May 24th, 2009 by eDocAmerica in Better Health Network, Health Tips, Humor
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One of our most revered faculty members, Lee Archer, MD, a neurologist, provided a copy of the handout he gives to his headache patients. With his permission, I adapted it for use with my own patients. I thought it was so good that I asked him if I could publish it on my blog so that others could benefit from his advice.
Headaches are incredibly common and usually frustrating for providers. It has become increasingly evident that chronic or frequently occurring headaches are often virtually impossible to identify as either “migraine” or “tension” headaches and often simply are called “chronic headaches”. Treatment often becomes a revolving door of trying new medications that sometimes work, but more commonly don’t. And, even worse, many headache patients gradually simply become dependent on addictive pain medications just to try to cope with their often daily discomfort.
But, there are some really basic things about dealing with chronic headaches that we should never forget to try. So, without further ado, here is his advice:
Ten Steps to Overcoming Your Headaches
There are some things that everyone can do to help their headaches. There are a number of things you can besides just take medication to help their headaches. If someone follows all of these directions, the need for prescription medication is often dramatically reduced if not eliminated.
1. First and foremost, taking pain medication everyday is definitely not a good idea. Daily pain medication tends to perpetuate headaches. This is true for over-the-counter medications like Excedrin and BC powders, as well as prescription medications like Fiorinal, Midrin, and “triptans” like Imitrex, Zomig, Relpax, Frova, etc. Exactly why this occurs is unclear, but it is a well established clinical finding. Anyone who takes pain medications more than twice a week is in danger of perpetuating their headaches. Occasional usage of pain medications several times in one week is permissible, as long as it is not a regular pattern. For instance, using pain medication several days in a row during the perimenstrual period is certainly permissible.
2. Regular exercise helps reduce headaches. Exercise stimulates the release of endorphins in the brain. These are chemicals that actually suppress pain. I encourage people to aim for at least 20 minutes of aerobic exercise (like walking or swimming) five days a week if not daily. In addition to helping reduce headaches, this also will prolong your life because of the beneficial effects on your heart.
3. Stress reduction is a definite benefit in reducing headache frequency and severity. Headaches are not caused by stress alone, but can make most headaches worse. There are no easy answers for how to reduce stress. If it is severe, we can consider referral to a therapist for help.
4. Too much or too little sleep can trigger headaches. Pay attention to this, and note whether or not you are tending to trigger headaches from sleeping too little or too much. People differ as to how much sleep is “right” for them.
5. Caffeine can precipitate headaches. I encourage patients to try stopping caffeine altogether for a few weeks, and we can decide together whether or not caffeine might be contributing. Abruptly stopping all caffeine can trigger headaches, too, so try to taper off over a week.
6. NutraSweet (aspartame) can cause headaches in some people. If you are drinking multiple servings/day of beverages containing NutraSweet you might consider trying to stop that, and see if your headaches respond.
7. There are some other foods they may trigger headaches in some people. Usually people learn this very quickly. For instance, red wine will precipitate migraines in many people, and chocolate, nuts, hot dogs and Chinese food triggers headaches in certain cases. I generally don’t advise omitting all of these foods, unless you notice a pattern where these foods are causing headaches.
8. If I give you a prophylactic medication for headaches, you should take it daily, as prescribed. If you have trouble tolerating it, please let me know and we can consider using something else. No prophylactic medication works in every patient with headaches. Generally, each of the medications works in only about 60% of people. Therefore, it is not uncommon to need to try more than one medication in any given patient. We must give any of these medications at least four to six weeks to work before giving up on them. It generally takes that long to be sure whether or not a medication is going to work.
9. Keep a calendar of your headaches. Use a standard calendar and mark the days
that you have a headache, how severe it is on a scale of one to ten, what you took
for it and how long it lasted. Also note anything that you think could have
precipitated it. By keeping this over time we can tell if our efforts
are helping.
10. Riboflavin (vitamin B2) 400mg daily helps prevent migraines in many people. It
comes in 100mg size tablets, so you will need to take four of them each day. You
can add it to anything else we try. You do not need a prescription for it.
Do you have chronic headaches? If so, I challenge you to apply these ten principles, then come back and provide a comment on this blog post!
Thanks and good luck!
*This blog post was originally published at eDocAmerica*
May 19th, 2009 by RamonaBatesMD in Better Health Network, Health Tips
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Being a plastic surgeon, I have a great interest in the skin and no I don’t see or treat much dermatitis as the primary physician. Patients do occasionally ask me about patches/rashes they have. It’s always nice to be up on the topic and to know when it’s important to make sure they see a dermatologist.
The article listed below is a nice, simple review of conditions that fall into the eczema /dermatitis categories. The article discusses atopic dermatitis (AD), nummular (coin-shaped) eczema, contact dermatitis, and stasis dermatitis. It is not a deep article on the subject, but did include some nice reminders and tips.
Allergic dermatitis is not uncommon in patients with chronic wounds. One study documented more than 51% of leg ulcer patients acquire contact allergic dermatitis to local dressings and other topical treatment. This is important to any of us who treat wounds, acute or chronic. Sometimes the wound fails to heal due to this.
There is a nice table which lists the common allergens in patients with chronic wounds. If your chronic wound patient has a contact allergy to these products, it can certainly complicate their wound healing.
