Category: Health Information

Buyer Beware: Did You Know Bad Doctors Can Skip From State to State and Keep Practicing Even If Their License Has Been Restricted in Another State?

Research your doctors carefully.  Several years ago I refused care from a surgeon (at a military clinic) who had a similar story to this doctor – malpractice suits and complaints in several states, and medical board action in at least one state, but licensed to practice in his current state.

When I expressed alarm about his long history of dissatisfied/disabled patients, other physicians at the military clinic told me that was in the past (IOW, they knew about it, but did not care.)

What tripped my alarms about that surgeon? He refused to stop hurting me during a pre-surgery exam, even though I specifically and loudly said “STOP! You’re hurting me!”

He also told me that if my surgical site developed internal scar tissue, it was his practice to anesthetize patients and then yank violently on the limb to tear apart the scar tissue in the joint.  In response to which, I thought”YOU ADMIT THAT???  No, thank you!  Brute force and ignorance is NOT my preferred approach!”

BOTTOM LINE: If I can’t trust my doctor or surgical team when I’m awake and able to advocate for myself, there is NO WAY I would trust them when I’m unconscious. Trust your instincts, and do your homework. You’re the one who lives (or dies) with the consequences.

NOTE: For information on avoidance of internal scar tissue and standard practices for internal scar tissue removal see this article,  this article, or this DIY video/article [I am not endorsing this product].

You will note in the second article that “manipulation under anesthesia” is a valid technique for dealing with internal scar tissue, but only AFTER gentler, non-invasive techniques have been exhausted.

 

How to Read an X-ray (or at least understand what the doctor is saying about it)

Prior to this most recent surgery, the ortho said something I didn’t quite understand during my last appointment.  He looked at the new x-rays and said that the surgical screw in my wrist was loose, and that the lucent areas on the x-rays were an indication of that.  I didn’t really know what that meant, so I went searching on the internet, and I found this webpage that explains how to read an x-ray.

Your doctor might not actually show you your x-rays (mine always does), but, if you read the webpage, you should have a better understanding of what your doctor is telling you about your x-rays.

This part explains the basics pretty well, I think:

“The first principle behind knowing how to read an x-ray is knowing how different parts of the body will absorb an x-ray. This absorption falls into three basic categories and they are:

  • Bone – appears light grey or white because it absorbs a high percentage of the x-ray (metal is pure white)
  • Tissue – appears a greyish color because it absorbs some but not a majority of the x-ray (water or fat, for example)
  • Air – appears black because it absorbs a very low percentage of the x-ray (gas, for example)” – https://www.npinstitute.com/how-to-read-x-rays-s/1860.htm 

Unfortunately, this webpage doesn’t talk about lucency.  However, this other webpage explains that “the term ‘lucency’ is a technical term for an area that lets X-rays through the tissue and as a result appears darker on the picture.”  In other words, “lucency” is doctor speak for x-rays being able to pass through a part of your body, thus appearing black.  So, in radiology terminology, “lucent” means dark, not light, which is why I was initially confused.

My understanding is this:  Rather than a white area (bone) around the screw, showing that the screw was tight in the bone, my ortho was seeing dark areas (air) around the screw, showing that the screw was NOT tight in the bone, i.e., the screw was loose.

Does this clear up x-rays for you too, or do you still have questions?

 

Shoulder Surgery: The Good, The Bad, and The Ugly

To repair some of the damage done when I wiped out on that wet tile floor, I’ve had two shoulder surgeries – performed by two different surgeons.

The first surgery was to repair my severed labrum.  This injury is more commonly known as a SLAP tear.  SLAP is an acronym for Superior Labrum Anterior and Posterior.  The labrum is a ring of cartilage that surrounds the socket of the shoulder joint.  It helps to deepen the shoulder socket and to stabilize the shoulder, and is the attachment point for many of the shoulder’s ligaments and one of the biceps tendons.

Torn labrums are ridiculously painful.  Before I was successful in convincing  my PCM that I needed a shoulder MRI, I was taking strong drugs and begging for a referral to pain management.

My first shoulder surgery was also my first ever surgery – if you don’t count having my wisdom teeth out years ago.  It was pretty straightforward.  My labrum was severed; the surgeon went in and reattached it.  He used a couple of plastic anchor bolts and some sutures to reattach the labrum.  He cut away a little dead tissue, and made sure there was no other damage that had not been detected by the MRI/arthrogram.

Prior to the surgery, I had been in a ridiculous amount of pain.  I was able to sleep in one position on the couch – lying on my non-injured side, with my back against the back of the couch, and surrounded by 5-6 pillows that held my shoulder in the one position in which the pain mostly subsided and I could fall asleep.  Of course, anytime I moved in my sleep and the shoulder shifted, the pain woke me up.

Post-surgery was worse.  I didn’t get the memo that the best way to recover from shoulder surgery is to sleep in a recliner.  We did not *have* a recliner.  Had I known, I would have begged, borrowed, or bought a recliner.

Seriously, if you’re going to have shoulder surgery, make sure you can convalesce in a recliner – or an adjustable bed.

