Tuesday, July 11, 2017

What is a Hernia?

A. What is a hernia?

An inguinal (in the groin) hernia is a painful groin bulge. The lifetime risk of this condition is twenty-seven percent in men and three percent in women. It is one of the most common surgical procedures in the U.S.

It occurs when tissue, such as a portion of the intestine, protrudes through a weak spot in the lower abdominal muscles, causing a bulge, “hernia sac.” Symptoms include pain and bulging on the right or left groin at the pubic bone. Coughing, standing, and passing a bowel movement are painful.

Bulging is more prominent at the pubic bone. Symptoms are more prevalent with standing, coughing, passing a bowel movement and straining. Pain may radiate to the scrotum. A burning or aching sensation occurs at the bulge. Application of an ice pack could ease pain and swelling. This reduces swelling enough so that the hernia slides inward with direct pressure. Watchful waiting is reasonable if symptoms don’t progress.

B. Cause

Hernias can be the result of a pre-existing weak spot in the groin, known as the “superficial inguinal ring.” Low abdominal wall weakness at the inguinal canal can be present at early childhood. Hernias can develop as the result of straining during bowel movements, strenuous physical activity, chronic coughing, or sneezing. In men, the weak spot is the inguinal (groin) canal, where the spermatic cord enters the scrotum. In women, the canal carries a ligament that helps hold the uterus in place. Hernias may be inheritable. Some hernias have no apparent cause.

C. Surgery is recommended to repair the hernia if is painful or enlarging. Incarcerated hernia is when the patient can’t nudge the hernia bulge back in place. This would suggest a “strangulated hernia.” A strangulated hernia cuts off the blood flow to tissue that is trapped. It could progress to bowel obstruction, which is life-threatening and surgery is necessary.

There are two types of hernia surgery; open and laparoscopic repair. Open repair is done under local anesthesia and sedation. The incision is closed with stitches, staples or surgical glue.

Laparoscopy this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in the abdomen. Gas is used to inflate the abdomen to make the internal organs more visible. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.

People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).

D. Prevention
·         Maintain a healthy weight. Talk to your doctor about the best exercise and diet plan for you.
·         Emphasize high-fiber foods. Fruits, vegetables and whole grains contain fiber that can help prevent constipation and straining.
·         Lift heavy objects carefully or avoid heavy lifting. If you must lift something heavy, always bend from your knees — not your waist.
·         Stop smoking. Besides its role in many serious diseases, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia.

·         Don't rely on a truss. Wearing a supportive garment designed to keep hernias in place (hernia truss) doesn't correct the problem or help prevent complications. Your doctor might recommend a hernia truss for a short time before surgery to help you feel more comfortable, but the truss isn't a replacement for surgery.

Monday, May 15, 2017

Hip Replacement

Image result for picture of older person reading a manual

Are you suffering from long term hip pain? The resulting difficulty of standing up and climbing stairs can make life miserable.  

Research reveals there are several sources of hip pain. When you are overweight there is additional stress on your joints. This can be compounded by osteonecrosis, an inadequate blood supply to the hip joint, which causes bone thinning and may ultimately collapse the bone. Dead bone tissue generates pain.  Arthritic damage is probably the most common reason to need hip replacement.  Arthritis degrades hip cartilage. The source of hip, pain in this case, is joint inflammation.

Initially, people try home exercises and physical therapy to improve balance and function. Over the counter medicines include Ben Gay, Capasaicin and Zostrix can help with pain management. More intense pain can be alleviated with prescription pain medicines. Weight reduction, over time, improves mobility. Holistic therapy may simply include a weight loss of 20 – 30 lbs.

Hip Surgery as a Solution

You might consider hip replacement when you're experiencing pain that persists despite home exercises and physical therapy. Artificial hip joints have a polished metal or ceramic ball that fits into a cup liner of hard plastic. Some prostheses use a metal cup liner, which may last longer (see illustration). If function doesn’t improve, total hip arthroplasty (touching up the bone) would be the next step. The primary goals of hip surgery are to increase mobility and function.

Post-op Recovery

Pain control is highest in the hierarchy of importance. You want to get a good night’s sleep. Sleep is restorative both physically and mentally.
The operated hip should not be flexed more than ninety degrees to prevent damage to the hardware. Once again, mobility initiates healing.

