Medical Insider Blog

Carpal Tunnel Syndrome

  • Posted Dec 15, 2014
  • Kathryn A. H. Heim, MD

What is Carpal Tunnel?

Healthy Carpal Tunnel v Median Nerve Compression
Several nerves supply feeling and function to the hand. One of these nerves, the median nerve, passes through a small canal near the wrist called the “carpal tunnel” along with several tendons that go to the hand.  When the median nerve gets pinched inside the tunnel, this condition is known as carpal tunnel syndrome.

Symptoms

The most common symptom of carpal tunnel syndrome is numbness and/or tingling in the hand, specifically in the thumb, index, middle and part of the ring finger. Patients with this condition often wake from sleep with tingling and the need to shake their hand to relieve the symptoms. Some patients also have pain that travels up the arm from the hand. 

Diagnosis

A variety of other conditions may also cause numbness and tingling in the hands, and a physical exam by a doctor along with nerve testing can help to determine what is causing your numbness and tingling. 

Talk to your doctor if you suffer from the above symptoms regarding possible treatment options.

Dr. Heim is an orthopedic surgeon who specializes in hand and upper extremity conditions. She practices in Lighthouse Point and Boca Raton, FL. For a physician referral, call 954-440-7606.


Inguinal Hernia

  • Posted Dec 02, 2014
  • Christopher Seaver, MD

Source: EbscoInguinal hernias are one of the most common surgical problems in the United States and account for over 600,000 annual procedures.  An inguinal hernia may be defined as a defect in the lower abdominal wall or groin that results in a protrusion of abdominal contents.  Symptoms are variable and range from a simple groin bulge to severe abdominal pain. Consequences of an advanced or strangulated (non- reducible) hernia may be severely morbid or even life threatening. Not all inguinal hernias require repair, however. If symptomatic, they are usually in need of surgical evaluation. Lifetime risk for males and females are 27% and 2% respectively.

Inguinal Hernia Repair

There have been multiple advances in inguinal hernia repair and the latest options include traditional open repair, laparoscopic/minimally invasive (MIS) and robotic-assisted repair.  The underlying principle in all methods of repair involves placement of a permanent mesh covering the defect. The method of repair depends on surgeon experience, primary vs secondary occurrence and medical-surgical history.  As technology has evolved, minimally invasive repair (including robotic repair) has shown equivalent short-term outcomes in terms of recurrence, compared to traditional open repair.

Major Advantages of Minimally Invasive Repair (Including Robotic Repair)

● Better outcomes in terms of long-term recurrence

● More rapid return to full activity

● Less pain

● Smaller incisions

Traditional repair requires avoidance of strenuous activity for nearly two months vs only 2-5 days with MIS. Furthermore, as many as 15% of patients have bilateral hernias(both groins) that can be repaired through the same small incisions with MIS vs two large groin incisions with traditional repair.

In the hands of a skilled MIS surgeon, laparoscopic and robotic assisted inguinal hernia repair has clearly become the repair of choice. If you believe you are experiencing the symptoms of an inguinal hernia, please visit your primary care physician or a general surgeon. If the pain is severe or disabling, urgent evaluation in an emergency room is necessary.

Dr. Seaver is a general surgeon who practices in Fort Lauderdale, FL and specializes in minimally invasive and robotic-assisted general surgery. For a physician referral, call 954-440-7606.


Platelet Rich Plasma (PRP) Therapy

  • Posted Nov 07, 2014
  • Fernando Manalac, MD, MMM

Used by professional and recreational athletes alike, platelet rich plasma therapy is used to regrow/heal tissue that is not healing or not growing. This therapy is done to address situations that in the past have required surgery.

This procedure is completed within 45 minutes in my office. Your blood is drawn and placed in a centrifuge that spins and separates the platelets and a little bit of white blood cells, and some of the plasma.