I came home from out-patient shoulder surgery narc’d to the gills (technical term) ;-).  Typically, for shoulder surgeries the anesthesiologist will do a nerve block, which blocks the nerve signals for up to 24 hours.  I was also placed under general anesthesia for the surgery.  And the nurses often will give you a narcotic before you leave post-op, to make sure you “stay ahead” of the pain.

So Spousal Unit got me back into the house and ensconced on the couch.  I got “comfortable” sitting sideways on the couch, with my newly repaired shoulder in a sling that was resting on multiple pillows and leaning against the back of the couch.  I dosed most of the rest of the day, and slept sitting up for the first few nights.  (Not comfortable.  Do not recommend.  You need to be exhausted to do it.]

I had a long and painful recovery.  My labrum hurt significantly LESS after surgery, but it still hurt like hell.  You have to keep your shoulder immobile for a long time to allow the labrum to heal, and that creates other problems, as your shoulder and elbow can get painfully stiff.

Flash forward two years, to shoulder surgery #2:

The shoulder felt “good as new” for about a year and a half.  And then it didn’t.  First the motion felt “off.”  The shoulder started to catch and clunk.  Then the pain started to return.

By this time, we had moved to another state, and I had a different orthopedic surgeon, who had already operated on my wrist and elbow.  After the manual examination and the MRI/arthrogram, he told me he would operate, but he wasn’t going to repair my re-torn labrum.

In fact, he told me that if he had performed my first shoulder surgery, he wouldn’t have repaired my severed labrum.

“Okay, doc, you HAVE my attention.  Please explain to me why you would not have repaired something that was totally severed and causing excruciating pain, because that sounds totally counterintuitive to me.”

We then proceeded to have a long conversation about labral tears.  And age.  In a nutshell, my ortho explained that labral injuries do not heal well in patients over 40.  Based on his experience and knowledge of the literature, he thought it was a waste of time to repair the labrum again.  Instead, he wanted to severe my (perfectly functional and not damaged in any way) biceps tendon from the labrum and reattach it to my humerus in a procedure called a “biceps tenodesis.”

The reason for this is that the biceps tendon is connected to the labrum, and the tension it exerts on the labrum can prevent the tear from healing and can actually make the tear worse.  By removing this tension, you create the possibility that the labrum might heal itself.  But even if it doesn’t heal, because you removed the stress on the labrum, hopefully the tear won’t continue to get larger.

My surgeon recommended I read a couple medical journal articles on the subject (because he knows I always thoroughly research my medical issues and the procedures doctors recommend to treat them), and then we would meet again to discuss the surgical options.

Here are some of the articles I read to inform my decision about revision [repeat] shoulder surgery:

“Controversy persists about whether to repair SLAP tears in patients over 40 years with associated rotator cuff tears (RTC).”

Torn rotator cuff with SLAP tear

The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs

“The cumulative evidence supports labral debridement or biceps tenotomy over labral repair when an associated rotator cuff injury is present.”

Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions.

Glenohumeral ligaments

Superior labrum anterior posterior (SLAP) tears

Rotator cuff injury

There’s a good quick-and-dirty summary of the research here, which answers the question: “Why would you fix my biceps if my labrum is torn?” It also provides a good explanation of the procedure and has an illustration.

The research supported what my ortho had said.  In fact, in recent studies labral tears were shown not to heal well in patients older than 26.  26!  In addition to the SLAP tear, the arthrogram had shown a small rotator cuff injury, and the research on that injury recommended repairing the rotator cuff, doing a biceps tenodesis, and leaving the torn labrum alone.

Had this been my first experience with this surgeon, my decision might have been more difficult.  But, based on the research, and based on my previous (all excellent) experiences with this surgeon , I decided to trust him to fix my SLAP tear by ignoring the labrum and jiggering with my biceps tendon.

I felt really uncomfortable letting him cut something that wasn’t broken to begin with.  In the end, you do your research, make the best decision you can, and trust your surgeon (whom you have carefully researched and selected) to do a good job.

Fortunately, when he got inside my shoulder, he found no evidence of rotator cuff damage, so he inspected it thoroughly and left it alone.  Had I needed rotator cuff repair, my recovery would have been much longer.

I was a lot smarter the second time around.  I had a recliner AND an adjustable bed.  Never even needed the recliner – the adjustable bed worked just great!  I was able to raise the head to get enough support for the shoulder, but still be able to sleep.  I still propped up the arm on several pillows, but got much better quality of sleep than the first time around.

But here was the absolute game-changer: a chiller (aka cold therapy).  Now, faithful readers of this blog will know that I seldom endorse any product.  But a post-surgery chiller is something I HIGHLY recommend.

I don’t know how I didn’t know about them before, but these devices circulate ice water over the site of your injury/surgery.  This helps prevent inflammation, and also brings pain relief.  Chillers are particularly useful for joint surgeries (shoulders, knees, ankles, etc.)

I was offered the use of a chiller by some folks at church, because Tricare would not provide one.  [Possibly because my surgery was through a civilian provider.  I have recently seen military facilities loan them to patients post-surgery.]  They come in various sizes.  I was loaned a pretty basic one (see image), but it worked just great.

I understand that the folks I borrowed it from keep an eye open at thrift stores, yard sales, etc., and pick them up pretty cheaply.  Then they have one when they need it, and one or two to loan out.  It certainly made my recovery quicker and much less painful, and I am grateful.