Post-operative physical therapy is crucial for improving mobility and balance. Recovery starts with simply using a wheelchair. The next step is incorporating a non-weight-bearing exercise called pool-walking. It is what it sounds like, simply walking in a pool against the water’s gentle resistance. This has a twofold effect. You increase blood flow to the hip, which speeds up healing; at the same time retraining muscles. Pool-walking also increases endorphins, hormones that give you a feel good sensation despite the pain of recovery. Gradual mobilization hastens progress and prevents blood clots.

Complications your physician will discuss with you might include post-operative infection, loosening of the prosthesis, blood clots, and infection.

How do you know hip surgery has taken effect? When you are progressively improving and the pain is gradually diminishing, then you are on the track to recovery. Are you exercising regularly? Go on-line to find locations in your area for a fitness program. ? Weight reduction, walking, stretching, and fitness classes are prescribed.
Older people may procrastinate. They may dread failure. Reassurance and motivation go a long way. We all want to get things done quickly. There are days you may not be able to summon up the energy for recovery; give yourself some grace to rest. Rest is an important part of recovery as well. Surround yourself with people in your life who are encouragers. A hopeful outlook and having a purpose in life will do a great deal in moving towards more pain-free mobility.

Saturday, February 4, 2017

Home Safety for Seniors

By Col. Ret Clement Hanson

Home Safety for Seniors: Old Folks at Home
During our military years, all of us have seen a few too many houses! You have been retired in Colorado for many years and want to put off another move for a long as possible.  Before you suffer a broken bone, make some minor fixes to your house which means fewer changes for you down the road. Now is the time to make life easier for the future and maybe save a painful and long recovery from a broken bone.
Older adults compose 11% of the population, but account for 23% of accidental deaths. Consider that in this population decreased reaction times, balance, hearing, and smelling abilities are decreasing even before we are aware and willing to admit it. Eyesight, depth-perception and peripheral vision are important to avoid a misstep. Increased use of prescriptions is more likely to cause dizziness and forgetfulness.
Last month, I discussed driving adjustments for older adults. This month is an article about accidents in the home, particularly falls. In the next months, I will give information about fire hazards and hazardous products commonly in the home.
Minor improvements will be mentioned first, followed by more extensive remodeling projects. Relatively easy and inexpensive fixes will be listed for the bathroom first, because that is the room where most accidents occur.
·         Install raised toilet seats.
·         Grab bars by the toilet, in the shower and tub areas.
·         Shower stool.
·         Mixer valve to avoid sudden hot and cold water.
·         Non-slip rugs
·         Lower the water heater temperature to 120 degrees to prevent burns
·         Do not store clutter on the stairs.
·         Extra railings
·         Improve lighting
·         Mark the edges of the highest and lowest step with bright-colored tape.
·         Good lighting
·         Use non-slide mats, no decorative rugs that slip.
·         Remove extension cords from traffic areas.
·         Place stools where you change shoes. Do not wear wet shoes into the house.
·         Wear good shoes with no loose shoe strings.
·         If you must use a ladder or step stool, make sure it is very sturdy. If you feel you must do these chores, do not hurry, be certain you are not tending to light-headedness due to illness, medicines, OR ALCOHOL. If your spouse says, “Don’t do it,” listen.

More Extensive Home Improvements:
·         Install new fire and carbon monoxide alarms with a ten-year life span. Then you do not have to think about getting on a ladder every time a fire alarm beeps. Have an electrician install them now, and give it no more thought for ten years!
·         Have your home security in top shape. Many possibilities to consider as technology improves. Video doorbells allow you to answer the door with your phone, whether you are home or not. Motion detector lights outside, both for your safety at night and to discourage intruders. Tell your regular visitors to call you before they come.
·         Have cellphones that you know how to operate for emergencies. Avoid having to rush to a telephone or the door when you can fall in the rush. Set up a MedAlert system.
·         Replace round door knobs with lever-type handles. Arthritic hands have a hard time with round knobs. Service dogs can open lever knobs, of course your cat can too!
·         Non-slip floor surfaces, especially where feet may be wet as in bathrooms and by outside doors.
·         Ramp at an exterior door.
·         Lifts at the stairs. Remodel to build a downstairs bedroom.
·         Make improvements that allow wheelchair or scooter access. Widen the interior doors to 36 inches wide.
·         Electric stoves instead of natural gas. This will remedy natural gas flooding and open flames.
·         Walk-in bathtub.
·         Have bathroom doors swing to outside the room instead of inside. If a person falls inside, they often block the bathroom door from opening, which makes it difficult for someone to enter the bathroom.