The platelet rich plasma concentration is then injected back into a very focused and specific part of the problem area using ultrasound / imaging guiance. In each platelet lives alpha-granules which contain all of the growth factors you need to heal or grow tissue. Following this procedure, physical therapy and other modalities are necessary.

PRP injections can be done for treatment of partial tendon tears, ligament tears, cartilage injury and osteoarthritis.

More information on this procedure, including what patients can expect after a PRP injection may be found in my interview below:
 
PRP Injection Video Screenshot

Dr. Manalac is a Primary Care Sports Medicine physician who practices in Fort Lauderdale, FL. For a physician referral, call 954-440-7606.


Cancer Patients Who Develop Brain Tumors

  • Posted Nov 06, 2014
  • Ali Jourabchi Ghods, MD

Brain Image from Medline Plus Medical EncyclopediaCerebral metastases are the most common intracranial tumor in adults. Studies have shown that 20-40% of cancer patients will develop cerebral metastases during their disease course. With the combined enhanced detection modalities and new cancer therapies, the life expectancy of patients with cancer is increasing, leading to an increase in expectance of brain metastases. This makes the treatment of cerebral metastases an important consideration in modern cancer therapy.

Historically, cerebral metastases were managed with palliative therapy and were considered the end stage of a patient’s disease, with a prognosis of less than a month. This improved with the introduction of corticosteroid therapy in the 1960s, followed later by the addition of whole brain radiation therapy (WBRT).

Currently, the life expectancy of patients with brain metastases can be dramatically increased with both a combination of surgery and radiation, whether stereotactic radiosurgery (SRS) or WBRT. Corticosteroid therapy is important in the treatment of symptomatic metastases but has significant side effects. Surgery alleviates the need for corticosteroid therapy, reducing the complications from steroid use (i.e. Infection, psychosis, myopathy, intestinal bleeding, elevated sugar and blood pressure). Therefore, surgery for cerebral metastases can have a profound impact on both life expectancy and quality of life.

At the Holy Cross Neuroscience Institute, our multidisciplinary group of expert staff (neurosurgeons, oncologists, radiation oncologists, pathologists and radiologists) determines the best treatment option for patients afflicted with such tumors. Not only do we treat the disease, but we spend time tailoring treatment best suited on an individual basis, knowing not every case is the same. We have expanded our team in order to treat patients in the community and all of Broward and nearby counties. In doing so, we hope to make it easier on patients and families in the community who would otherwise need to commute long distances to other hospitals in order to receive treatment. Our goal is to make a difference and to give a longer and more meaningful quality of life to both the patient and their family.


Dr. Ghods is a neurosurgeon who specializes in brain tumors, and he practices in Fort Lauderdale, FL. For a physician referral, call 954-440-7606.


Ask the Doc - Ali Jourabchi Ghods, MD, Neurosurgery: Why did you become a Neurosurgeon?

  • Posted Oct 22, 2014
  • Ali Jourabchi Ghods, MD

Dr. Ali Jourabchi GhodsI remember meeting a man in his 30s at the local gym fifteen years ago. At the time I was doing research on malignant brain tumors at a university hospital in Los Angeles. The man overheard me mention the name of the neurosurgeon I was working with and approached me with a smile to convey a story regarding his wife, who was diagnosed with breast cancer and large brain metastases two years before. The man grinned as he told me that his wife passed away the year before at the age of 40, and my mentor was the man who removed her tumor. I thought to myself, “Why is this man smiling if his wife passed away?” It soon became clear. His wife was given 3-4 weeks to live as a result of her tumor, and one surgeon said there was nothing to be done. My mentor, on the other hand, told the husband “I’ll go in with a spoon and a knife if I have to and get it out.” At the end of the story, his wife lived 16 more months and in those months were the best times they shared with one another.

My question of why this man had a smile on his face was now answered. This is why I became a neurosurgeon.