[For the curious: Yes, it’s basically a small ice chest, but it has a pump and hoses that circulate ice water around the injury.  At the end of the hose is a plastic pad (see image) that you wrap around the injured site.  You can secure it with an included velcro flex strap (like an ace bandage).  All you have to do is add ice and water and plug it in.  BE CAREFUL TO AVOID COLD INJURIES.  Don’t ice for more than 20 minutes at a time, remove if it’s uncomfortable, and always place something between the pad and your skin (a hand towel, washcloth, pillow case, etc.).  ]

Why I am in love with cold therapy: After my first shoulder surgery, I was prescribed narcotics – “Take 1-2 pills every 4-6 hours, as needed.”  They wore off after TWO hours, and the pain was overwhelming.  I was living from dose to dose, just trying to hang on.  After my *second* shoulder surgery, I was given the same prescription, but I also used cold therapy.  I took 3 pills TOTAL.  And the second and third were only because the staff had given me multiple warnings about staying ahead of the pain, and I knew from previous experience that I did NOT want the pain to get ahead of ME.  I didn’t think I needed the narcotics, but was afraid to rely on the machine for pain control.  But as I increased the interval between pills, taking them only one at a time, and found that I was able to control the pain with cold therapy, I stopped taking them.  (The other great thing about that is, if you’re not taking narcotics, you don’t get opioid-induced constipation.)

Was the first surgeon wrong?  He repaired the damage, did a pretty good job, and it worked great for about 18 months.  He did no further damage, scarring was almost non-existent, there were no complications, and he didn’t overlook or fail to repair anything else.  My biggest complaints would be that 1) he did a repair that the research clearly shows to have a high failure rate in patients my age.  So I question how current he is in his knowledge of the literature in his field.  And 2) I did not have to suffer as much as I did post-surgery.  I really wish he’d told me about the chiller and the benefits of recovering in a recliner.

Had I seen my second orthopedic surgeon first, I probably would not have needed the second shoulder surgery.

Bottom line: The first orthopedic surgeon was adequate, but probably not as knowledgeable as he should have been.  There is a world of difference between surgeons, even between an *average* surgeon and an *excellent* one.

The Good: Cold Therapy/Chiller.  Adjustable bed/recliner.  An expert surgeon.

The Bad:  Needing revision (repeat) surgery.

The Ugly: The excruciating pain after my first shoulder surgery.  Sleeping sitting up on the couch.  Trying to take a shower after surgery (once cleared by the surgeon).

I did a lot of research before my first shoulder surgery.  I avoided a truly horrible surgeon, and selected one based on research and recommendations.  There was still a lot I didn’t know I didn’t know.  

Stay tuned for blog posts on how to select a specialist, such as a surgeon.  Knowledge is power.

 

Weekly Wrap-Up (28 November-2 December)

In case you missed it (ICYMI), here’s a list of the links that appeared on One Sick Vet’s Facebook page this week:

Monday: New Post!

Health Hack: How to Eat (Mostly) Healthy for Thanksgiving

Tuesday: Urinary Tract Infections (UTIs) and Dementia

“UTIs can cause a significant and distressing change in someone’s behaviour that is commonly referred to as ‘acute confusional state’ or ‘delirium’. Delirium is a change in someone’s mental state and usually develops over one or two days. There are different types of delirium and symptoms may include agitation or restlessness, increased difficulty concentrating, hallucinations or delusions, or becoming unusually sleepy or withdrawn. Symptoms of delirium vary in severity (fluctuate) over the course of the day.

It is important that family and friends who know the person well seek medical help if they see a sudden change in behaviour, to ensure that an assessment takes place.”

https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1777

Wednesday:

I don’t know what the heck happened to Wednesday’s scheduled post.  Gremlins.

Thursday: Airman Reflects on Cancer Battle

“Combs advises other men that knowledge is the best weapon against cancer and not to let the “macho” view of something abnormal going on to deter them from seeking help.”

http://www.af.mil/News/ArticleDisplay/tabid/223/Article/1008949/airman-reflects-on-cancer-battle-gives-back-with-passion-project.aspx

Friday: Liver Damage from Supplements is on the Rise

“A new review suggests that many herbal remedies and dietary supplements can also harm the liver, including some that you can easily buy online or over-the-counter in drug or health food stores.

The study also found that injuries linked to those supplements are rising fast, jumping from just 7 percent of all drug-induced liver injuries in 2004 to about 20 percent in 2014.”

http://www.consumerreports.org/health/liver-damage-from-supplements-is-on-the-rise/?EXTKEY=I175E000&utm_medium=paid_social&utm_source=keywee&utm_campaign=protect_privacy&utm_content=66-ways-to-protect-your-privacy-right-now&utm_keyword=desktop&kwp_0=272572&kwp_4=1054895&kwp_1=495899

What It’s Like to Have an Allergic Reaction Pre-Surgery

It’s been pretty quiet on this blog lately.

Have you heard the saying that flying consists of hours and hours of boredom interrupted by moments of sheer terror?

