Cytokine Storm – Treatment with Etanercept – Could it Stop Influenza Death?

Mild cytokine reactions give you a flu like situation where achy all over and malaise. Cytokine storm occurs with certain viral infections and can kill. Etanercept (Enbrel) can block that effect some in the mouse model infected with H1N1.

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Hip Labral Tear or Impingement – Steroid Injection Not Good

Steroid injection into hip with impingement or labral tear only gave relief for 10 days.

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Some Supplements May Aid Cancer Growth – A Few Might Stop

One would naturally assume keeping in good health through supplements would help your fight with cancer. Turns out, cancers may like supplements too…

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Aphthous Ulcer/Canker Sore – Pepto-Bismol Treatment

Simply applying pepto-bismol to a canker sore with a q-tip or “swish and spit”  for multiple sores can soothe irritated area within minutes

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Fibromyalgia – Part of “Software Malfunction” is Dopaminergic/GABAergic Neurotransmission Disruption

Excessive pain due to brain central sensitization has been called a “software malfunction”. Part of that appears to be of Dopa/GABA circuits.

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Sacrococcygeal (SC)Ligaments Look Like Facet Ligaments And May Be Source of Pain

On anatomical study “small nerve fibers were observed adjacent to the ventral aspect of the SC intercornual ligament and piercing the ligament in one specimen” – similar to what is seen in facet joints. Commentary on article speculated they could be a source of pain and perhaps treated similarly to facet joints.

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Posted in coccygodynia | 1 Comment

Post Herpetic Neuralgia (PHN) Treatments – Lots More Than Just Pills

Pregabalin helps 1 in 4.93 while lidocaine patch helped 1 in 2.. Still, reliance on meds only helped 1/2 then…- there are plenty of alternatives though

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Followup Guidelines For Early Breast Cancer

Primary Care Physician (PCP can do much of followup. Here are guidelines:

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Chemotherapy Neuropathy – Prevent and Treament

Use of agents to reduce chemotherapy induced peripheral neuropathy confounded by issues of decreased anti-cancer effectiveness. L-Acetyl Carnitine during chemotherapy, and Venlafaxine or Duloxetine after are my choices.  Tricyclics, gabapentin, lyrica, and topical agents did not rate well and belie the idea neuropathy can be treated as a”group” process.

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Bruxism (Teeth Clenching) – At Last a Treatment

Electrically stimulating a masster muscle should pulse go over 110% during night helps suppress bruxism.

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Fibromyalgia (FM) Recommendations Vary By Country

Canada has no alternative (CAM) FM treatment recommendations but Isreali and German Recommendations do..

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Monotherapy Mediocre in Treating Fibromyalgia (FM)

New Acceptance and Commitment therapy – 8 sessions of 2.5 hours reduced pain by 20% in 1/2 cases but only 50% in 1/48 cases. Fairly maximal drug therapies with pregabalin +/- Duloxetine alone was not great

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High Dose Metoclopramide (20 mg IV over 15 min) Beats Subcut Sumitriptan (Imetrix) 6mg For Acute Headache

Metoclopramide 20 gm IV was VAS pain score  0.55/10 better on VAS than Sumitriptan injectable 6 mg. However, the later needed starting an IV and slow infusion over 15 minutes to avoid extrapyramidal oculogyric crisis (0.2% incidence with the 10 mg)

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Applying Sleep Hygiene Questionnaire to Chronic Pain Subjects Comes Out With Two Factors

Irregular Sleep -Wake Schedule and Sleep Disturbing Behaviour and Environment factor out as two main sleep issues in chronic pain.

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In Unilateral Chronic Episodic Headaches – Should Prolactin Levels Be Done?

