What a Pain in the Butt!

"...my problems are all behind me"
Hall-of-Fame baseball player George Brett, after hemorrhoid surgery during 1980 World Series

I've heard the term "piles" but had no clue that it meant hemorrhoids; nor did I really have a clear idea of what hemorrhoids are. So I've done some reading on this pain in the butt topic.

The MayoClinic says, Hemorrhoids (HEM-uh-roids), are swollen and inflamed veins in your anus and lower rectum that may result from straining during bowel movements or from the increased pressure on these veins during pregnancy [or from being overweight]. ... By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids.

WebMD says, normally, tissue inside the anus fills with blood to help control bowel movements. If you strain to move stool, the increased pressure causes the veins in this tissue to swell and stretch.

Symptoms include

• Bleeding during bowel movements with streaks of bright red blood on toilet paper
• Anal Itching
• Rectal pain when sitting or wiping your bottom

If you are younger than 50 your doctor may just examine your rectum with a gloved finger or use a short, lighted scope to look inside. If older than 50 or there's not an obvious hemorrhoid the doctor may recommend a colonoscopy because bleeding can also indicate colon-rectum cancer.

Bottom Line

For most hemorrhoids, home treatment is sufficient - eat more fiber, drink more water, and use over-the-counter ointments for a limited time to stop itching. Get more exercise, especially walking to reduce constipation. You might also use stool softeners to reduce straining.

For painful internal hemorrhoids a doctor may tie off the hemorrhoids with rubber bands or scar the tissue around the hemorrhoids to reduce the blood supply and make them shrink or go away.

Side Effects

“America is the country where you buy a lifetime supply of aspirin for one dollar and use it up in two weeks”
-John Barrymore

All medicines can cause side effects. And sometimes one medicine is prescribed over another because of the side effects. For example, I recently saw a doctor about back pain and she recommended an odd (to me) schedule of medicine. Advil at breakfast, Tylenol at lunch, Advil at dinner, and Tylenol before sleeping. Why the two different pain killers I asked? She explained:

Advil and similar Ibuprofen products can upset the stomach, and according to Drugs.com, cause constipation, diarrhea, dizziness, gas, headache, heartburn, and nausea. Since I have GERD (acid reflux) I have to go easy on the Advil.

Tylenol is easy on the stomach but there are strict limits on its usage. This is not a drug you want to overdose on, it can be fatal. USA Today reports a study that claims even small overdoses of Tylenol repeated over time can damage the liver.  Many people I know will take extra aspirin or Ibuprofen when the regular dosage did not kill the pain. But few are aware that they should NEVER exceed the recommended dosage Tylenol, no matter how bad the pain is.

Bottom Line

Never just assume that if a little medicine is good than more must be better. Always check with a doctor if the recommended dose is not doing the job you want.

Stroke

“I thought so hard I got a headache.” - J.D. Cobb

Some serious illnesses can be difficult to detect. Appendicitis is often confused with stomach pain. Since the heart has no pain nerves a Heart Attack makes itself felt as left arm pain or nausea. Likewise with stroke, would you recognize the precursor symptoms of a stroke?

At http://www.everydayhealth.com/ patient hcwriter describes the symptoms she experienced before her stroke.

The First Precursor: The Pain in My Legs

“I can't really say exactly what happened when I had my hemorrhagic stroke on April 8, 2009, because I was unconscious for the first eight days. I can tell you about some events before…
It was Thursday, March 26, when ... I had an awful pain in my feet and ankles … I realized if the pain continued until the next day, I couldn't go to work.

I woke Friday morning and the pain was worse. I called my ENT doctor and he put me a round of antibiotics since I had ear surgery two weeks before. Maybe I was getting an ear infection. The doctor didn't know.

[On Saturday] I called a friend of ours, an Orthopedic Surgeon, and these were his words to me: "If a warm bath doesn't help and if the pain increases and moves up your leg on Sunday, go to the Emergency Room."

[On Sunday] All of the above happened and I was scared. I drove myself to the ER on Sunday. I was tested using an Ultrasound and the doctor saw blood clots in both legs. My platelets … had also dropped dangerously low.… I was admitted.

The Second Precursor: My Experience with a Blood Thinner

During the next two days, I was given tests and my blood clots in both legs were reconfirmed. … A hematologist … put me on Lovenox, an injectable blood thinner, … to break up the clots.
On April 1, the hospital finally released me and I drove myself home. … The pain in my legs was still there and it was constant. Over the next two days, I saw an improvement in the pain level. … I thought, I had narrowly escaped something that would throw my life is disarray. Besides, this wasn't a good time to miss work, with events coming up, one after the other. It's never a good time to miss work.