Well, let me tell you about the time I was waiting for anesthesia prior to surgery, but I developed an allergic reaction and the surgery was cancelled…

[Image of allergic contact dermatitis from Google Images]

So far I’ve had two surgeries, both of which were Tricare referrals to civilian facilities.  This was to be my first surgery at a VA hospital.

The contrast between civilian and VA facilities and experiences was interesting, but I’ll save that for another post.

I will say, though, that the military “hurry up and wait” dynamic is alive and well at this VA facility.  That may have saved my life.

Every stage of the process at the VA hospital felt slow and inefficient.  There was a whole lot of waiting.  And communications could have been better as far as what would happen during each stage of the process.

One thing that was well communicated, however, was the pre-surgery cleansing process.

I was given a nifty hospital gown and robe, a pair of no-slip hospital socks, and some antiseptic body wipes, and was escorted to the bathroom.  Once there, I was directed to follow the cleansing protocol on the wall chart using the antiseptic wipes and I was left to accomplish the task.

There were three packages, each of which contained two wipes.  The wall chart showed a body with six defined zones and directed me to use one wipe for each zone, in a prescribed sequence.  Excluding the head and genitals, I was to start at the neck and wipe my entire body with the antiseptic wipes.  The chart spelled it all out: use the first wipe to clean the neck, shoulders, and chest; use the second wipe to clean the arms and hands; etc.  When I had completed wiping down my body with the antiseptic wipes, I let it air dry as directed.  (The antiseptic was supposed to remain on my body, rather than being rinsed off.)

After having completed the pre-surgery cleansing protocol as directed on the wall chart and donning my nifty gown, robe, and socks, I returned to my hospital bed and waited.  And waited.  I could feel the residue from the wipes on my body – it felt tacky.  I remember commenting that I hadn’t had to do this cleaning procedure for either of my previous surgeries.  We assumed the VA was being ultra-cautious about infections.

Eventually I was taken back to some kind of a surgical staging area.  The nurse anesthetist put in an IV line, and I had pre-surgery conversations with a nurse, the nurse anesthetist, the anesthesiologist, and my surgeon. Again there was more waiting around than I had experienced prior to previous surgeries.

The nurse anesthetist returned and said it was time to remove my robe.  As she assisted me in getting the robe off of my shoulders (while I was propped up in the hospital bed), she exclaimed, “Your back is really red and splotchy!”  This got the attention of the nearest nurse, who came over, looked at my back, and agreed it didn’t look normal.

They asked me questions:  “Do you have a history of eczema?” [No]. “Do you have a history of hives?” [I don’t think so].  “Is it spreading?”  I could feel that my face and neck were getting more and more flushed.  I could tell when the hives spread up my neck, although I couldn’t see them.

They started looking at the rest of my body, asking questions while they looked under my gown and folded back my blanket:  “Is it on your chest?” [Yes].  “Is it on your abdomen?” [Yes].  “Is it on your arms?” [A bit].  “Is it on your legs?” [Not yet].

Once they determined that I was probably having an allergic reaction, they started asking lots of questions: “Does it itch?” [No]. “Does your tongue feel swollen?” [No].  “Stick out your tongue and let me look at it.”  “Are you having any trouble breathing?” [No].  Other medical staff came and went, looking at the situation and asking questions.

At some point the nurse anesthetist went and got Benadryl (an antihistamine) and started administering it through my IV.  Then they started trying to determine the cause of my allergic reaction.

It was pretty clear to me that it must be the antiseptic wipes.  But the pre-surgery cleansing protocol had apparently been instituted fairly recently, and not many people in the pre-surgery staging area seemed to know about it.  I explained it to person after person.

Finally one or two people who were aware of the new cleansing protocol got involved.  A consensus was reached that I was having an allergic reaction, as evidenced by allergic contact dermatitis and hives (urticaria), and that it was caused by the antiseptic wipes.

A decision was made to delay my surgery while they monitored my condition.  The nurse anesthetist was prepared to administer steroids if necessary.  The patient who was scheduled after me was moved up to my surgical time slot.  I started to feel light-headed and buzzed from the Benadryl.  A nurse told me that my blood pressure was “slightly high.”  When I asked her “How slightly?”, she responded “185/99.”

I was informed that the hospital was tracking adverse patient reactions to the new protocol.  Someone sent for the Chief Surgeon, who came and looked at me, asked me a few questions, proclaimed that I was manifesting a classic dermatologic allergic reaction, and told me he was sorry I was having this negative reaction and that it would be logged.

I was also informed that this allergy would be added immediately to my VA medical records.  The substance to which I reacted is Chlorhexidine.  In the wipes, it was a 2% Chlorhexidine Gluconate solution.  I was told that Chlorhexidine reactions were rare, but could be severe.

The anesthesiologist suggested that I have a shower to wash off the antiseptic.  No one responded to his suggestion, although a nurse went and got a wet wash cloth and proceeded to wipe down my back and part of my neck.

The rash/dermatitis/hives seemed to stop spreading in response to the Benadryl.  My blood pressure also started coming down.  My surgeon, who had been monitoring my situation, returned and informed me that he had decided to cancel my surgery and re-schedule it for another day.

