get tested, then you need to get tested.

*This blog post was originally published at The Dermatology Blog*

A Minor Requests A Labiaplasty: What Should The Plastic Surgeon Do?

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Reader Question:

I am 16 in Orange County and want a labia reduction. Can I have it without telling my parents?

For those of you who may not know, labiaplasty (sometimes called labioplasty) is an operation to change the shape of the labiae, a woman’s outer genitals. It can be performed for cosmetic or functional concerns. Some women with large labiae experience pain with tighter garments and in rare circumstances they can get in the way of sexual relations. The operations are different things to different surgeons and have been controversial to say the least.

Quite a bit in the practice of surgery of the privates is a matter of the surgeon’s philosophy. This includes the design and scope of the operation as we’ve mentioned. Traditionally for any surgery on a patient under the age of legal consent, a legal guardian (usually a parent) must consent. Read more »

*This blog post was originally published at Truth in Cosmetic Surgery*

Things You Can Learn From A Bad Nurse

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My husband had a screening colonoscopy last Friday.  His nurse in the recovery is the only one I had issues with.  I, not my husband.

All went well, but let me tell you he is not an ePatient Dave.  He did not read his instructions about when to quit eating and the prep.  I did.  I then reminded him along the way:  “Only clear liquids today.”  “You must take the Ducolax at 3 pm.  Do you want me to text you a reminder?”

Sometimes the instructions we give patients are clear, but not always read.

The staff at the front desk were very kind and organized.  Calls had been made the day before and I had insured the insurance information they had was correct.   I did not tell anyone I was a doctor.  I’m not sure if my husband did later or not.

…..

When I was called back by the nurse, she mispronounced my name calling me Rhonda (which I forgave easily).  She did not introduce herself to me.

As we entered the recovery area, she did not take me to my husband and assure me he was okay.  She took me to the desk and abruptly said, “You need to sign this.” Read more »

*This blog post was originally published at Suture for a Living*

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