Keep in Mind: Any fall is a predictor of future falls. Two-thirds of folks who have fallen, will fall again within 6 months. The older the person, the more severe the falls and more likely to experience a broken bone. Many of those who fall will never return to their former functionality, and many will die from complications from falls.

Elders are often reluctant to admit to a fall for fear their activities will be curtailed. Modify your surroundings before something happens and have another pair of eyes look at your environment for hazards you have long grown used to and do not notice. 

Saturday, January 7, 2017

Older Drivers Driving!
Let’s look at some driving statistics. Drivers over the age of sixty have the highest incidence of fatalities. However, ninety percent of crashes are preventable. Thirty percent of fatal crashes occur in people sixty-five and older. Those accidents mostly occur in intersections. I recently experienced my first accident in forty-five years. It was scary and I don’t want to repeat it. Yes, it occurred at an intersection and it should have been prevented. I’m over sixty-five. It was my fault.  Thank goodness, there were no injuries. The incident compelled me to reassess my driving skills.

On the AARP (American Association of Retired Persons) website, there is an “older driver’s review course” that I found helpful. Check it out. The cost is $19.95 for AARP members. The entire program includes four hours of interactive instruction that you can complete in up to sixty days. As you work through the course,   your computer will remember where you left off. Take it at your convenience. The instruction is designed for older learners, and it’s entertaining. Select, “Colorado” from the menu. A few things have changed since you learned how to drive in your dad’s 1955 stick shift on rural roads.

I won’t insult your intelligence by listing all Colorado driving rules. You know the importance of seat belts. Don’t drive and drink. Hey, wait! We didn’t always have those laws! Your best girl used to slide across the front seat to be close to you on dates.  No more! Grand-kids must sit in the back seat in specially designed seats.

Do you have the habit of swinging your right arm over the passenger seat when you brake suddenly? This was to restrain and hold in place the kid without a seatbelt in a seat that folds over to allow passengers to get into the back seat. We have already unlearned old habits. Let's learn new habits.

You may have some health issue to take into consideration now. Know your prescription drugs and how they may affect your response time. You may have passed your last eye exam, but don’t assume that you see like an eighteen-year-old. Compensate for a decrease in your depth and peripheral vision. When was your last vision exam? Scan from left to right constantly. Don’t stare blankly straight ahead.

If night driving bothers you, be prudent and admit your weaknesses. If glare from rain, ice, and snow confuse you, postpone the trip. You are not as quick with your feet anymore. Reaction time has slowed, so increase your following distance. Three seconds should pass between when the vehicle in front of you passes a stationary object, and when you pass it.
You fatigue more quickly during long trips. Don’t plan long stretches of driving within a day. Stop for breaks and coffee. The trip you used to take in a day may now require two days. Do I need to remind you that alcohol consumption while driving is deadly? Even more so with older drivers. Select a designated driver.

Turn down the radio as well as your noisy passengers. Drive with your lights on during the day and night. Consider a driver's refresher course for seniors.

Our cars and technologies have changed a great deal. The AARP course can bring you up to date. Remember when an airbag was someone who talked too much?Anti-lock brakes require a firm touch, not pumping. They require practice. You will appreciate skidding straight instead of doing 360s.  Adjust your mirrors. Use them and know how to adjust them. Know your “blind spots.”

GPS, smartphones, and the Garmin are great for finding your way. Learn how to use them and practice while you are a passenger. Your grandkids can help you with that. Technology, of course, is not infallible in some high density or remote areas. Keep a paper map in your car. Your grandkids will be impressed you can read one.  Always have a charger in your car for your cell phone.  

Most accidents involving older drivers occur when making a left turn. Pay attention to the green and red arrows at stoplights. No green arrow? Do not turn left until there is a sufficient break in the traffic. Older drivers are most often stopped for failure to yield the right-of-way. Know who must yield and who can go.

In our lifetimes, we have learned to drive in five lanes of traffic in each direction and intersections stacked four bridges high, turning right to turn left. Wow! All of this can be confusing. If this bothers you, avoid congested roads during rush hours. Practice driving during the slow part of the day with a more experienced driver. Otherwise, fly to Los Angeles and don’t drive. Two sets of eyes are better than one if you are not arguing with the other set of eyes. Consider stopping at a rest area. Pull over, get out, stretch, settle your differences, and do some pushups. The AARP website contains information on rules of the road, sign interpretation, crash reporting, and vehicle maintenance. Check it out.