Initially I was disappointed by this decision, since I wanted to get the condition I needed surgery for dealt with, and because I would have to go through the surgical preparation logistics all over again.

But after I got home and started feeling better, I researched Chlorhexidine reactions and found multiple medical journal articles describing patients with Chlorhexidine reactions having anaphylactic reactions* under anesthesia, either in pre-op or during surgery.  Then I was very grateful for my surgeon’s caution.

(And for the inefficiency of the hospital staff.  Had my surgery started on time, I might have been under anesthesia when my allergic reaction manifested.)

Additionally, I was warned that my symptoms could return (presumably after the Benadryl wore off).  It would not have been good for my symptoms to get worse or to return while I was under anesthesia.

After monitoring, and the return of my blood pressure to an acceptable level, I was permitted to go home, with the caution to continue to monitor my symptoms and to get help if the symptoms returned/got worse and I started to have trouble breathing.

[I insisted on a shower before leaving the hospital, to remove the offending substance from my skin, however no shower was available, so I was given wash cloths and towels, and escorted to a bathroom to clean up in the sink.  I washed myself as best as I could, and took a complete shower after I got home.]

I did have symptoms again at home the next day, which I treated with an OTC antihistamine and an NSAID.  Had my symptoms gotten worse, I would have called 911 or driven to the emergency room.

I am still waiting to re-schedule the surgery…

BOTTOM LINE: The VA has a new (as of April 2016) pre-surgery cleansing procedure which consists of using 2% Chlorhexidine Gluconate body wipes.  Some people, like me, are allergic to Chlorhexidine.  Chlorhexidine is also used in hospitals in catheters, antimicrobial skin dressings, and antimicrobial surgical mesh, among other things.  It is also used sometimes to sterilize medical equipment.  If you are allergic to Chlorhexidine, be VERY, VERY cautious in a medical setting and make sure all of your healthcare providers know.

Chlorhexidine is also used in dentistry, in certain mouthwashes and rinses and in certain dental procedures, so be cautious there as well.

WARNING:  If you are allergic to Chlorhexidine, you should be aware that it is an ingredient in many products besides pre-surgery antiseptics.  Please see this website for other products (including everyday household products) which may contain Chlorhexidine.

NOTE: Prior to this incident, I was aware that my skin was sensitive to some laundry detergents (they make my skin itch) but I had never had an allergic reaction, nor had I been diagnosed with any allergies.  I had no idea I would have an allergic reaction to the antiseptic wipes.

*NOTE: An anaphylactic reaction/response is a severe allergic reaction.  The most dangerous anaphylactic reaction is one in which the airway is compromised due to swelling of the mouth, tongue, throat, and/or lungs.  For more information on anaphylaxis, see this Mayo Clinic website.

Where Do You Get Your Health Information?

Previously, I spoke about becoming a critical consumer of health information. Today I read an article at U.S. News that adds another element to the discussion – the element of celebrity health advice.

As the article points out, most celebrities are not medically trained, nor are they experts in health science.  Neither are we.  So we often listen to celebrities because we are familiar with them, and they’re good at getting their message across.

Sometimes, we don’t even know where the health information we’re hearing originated from.  A friend tells us.  Then we hear it from our mail carrier, barista, or barber.  If we hear the same health advice from many acquaintances, we start to believe it.  But that doesn’t mean it’s true (or scientifically proven).

I am beginning to read more frequently the argument that scientists and health experts are not as good at getting their health information out to the public as celebrities and other sources are.  I tend to agree that they could be much better at this.

In the Information Age, the traditional academic and scientific methods of distributing information are too slow and too narrowly distributed.  If they do not improve, they will be seen more and more as irrelevant, and the public will get their information elsewhere (as we are already seeing).

Please read this article about celebrity health advice, and why we tend to believe it even though we probably shouldn’t.  Hopefully it will make you more aware of where your health advice comes from, and it will encourage you to get your health information from expert sources such as the NIH, the CDC, the Mayo Clinic, Johns Hopkins, or other academic and scientific sources.

After all, if you get health information from academic and scientific sources, controlled experiments have already been safely conducted on other people.  If you follow health advice from unproven sources, you’re conducting uncontrolled experiments on yourself.

Here’s to your health,

Crew Dog

Indoor Air Quality – How I Made the Air I Breathe Healthier By Using NASA Research

Some of you may be wondering why I said in my first post that I’d rather have house plants than an air purifier.  I chose house plants because they do not use any energy other than sunlight, and because my research did not convince me that air purifiers were significantly better than houseplants.  Thus, I preferred the cheaper, more natural option.

What I said in the previous post:

To me, [naturopathic self-healing] means utilizing evidence-based natural solutions when possible, such as using house plants to improve the quality of the air in my house, rather than buying an air purifier.

The Spousal Unit and I had talked for years about getting an air purifier.  We thought that putting an air purifier in the bedroom would help us get better sleep.  I had read blogs and websites written by asthmatics and allergy sufferers who highly recommended air purifiers with HEPA filters, and they were pretty persuasive.  The only thing holding me back was the price – $500+ for a one-room HEPA filter air purifier.