The Third Precursor: A Cosmic Headache

Tuesday evening [April 7] I had the beginnings of a headache. I could count on one hand how many times I've had headaches in the past twenty-five years. [She stayed the night at a friend’s house and the pain increased. After 9pm she took some Tylenol.] Somehow, after a while, I fell asleep. And that was all I knew.

I went into convulsions about 4:30 am. I missed the paramedics who came to my friend's house, [I missed] the hospital … where I spent fifteen hours under observation, and [I missed] the flight to Capital Health in Trenton, known for treating severe neurological problems.

Eight days later, I am told, I woke up. And that's what I heard first upon awakening: You've had a stroke. I was stunned to hear that news, but when I wanted to speak, to ask questions about why the stroke happened, no words were coming out. I …was without speech.

There are two types of strokes. 80% are ischemic stroke when a brain artery has been blocked by a blood clot. A hemorrhagic stroke occurs when an artery ruptures or leaks. If an artery is unable to supply a portion of the brain with oxygen-rich blood, that portion of the brain can become permanently injured within minutes. Stroke often results in permanent serious complications and disability. It is the second leading cause of death worldwide and the third leading cause of death in the U.S.


Bottom Line

“A stroke was the furthest thing from my mind. It was something that happened to other people, which leads me to believe, if I could have a stroke, anybody could have a stroke.”

Many strokes are sudden with no warning. If you experience one of the following “mini-stroke” symptoms, get emergency treatment immediately before the brain is permanently damaged:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion or problems understanding
• Sudden difficulty speaking
• Sudden vision difficulty in one or both eyes
• Sudden dizziness, loss of balance or coordination, or difficulty walking
• Sudden, severe headache with no apparent cause

Sciatica

Migraines one day, sciatica the next. – from the movie Amelie

Since I appear to have a medical theme this week, I’ll keep the theme going with something I knew nothing about when it happened to me a dozen years ago. I had incredible pain in my left leg which was worst when sitting; the only thing that lessened the pain was lying down. I kept hoping it would go away but an acquaintance of my wife thought it was “sciatica” and recommended I see a doctor.

The sciatic nerve is the largest nerve in the body and begins at the spinal cord in the lower back and extends through the buttock and down each leg to the feet. When the nerve is “pinched” or squeezed in the lumbar region of the back, it sends pain signals down the limb. And oh what a pain it is! The usual cause for a pinched nerve is a herniated disc in the spine; the disc ruptures and cartilage oozes out pressing against the sciatic. Less common is pressure from a tumor, infection, or internal bleeding; injury and inflammation; or irritation from rubbing against a nearby bone spur or muscle.

The initial prognosis was bed rest, pain killers, and a cortisone shot to shrink internal swelling; i.e. the classic “take two aspirin and call me in morning”. This is effective for many and the pain subsides within 12 weeks. But a doctor is just guessing unless they see an X-ray, CT scan, or MRI scan to check for internal damage. My X-ray showed I had a marble sized herniation from a disc low in my back. This made the doctor extremely nervous because with enough pressure, the sciatic could be permanently bruised or damaged; rending me paralyzed below the waist. I was rushed to surgery within days and felt wonderful afterwards (that is after six weeks of recovery for the muscles in the back to repair themselves from the incision.)

Without surgery, treatment for sciatica is limited to what you might do for any pain – take a pain killer and apply heating pads or ice packs. Lie down and rest or go walking (whichever works for you.) After my surgery I was prescribed Physical Therapy which helped. I have very tight calf muscles and stretching exercises helped release pressure. There were also exercises to strengthen the back muscles.

Bottom Line

Sciatica is not usually a medical emergency. At least not until the sciatic nerve is under severe and damaging pressure. If you experience difficulty with bowel or bladder function, decreased sensation around the genitals, or progressive leg weakness or numbness contact your doctor or go to the emergency room immediately. These are the warning signs that paralysis is pending.

Web Sites

http://www.medicinenet.com/sciatica/article.htm
http://orthopedics.about.com/cs/backpain/a/sciatica.htm

Nocturnal Leg Cramps

“For this, be sure, tonight thou shalt have cramps, side-stitches that shall pen thy breath up”- William Shakespeare, The Tempest

This morning I was awoken by a painful leg cramp. It’s an odd feeling to have one or more muscles do their own thing and completely disregard what you want. So what causes nighttime leg cramps and what can you do about it?

Nocturnal leg cramps are true cramps and not spasms. The muscle remains in a cramped and contracted position, which accounts for the intensity of the pain. If you touch the affected region, you may be surprised to discover that your muscles feel very hard, almost like concrete.

Leg cramps usually occur in one of the calf muscles, below and behind a knee, but painful cramps can also occur in the feet, ankles, shins, and big muscles of the thigh (quads). It can be caused by diabetes, hypertension, fibromyalgia, and as a side effect to some medication so if you have frequent cramps, see a doctor to discover if any of these apply. For instance, my wife experiences terrible muscle cramps when taking a statin to lower cholesterol.