Dr. Ghods is a neurosurgeon who specializes in neurological conditions including glioma, brain metastases, meningioma, trigeminal neuralgia, minimally invasive spine surgery and stereotactic radiosurgery. Learn more about Dr. Ghods on his physician profile: Ali Jourabchi Ghods, MD. For a referral to Dr. Ghods, please call 954-440-7606.


Ask the Doc - Audrey Liu, MD, Internal Medicine: Shingles Vaccine and Chickenpox

  • Posted Aug 18, 2014
  • Audrey Liu, MD

Q: Since the cause of shingles is the chickenpox virus that stays in the body, can/should Zostavax (the shingles vaccine) be given even if I've never had chickenpox before?

Dr. Liu: You can be given Zostavax even without a clear history of chickenpox. Studies have shown that most people born before 1980 have had chickenpox, whether or not they recall actually having the infection.

Dr. Audrey Liu is an internal medicine physician who practices at the Holy Cross Medical Group Pompano Beach Practice. For a referral to Dr. Liu, please call 954-440-7606.


Do We Say Goodbye to Pelvic Exams?

  • Posted Jul 30, 2014
  • Anele R. Manfredini, MD

American College of Physicians logo

After a review of studies conducted between 1946 and 2014, the The American College of Physicians (ACP) - which represents 137,000 internal medicine physicians and related s
pecialists - recently released new guidelines regarding an annual pelvic exam.

A pelvic exam consists of inspection of the external genitalia; speculum examination of the vagina and cervix; bimanual examination of the adnexa, uterus, ovaries and bladder; and sometimes rectal or rectovaginal examination.

Pap smears on the other hand is a method of cervical screening used to detect pre-cancerous and cancerous cells from the cervix  and endocervix.

The new guideline concluded that the risks posed by pelvic exams may outweigh the benefits for most healthy women since they may result in false positives, leading to unnecessary tests and procedures. Also the ACP states that the exam "rarely detects important disease and does not reduce mortality." Having a pelvic exam can cause women discomfort, anxiety, pain and additional medical costs.  Studies also showed little benefit in detecting ovarian cancer or other disorders.

As a result the ACP “recommends against performing screening pelvic examination in asymptomatic, non-pregnant, adult women” who have no elevated risk of cancer or other disease.

The American College of Obstetricians and Gynecologists, however, immediately responded in favor of doctors’ continuing to perform routine pelvic screening on healthy women. That group “continues to firmly believe in the clinical value of pelvic examinations,” it said in a statement, which helps physicians to diagnose incontinence, sexual dysfunction, and allows them to explain a patient’s anatomy.

This topic is still controversial among different organizations, therefore, you should discuss with your primary care physician or gynecologist if having an annual pelvic exam, in addition to pap smears, is appropriate for you.

Dr. Anele Manfredini is a family physician who specializes in women’s health, and she practices at the Dorothy Mangurian Comprehensive Women’s Center. For a referral to Dr. Manfredini, please call 954-440-7606.


Ask the Doc - Audrey Liu, MD, Internal Medicine: Vaccine if You've Had Shingles?

  • Posted Jul 22, 2014
  • Audrey Liu, MD

Q: Last time, you wrote about Zostavax as a vaccine that prevents shingles. Can it be given if you've had shingles before?

Dr. Liu: Yes, Zostavax can be given even if you have had shingles before.

Dr. Audrey Liu is an internal medicine physician who practices at the Holy Cross Medical Group Pompano Beach Practice. For a referral to Dr. Liu, please call 954-440-7606.


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About Holy Cross Hospital

Holy Cross Hospital is a nonprofit, Catholic hospital in Fort Lauderdale, Florida, dedicated to innovative, high quality and compassionate care. For nearly six decades, Holy Cross has continuously expanded its services to provide leading-edge care for their patients in Florida and for those from elsewhere in the United States. Holy Cross also offers an International Services program to ensure that patients from outside the U.S. receive the care they need.

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