“Maybe I could start with something less expensive,” I thought.  “What about those Himalayan salt lamps?”  According to the advertisements, a Himalayan salt lamp “works as an air purifier by emitting negative ions into the air.”  And they retail for $25-$30 for a smaller lamp.  So I did some research.  Unfortunately, I found that Himalayan salt lamps do not emit negative ions in a large enough quantity to have an actual effect on your indoor environment.  For a thorough examination of Himalayan salt lamps, I recommend this post over at A Breath of Reason blog.  Bottom line: they don’t improve air quality.

Ok, what about beeswax candles?  They are also touted as being good for air quality because they release negative ions.  Nope, Skepticcystic over at A Breath of Reason debunked beeswax candles too.  (See this post.)  According to her research, not only do beeswax candles not release stable negative ions, but there is no scientific evidence that beeswax is healthier to burn than other types of wax.  So, although some would argue that you should avoid the phthalates in artificially scented candles, the type of wax  a candle is made of doesn’t appear to make a difference to indoor air quality.  Bottom line: Regardless of what they are made of, burning candles does not improve indoor air quality.

So back to air purifying machines…

For a practical overview of air purifiers, check out this article from ConsumerReports.  For example, ConsumerReports suggests:

“Before you buy an air purifier, try some simple, common-sense steps to reduce indoor air pollution. Begin by vacuuming often, banning smoking indoors, minimizing use of candles and wood fires, and using exhaust fans in kitchen, bath, and laundry areas.”

As the article continues, various claims made by air purifier companies are tested.  ConsumerReports cautions that ozone-producing air purifiers are actually harmful to your health and should be avoided, particularly if you have allergies or breathing problems.  This is confirmed by the American Academy of Asthma Allergy & Immunology:

“There is no debate about the negative effect of ozone…with the FDA concluding there is no place for ozone in medical treatment.” (See article here.)

For more information on the pros and cons of air purifiers, read this article from the New York Times, in which Steven Kurutz, an allergy sufferer, tested six popular air purifiers.  Here are a few excerpts from his article:

“For all their high-tech wizardry (some claim to be able to eliminate particles 0.3 microns in size and smaller), air purifiers occupy the same category as faith-based wellness products like nutritional supplements.”

And,

“Over the years, the Federal Trade Commission has taken action against several makers of air purifiers, including brands like Honeywell and Oreck, for unsubstantiated allergy-relief claims or for advertising that their devices removed virtually all impurities from the indoor air people breathed.”

According to ConsumerReports’ deputy home editor, Celia Kuperszmid Lehrman, whom Kurutz interviewed for the article,

“The first thing you need to know about an air purifier is that most people don’t need one.”

However, some doctors do recommend air purifiers for their patients, particularly children who suffer from asthma.  So, if you have asthma or allergies (or both), talk to your doctor about whether an air purifier would be beneficial for you.

According to the American Academy of Allergy Asthma & Immunology:

“There is no definite evidence of filtration clinically benefiting patients with allergic disease, but this may be the result of the studies being of insufficient durations to prove benefit.   The best review of the topic is by Sublett et al in 2010, a report of the Indoor Allergen Committee of the American Academy of Allergy Asthma and Immunology.” (See AAAAI article here.)

The Bottom Line for Air Purifiers: The different things you may be allergic to (dog allergens, cat allergens, mite allergens, mold, pollen, etc.) have different-sized particles.  You will see the most benefit if you select an air purifier that is designed to filter the particle size of the allergen that most affects you.

Conclusion from the Sublett et al report:

“As far as optimal choice of cleaning devices, initial cost and ease of regular maintenance should be considered. Portable room air cleaners with HEPA filters, especially those that filter the breathing zone during sleep, appear to be beneficial.

For the millions of households with forced air HVAC systems, regular maintenance schedules and the use of high-efficiency disposable filters appear to be the best choices.

However, further studies and research in this area are desirable to make more definitive recommendations in the role of air filtration on improving disease outcomes.”

Ok, so I could buy an expensive HEPA filter air purifier for my bedroom, which might help us sleep a bit better.  Are there any other options?

That’s when I remembered that house plants help improve indoor air quality.

Most of us learned in school that plants breathe in carbon dioxide and breathe out oxygen (roughly speaking), which is great for humans because we breathe in oxygen and breathe out carbon dioxide.  So having plants in the house helps increase the oxygen level in the air and decrease the carbon dioxide level.  But indoor plants can do more than just produce oxygen.

NASA published research in 1989 which demonstrated that house plants help reduce indoor air pollution.  Due to the energy crunch in the 70’s, buildings became more air-tight to reduce energy costs associated with escaping heated or cooled air.  But then occupants began developing health problems, and researchers determined that decreased air flow in buildings led to higher concentrations of carbon dioxide and volatile organic compounds (VOCs) in the indoor air.

Three of the VOCs NASA focused upon in its research were benzene, tricloroethylene, and formaldehyde.  These chemicals pose various health hazards that range from skin and eye irritation to headaches, asthma, and cancer (pp. 3-5).  Assuming we’d like to avoid these health hazards, what can we do to reduce the levels of these chemicals in our homes?

