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.

The Relationship Between Diabetes, Vitamin D, & Pain

December 9, 2013June 24, 2014 / Thomas Cohn, MD

A research presentation at the University of Chicago has indicated that vitamin D may have an effect on pain and depression in patients with type-2 diabetes. The study indicates a relationship between pain and vitamin D supplementation. Those with low vitamin D levels, who then received vitamin D, then had less pain complaints. The study just shows that these problems of diabetes with pain and vitamin D have some connection.

Secondary Problems

As with many medical problems, many secondary problems can occur with diabetes. Diabetes causes problems with multiple body systems, including the kidneys, eyes, blood vessels, and the nerves among many organs it damages. It is no surprise that diabetes can affect vitamin D levels. Whether treating diabetes more successfully and comprehensively is the answer or vitamin D has a correlation to pain levels is not known. The study just notes that there is some sort of relationship.

Diabetes can cause multiple health problems. Controlling diabetes is the most important way to prevent complications. Pain is often a complication of the disease due to damage to the vascular system and nervous system. Vitamin D may turn out to be an important aspect of controlling aspects of diabetes. However, it is unlikely it will be a solution to pain in diabetes. The first and most important aspect in reducing pain in diabetes is to keep control of the blood sugars. Most pain in diabetes is related to nerve damage, and neuropathic medications like Neurontin, Lyrica, and Cymbalta are some of the best at reducing pain symptoms.

More Research Needed

New research in pain control in any disease is welcome. The most important thing in any medical study is understanding what the researchers have found. In this study, researchers found that patients with diabetes type 2 and depression often have vitamin D deficiency. The relationship between all these variables at this point is interesting but needs further study before any definite conclusions can be drawn.

Fibromyalgia Pain Treatment Options

October 2, 2013November 17, 2015 / Thomas Cohn, MD

Fibromyalgia is a painful condition in which the body hurts all over. It is more common in women, and often comes with other problems such as:

Stomach acid issues
Irritable bowels
Sleep issues
Depression
Headaches

Treatment is aimed at managing the symptoms and understanding the disease. Fibromyalgia treatment begins with making an accurate diagnosis, and educating the patient on the best treatment options.

A Team Approach to Treatment

The most effective approach to treatment is attacking the condition with a team of medical professionals consisting of:

Nurses
Physical therapists
A Psychologist
A Physical Medicine Doctor

A multi-disciplinary approach is helpful to shift the patient away from a perception of helplessness, defeat, and frustration and toward a positive and active lifestyle. Psychology is beneficial in changing attitudes from defeat and depression to understanding and self-motivation. Psychologists use a variety of techniques including cognitive behavioral therapy and biofeedback to influence changes. Physical therapy is necessary to teach the patient to go from being inactive, to exercising. Nursing is helpful to work with sleep problems, diet, nutrition, and understanding lifestyle and medication issues.

Medications & their Effectiveness

Pharmacologic strategies include prescription and non-prescription medications. There are three drugs approved for Fibromyalgia, and many others that have limited affects. The most commonly used drugs that are approved are Cymbalta and Lyrica. They both decrease the sensitivity of the nervous system to excessive signals that influence pain. Amitriptyline and Nortriptyline at low doses also have similar affects and are helpful with sleep. Narcotics and anti-inflammatory medications are not effective in management and usually lead to more problems than solutions.

Nonprescription medications have varied success rates and the research is not solid to support their effectiveness. S-adenosine-L-methionine(SAM-e) has been used for joint pain and general pain, and is commonly used in Europe. Tryptophan and melatonin may improve sleep and help with mood. Fish oil is felt to help with joint and spine pain, and may help control cholesterol levels. Glucosamine and chondroitin sulfate have been used to help control joint pain. These supplements are generally felt to be safe. Whether they are going to be helpful is open to question but they should not cause problems.

Fibromyalgia is best treated by a knowledge team of practitioners, headed by an experienced Physical Medicine pain physician. The goal of treatment is to improve function and activity level, and manage pain symptoms. Education and psychological well-being are important. Fibromyalgia is a real syndrome, when treated appropriately can be successfully managed.

Are Supplements an Effective Joint Pain Relief Option?

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

Critical review of articles is essential to understanding whether or not the conclusion is accurate. A recent New York Times article cited a study that researched whether Vitamin D and Calcium help relieve joint pain. The conclusion was that these supplements do not help.

