Health Topics
What is a stroke?
A stroke occurs when the carotid arteries (one on each side of the neck), which carry blood to the brain, become narrowed significantly or blocked thus decreasing the blood flow to the brain for a prolonged period of time resulting in brain damage.
What is a "mini" stroke?
A "mini" stroke is also known as a TIA (transient ischemic attack).
As with a stroke, there may be a decrease in blood flow to the brain;
however, it is brief resulting in a temporary stroke which resolves
usually within twenty-four hours.
Who is at risk?
Aging causes "hardening" of the arteries (atherosclerosis) which
leads to a gradual narrowing, and thus decrease in blood flow to the brain.
Occasionally, a tiny piece of plaque (atherosclerosis) can break
away within the artery and block smaller arteries upstream in the brain
or the eye leading to a TIA or fleeting blindness respectively.
Approximately thirty percent (30%) of those who experience a TIA
will develop a full stroke. High blood pressure and cigarette smoking
also places one in a higher risk category as it leads to hemorrhage in
the brain and accelerates the athersclerotic process.
What symptoms may I experience?
People who sustain a stroke or TIA may experience one-sided weakness, partial or complete paralysis, slurred speech and/or transient one-eyed blindness. Other symptoms can include lightheadedness, fainting, difficulty walking and/or brief memory loss.
What tests help to diagnose carotid artery narrowing?
Following a comprehensive examination by your family physician
or vascular surgeon, they will arrange for an ultrasound (U/S)
of your carotid arteries. The U/S is a painless, risk-free test
which provides a preliminary picture of these arteries. It may be done in
the office or outpatient hospital. Following interpretation of
the U/S by your vascular surgeon, further tests may be required.
Who needs surgery?
Once all the tests have been performed, your vascular surgeon
will discuss the extent of narrowing/blockage and the associated risks
of future stroke. For those with significant narrowing (greater than 70%)
and/or associated symptoms, surgery may be indicated. The surgical
procedure is known as carotid endarterectomy.
It involves the cleaning out of the narrowed portion of the artery.
A two day hospital stay is usually all that is required.
How can I reduce my risk?
Avoid a high cholesterol and high fat diet. Limit your salt intake. Take your medications as prescribed. Stop smoking. If you have experienced any of the symptoms discussed in this article, a prompt examination is warranted.
Hemorrhoids affect most of us at one time or another. Although common, it is not a problem that enjoys great discussion. Here are a few insights as to how to best deal with that painful, gnawing itch of a hemorrhoid flare.
What is a hemorrhoid?
Hemorrhoids are a series of "veins" found in the anal canal. These veins are present from birth and normally may act as cushions during regular elimination. These veins become troublesome when they bleed, clot (thrombose), enlarge, and become inflamed.
How do I know that I have hemorrhoids?
In the most simple but aggravating situation the first symptom may be rectal itching. Others may experience a "tearing" sensation with a constipated bowel movement. This is not a hemorrhoid but an associated condition. Either of these may readily resolve with a little time, cleanliness, and care. Bright red blood in the toilet is one symptom of great worry to an individual. Another demanding symptom is severe pain. Both of these symptoms are to be respected and should illicit a call to your physician. As anyone who has been pregnant can tell you, hemorrhoids are often synonymous with pregnancy, especially in the third trimester.
What causes hemorrhoids?
Though rarely symptomatic before the fourth decade of life (with the exception of pregnancy), it is believed that it is a combination of factors that lead to their becoming problematic. Straining upon defecation is the first to be mentioned. The other contributing factors may be more anatomic in nature, such as "sliding hemorrhoid", that is, loosening of the bands that typically hold veins in the anal canal. Increased anal canal pressure and weakness of the vessel wall itself may also contribute to the protrusion of hemorrhoids out the anal canal.
Is there anything to help prevent or relieve hemorrhoidal attack?
Diet is the number one highly contributing factor. Your diet should always contain a high degree of fiber from the unprocessed bran, fruits with skins, vegetables (both raw and cooked) and legumes. An increase in your daily water/liquids intake is also helpful, preferably six glasses a day. A psyllium product (such as Citrucel or Metamucil) may be used (be sure to follow the directions on the package). For those who love to read of the worlds events in the privacy of their bathroom, it is recommended that you do not do so sitting down. This is the habit that contributes to the downward pressure on these veins. If you have already developed hemorrhoids, alas, you read this article too late.