As NASA points out, “The first and most obvious step in reducing indoor air pollution is to reduce off-gassing from building materials and furnishings before they are allowed to be installed.” (p.2)

The best way to reduce chemical indoor air pollution is to choose lower-VOC or zero-VOC options for furnishings, floorings, and other elements inside your home (wall paint, flooring glues, shower curtains, etc).  That way, you’re bringing less VOCs into your house to begin with.  (There are lots of good articles about this on the web; I encourage you to Google-Fu them.)

In addition to reducing VOCs by using less-toxic cleaning supplies, lower-VOC paint, etc., we figured “If it’s good enough for NASA, it’s good enough for us,” and bought houseplants – lots of houseplants.

Before I bought the plants, I did an online search and found many helpful articles.  This article at Lifehacker.com has a graphic of various houseplants and the chemicals they filter best.  And since houseplants have not fared well at my house in the past, I also read articles, including this one, on low-maintenance, hardy houseplants.  See this article for a good overview of the benefits of houseplants, including how many you need per room/ per square foot.

In the end, I decided to buy plants that didn’t have runners that would wind up all over the house (I’m looking at you, golden pothos).  I found a local nursery and selected plants for various rooms based on the available sunlight in those rooms, the amount of available space, and what looked good to me.  Be sure to check how big each plant typically grows, so you don’t buy ones that will outgrow the space you bought them for.

For the bedroom, I selected a snake plant (a.k.a. mother-in-law’s-tongue; see picture at top of post) because they are one of the only plants that continue to take in carbon dioxide and give out oxygen at night.

So far, it’s been about six months and none of the houseplants has died.  In fact, nearly all of them are thriving.  It’s hard to say whether our indoor air quality has improved, since we don’t have a way to test it.  But at least we know that science is on our side, and we didn’t waste our money on air purification myths like beeswax candles or salt crystal lamps.

CAUTION: Many low-maintenance houseplants are toxic to dogs, cats, and sometimes children if they chew on the plants.  If this is likely to happen in your home, make sure you know which plants are toxic, and put them where pets or children cannot reach them.

 

 

Medical Procedures: What It’s Like To Get An EMG (Electromyography)

Raise your hand if you’ve got a bad shoulder (badum ching!).  Yup, me too.  Although I had surgery to repair it a year ago, I’ve had some lingering problems.

Since physical therapy (PT) hasn’t resolved the functionality problems with that arm, my primary care manager (PCM) ordered some diagnostic medical procedures to try to determine what’s causing the problems.  One of the procedures that was ordered was an electromyography.

Electromyography (EMG) is a diagnostic procedure that assesses the health of muscles and the nerve cells that control them (motor neurons).  According to the Mayo Clinic,

“Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets…EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.”

In my case, they were trying to determine whether a pinched nerve in my neck was causing the problems with my arm.

Electromyography is an outpatient procedure that typically takes about an hour.  EMG is often done in conjunction with a nerve conduction study (NCS), which I also had.  NCS is the measurement of “the speed of conduction of an electrical impulse through a nerve. NCS can determine nerve damage and destruction” (Johns Hopkins).

According to WebMD,

“Nerve conduction studies are done before an EMG if both tests are being done. Nerve conduction tests may take from 15 minutes to 1 hour or more, depending on how many nerves and muscles are studied.”

Since they were going to need access to my arm and shoulder (and trapezius, as it turned out), I wore a track suit with a tank top underneath. They asked me to take off the track suit jacket and lie down on an examining table.

To prepare for the NCS, the person administering the torture procedure asked me to move my fingers, hand, and arm in several different directions so she could determine her targets.  These she marked on my arm with a marking pen.  She fastened several electrodes to my hand and fingers with tape (see picture below), and proceeded to zap me with a machine that looked like a taser (but used less voltage, obviously).

 

This is not a pleasant sensation.  It typically wasn’t too painful, except when she applied multiple shocks in the same location.  The second or third consecutive shock in the same spot became more and more painful.  For the most part, she told me what she was going to do before she did it, which helped me prepare.  When she told me she needed to do 10 shocks in the same place, I knew two things: 1) It was going to hurt like hell, and 2) I’d better do the stress management/relaxation breathing techniques I learned at the base Wellness Center.

Breathing techniques, whether learned through biofeedback training or as part of yoga or meditation can be very helpful for managing pain or stress.  I use them whenever I am having an uncomfortable/painful/stressful medical procedure.  Of course, in this case, relaxing was a bit more challenging, since my body was also jerking from the shocks.  For some of the shocks, only my hand/wrist twitched.  But for some of them, my opposite leg jumped.  Several times I got a cramp in my arm muscles, and toward the end, I got a cramp in the muscles in my lower back.

That was part one.  Part two was the EMG.  “During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle” (Mayo Clinic).

The needle is inserted into various muscles.  It didn’t hurt most of the times it was inserted, since it is a very fine needle.  It did hurt when it was inserted into the trapezius muscle.  Once it is inserted, the doctor taps on the needle, and sometimes moves it around inside the muscle as she listens to the signal.  As you can imagine, this doesn’t feel very good.  Then she asks you to engage the muscle.  You can hear an increase in signal noise while you are engaging the muscle.  This also doesn’t feel very good, as the needle feels like it is stabbing you more.

