Eastside Family Health Center

Tuesday, May 10, 2011

Carpal Tunnel Syndrome

What is carpal tunnel syndrome? Carpal tunnel syndrome (CTS) refers to the pain, numbness, and sometimes, but less commonly weakness which is caused by the compression of the median nerve as it travels through the wrist. Carpal tunnel syndrome is one of the most common causes of hand numbness seen.

What are the symptoms? The classic symptoms include numbness and tingling limited to the median nerve innervated fingers (or fingers that contain nerves that are supplied stimulation through the median nerve), but there is wide variability. The pain and numbness may be localized to the wrist or involve the entire hand. It is also not uncommon for the symptoms to radiate into the forearm, and as well, less frequently to radiate above the elbow to the shoulder. So, the hand symptoms described could be carpal tunnel or radiating pain from the neck.

These symptoms are often provoked by activities that involve extending the wrist, such as raising the arm while driving, reading, writing, typing, or holding a phone.

It is good to know that CTS often presents bilaterally (in both hands), up to 65% of the time.

Carpal tunnel may follow an alternating pattern with periods of remission and exacerbation. In some cases, there is progression from intermittent to persistent that may even advance to motor loss (strength). In the most severe cases, motor loss involves difficulty holding onto objects, turning keys or doorknobs, or buttoning clothes. One may even see atrophy.

How is it diagnosed? The diagnosis is a clinical one determined by a physician based on some testing and symptoms. The most important clue is nighttime pain or numbness. Standard symptoms include: dull, aching discomfort of the hand, forearm, or upper arm; numbness in the hand, weakness or clumsiness of the hand, any symptom in median distribution.

Some provoking factors include symptoms occurring in the sleep and repetitive actions of the hand. A test called an EMG which is a series of electrodiagnostic studies are needed to make the diagnosis. The EMG results in combination with the physical exam and the clinical history all lead to the diagnosis.

Who is at risk? Risk factors for CTS: obesity, female gender, pregnancy, diabetes, rheumatoid arthritis, diabetes, hypothyroidism, connective tissue disease( ex: lupus), pre-existing CTS, genetic predisposition, use of HIV meds, or workplace factors such as cold temperatures, vibrating tools, or repetitive hand use. As an interesting note, most studies do not support the association between computer usage and developing carpal tunnel.

What is the treatment? Treatment includes splinting, stretches, physical therapy, yoga, injections into the carpal tunnel and finally surgery. For sure there are many treatment options, the success of which usually depends on the severity of the compression. Ask your doctor to discuss the risk and benefits of each. Not all carpal tunnel needs necessarily end in surgery! As well, there are potentially other causes of it other than just overuse.

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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Monday, May 9, 2011

Colon Polyps

Colon cancer is one of the leading causes of death for both men and women. For the most part, death is avoidable with by using the very good screening tool we have called the colonoscopy. The colonoscopy is a procedure where a probe is inserted into the colon (commonly known as the large bowel) which allows the physician to view inside the colon for abnormalities as well as take samples of these to determine what the nature of these abnormalities are. This blog is about an announcing growth that needs investigation referred to as a precursor growth in the colon called the polyp.

Normal Colon Colon polyps

There are all different types of colon polyps, some pre-cancerous and some not. The most common polyps seen are called non-neoplastic polyps which include those called hyperplastic. Even though hyperplastic polyps are benign (or noncancerous), consideration must be given to their appearance, such as some (serrated forms) may have the potential for cancer. As well, there are some hyperplastic polyps which occur in large numbers together; a syndrome called Hyperplastic polyposis syndrome. This syndrome requires more intense screening due to increased risk of cancer development.

There are other polyps associated with other conditions such as Crohn’s disease or inflammatory bowel disease (IBS) which are both other diseases of the bowels. These types of polyps typically occur in multiples and need to followed closely by a physician.

Another important category of colon polyps are adenomatous polyps. These are by definition pre-cancerous. Nearly all colorectal cancers arise from adenomas, but only a small minority of adenomas actually progress to cancer( about 5 %). Risk factors for getting this type of polyp include older age( starts at age 50), obesity, and being a man. Adenomas can go through a process from low grade to high grade to cancer, or can present as high grade. You just don’t know where it is without looking under the microscope!

Adenomas have different shapes. Tubular adenomas account for about 80% of colon adenomas. Another type of adenoma is called villous adenoma. These polyps grow at variable rates, thus, when to repeat colonoscopy is based on size of the polyp. Adenomatous polyps bigger than 1 cm are a risk factor for containing cancer. If the adenomatous polyp is has a villous pathology( fingerlike under the microscope), the risk one whether one will develop cancer is also based on size( more than 1 cm, risk is up to 30% for that polyp to develop cancer).

So, it is very important to get screened for colon cancer. How often and when to begin depend on multiple factors including family history. This is a good topic to discuss with your doctor. There are some factors to prevent colorectal adenomatous polyps have been studied: diet—low in fat, high in fruits and vegetables as well as fiber. Maintaining normal body weight, regular exercise, dietary calcium intake, and avoidance of tobacco and excessive alcohol intake, especially beer are recommended.

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Tuesday, May 3, 2011

Melatonin for Sleep

Melatonin is a hormone made by the pineal gland in the brain that controls the sleep/wake cycles. Our body has an internal clock that dependent on the time of day will control how much melatonin is produced. As insomnia can be a common symptom among patients, one of the recommended treatments for the often requested “natural” alternative is the dietary supplement melatonin.

Studies suggest that melatonin supplements may help people with disrupted circadian rhythms (such as people with jet lag or those who work the night shift) and those with low melatonin levels (such as some seniors and people with schizophrenia) to sleep better. Melatonin supplement doses can range from 0.3 mg to 80mg.

Melatonin is a dietary supplement and therefore it is not federally regulated. Thus the dose listed on the bottle may not be congruent to the dose contained inside. The timing of the dose can also be tricky as some sources recommend taking Melatonin up to 30 minutes before sleep while others suggest increasing the time by 30 minutes to as much as 6 hours to have an optimal effect on shifting the internal biological clock.

Melatonin has been found to be more effective on people that have already natural low levels of melatonin such as the elderly. Thus it is recommended that it be taken in the day time when low internal levels of melatonin already exist. It has also been found that the best method for delivery of melatonin is sub-lingual (under the tongue) or trans-dermal (through skin usually creams or patch) for better absorption.

All in all, the effectiveness of melatonin in treating insomnia is questionable and very individual. It is good to be aware that beta blockers and anti-depressants can suppress or reduce melatonin levels and thus may impact the effectiveness of the supplement as well. If insomnia becomes a chronic issue, it is recommended that you see your primary care provider for evaluation and treatment.

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