April 10th, 2008 by Dr. Val Jones in True Stories
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I’ve been presenting cases of important diagnoses made simply by physical exam. A ganglion cyst, a foot ulcer, and a dissecting abdominal aortic aneurysm were all correctly identified with a basic physical exam. However, there are times when a physical exam may not be enough – and reliance on it alone can be quite misleading.
A middle aged man was referred to our sports rehabilitation clinic after undergoing an unsuccessful orthopedic surgical procedure. He had been lifting heavy weights at his gym for some time, and was complaining of weakness in his right arm. He eventually got an appointment with an orthopedic surgeon, who noted that his right biceps muscle was severely reduced in its bulk. Assuming he had ruptured his biceps tendon, he was scheduled for repair the next week.
The surgeon was baffled after opening the arm and exploring the anatomy – the biceps tendons were both perfectly in tact, though the muscle was indeed quite atrophic.
What he didn’t realize was that the man had not ruptured his tendon, but had severely impinged his musculocutaneous nerve where it travels through the coracobrachialis muscle. The heavy weight lifting had caused his coracobrachialis muscle to hypertrophy to a point where the nerve supplying the biceps muscle was actually crushed by the size of the muscle.
The man slowly regained nerve function and was fine so long as he didn’t lift heavy weights again. The only long term side effect that he suffered was a surgical scar on the inner side of his right arm.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
November 1st, 2007 by Dr. Val Jones in News
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A recent research study suggests that as many as 7% of adults over 45 have had a stroke without even realizing it. Researchers performed brain MRI scans of 2000 “normal” (asymptomatic) Dutch men and women between the ages of 45 and 96, and found that 7.2% of them (145 people) had evidence of an infarct (stroke), 1.8% (36 people) had small aneurysms, and 1.6% (32 people) had benign tumors (usually a small malformation of the blood supply to the brain).
Interestingly, they also found one person with a primary brain cancer, one person with a previously undiagnosed lung cancer that had metastasized to the brain, one person with a life-threatening subdural hematoma (brain bleed), and one person with an aneurysm large enough to require surgery. So altogether, they found 4 people out of 2000 who needed urgent medical intervention.
Although the authors of the article emphasized the point that many “normal” people have harmless brain abnormalities – I was a bit surprised by the fact that they found 4 asymptomatic people unaware of a ticking time bomb in their brains.
Keep in mind that the study was conducted on middle class Caucasian adults in the Netherlands – so we cannot generalize these findings to more diverse populations. But I do think it’s a bit of an eye-opener.
MRI scans are quite expensive (well over $1000 in most cases) and are therefore not offered to the general population as a screening test. But it does make you think about saving up for one. Your radiologist may find something unimportant, or she may find something that you hadn’t bargained for. Or maybe one day the technology will be inexpensive enough to offer as a screening test in a primary care setting. But that’s not going to happen any time soon.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
October 31st, 2007 by Dr. Val Jones in Health Tips
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Gruesome costumes abound at Revolution Health today. Characters from popular horror movies seem to be a favorite, some employees even toted plastic chainsaws and spouted red ink/blood. As I was chased down a hallway by a ghoulish colleague who pretended to amputate one of my arms, I began to think – maybe this could be the subject of an interesting blog post? [Enter awkward segue here.]
Did you know that one in every 200 people in the United States has had a limb amputation of some kind? While the majority of amputations occur due to poor circulation (usually related to diabetes), some are caused by trauma, cancer, or birth defects. Limb loss is not a fictional issue, but a real concern for more people than you think. The good news is that most folks do very well with prostheses and rehabilitation programs. But since this is Halloween, I couldn’t resist discussing a potential complication of limb loss: phantom pain.
“Phantom pain” is the term used to describe pain sensations in a missing limb. Although this may sound impossible at first (how can a person feel pain in his foot when that same leg was amputated already?) the reality is that the brain takes some time to adjust to limb loss. The human brain has entire sections devoted to sensing input from and delivering movement messages to our arms and legs. When an arm or leg is lost, that part of the brain continues to function for several months or more. And so as the local brain cells lack the usual input from the nerves in the absent limb, they fire in a spontaneous manner that is perceived as cramping, aching, or burning.