These tests may be done only on one side of your body (one arm, one leg, etc.), or they may be done on both sides of your body in order to compare results.  In this case, they only tested the problematic arm, not both, and the doctors were able to give me my results at the end of the procedures.

The good news is they didn’t see any evidence that I have a pinched nerve in my neck.  The bad news is that these diagnostic procedures didn’t help determine the cause of the problems with my arm.

After the tests: I had one righteous bruise, and I was tired for the rest of the day.

According to WebMD:

“After the [EMG], you may be sore and have a tingling feeling in your muscles for up to 2 days. If your pain gets worse or you have swelling, tenderness, or pus at any of the needle sites, call your doctor.”

“If you still have pain after the [NCS]:

  • Put ice or a cold pack on the sore area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.”

Becoming a Critical Consumer of Health Information

“Everything we hear is an opinion, not a fact.  Everything we see is a perspective, not the truth.” – Marcus Aurelius

It is increasingly difficult to distinguish between signal and noise these days.  Information sources tend more toward being the first to release information (“getting the scoop”), and less toward fact-checking before distribution.  They also tend more toward hyperbole, and less toward sober, objective reporting.  When you add cognitive biases such as confirmation bias to the pressure to draw high ratings or optimize traffic to your site, the signal can become very hard to detect.

In other words, how do you know if health information is accurate or effective?  As of 2009, alternative medicine was a $34 billion-a-year business.  How do you know you’re not spending your hard-earned money on modern-day snake oil?

One place to start is here.  This article, provided by the National Institutes of Health (NIH), gives an overview on how to evaluate health information.

And this article in The Guardian explains a few of the reasons we can get it wrong: cognitive biases.  As one scientist in the article explains, “As a health condition degrades and there become fewer and fewer treatment options, the tendency to try anything rises. The confounding part of this equation is the concept of human hope – and that, unfortunately, is what undermines science every time. We hope that something will work, we believe that something will work.”

When I was healthy, I thought going to the doctor was like going to a car mechanic: you tell them what’s wrong and they fix it.  But when I developed a chronic health condition, I learned that doctors don’t always know how to “fix it”.  I also learned that they often don’t want to admit that they don’t know how to fix it.  I have a great deal of respect for the one and only doctor who told me, “You know more about your condition than I do.  You’re talking over my head, and I’m just going to refer you to a specialist because this is way beyond my areas of expertise.”  I have a great deal of contempt for the multiple doctors who have been unwilling to admit (perhaps even to themselves) that this is a case that *should* be referred to a specialist, and insist on trying to treat it themselves even though it is obvious to me that they have insufficient knowledge of or experience with this condition.

So, yes, when traditional medicine failed to heal me and my quality of life decreased to the point where I could hardly work and rarely left the house, I started exploring alternative medicine.  I want to believe that I will find ways to manage my condition and live a satisfying life.  Part of that has to do with hope, but a bigger part has to do with trying to regain a sense of control.  So, I’m willing to explore alternatives – but I’m also a frugal skeptic who doesn’t want to throw away money on things that don’t work.  I’m used to providing evidence to support my statements, and I expect others to do the same.

What I am finding is that it’s difficult to find empirical evidence for alternative treatments.  Many of them have not been scientifically studied, or the number of studies or number of participants are small.  So we don’t really know whether they work or not.  There are a growing number of blogs and websites that recommend various alternative treatments, but I am hesitant to endorse any of them because I find that they cite each other as support for their statements, but I can’t find scientific evidence for their claims.  That doesn’t necessarily mean that what they are saying is wrong – I just can’t prove they’re right.

It’s human nature to believe something we hear from someone we trust.  If a treatment “worked” for our friend, or someone they know, we’re often willing to try it ourselves.  The problem is that we don’t know for sure *if* it worked or *why* it worked.  Thus, we don’t really know whether it will work for us.  And we often don’t know if there are any potential side-effects or interactions with treatments, medications, or supplements we’re already trying.  We’ve all done it – but it’s a game of roulette, really.

So how can you become more informed about alternative treatments?  I have found a few information sources that have been very helpful for me.  For learning more about vitamins, minerals, supplements, and nutrition, I go to Examine.com, a site run by editors who examine primary peer-reviewed research on these topics, or to the Mayo Clinic’s website.  For a skeptical, science-based analysis of various alternative treatments, I turn to The SkepDoc, written by Harriet A. Hall, MD, a retired family physician and former Air Force flight surgeon. She writes about “medicine, so-called complementary and alternative medicine, science, quackery, and critical thinking”. She also is one of the editors for Science-based Medicine, a website that tackles “issues and controversies in science & medicine”.  There are also some very thought-provoking articles at A Breath of Reason, which is run by a skeptical cystic fibrosis patient.  In her own words: “I started this blog as a way to offer science-based refutations for other CF patients and their loved ones to refer to when swimming through the sea of misinformation flowing around the internet, TV media, bookshelves and health stores claiming to better your health in one way or another.”

I’ll add to this list as I discover new resources, and be sure to check out the Resources page.  Finally, always ask yourself: what does this person, website, company, or organization have to gain by promoting this treatment or product?  What is their motive for providing this information?  What evidence can I find to support (or refute) their claims?

If you know of other sources of scientifically tested health information, please share them with us.  Knowledge is Power!