You may find relief with sitz baths, ice packs, or topical ointments. For soothing relief add a few tablespoons of Epsom salts to three to four inches of warm (not hot) bath water. Sit in this bath water for brief periods of temporary relief. To reduce discomfort of a thrombosed hemorrhoid (clotted vein), you may apply an ice pack for only a brief few minutes and rest. This is a common condition, however, until your appointment this may provide a little relief. Last but not least, topical agents, found in your local pharmacy, may provide some relief. If you continue to experience discomfort after this application you should check with your physician.
When should you see a surgeon?
Bleeding, painful, or swollen hemorrhoids not quickly relieved by over-the-counter treatments, or recurrence, are indications that you should see a surgeon. The diagnosis of hemorrhoids is fairly simple and begins with visual inspection. The examination may proceed with rectal examination to determine the extent of the hemorrhoids and to rule out other more serious problems. The exam will take place in the surgeon's office.
What types of treatment are available?
Thrombosed hemorrhoids, those where a clot has stretched the skin, are acutely painful and will need to be immediately relieved surgically. This will take place in the surgeon's office with local anesthetic and a small incision to remove the clot (enucleation). Internal and/or external hemorrhoids may be treated surgically, usually on an outpatient basis. A hemorrhoidectomy is the surgical removal of swollen veins. Your healing time following this may be from five weeks to two months, but you may return to work before this. Banding is another procedure but reserved for internal hemorrhoids only. Laser treatment is also available at the discernment of the surgeon. All of these surgical interventions are reserved for the treatment of hemorrhoids that are unresponsive to other means of relief. Your surgeon will be glad to discuss the options most appropriate for you.
WHAT IS CIRCULATION?
The active flow of blood from the heart to the body and back to the heart is called circulation. Blood vessels are responsible for carrying blood throughout the body. Arteries are those vessels that deliver blood to the body (away from the heart). Veins are the vessels that return blood to the heart.
HOW DO VEINS FUNCTION?
Veins have cup-like flaps within the walls called valves. These valves are equally spaced throughout the veins and open upward to allow blood to move up the vein. The valves open when muscle contracts (thus squeezing the blood upward) and close when muscle relaxes, keeping blood from falling back down the vein.
HOW DOES CIRCULATION BECOME IMPAIRED?
When a vein becomes damaged, blood flow back to the heart is diminished. Weak or injured valves are not able to support the blood when muscle relaxes, thus resulting in a pooling of blood within the vein. This leads to increased pressure on the valves, which further distends the vein wall causing more separation of the valve leaflets and thus increased blood pooling (vicious circle). This results in the condition known as varicose veins.
WHAT ARE VARICOSE VEINS?
Varicose veins are damaged veins in which blood flows in both directions resulting in increased pooling (venous distention), causing veins to bulge and/or twist like a rope. The tiny superficial reddish or purple bursts seen at the ankles, knees, and thighs are known as spider veins (telangiectasias).
WHO IS AT RISK?
Venous disease can affect men and women of all ages. Certain health conditions and lifestyle habits increase the chances of developing a problem. Heredity, surgery, injury, and pregnancy are risk factors that may not be under direct control. Other factors, however, may be controlled such as being overweight, not exercising, and prolonged standing.
WHAT SIGNS AND SYMPTOMS MAY I EXPERIENCE?
Varicose veins are often hereditary and inevitably become larger and more numerous over time (especially with pregnancy). As a result, symptoms may progress to swelling (edema) of the legs and ankles, causing heavy, tired, aching legs. They may also cause localized tenderness, burning, itching and pressure-like sensation to the area of the varicosity. In addition, you may experience increased warmth, redness, (erythema), and pain as a precursor to formation of a blood clot (superficial phlebitis). Chronically untreated varicose veins associated with recurrent bouts of phlebitis may lead to irreversible leg discoloration, swelling, and ulcer formation.
WHAT CAN I DO?
You can usually decrease the burden on your veins and reduce your symptoms by increasing exercise and by losing any excess weight. The association of leg swelling and prolonged standing may be alleviated by elevating as frequently as possible and by wearing prescribed graduated compression stockings. Exercise itself without adequate stocking support will aggravate the condition. Prescription stockings should be worn during the second and third trimester of pregnancy if the condition is pre-existing.
WHAT TREATMENTS ARE AVAILABLE?
Two procedures can be used to treat superficial varicose veins - sclerotherapy and surgery. Sclerotherapy (chemical injection) is very effective for the treatment of spider veins. Larger veins can also be successfully treated with sclerotherapy, either alone or in combination with surgery. A vascular surgeon with an interest and training in venous diseases performs both sclerotherapy and surgery.