Finally, hope is in sight. Self-driving cars are not far in the future!

Source: AARP.ORG website. In addition, contact call AARP 1-800-350-7025.

Sunday, October 23, 2016

How to Avoid Spreading Disease.
Do no spit.
Do not put fingers in the mouth unnecessarily.
Do not pick the nose or wipe it on the hands or sleeves.
Do not put pencils in the mouth.
Do not put anything in the mouth without a good reason, and never when it has been in another’s mouth.
Do not use a common drinking cup.  Use your own.
Never cough or sneeze into the air or in another person’s face. Use a handkerchief.
If the hands become soiled with saliva or nasal secretion, wash them.
If you use another’s tobacco pouch, do not close it with your teeth.

Source: Myers,P., 1994, Disease Prevention:  U.S. Army Health services Command (Prov), Preventive Medicine Division, Medical War Manual, Sanitation for Medical Officers, by Edward Vedder MD. Published by Lea and Febiger, 1917. 

Friday, July 22, 2016

The “flu,” Influenza, resolves with no specific treatment. However, it can be deadly for children under two to five years of age. Adult flu risk factors include age over sixty five, residents who live in care centers, and those with as asthma, heart disease, obesity, kidney disease, and diabetes.
Flu symptoms include fever over 100 degrees with muscle aches. It can be transmitted from one person to another by coughing, sneezing, or handing an object to another person who has the flu. Seasonal influenza targets young children and older adults. People with weakened immune systems and those who live with other residents, such as nursing homes, are more likely get the flu. .Antibodies against past flu sickness provides no protection against the current flu virus.

Flu risk factors include having had cancer treatment, anti-rejection drugs for organ transplant, and HIV/AIDS infection. The flu virus weakens the immune system. It increases risk for those with asthma, diabetes, and heart problems. Prescription medications that shorten the clinical course include Oseltamivir (Tamiflu), and Zanamivir (Relenza), both administered by inhaler. These medicines should not be prescribed for those who have underlying COPD (Chronic Obstructive Pulmonary Disease) or asthma. Symptoms can be alleviated by drinking water, juice, and warm soups. These remedies prevent dehydration. Increasing sleep time bolsters the immune system. Tylenol or Ibuprofen alleviate muscle aches.
The Centers for Disease Control and Prevention recommends annual flu vaccination for everyone over the age of six months. Frequent hand-washing lowers flu risk. Alcohol-based hand sanitizers prevent spread of flu sickness.
Sources of flu sickness including child care centers, schools, auditoriums and public transportation facilities. Antiviral medicine side effects include nausea and vomiting. These symptoms can be lessened if the medicine is taken with food.

The Centers for Disease Control and Prevention recommends annual flu vaccination for everyone over the age of 6 months.
Each year's seasonal flu vaccine contains protection from the three or four influenza viruses that are expected to be the most common during that year's flu season. The vaccine is available as an injection or nasal spray.
The flu vaccine isn’t one hundred percent effective. Thorough and frequent hand-washing is an effective way to prevent infection. Use alcohol-based hand sanitizers if soap and water aren't available. Cover your mouth and nose when you sneeze or cough. To avoid contaminating your hands, cough or sneeze into a tissue or into the inner crook of your elbow. Flu spreads easily wherever people congregate, including child care centers, schools, office buildings, auditoriums and public transportation areas. If you’re sick, stay home for at least twenty four hours or until symptoms resolve. Drink plenty of liquids to prevent dehydration.
This will lessen your chance of infecting others. Getting more sleep can bolster your immune system. Use over-the-counter pain relievers, such as acetaminophen (Tylenol), or ibuprofen (Advil, Motrin) to combat the achiness associated with influenza.

Be careful not to take too much of Tylenol or Advil. Overuse of these medicines could cause a rare side effect, Reye’s Syndrome.
The Centers for Disease Control and Prevention recommends annual flu vaccination for everyone over the age of six months. The vaccine is available as an injection or a nasal spray.
Use hand sanitizers if soap and water aren't available. Cover your mouth and nose when you sneeze or cough.
Flu spreads easily wherever people congregate, to include child care centers, schools, office buildings, auditoriums and public transportation. By avoiding crowds during peak flu season, you reduce the infection risk.
If you do get the flu, stay home for at least twenty four hours after your fever subsides This will decrease your chance of infecting others.

Source: http://www.medscape.org/sites/advances/influenza-prevention