Unfortunately, this conclusion is misleading. Vitamin D and Calcium are used primarily to promote healthy bones and prevent osteoporosis. Joint health is a completely different issue

The question of whether supplements such as Glucosamine, chondroitin and fish oil help with joint pain is unclear. Multiple studies have been done on these compounds and the results have been mixed on whether they actually do anything. Many people find these compounds to be very helpful. It is fairly clear that they are not harmful. Take these as directed on the bottle, and they might help, a 3-month trial would be reasonable and decide on your own.

Medications that Reduce Joint Pain

So if these supplements do not help reduce joint pain, what are some pain management options? There are numerous ways to combat joint pain. Medications that have FDA approval for joint pain include:

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen
Analgesics like acetaminophen
Steroids like prednisone
Injections like hyaluronic acid

Some of these are now available without a prescription. NSAIDs act by interrupting compounds in the body that cause inflammation and thus joint pain. Prednisone is a corticosteroid, a very powerful prescription level medication that decreases inflammation, but can cause significant other problems when not used cautiously. Analgesics block the transmission of pain signals to the brain or their perception. As noted, these medications all may have significant side affects and can cause other more severe medical problems besides helping with joint pain.

Other Joint Pain Treatment Options

A lot of joint pain is caused by slow deterioration of the joints as we age. Maintaining a healthy lifestyle is one of the best ways to prevent joint pain. Here are a few specific ways to maintain a healthy lifestyle and prevent joint deterioration:

Eating appropriately
Exercising regularly
Keeping muscles strong, and the body moving
Proper body mechanics while doing activities
Not over stressing the body

To maintain bone health, taking Vitamin D and Calcium has been proven to be healthful. However, joint health is a different issue entirely. When reading research, sometimes it is necessary to understand more background information to be able to determine if the conclusions make any sense. Just because someone did a study does not make it correct.

Source:

http://well.blogs.nytimes.com/2013/08/21/supplements-fail-to-relieve-joint-pain-in-study/?_r=1

4 Rehabilitation Techniques for Ankle and Foot Pain

August 21, 2013May 24, 2017 / Thomas Cohn, MD

Ankle and foot problems affect people in all walks of life (pun intended). In fact, over 30,000 people sprain their ankle on a daily basis. Because your feet and ankles shoulder your weight as you move about, it is extremely important to take proper steps to avoid injury. This includes proper stretching before and after exercise, wearing appropriate footwear, and using ankle supports.

Despite our best efforts, we all know the pain associated with missing a step and rolling our ankle. Sometimes you can walk off the pain, but other times you may find yourself on a doctor’s table. Whether your diagnosis calls for physical therapy or a surgical procedure, following through with your post-visit rehabilitation is vital to ensuring your foot returns to pre-injury form. To aid in your rehab, we put together a series of rehabilitation videos that can help get you back on your feet in no time. Take a look at the videos, and check out the descriptions to learn more about how each technique strengthens your foot.

Toe Fists

Toe fists are a great exercise because they really work the muscles in your feet. The exercise also helps increase mobility and range of motion in your arches. Hold your toes in a fist formation for three seconds, then release. Repeat this exercise for a couple of minutes each day.

Bridges

Bridges are a valuable exercise because they target another area of your body that may be indirectly affected by your foot injury – your hips. While lying on your back with your feet flat on the ground, thrust your hips into the air and make a straight line from your knees to your shoulders. This stretch will build pelvic support and stabilization, which is key if you are forced to forgo weight bearing for a period of time.

Toe Splay

Toe splaying is technique used to increase the lateral range of motion in your toes. Sometimes this stretch is tough to preform after surgery, but it’s important to remember that the benefit of the exercise is the challenge it presents, more so than the movement itself.

Toe Extensions

Toe extensions can be preformed either actively or passively. You can preform the passive exercise by slipping a towel or rag underneath your toes and gently pulling upwards. This will help maintain flexibility in your toes. The active exercise is done without the aid of a towel; patients simply try to raise their toes in the air as high as they can.

About the Author:

Dr. Lance Silverman is an orthopedic specialist and founder of Silverman Ankle & Foot. Dr. Silverman is an accomplished orthopedic surgeon. He received his medical degree from Baylor College of Medicine in 1996 and is a board-certified member of the American Academy of Orthopaedic Surgeons and the American Orthopaedic Foot and Ankle Society. You can find him online his website.