Recently a series of patients with Prolactinomas (a pituitary prolactin – secreting tumor in brain) was published. They found they often presented with either one sided migraines (often orbital) or SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). They felt prolactin levels should be done in those with with trigeminal autonomic cephalalgias like SUNCT. Cabergoline, a dopamine agonist, worked well.

prolactinoma

 

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Hip/Knee Arthritis – Not Satisfied With Acetaminophen? – Using Arthritis Pills (NSAIDs) Instead Helps

When Osteoarhtritis patients were allowed to try NSAID instead of acetaminophen,  “proportion of patients on acetaminophen treatment during the study decreased from 74.8 % at baseline to 23.9 %, while the proportion on non-steroidal anti-inflammatory drugs (NSAIDs) increased from 59.8 to 85.8 %.”

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Hypnomanic Checklist

Once had a psychiatrist phone me very irritated because I had diagnosed a teeanger as potentially bipolar. Fortunately, I had seen her hypomanic, and run a hypomanic questionnaire at time – adequate documentation despite his hostility (guy needed a holiday). Chronic depression and a history of suicide in family helped as well. Here is a simple checklist taken from the 15 point checklist:

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Taping Elbow Reduces Tennis Elbow Pains 50% – But Maybe Use a Band?

Taping around a tender tennis elbow can reduce pain from 4/10 to 2.2/10

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Remarkable New Treatment – Injecting Over Tenderized Skin Nerves With Plain 5% Dextrose

For year I felt the main expression of chronic pain was through activation of myofascial knots – now it looks like tenderized skin nerves is a front runner. Merely injecting D5W overtop tenderized nerve tracts an average of 6 weekly times can settle down even recalcitrant back pains.

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Posted in Back Pain, Injection, Leg Pains, Neck | 4 Comments

T Wave Inversion in AVL Could be Important – Don’t Always Rely on ECG Computer Diagnosis

In an acute coronary syndrome situation in emergency, ALV inversion had significance.  84.8% of patients had > 50% obstruction of the mid-segment left anterior descending (MLAD) artery.  In subjects with >50% obstruction, 84.9% had T wave inversion in one other lead – mostly lead I. In subjects with no significant obstruction, finding another lead inverted was only half as likely (42.1%).  It had a 76.7% sensitivity and 71.4% specificity.

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New Daily Persistent Headache Lasting Over 1 Year Responding to Nimodipine (Nimotop)

Case of thunderclap (severe sudden onset) headache associated with inability to do calculations (acalculia) that persisted for 13  months despite interventions.  Nimodipine 30 mg, initially bid, then od, relieve headache. It was felt that cytokines and vasospasms persisted the headaches.  Nimodipine is a TNF/interleukin inhibitor as well as an antispastic drug used in subarachnoid hemorrhage cases – which is why it was thought to miraculously work.

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Extensor Digitorum Brevis Manus as Cause of Dorsal Hand Pain Myalgias – Botox Rx

This  anomalous hand muscle presents as a a “fusiform, soft prominence” between the 2nd and 3rd extensor tendons near the wrist to hand. It can become sore as it is compressed against the extensor retinaculum and possibly irritates the posterior interosseous nerve.  Botox injections helped one case.

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Unresectable Painful Bone Cysts – IV Zoledronic acid For Adults and IV Pamidronate For Children Gives Rapid Relief

Painful large and unresectable bone cysts responded rapidly to IV biphosphonate therapy within first cycle in 88% of cases. Adults received 4 mg of Zoledronic acid (Zometa®, Novartis), and children got IV pamidronate 1mg/kg.  Zoledronic acid, if more than one was needed, was cycled every 1-2.7 months; pamidronate was cycled every 2.7 – 6 months.

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Posted in Back Pain, children, Drugs, Hip Pains, IV therapy | Leave a comment

Knee Arthroscopic Surgery – NEJM Needs to Get Their Story Straight

Quite some years ago, NEJM published an article saying flushing of the knee did not help knee pains, putting an end to that procedure. Now an article has been published by same journal says that partial arthroscopic meniscetomy does not work because flushing with sham surgery alone will decrease pain by 50% in two months. Sorry, NEJM, you can’t say both…

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Teenage Chronic Headaches – 1/2 Might Be Chewing Gum

Isreali article found in teeenagers with chronic headaches, 19/30 cases resolved by quiting gum chewing

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