THE HEAD
Migraines
The Treatment: Just a headache, huh? Don’t be so sure. A headache could be a migraine, which could signal some problem in the brain, says Dr. Marek Buczek, a neurologist at University Hospitals Health System. He sometimes orders blood work, CAT scans or MRIs to rule out other conditions. Then Buczek evaluates how often the migraines are occurring and how debilitating they are, which helps him decide what medication to prescribe. Fast-acting drugs, such as Imitrex or Maxalt, should shorten the migraine once it starts. Using antidepressants such as Prozac and beta-blockers such as Inderal on a daily basis can help prevent migraines from starting.
Dr.’s Note: A new treatment, vascular decompression, is on the horizon, says Buczek. But the highly experimental surgical procedure is only done as a last resort. “It’s done by a plastic surgeon,” he says. “They follow the vessel along the scalp and cut the muscle and when the vessel is open it should help the blood supply and release pressure on the nerve.”
Insomnia
The Treatment: If you’re regularly bleary-eyed from lack of sleep and you don’t have a newborn at home, you might be suffering from a sleep disorder. Craig Myers, director of the Sleep Disorder Treatment Center at St. Vincent Charity Hospital, recommends seeing a physician to rule out sleep apnea and other disorders before taking any medications. “If they are given a sleep aid without being cleared [from sleep apnea], that can affect their breathing,” he says. “It would be detrimental to their health.”
Dr.’s Note: You can try warm milk or counting sheep, like grandma always said. Or you can follow Myers’ advice: Don’t nap during the day. Don’t drink alcoholic beverages in the evening. Avoid caffeine in the afternoon. “Exercise regularly during the day is a good idea,” says Myers. “But they should certainly not exercise within six hours of bedtime.”
Allergies
The Treatment: Some of us accept seasonal sneezing and coughing like we accept the snow and ice in this part of the country. Unlike the weather, you can do something about your allergies. But first, says Dr. Irene Jarmoszuk, an allergist at Community Health Partners, “you need to find out where and when the symptoms start, how long they have occurred, if there’s any seasonal pattern to them and what trigger factors there are.” Depending on the history, doctors proceed with allergy testing to find out what’s causing your nose to run.
Dr.’s Note: Prescription steroid nose sprays such as Flonase or Nasonex can bring relief. Unlike traditional nose sprays that work immediately, they take time to work. “People need to know that it is a long-term treatment,” Jarmoszuk says. “It cuts down on the inflammation, a significant part of allergies.”
TMJ
The Treatment: Click. Click. Click. If you hear that sound in your head whenever you open your mouth, you may be a TMJ sufferer. Other symptoms include pain when opening and moving the jaw and an inability to open the mouth. “Most of the problems are really from the muscles around the temporomandibular joint,” says Dr. Stuart Katz, a dentist in Beachwood. There are two temporomandibular joints, one in front of each ear. They connect the lower jaw bone to the skull. Patients are often fitted with a bite splint, which is similar to a retainer that fits over the teeth and provides a good separation between them, Katz says. Opening the mouth a few millimeters allows your jaw muscles to relax.
Dr.’s Note: Doing jaw exercises such as opening your mouth wide and closing it, and moving your jaw from side to side throughout the day is also key to recovery, Katz says. “Take a non-steroidal anti-inflammatory drug to help with pain and to decrease inflammation in the muscles,” he says.
THE HEART
High Blood Pressure
The Treatment: Doctors don’t always know what causes high blood pressure (a.k.a. hypertension). If you have it, you just have to deal with it. Or pay a steep price when the stroke or heart attack hits. The newest recommendations define high blood pressure as greater than a 140 over 90 reading — 130 over 80, if you are diabetic — on that gray sleeve with the meter that nurses gleefully pump until it cuts off the circulation in your upper arm. The first line of attack, according to Dr. George Litman, chief of cardiology and medical director of the Akron General Hospital Heart and Vascular Center, is risk-factor modification. Exercise, weight loss, low-salt diets and so forth. Docs then have a host of blood pressure medications they can prescribe, starting with diuretics, to help reduce hypertension. This condition also lends itself to alternative approaches, including increases in calcium or magnesium intake or participation in stress-reduction activities such as tai chi or guided imagery, in which you imagine yourself in a relaxing place such as Cleveland Browns Stadium. Just kidding.