There is some evidence that cramps are also caused by a chemical imbalance in the body - some say potassium and recommend bananas, etc.; others magnesium and swear by a nightly dose of Milk of Magnesium; for some a 1/4 cup of pickle juice or vinegar does the trick or Tums for a dose of calcium. Other studies say dehydration is the cause and a glass of water helps.

Tips to Relieve a Cramp

• Pull your toes back towards you (don't point them).
• Try putting your foot on the floor and lean forward to stretch a calf cramp.
• Apply a hot compress to the cramp or take a hot shower/bath
• Massage the cramped muscles

Bottom Line

The most common treatment to prevent leg cramps in bed is stretching exercises. Regular stretching of leg muscles, especially those in the calf, is effective. You should also examine your sleeping posture. If you sleep on your back with tight fitting sheets then your toes are forced to point downwards, compressing the calf. When something triggers the calf to compress even further, there is pain.

Update: June 9

The NY Times has an article today on a similar subject:
Phys Ed: Can Pickle Juice Stop Muscle Cramps?

The conclusion of a scientific study is yes. But no one knows why. The pickle juice or vinegar works within a minute - far too fast for the juice to leave the stomach or enter the bloodstream.

Web Sites

http://www.dummies.com/how-to/content/nocturnal-leg-cramps-nighttime-calf-muscle-pain.html
http://www.buzzle.com/articles/leg-cramps-in-bed.html
http://www.patient.co.uk/health/Cramps-in-the-Leg.htm

Carpal Tunnel

He's coming right onto the boat! Mr. Jaws [the shark], why are you grabbing my hand?
"Wouldn't you give your hand to a friend?"
– lyrics to “Mr Jaws” by Dickie Goodman

As a computer programmer, blogger, and computer game player I spend a lot of time at a keyboard. I have only once, knock on wood, experienced the pains of carpal tunnel syndrome. The carpal tunnel is a passage where the median nerve and flexor tendons pass through the wrist bones. If the tendons swell from overuse or the nerve becomes inflamed, the nerve is pinched inside the tunnel causing pain.

There are many recommended exercises to help prevent hand pain from repetitive typing or writing.

About.com recommends:
1) Extend both arms straight out in front of you
2) Extend your wrists and fingers back (as if directing traffic to stop)
3) Hold this position for 5 seconds
4) Now straighten your wrists and relax your fingers
5) With your arms still straight out in front of you keep your wrists straight, make a fist, and squeeze it tightly
6) Hold this position for 5 seconds
7) Keep your fists clenched and bend your wrists down
8) Hold this position for 5 seconds
9) Straighten both wrists and relax your fingers again
10) Repeat above ten more times

At eHow.com, physical therapist, Monica Paradise, demonstrates exercises and stretching in several online video clips.

Another eHow site describes stretching ideas for wrists and fingers. It also claims that your forearm muscles determine your wrist strength. Build up the forearms by squeezing a rubber ball and doing wrist curls with a light weight. Don’t over do the exercises!

A percussionist instructor demonstrates three clever wrist stretches.

eFuse.com has recommendations for Desktop Yoga, with many exercises for bad computer posture and repetitive stress.

Bottom Line

Don’t take your hands for granted. Work some type of wrist stretching into your daily routine.

If you experience pain, see a doctor. I can not vouch for the effectiveness of the exercises listed above.

Deep-vein thrombosis

"Just as the body cannot exist without blood, so the soul needs the matchless and pure strength of faith"- Mahatma Gandhi

Today we reach the final item on Women’s Health Magazine’s list of Seven Warning Signs not to ignore.

Your calf is extremely tender in one location, noticeably swollen, and red or warm to the touch.

You might have deep-vein thrombosis, or DVT, also known as a blood clot. I know two people who have died of blood clots. One, the father of a friend, died of a clot a week after surgery. The other had a leaky heart condition and a clot traveled to her brain. Nowadays I notice that hospitals put leg pumps on patients to prevent clots while recovering.

Anytime blood starts to pool in your lower body and there is a risk of forming a clot. It could be hours sitting at a computer, on a long flight or in a hospital bed. I try to keep my feet at least slightly elevated when sitting – and it helps to stand up and walk around.

When a clot gets big enough to act as a stopper in the vein or artery, the area around it will start to hurt and swell. Smokers and women who take the Pill have a higher risk of developing clots.

If you suspect a clot, resist the urge to massage the area or to walk it off. If the clot breaks free, it can travel through to your lungs and cut off your oxygen supply or to your brain and cut off blood flow there.

Bottom Line

See your doctor, who will do a CT scan or ultrasound to look for DVT. If you have a clot, you'll need to take blood thinners--sometimes for up to a year--to dissolve it.