How on earth can you treat this kind of pain? As you can imagine, it’s quite tricky. Some of the more successful approaches involve helping the brain to adjust to the loss of sensory input by touching or massaging the stump and walking on a limb prosthesis. These new sensations help the brain to adjust to the body’s changes. In fact, imagining moving the lost arm or leg can result in some relief of the perceived pain. This is the one case I can think of where imaginary exercise can be of real benefit to your body!Some folks do require special pain medicines (tricyclic antidepressants, seizure meds, and beta blockers can help modestly) to cope while their brain adjusts to the new input. However, most amputees experience the sensation that their limb is still there, but without any pain or unpleasantness. Phantom sensations and phantom pain almost always resolve with time – which is a testament to the amazing flexibility (or “plasticity“) of the human brain.
That being said, I hope you each have a safe Halloween – and that your only potential injury comes from a ghoul with a plastic chain saw.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
September 23rd, 2007 by Dr. Val Jones in Health Tips
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If you’re one of those unlucky souls who is easily nauseated by riding in planes, trains, and automobiles – and forget about boats, they’ll keep you hanging over the rail for hours – then welcome to the motion sickness club. You’ve probably already read about your treatment options, but you may not find any of them completely satisfying.
Motion sickness (like car sickness, sea sickness, etc.) is caused by an uncoupling of input from the eyes, ears, and joint position-sensing nerves throughout your body. In other words, your brain becomes confused by conflicting messages about where your body is in space. If you’re sitting in a chair, your brain expects it to be fixed and not to move – but then if that chair is in a car or on a boat, the movement doesn’t make sense to it, and you become dizzy and nauseated. The details of the science behind motion sickness is quite complex – and there are many different approaches to treating and preventing it.
In terms of medications – antihistamines such as Benadryl (diphenhydramine), Dramamine, Antivert (meclizine), and Phenergan and anticholinergics like Scopolamine may be the most commonly used. They have varying sedative side effects which can be very inconvenient for those who need to be alert and active immediately after they get out of the car, train, boat, etc.
Some people have used Zofran (ondansetron) for motion sickness prevention – and although this drug is only approved for the treatment of nausea side effects caused by cancer chemo and radiation therapy, it has a unique mechanism of action for preventing nausea. It works by blocking serotonin receptors in the brain (and perhaps in the gut) to head off motion sickness. It does not produce drowsiness as a side effect, and is generally well tolerated. Unfortunately, it is very expensive (about $50 per pill – without insurance).
Personally, I try to stay away from medications as much as I can (they always have the potential for unwanted side effects) – but if you’re really struggling with motion sickness and have exhausted all your options, you might want to ask your doctor about Zofran. I must admit that for me (someone who gets ill just looking at amusement park rides), a little bit of Zofran has radically improved my traveling difficulties. In fact, I’m writing this blog post from a seaside vacation spot in sunny California… and I have no worries about the flight home, choppy air or not. Bring on the deep sea fishing, parasailing, and jet skiing – I have no fear, Zofran is here!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
August 21st, 2007 by Dr. Val Jones in Uncategorized
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I had an interesting dialog with Dr. Bruce Campbell recently. In his blog he described a patient who lost about 60 pounds after losing his sense of taste. The patient had undergone radiation therapy for throat cancer, and in the process lost his ability to taste food. He soon lost interest in eating, and eventually dropped 60 pounds – not from the cancer, but from the side effect of radiation therapy. In this case there was a happy ending (his sense of taste eventually returned and he regained some of his weight) but it made me think about the relationship of flavor to obesity.
Just as I was musing on this very fact, a new research study was published in the journal Neurology. It suggested that unexplained weight loss was an early warning sign of dementia. They speculate that this could be linked to another early sign of dementia: loss of the sense of smell. Of course taste is largely a function of smell, so we can easily understand how people lose interest in eating when they can’t enjoy the flavor of food.
Wouldn’t it be interesting if we could temporarily alter a person’s sense of taste in order to affect weight loss? I doubt I’m the first to think of this… has anyone else heard of such a strategy? Surely this would be a little bit less invasive and dangerous than bariatric surgery.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