Dr.’s Note: Stay on the medication and follow it carefully. “A lot of patients start to feel good, so they stop their medication,” Litman laments. “Next thing you know, they have a stroke.”
High Cholesterol
The Treatment: You shouldn’t feel guilty if you have high cholesterol. No, seriously. It’s not your fault. Keep telling yourself that as you dig into the aggressive diet your physician will recommend. “Still, you can diet as much as you want,” says Dr. George Litman, chief of cardiology and medical director of the Akron General Hospital Heart and Vascular Center. “You’re usually going to end up necessitating some therapy, especially if you are a diabetic or hypertensive.” The most common medications prescribed come from the statin family of drugs that reduce LDL (low-density lipoprotein cholesterol, a.k.a. the “bad” kind). Litman says patients who cannot tolerate statin drugs now can take omega-3 fatty acids and high amounts of B-complex vitamins.
Dr.’s Note: Know if you have any other conditions such as diabetes or coronary heart disease, Litman says. Adding high cholesterol to either of those could be a deadly combination.
Irregular Heartbeat or Arrhythmia
The Treatment: If your heart skips a beat, then you probably need to skip on over to your primary-care physician, stat. That’s the advice of Dr. Patrick Tchou, co-head of cardiac electrophysiology and pacing at The Cleveland Clinic Department of Cardiovascular Medicine. While some people may never realize they have an irregular or arrhythmic heartbeat or suffer any consequences from it, others may die from rhythm disturbances, Tchou says. While some patients may not need treatment, others may require medications to suppress the extra beats or an implantable defibrillator that can protect from potential life-threatening arrhythmia.
Dr.’s Note: The latest advances in computer mapping have enhanced the success of radio frequency ablation procedures, in which cardiologists employ catheterization techniques to reach the heart through veins and arteries to identify and then cauterize the areas causing the rhythm disturbance.
Heart Disease: Cardiomyopathy
The Treatment: Cardio-what? It’s hard to pronounce but crucial to treat. Cardiomyopathy describes a weakening of the heart muscle that may arise from coronary artery disease, blockages of the vessels, a heart attack or other impacts that damage or scar the heart muscle, resulting in a reduced capacity to pump blood. You definitely want to identify and treat the underlying problem, says Dr. Patrick Tchou, co-head of cardiac electrophysiology and pacing, The Cleveland Clinic Department of Cardiovascular Medicine. “For example, if you have a tendency to develop blocked vessels from arteriosclerosis, you need to treat that with cholesterol reduction, diet changes and so on” he says.
Dr.’s Note: Typically, drugs that can arrest or even reverse the cardiomyopathy are prescribed. Surgeons can also implant a biventricular pacemaker, a device developed within the past five years, to counter certain types of cardiomyopathy.
THE STOMACH
Ulcers
The Treatment: Let’s dispense with the big myth up front: A predilection for spicy foods does not predispose one to ulcers. This year, Barry Marshall and Robin Warren, two Australian scientists, received the Nobel Prize for their discovery that the “h.p.” you must worry about is not habanero pizza, but helicobacter pylori, the bacteria that causes ulcers. “More than 90 percent of patients who have duodenal or small intestine ulcers and about 80 percent of patients with gastric ulcers have an h. pylori infection,” says Dr. Hemangi Kale, a gastroenterologist with The MetroHealth System. In medicine, myth-busting has many perks. This one revolutionized treatment. Twenty years ago, ulcer sufferers usually endured painful surgery and were consigned to drinking lots of milk. Today, thanks to Marshall and Warren, a dosage of antibiotics paired with proton pump inhibitors returns patients to fine dining form in just 10 to 14 days.
Dr.’s Note: As for milk — and here’s a potential pain in the gut to moms everywhere — while many patients swear by its stomach-calming effects, Kale emphasizes that it’s only temporary, since the calcium content stimulates acid secretions.
Stomach Viruses
The Treatment: They’re out there. Lots of them, just waiting to attack your gastrointestinal tract. When they get you so sick that you drag yourself to the ER, expect the following to happen: Doctors will check to see if you are dehydrated and, if so, either give you fluids to drink or hook you up to them intravenously, says Dr. Charles Emerman, chairman of emergency medicine at The MetroHealth System. They’ll also investigate if anything else is making you sick, such as food poisoning. Prescription medicine can be given for nausea and diarrhea, but there is no miracle pill to cure viral infections. Just time.
