Dr. Cohn Out of Office Until July 7

June 23, 2014June 23, 2014 / Thomas Cohn, MD

I wanted to take a moment to let my readers and patients know that I’ll be out of the office from June 21 through July 6. I will be going on vacation for a portion of that time, and I’ll be unable to be contacted for most of that duration. I will begin seeing patients again at the CDI Sartell office on July 7th.

If you have immediate needs during that time please contact Dr. Robert Long or his assistant Julie Marden by calling 952-738-4456. If you want to set up an appointment with me when I get back, call the main office number at 320-251-0609.

After Hours Calls

If you want to set up an appointment after the office has closed for the day, you’ll need to follow the after hours procedure. We always have a doctor on call in case something arises. Dr. Long and Dr. Kim will be the on call physicians in my absence. They are wonderful doctors and are more than capable of providing you with the care you need.

I have written some blog posts to be shared while I am on vacation, so there will continue to be new stories on the blog as well as activity on my social media profiles. So while you will continue to see activity, remember that I will be unable to personally answer any questions that may be submitted through Facebook or on a blog post. I’ll answer your questions when I get back, and if it’s a serious concern please call CDI. They’ll make sure you get the care you deserve.

Thanks,

Dr. Thomas Cohn.

P.S. I meant for this post to appear on Friday, but we are currently in the process of switching to a self-hosted server. This created a visibility issue for this post on Friday. I apologize for any inconvenience.

Tarlov Cysts and Back Pain

April 30, 2014December 11, 2015 / Thomas Cohn, MD

Tarlov cysts are fluid filled sacs in the spinal cord region along the nerve, usually close to where it enters the region to leave the spinal canal. The cysts are usually small, and not in a position that would cause symptoms. They became better known once we developed advanced imaging like MRI and CT scans. Their cause is not known, and usually they do not need to be treated, although occasionally they have been associated with connective tissue disorders including Marfans and Ehlers-Danlos syndrome.

Symptoms and Diagnosis

Tarlov cysts are sometimes larger than 0.5 inches in diameter, and at that size they may become symptomatic. The larger size may cause them to put pressure on a nerve root or even the spinal cord. Symptoms are related to the location; most likely in the sacrum. Problems include tailbone pain, pain in the groin region, sexual dysfunction, bladder dysfunction, and lower extremity numbness and weakness. Over time, without treatment, they do have a tendency to enlarge, meaning the cysts may start without symptoms and later develop into problems.

The diagnosis now is usually made by MRI scan, but may also be noted on CT scan. Tarlov cysts are usually found incidentally when scans are done looking for causes of back pain symptoms. Since most of these cysts are small, they usually are not correlated to symptoms being investigated.

Causes and Treatments

The cause of Tarlov cysts is unknown. There are many theories, but none appear to be definitively correlated to their development. Since there is no known cause, there is no known method to prevent their formation.

Treatment of Tarlov cysts is only necessary if they are definitely linked to symptoms or bone/neurologic compromise. Depending on the exact location, sometimes they can be ruptured by a radiologically guided needle under CT scan. Otherwise, they may need surgical management to drain. Unfortunately, they do have a propensity to re-occur and may need retreatment.

In summary, most Tarlov cysts are found by accident on an MRI scan for another issue. They are often small and usually cause no problems. If they are large, sometimes they do need treatment and your physician can help determine possible options that would relieve the problems.

How Steroid & Corticosteroid Injections Relieve Pain

January 6, 2014June 24, 2014 / Thomas Cohn, MD

Corticosteroids, also known as steroids, are powerful anti-inflammatory compounds. They mimic the body’s own steroid hormones and can diminish inflammation by preventing phospholipid release and eosinophil action. In plain English, these are man-made compounds that reduce inflammation when tissue damage or irritation is occurring.

Inflammation and Pain

Many problems that cause pain are due to tissue damage or irritation, sometimes it is acute and at other times it is chronic and ongoing. Inflammation can result from any of the following:

Degenerative changes in the spine and joints
Disc bulges and herniation
Injury

The body can often deal with routine inflammation with its own mechanisms. The inflammation often stimulates sensory nerves and is perceived as pain.

When inflammation and pain is beyond normal control and impacts function, the use of corticosteroids is sometimes appropriate. These medicines can be given in a number of different ways. They are easily given orally and travel to everywhere in the body. Oral steroids, often prednisone or decadron, are inexpensive, and if given for a week or less have very little side effects or risk. They can often be very effective for acute or sub-acute pain in many areas of the body.

Corticosteroids

Corticosteroids are often used as injections targeted to very specific sites to treat pain caused by ongoing inflammation. Many joints, such as the knees, hips, and shoulders, can be injected to reduce pain, especially if it is just one isolated area. If multiple areas inflamed, injections are usually not used since the risk of too much steroid exposure may be a problem.