WHAT CAN I EXPECT?
To obtain an accurate diagnosis and treatment for a possible venous disorder you should undergo a complete vascular examination. Upon evaluation by a vascular surgeon, he will describe your exact venous condition. Depending on the extent of your venous disease the surgeon will recommend supportive treatment, sclerotherapy, surgery, or a combination of these.
If sclerotherapy alone is recommended you can expect to undergo injection of a medicine directly into the varicosity. The medicine helps to close the damaged veins. The blood is then directed to other nearby healthy veins. The doctor will perform the injections and advise you with post injection instructions. Following the procedure you may drive yourself home.
Should surgery be recommended it might be one of several types, ranging from minimally invasive, which limits scarring, to complete vein stripping. Rarely is the latter necessary. All of these surgeries are performed on an outpatient hospital basis. Usually recovery time is several days (depending on the surgery required). For some conditions your surgeon will recommend a combination of surgery and sclerotherapy. In this situation surgical intervention will be carried out first, followed by sclerotherapy at a later time. This treatment modality speeds recovery time (return to normal activity in 24-hours) and minimizes scarring.
The results of sclerotherapy will occur in anywhere from two to twelve weeks. The vessels, after being closed off, will gradually fade away. Some bruising may initially occur but shall clear. The degree to which your particular veins "fade" depend on such factors as size, chronicity, sclerosing agent, and the individuals' own healing ability. Upon completion of the sclerotherapy course you should not experience any further discomfort from the once varicosed veins.
When surgery is the course of treatment you should expect immediate results. The degree of bruising following surgery is proportionate to the extent of surgery. Postoperative discomfort is readily controlled with medication and usually lasts a couple of days following surgery.
Men and women of all ages can have hernias. Commonly called a "rupture", a hernia is a weakness or tear in the wall of the abdomen. There are two causes which best explain hernias. Acquired hernias are the result of wear and tear over years. Congenital hernias result from a weakness in the abdominal wall that is present from birth. Both types of hernias may enlarge or get worse with time or physical stress.
It is usually easy to recognize a hernia. Often there is a painful bulge under the skin that becomes symptomatic when lifting heavy objects, coughing, or straining during urination or bowel movements. This pain is described as sharp and immediate. Other people may describe the pain as more of a dull ache or burning discomfort that gets worse toward the end of the day or after standing for long periods of time. Hernias can occur at the navel, in the groin, or along a previous abdominal incision.
A hernia develops when the abdominal wall weakens, often to the point of tearing. A loop of intestine (or fatty tissue) pushes against the inner lining of the abdomen and a hernia sac forms. Most hernias bulge and cause pain as the intestine pushes into this sac.
If you think you have a hernia, see your physician for an evaluation that will include obtaining a medical history and physical examination. With accurate diagnosis surgical repair should be performed before the hernia enlarges or complications arise. If the hernia bulge flattens out when you lie down or push (with gentle pressure) against it, it is termed a reducible hernia. Although not of immediate danger, this hernia should be surgically repaired. Should the intestine become trapped or incarcerated and the hernia bulge cannot be flattened it is termed a non-reducible hernia. This is often a painful condition and prompt surgical repair is required. An uncommon, but nevertheless dangerous, complication may arise when the intestine is tightly trapped in the hernia sac. This strangulated intestine eventually loses blood supply and dies. Strangulated intestine can block digestion and cause severe pain. Emergency operation is required to relieve the blockage and repair the hernia.
Advances in technology have led to various successful methods in the treatment of hernias. Laparoscopic surgery can decrease operative time although it is typically more expensive than the standard repair. Furthermore, not all hernias can be repaired using laparoscopic techniques. The Kugel Hernia Patch repair, on the other hand, is quick, decreases postoperative disability as well as maintaining a low risk of hernia recurrence. The Kugel Hernia Patch, designed by Dr. Robert D. Kugel, is a patented design, which reduces recurrence rate by covering the entire inguinal floor. The Kugel repair is a minimally invasive procedure that combines the best features of the open hernia repair and the Laparoscopic hernia repair. The Kugel procedure is a tension free near "suture-less" repair. Post operatively, patients are released to "common sense" activities. Best of all, the repair is performed quickly through a single small incision, usually under local or regional anesthesia.
A careful evaluation by a qualified surgeon is necessary prior to all surgical repairs. Non-surgical treatment is only a temporary solution. Hernias should be repaired before complications arise. Because hernia repair is safe and effective, I recommend prompt surgical treatment. A hernia need not keep you from doing your work or enjoying your life.