Archive | March 2010

Patience and Patients

A man too busy to take care of his health is like a mechanic too busy to take care of his tools.
– Spanish Proverb

Arachnoiditis

 a neuropathic disease caused by the inflammation of the arachnoid membrane that surrounds and protect the nerves of the central nervous system, (brain and spinal cord).

Etiology

 adverse reactions to:

  1.  chemicals
  2. blood
  3. steroids
  4. infection as the result of direct injury to the spine, chronic compression of spinal nerves, or complications from spinal surgery or other invasive spinal procedures such as epidural steroid injections.

Manifestations:

Chronic pain 

neuralgias

Numbness and tingling of the extremities

Bowel, and bladder dysfunction (with lower spinal cord involvment)

Note: arachnoiditis has no consistent manifestation, however frequently affects the nerves that supply the legs and lower back.

Treatment and Management:

  • symptom management
  • pain relief€

Three simple things

“Good doctors have three things in common: they know how to observe, they know how to listen and they’re very tired”

 – Shantaram

Thrifty Gene Hypothesis and Diabetes

proposed by geneticist James V. Neel

hypothesized genes (thrifty genes) that predispose an individual to developing type II diabetes

Thrifty genes are those that enable our human ancestors to efficiently collect, process and store food as fat during periods of food abundance to aid with survival through times of famine.

Hypothesized that the thrifty gene predispose an individual to obesity (with continual food storage as fat) and the development of type II diabetes in constant times of nutritional abundance.

Gastrointestinal intubation

 

 

  • insertion of a tube into the stomach, duodenum or intestine
  • insertion through mouth or nose or abdominal wall
  • NG tubes are short, nasoenteric tubes are longer

 

GI intubation Etiology

  1. to decompress the stomach, removing gas and fluid
  2. gastric lavage for toxin removal
  3. diagnostic of GI motility disorders
  4. Medication and nutrition administration
  5. Obstruction treatment
  6. bleeding site compression (esophageal varices)
  7. gastric aspirate analysis

 

High Aspiration Risk Patients

  • decreased LOC
  • confused mental state
  • poor of absent cough and gag reflexes
  • agitation during insertion

 

Assessment

  • ensure tube is plugged b/t feedings
  • ensure correct placement – X-ray
  • tube length measurement
  • visual aspirate measurement
  • pH aspirate test

Arthritis

  inflammation of joints due to infectious, metabolic, or autoimmune causes resulting in  pain, stiffness and limitation of motion of the affected joint.

Pathophysiology

  • affects synovial joints
  • characterized by inflammation and degeneration of the joint
  • antigen complexes adhere to joint surfaces
  • phagocytosis of the immune complexes result in tisue estruction
  • phagocytosis produces leukotrienes and prostaglandins which determine the level of inflammation
  • prostaglandins produce collagenase degrading collagen in the joints

 

Menchanical stress

  • repetitive impact loading results in cartilage destruction
  • walking transimts 3-4 times the body weight to the knee
  • repeated mechanical stress decreases elastiticity of ligaments and articular cartilage
  • the joints shock absorbancy declines
  • thining of subchrondral bone results
  • joint stability overall decreases
  • osteophytes form
  • synovial capsule and membrane thicken
  • joint cartilage atrophies

 

Joint lubrication:

  • declines as mechanisms that normally operate under high weight loads to produce joint lubricating film decline.

 

Immobilization of a joint

  • may result in joint degeneration
  • cartilage degeneration may result from loss of lubrication flow within the joint capsule with lack of mechanical movement.

 

Clinical Manifestation

  • pain
  • joint swelling
  • limited movement
  • stiffness
  • weakness
  • fatigue

 

Assessment

  • Hx of symptom evolution and onset
  • previous tx and effectiveness
  • fx assessment
  1. gait
  2. posture
  3. musculoskeletal size and structure
  4. gross deformities and abnormalities noted
  5. symmetry, size and contour of other connective tissues
  6. reported abilities vs observable functioning

 

Dx:

  1. ESR – erythrocyte sedimentation rate – indicative of degree of inflammation
  2. arthrocentesis – relieve pressure and analysis for infection (rule out infectious arthritis or tx gout)
  3. X-ray – joint changes
  4. Arthrography – detect connective tissue disorder
  5. Bone and Joint scan – indicative of bone density in affected region and joint degeneration
  6. Tissue biopsies – myositis, vascular changes
  7. blood test – auto-Abs

 

Geri:

  • individual may expect limitations with aging as normal
  • OA increases in prevalence with aging
  • pharmacologic intervention SE intensifies in the elderly

 

Management

  • involves multidisciplinary team

 

Pharmacologic intervention

  • symptom management and anti-inflammatories
  1. Salicylates
  2. NSAIDs
  3. antirheumatics
  4. pain management
  5. sleep aids – promote adequate and normal sleep pattern

 

Additional management

  1. heat and cold packs
  2. protective splinting
  3. supportive devices
  4. maintain low impact regular ROM excercise

Simply

The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention…. A loving silence often has far more power to heal and to connect than the most well-intentioned words. ”

— Rachel Naomi Remen