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lanolin (common in moisturizing creams and ointments)
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perfumes/fragrances
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cetylsterol alcohol (used as an emulsifier, stabilizer, and preservative in creams, ointments, and paste bandages)
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preservatives: quaternium 15, parabens, chlorocresol (all are used to prevent bacterial contamination in creams, but are not in ointments)
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rosin (colophony) — a component of some adhesive tapes, bandages, or dressings
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rubber / latex
The key to treatment and prevention of future exacerbations is identification of any provocative factors so that they may be avoided as there is no absolute cure for dermatitis. Here is a summary of tips the article gives:
Laundry and Clothing Suggestions
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Avoid wearing wool or nylon next to their skin as they may exacerbate itch. Choose materials made of cotton or corduroy which are softer.
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Rather than use fabric softeners and bleach, which may be irritating to the skin, add a white vinegar rinse in the washing machine rinse cycle cup/dispenser to remove excess alkaline detergent.
Moisturizers
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Keep water exposure to a minimum.
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Use humectants or lubricants regularly to replenish skin moisture. Apply these agents immediately after bathing while the skin is damp.
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For severe hand eczema, cotton gloves may be worn at night to augment the moisturizing effect of humectants and other topical treatments.
Topical Steroids
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Topical steroids continue to be the mainstay therapy for treating dermatitis.
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Topical steroid creams can be kept in the refrigerator or combined with 0.5% to 1% of menthol (camphor and phenol are alternatives) to give a cooling effect. This often helps.
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Treat the dermatitis with a topical steroid when the skin is red and inflamed. Tapering the topical steroid use by alternating with moisturizers as the dermatitis resolves.
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Remember that percutaneous absorption of topical steroids is greatest on the face and in body folds. They suggest only weak or moderate preparations be used in these areas.
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Moderate to potent topical steroids should be used on the trunk and the extremities.
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The palms and soles are low-absorption areas, so may require very potent topical steroids
REFERENCE
The ABCs of Skin Care for Wound Care Clinicians: Dermatitis and Eczema; Advances in Skin & Wound Care: May 2009, Vol 22, Issue 5, pp 230-236; Woo, Kevin Y. RN, MSc, PhD, ACNP, GNC(C), FAPWCA; Sibbald, R. Gary BSc, MD, MEd, FRCPC (Med, Derm), ABIM DABD, FAPWCA (doi:10.1097/01.ASW.0000350837.17691.7f)
*This blog post was originally published at Suture for a Living*
December 30th, 2011 by Berci in News, Video
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2011 was a very intense and exciting year regarding the developments and new insights of the relationship between medicine/healthcare and social media. Here are my favourite stories from 2011 selected and featured month by month.
January
I had the honour to be included in the Advisory Board of the Mayo Clinic Center for Social Media; I wrote about how a Samsung Galaxy Tab changed totally my online activities, how Google Translate can be used in medicine and featured HealCam, a medical alternative of ChatRoulette.
February
Facebook diagnosis by surgeon saved a friend; there was a lively discussion whether pharma companies can edit Wikipedia entries about their own products, it turned out Wikipedia can be a key tool for global public health promotion; and Scienceroll won the Best Medical Technology/Informatics Blog category for the third time in a row in the Medgadget’s Weblog Awards.
March Read more »
*This blog post was originally published at ScienceRoll*
December 16th, 2011 by Nicholas Genes, M.D., Ph.D. in Opinion
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Yesterday’s ACEP Member Communication email (entitled Emergency Medicine Today, in affiliation with BulletinHealthcare) had this as its top story: Injuries Linked to Holiday Decorating on the Rise, from a website called HealthDay News. The reported cites a US Consumer Product Safety Commission press release, crafted with help from Underwriter Laboratories (the wire engineers). They claim:
In November and December 2010, more than 13,000 people were treated in U.S. emergency departments for injuries involving holiday decorations, up from 10,000 in 2007, and 12,000 in 2008 and 2009, according to the U.S. Consumer Product Safety Commission (CPSC).
“A well-watered tree, carefully placed candles, and carefully checked holiday light sets will help prevent the joy of the holidays from turning into a trip to the emergency room or the loss of your home,” said CPSC chairman Inez Tenenbaum in an agency news release.
Good advice. Though it’s been said many times, many ways. So when it came time for CPSC and UL to raise the topic, did we need the very questionable statistics to justify it? Read more »
*This blog post was originally published at Blogborygmi*
July 23rd, 2011 by Dr. Val Jones in Health Tips, Opinion
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Alright, I admit that the title of this post is a little dramatic. But it really does seem that most people I know socially have had a bad experience with the healthcare system lately. Take for example my friend whose 3- year-old went to the hospital for a common pediatric procedure – the little girl was overdosed on a medicine, aspirated, got pneumonia, went into respiratory distress (noticed first by her mom) and remained in the pediatric ICU for several days. The hospital staff swept the overdose under the rug, and outright denied it happened when faced with direct questioning. As outrageous as that all is, my friend chose not to pursue action against the hospital and staff for their error and behavior. She just “let it go” because no permanent harm had occurred.
Another dear friend was recently misdiagnosed with having a pulmonary condition when he was in heart failure from an arrhythmia… and almost had a stroke during a contraindicated pulmonary stress test. His simple conclusion: “doctors suck.” Was anyone held accountable for this? No. Again because no permanent harm had occurred.
Just the other night I was having dinner with some visitors from out of town. They both told me Read more »