Dr.’s Note: Emerman advises people with simple viral stomach infections to stay well-hydrated. Plenty of water or sports drinks will work. Emerman also recommends Emetrol, a carbonated sugar solution that is available at most stores. Also avoid milk products and high-fat meals, he says. “Those things will make them sicker.”
Heartburn
The Treatment: While we’d like to confirm that indigestion does, in fact, result from the failure to adjust a square meal to a round stomach, as some anonymous pundit once diagnosed, it’s not that simple. Typically, an esophageal sphincter muscle that doesn’t always know when to keep a good meal down causes heartburn or acid reflux disease (ARD). Ingesting acidic foods such as orange juice, coffee or five-alarm chili merely exacerbates the problem. Thus, the first line of defense requires lifestyle modification, says Dr. Suresh Mahajan, a gastroenterologist at Medina General Hospital and Southwest General Health Center. In other words, nix the acid intake and eat smaller meals. Secondly, for the 93 percent of the population that doesn’t have ARD, over-the-counter medications such as Prilosec OTC help counter occasional heartburn. More serious cases may require prescription medications or even surgery to tighten the sphincter muscle. Several new procedures are just being debuted, Mahajan says, that can be done endoscopically.
Dr.’s Note: Chronic sufferers should consult their physicians for testing, since heartburn-like pain may be symptomatic of a more serious condition. “Even though over-the-counter medications may help, they could be masking other things like esophageal cancer,” Mahajan explains. “So they should see their doctor and have at least one endoscopic exam done.”
Stretch Marks
The Treatment: Those ugly, silvery lines worming across your abs may be a small price to pay for that beautiful baby you had, but they’re still ugly, silvery lines worming across your abs. First the bad news: “Stretch marks are dermal damage,” says Dr. Roland Reyes, a plastic and hand surgeon at EMH Regional Healthcare System. “There’s isn’t very much you can do.” And more bad news: Creams and lasers can lighten and fade the stretch marks, but only briefly. “After three months’ time, they come back,” he says.
Dr.’s Note: Most people opt for a tummy tuck after their 40s when they are done having children, Reyes adds. “They are unhappy with excess skin and fat that has accumulated there.” While you can tighten the muscle, you cannot tighten the skin with exercise. By performing a tummy tuck, doctors remove excess fat and flabby skin, pulling the remaining skin taunt.
THE BACK
Upper Back Pain: Osteoporosis
The Treatment: You ingested a lot of calcium between the ages of 16 and 35, right? Oops. Well, if you’re old enough to remember President Harry S. Truman in office, that pain in your upper back, especially when you stand, sit or change positions, may be due to osteoporosis. The disease, a weakening of the bones with age, can result in small fractures in the vertebrae. “Most of these fractures will heal on their own with rest and pain medications in about four to six weeks,” says Dr. Douglas Orr, director of The Cleveland Clinic Spine Institute at Lutheran Hospital. For those who don’t heal, two surgical procedures developed over the past decade may help. A vertebroplasty, an injection of bone cement into the vertebrae, will stabilize and eliminate or significantly reduce the pain in most patients, Orr says. In a newer procedure, kyphoplasty, the surgeon injects bone cement and inflates a balloon to restore the spinal alignment.
Dr.’s Note: With osteoporosis reaching epidemic proportions, Orr says identifying and treating the disease that causes the fractures has become critical. “Every woman of menopausal age and every person over 40 who’s been on steroids for more than a year should have their bone density checked,” he says. Prolonged exposure to steroids weakens the bones and can lead to osteoporosis.
Lower Back Pain: Muscle Strain
The Treatment: Don’t take this as an affront to your originality, but that lower back pain you’re claiming sick days for is “phenomenally common,” says Dr. Douglas Orr, director of The Cleveland Clinic Spine Institute at Lutheran Hospital. At some point in our lives, 80 percent of us working stiffs will experience an episode of back pain severe enough to curtail our quotidian activities. It could be a ruptured disc, but chances are strong it’s a good old muscle strain, Orr says.
Dr.’s Note: The days of citing the need to lie down as an excuse for not cleaning the house are over, too. “Bed rest is bad for any back condition, short of a fracture,” Orr explains. “People should be moving and staying as active as they can.” For extreme cases, Orr prescribes anti-inflammatory drugs, muscle relaxants and an exercise program.