Severe spinal pain is often treated with steroid injections. The discs and spinal facet joints are deep structures with limited blood flow. The delivery of oral steroids to these regions may not be sufficient to decrease inflammation. Injection of these medications can deliver them to the specific structures that are inflamed and be maximally effective in controlling symptoms of pain for months at a time. These spine injections are best done by an experienced pain management physician and done with real time x-ray guidance to make sure they are delivered to the right spot and no other damage is done.

Since steroids can have significant side effects, and cause damage to the body if over used, the overall use must be closely monitored. Most pain physicians prefer that steroid shots be limited to 4 to 6 times in one year for safety reasons. There is not an absolute maximum and not a lifetime maximum. The risk and benefit needs to be evaluated for each individual and discussed between the patient and physician. Careful use may have a profound effect on pain control and often can be life changing in some pain patients. Since everyone is different, a pain physician can help guide a patient through a comprehensive strategy that maximally benefits each individual.

How to Identify & Treat Abdominal Pain

December 23, 2013June 24, 2014 / Thomas Cohn, MD

Most everyone has had abdominal pain at some point in his or her lives. Thankfully, the most common causes of abdominal pain are not serious. Every structure in the abdomen can cause pain. The organs and structures in the abdomen include:

Stomach
Intestines
Liver
Spleen
Kidneys
Bladder
Appendix
Sexual organs
Blood vessels and muscles

Since each of these structures tends to have some type of sensory innervation, they can all be a source for pain.

Almost everyone has had pain from the stomach and intestines. From overeating, to acid reflux and indigestion, to constipation or diarrhea, the problems are not unusual. Most of the problems are short-lived, inconvenient, and not serious. When they are intense and not resolving, sometimes they do require medical intervention.

When to Seek Medical Attention

The main concern with abdominal pain is when to seek medical attention to help determine the cause. Signs that indicate a need for further medical attention include:

Fever
Inability to eat or drink fluids for over a day
Ongoing vomiting
Vomiting blood
Severely painful abdomen and not being able to touch it
Painful urination
Passing blood in urine or stools
Difficulty breathing due to pain
Acute traumatic injury

Since there are so many different organs and structures linked to the abdomen, the diagnosis of the cause of pain may be difficult. The starting point is always the history and story provided by the patient. After the history, a physical exam gives the next set of information. With the basic information, the clinician then can determine the best tests to help find the answers to the cause of the pain. Tests may include blood and urine analysis, X-rays, CT scans, ultrasounds, and sometimes invasive scopes of various systems and possibly surgery.

Treatment for Abdominal Pain

Treatment of abdominal pain is as variable as the causes. Since the vast majority of causes are not life threatening, treatment is often simple. Serious problems often require the intervention of medical specialists to guide the evaluation and treatment. Self-diagnosis and treatment for minor problems is fine. When the problems are more serious, find a medical specialist who you work well with and can trust. If looking up information on the internet, stick to respected medical sites, including WebMD, Mayo Clinic, and the NIH (National Institutes of Health). Do not panic about information on the Internet but use it to discuss concerns with your provider.

Electronic Medical Records & E-Prescriptions

December 16, 2013June 24, 2014 / Thomas Cohn, MD

There have been several articles published in the last few weeks about the push to electronic medical records and prescribing. Just as technology has changed every other part of our lives, it is also changing medicine. The US government is now recommending electronic medical records and prescribing. The purpose of this recommendation is to improve the quality and care provided. Since computers can be programmed to analyze so much data, the thought is if medicine uses them, the errors that occur in medicine will be reduced.

Many Different Program Formats

From outside the world of medicine, the use of computers sounds like a wonderful idea that may solve many problems. In reality, computers are only tools that can help handle the data that is present. The computer programs and system are only as good as the information that is assembled, and the ease and clarity of its presentation.

There are many different program formats for medical records. Most hospitals, physician offices, and medical facilities end up using their own program, and none of these can communicate with each other. To further complicate the issue, it seems that everyone is concerned that only appropriate people can access any of the information due to privacy rights. As a result, there is a lot of information in electronic form, but the use of it to improve medical quality and safety is almost impossible. Therefore, electronic records, and electronic prescribing are no better than the ability of any person using the information and translating its importance.

A Fully Integrated Data System

Healthcare in other parts of the world is often better than the US due to the fact that all health information is part of a universal healthcare system. All medical data then is kept in one place, one system, and is shared by all providers. Parts of information are not scattered or hidden, and the picture that the data provides can be better analyzed. The critical feature is that all medical information is kept in a central place and every provider uses the same information on each patient.

Until the United States becomes serious about changes in how electronic medical records are used and integrated into a universal data system, improvements in patient safety will be limited. Computers can help with data management, and sometimes help prevent the worst of errors. The limits to computers help in the medical system at this time are significant until we get past our concerns of privacy, security, and the need for a fully integrated data system. At this time, in the United States it does not look like this will happen. Computers are well known for the phrase “junk in, junk out.” Patient safety and health will only improve small amounts with the use of computers, electronic medical records, and prescribing.