Back Pain

"Low back pain is common and affects people of all ages. It is second only to the common cold as the most common affliction of mankind, and it is among the leading complaints bringing patients to physicians’ offices."-Cleveland Clinic Journal of Medicine

The sixth of the seven Warning Signs from Women's Health magazine is back pain with tingling toes. This sign I can personally relate to.

As a computer progamer I sit for hours at my PC with less than perfect posture. Some 15 years ago I began experiencing awful back pain. It got worse and worse but I did nothing about it. Then one day it went away. Hurray, I thought. Not long thereafter a stange, new experience began - a shooting pain down my leg that became worse over time. I had no clue what this meant until a friend of my wife gave it a name, Sciatica. My first visit to the doctor was odd - I was in so much pain that it hurt to sit and was easier for me to lie on the floor. The prescription was an x-ray, take some asprin, and rest. Nothing to worry about - until the x-ray results came back. Then the doctor was seriously worried.

A cartiledge disk in my lower back had ruptured. The original pain was the disk being squeezed, then relief when it popped, and new pain as the protruding disk began pushing on my spinal column. A Neuralogist tapped my knees and toes to see if there was any nerve damage (no thankfully) and I was scheduled for surgury within days. There was great concern that the protrusion would bruise or damange my spinal column causing paralysis from the waist down.

The operation was simple with a scar only a few inches long and I was sent home early morning after an overnight stay on some powerful pain medications. The recover took six weeks before I was allowed to drive or go back to work. Physical therapy lasted many months to rebuild the back muscle and strengthen other muscles.

Bottom Line

If I had gone to a doctor earlier, during the back pain stage, I could have avoided later pain and surgery by early application of steroids and physical therapy. I was lucky that the surgery was successful. Sometimes it is not and the pain remains.

Sharp pain in your side

"If people let government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as are the souls of those who live under tyranny."-Thomas Jefferson

Let’s continue with the 7 Warning Signs You Should Not Ignore by Women’s Health magazine. Warning sign number three is a side stitch, a piercing stab, which intensifies over a few hours or days. It could be gas. It could be a pulled muscle. Or it could be something dangerous.

If it feels like your right side is skewered and you're nauseated and running a fever, you could have appendicitis. I covered appendicitis a year ago in this blog, Appendicitis.

Another possibility (for women) is an ovarian cyst. Typically these fluid-filled sacs are harmless and disappear on their own. But if one twists or ruptures, it can cause terrible pain and damage the ovary.

Bottom Line

In both cases above, you need emergency surgery immediately. A burst appendix is fatal unless treated. An twisted ovarian cyst can block bloodflow to the ovary, killing it within hours. If that happens, the doctor will need to cut out the entire ovary (and the eggs inside) along with the cyst.

Abscess

"Love conquers all things except poverty and toothache."-Mae West

Today I look at the second topic from 7 WARNING SIGNS YOU SHOULD NOT IGNORE. Prior to the invention of antibiotics, infections were the main cause of human death (now the leading killers are Heart Attacks and Cancer). There are obvious infections from cuts or bites but there is also a type of deadly infection that is not so obvious (except for the pain). This is the common tooth cavity.

Bad teeth have plagued man since the dawn of time. A study of 3,000 Egyptian mummies concluded that 18% of all mummies had a nightmare array of dental diseases. Just like a cut in the skin, a hole or crack in a tooth allows outside bacteria inside the body where it can grow and spread. Sadly for us, a tooth is a lovely place for bacteria to grow. The narrow opening in teeth roots is too small for white blood cells to enter inside the tooth and wage war. So bacteria can grow unchecked until it pushes out of the tooth into the surrounding gum tissue and jawbone. At this point the cavity becomes an abscess.

The infection from a tooth abscess can spread to the brain and kill or spread to the throat, swelling it and making breathing difficult.

Have a dentist examine any persistent toothache. If you cannot see a dentist immediately, here are some steps you can try for tooth pain before your dental appointment:

· Bite down on a tea bag (wet or dry) for a few hours
· Mix salt and baking soda, dip a wet cotton ball in this mixture, and position the cotton between your cheek and tooth for a few hours. Hydrogen peroxide is known to reduce toothache.
· Use hydrogen peroxide 1.5% as a mouthwash.
· Gargle in your mouth with tea tree oil mixed with water.
· Gargle in your mouth with salt water.
· Apply drops of clove oil or vanilla extract to the infected tooth.

Bottom Line

Just because your tooth stops hurting does not mean the problem is gone. It could mean that the bacteria has reached the root of the tooth and killed the nerve. The next step is an abscess and danger. You’ll be pain free until the infection is deeply rooted in the gum or jaw or brain and much more difficult to fix.

See a dentist; don’t risk your life with a tooth infection.

"It is outrageous today that in America, a young boy can die because his family can't find a dentist to remove an infected tooth," – actual event in Maryland in 2007