Slipped Disc
The Treatment: Degeneration precedes herniation. Dr. Abdul Itani, neurosurgeon at Lake Hospital, wants you to remember this unforgiving fact. If you have a disc that your doctor tells you is now preceded by the words “slipped,” “ruptured” or “herniated,” then you have breakage in the disc from its housing tissue. That means you probably have pain in your legs from the resulting pressure on the nerves. While some surgeons and researchers are experimenting with new procedures, Itani doesn’t care to discuss what he disdainfully refers to as “shortcuts,” since “the gold standard” is the micro-discectomy. Performed through a one-inch incision above the herniation, the procedure removes any free-floating pieces that impact the nerves in that area. In the past, they’ve simply removed the damaged portions of the disc, but over the past year, disc replacement surgery has been approved by the Food and Drug Administration and is now available.
Dr.’s Note: Surgery isn’t always necessary. Frequently, physical therapy will suffice. Maintaining a healthy weight is vital to reduce pressure on the spine, as is paying close attention to how you move. “Patients should use their hips and knees while getting up and down and keep their abdominal and back muscles in fairly good shape,” Itani says.
Degenerative Scoliosis
The Treatment: As a baby boomer you’ve never liked authority figures dictating your behavior. So you sure as heck won’t accept scoliosis as a reason to limit your activities. “Thirty years ago, people just said, ‘I walk stooped over. I need a cane, and I can’t walk as far,’ ” says Dr. Douglas Orr, director of The Cleveland Clinic Spine Institute at Lutheran Hospital. “But people today are less likely to accept the restrictions on their lifestyle, so they seek treatment more often.” Since vertebral discs don’t wear out symmetrically, the worn side puts pressure on nerves, which can cause sciatic pain in the legs. Degenerative scoliosis is most often treated with a combination of exercise and epidural injections or nerve root blocks to treat the pain. If pain persists, surgery can eliminate the pressure on nerve roots, and in many cases, surgeons insert rods to correct the curvature of the spine that may have become deformed.
Dr.’s Note: Staying active is the key. “If you can tolerate your level of symptoms,” Orr says, “the safest and easiest thing to do is just live with it.”
THE JOINTS
Tennis Elbow
The Treatment: True, the only time you swing a racquet is the annual badminton game at your family reunion. But if you suffer a chronic, severe pain from an inflammation in your elbow, you could have something in common with the country club set. Popularly known as tennis elbow because the condition afflicts tennis players, who stress the joint through repeatedly swinging their racquet arm, this tendonitis is caused by repetitive overuse of the elbow joint. “Probably as many people who don’t play tennis end up getting this problem,” observes Dr. Daniel Karns, an orthopedic surgeon at Parma Community General Hospital. “We see it in carpenters, construction workers and people who use scissors a lot for some reason.” Initial treatment includes anti-inflammatory pills combined with a program for stretching and strengthening the joint. More severe cases may require a cortisone injection or surgery.
Dr.’s note: Karns says seek treatment early to reverse the symptoms sooner, and avoid or modify the repetitive activities.
Dislocated Shoulder
The Treatment: When this happens, it means some serious pain. Go straight to the ER. X-rays will be taken to see where the shoulder is dislocated (front or back), says Dr. Charles Emerman, chairman of emergency medicine at The MetroHealth System. Then after putting the patient to sleep, the shoulder is put back into place. “When they wake up, they will be all better and go home,” he says. “There will be no pain or discomfort.”
Dr.’s Note: Beware of those Hail Mary passes. “A typical shoulder dislocation comes from playing pickup football where you are the quarterback, you have your arm up to throw a pass and somebody tackles you and hits the arm that is up,” Emerman says. “And that forces your arm to rotate and bops the shoulder out of place.”
Arthritis
The Treatment: More than 70 million people in the United States deal with some type of arthritis. Osteoarthritis and inflammatory arthritis are two of the most common types. “Osteoarthritis is a degenerative arthritis where the cartilage wears out,” says Dr. Michele Hooper, a rheumatologist at University Hospitals Health System. This type is associated with injury and aging. Heat creams, such as capsaicin formulas made from hot peppers, can be used to lessen the pain. But inflammatory arthritis is treated differently. “The joints are attacked as part of the immune system attacking the body,” she says. “If not treated aggressively, they are associated with an increased mortality rate.” A patient should start on a disease-modifying drug such as Arava or biological drugs such as Enbrel and Humira.
Dr.’s Note: “Anyone who has arthritis needs to understand their disease,” Hooper says. Check out the Arthritis Foundation Web site, www.arthritis.org. The foundation offers courses in therapy and exercises that may help.
Achy Knees
The Treatment: If you’ve got a knee, an achy, breaky knee, and you’re not old enough for arthritis, there’s probably one good reason. “In the younger, active age group, you have to be concerned about torn cartilage or torn meniscus, the cartilage in the side of the knee,” says Dr. Scott Weiner, chairman of orthopedics at Summa Health System. For weekenders waging war against aging bodies, mortality and other nonprofessional athletes, that painful swelling, clicking or locking of the knee can often be cured, Weiner says, via a course of nonsteroidal anti-inflammatory medicines, rest and physical therapy. That means four to six weeks before hitting the court again. If the cartilage is torn, arthroscopic surgery to repair or remove damaged cartilage is usually necessary. In a new twist, torn cartilage can be replaced with tissue from a different part of the patient’s knee or cadaver cartilage. You can only hope the donor was a former Olympian or NBA star.
Dr.’s Note: While it’s hard to prevent sports-related injuries, keeping in shape and controlling weight can help. So you won’t shoot the diagnostician, Weiner adds: “I’m 45, and I still play hardball, which is dumb, too. But young people are going to do what they want to do.”
THE EXTREMITIES
Sprain
The Treatment: In the ER, an examination and X-rays will be done to make sure there is no fracture. If it’s just a sprain, ice the injured area for the first 24 to 48 hours, says Dr. Charles Emerman, chairman of emergency medicine at The MetroHealth System. Then use heat. A splint or wrap will help, but don’t put it on too tight, which could constrict the blood supply. “You should just really roll it across,” he says. Think papier mché, not mummification.
Dr.’s Note: After a couple days, Emerman recommends doing some simple range-of-motion exercises, rotating gently. “Sprains take a while to heal up,” he says. “I typically tell people it’s going to be six weeks.”
Carpal Tunnel
The Treatment: If you’ve got carpal tunnel, typing on the keyboard might not be the only time you feel the pain in your fingers or wrists. “The pain is usually more profound in the night,” says Dr. Marek Buczek, a neurologist at the University Hospitals Health System. Medications such as Aleve and other pain relievers might help the pain. Oral steroids and diuretics can also be used. “Together with medicine, standard care is using a special wrist splint at night,” he says. Local steroid injections can also decrease swelling and reduce inflammation.
Dr.’s Note: Carpal tunnel can be a secondary condition to diabetes or hypothyroidism and will improve with treatment of the primary condition, says Buczek. Beware of repetitive movements of the fingers such as typing. “Alternate typing with some other activity,” he says. “Or use occupational splints.”
Frostbite
The Treatment: Brrrrr. “You always have to take frostbite seriously in Northeast Ohio,” says Dr. Michael Anderson, a pediatrician at Rainbow Babies and Children’s Hospital. “Kids in particular are more prone to frostbite and hypothermia because they lose a lot of heat through their skin.” If you suspect frostbite, do not rub or vigorously massage the area. Also, do not apply direct heat or pop any blisters on the skin, which could lead to infection. Soak the area in warm water. For significant frostbite, see a doctor to ensure normal circulation returns to the area.
Dr.’s Note: Prevention is important, says Anderson. Always dress your children in layers, take off wet clothes, make sure the inside layer allows skin to breathe and limit time outside to about 10 to 20 minutes. “Parents have to evoke the law of common sense,” he says. “If it’s too cold for you, then it’s too cold for your child.”
Warts
The Treatment: These rough, domed shaped patches of skin caused by viruses aren’t just for witches. They’re often on the hands and feet of little angels too. If a wart doesn’t respond to chemical treatments done in the dermatologist’s office, the patient will have to see a plastic surgeon. “What I first do is I shave the top off and then I cauterize it,” says Dr. Roland Reyes, a plastic and hand surgeon at EMH Regional Healthcare System. “I’ve had very good results with [warts] not coming back,” he says. The procedure leaves a very minimal scar.
Dr.’s Note: When trying over-the-counter treatments, patients need to be careful, Reyes says. “I have seen some patients who have left certain over-the-counter stuff on more than what is directed and they end up with what is essentially a burn,” he says. And some of these burns can go down to the bone. Ouch!
