Medical Insider Blog

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.


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.


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.


Shingles and How to Prevent It

  • Posted Jul 17, 2014
  • Audrey Liu, MD

Shingles is a painful blistering rash caused by the same virus that causes chickenpox (varicella-zoster virus). After chickenpox the virus stays in the body and quietly lives in the nerve endings in the spine, but at times it can reactivate to cause shingles. The virus comes out along the nerve, causing swelling and damage to the nerve. A painful, blistering rash appears along the path of the nerve. The acute pain lasts for a few weeks, but approximately 10-15% of people will have a prolonged pain syndrome called postherpetic neuralgia, which can last from months to years. While shingles is not considered a life-threatening infection, the nerve pain associated with shingles is very difficult to treat and can cause much suffering.  Shingles tends to occur as people age due to weakening immune systems. Approximately 50% of people after age 50 will develop shingles.

Can it be Prevented?

elderly woman getting vaccineThe Zostavax vaccine can prevent shingles. The vaccine has been available since 2006 and uses a live - but weakened - version of the varicella-zoster virus. This is the same vaccine that has been given to children to prevent chickenpox since 1995, but in a much stronger dose.

Zostavax is FDA-approved for use in adults after the age 50. The Centers for Disease Control and Prevention recommends that Zostavax be given to adults after age 60 as a one-time dose.  Side effects of the vaccine include pain and irritation at the injection site, a small rash at the injection site and headache.

Check back for my next posts, as I will be answering some frequently asked questions about the shingles vaccine.

Dr. Audrey Liu is an internal medicine / primary care physician who practices in Pompano Beach, FL at 2700 NE 14th St. Causeway, Suite 103.

Sources:
www.cdc.gov
www.uptodate.com


Gain Control Over Back Pain

  • Posted Jul 08, 2014
  • Shannon Hastings, MSPT

Photo from Web MDChances are either you or someone close to you has experienced back pain.  Most people will tell you how debilitating it can be and have sought treatment to help reduce their pain.  Treatments can range from conventional medications, physical therapy, massage, acupuncture, chiropractic care, and can sometimes require surgery.  Most patients opt for the least invasive method to treat their condition.

Physical therapists are board certified medical professionals that utilize exercise and equipment to help patients regain or improve their physical abilities.  Physical therapy can help you improve your mobility and strength, while reducing your pain to enable you to return to your active lifestyle.  The key to successful therapy requires an extensive evaluation to identify each client’s specific problems.  Once indentified, it is imperative to customize a program specific to a patient’s needs to accurately treat their diagnosis. Our job is not only to help you regain your function, but also to educate you about the specific condition you may be dealing with to better serve you moving forward in your own treatment.

The McKenzie method is an indepth assessment of the spine to develop treatment and preventative strategies for patients with spinal pain.  By identifying certain motions that can reduce or eliminate pain, it enables patients to gain control over their specific issue.  This method focuses on self treatment through exercise and stretching, which empowers the patient by enabling them to be an active participant in recovery.  It can be effective in reducing the recurrence of future episodes of pain and ultimately decreasing the length of treatment time needed with physical therapy.

Physical therapists utilize a variety of treatment options to combat back and neck pain including exercise, manual therapy, joint mobilizations, ultrasound, electrical stimulation, and traction.

Physical therapy can be utilized for a variety of spinal conditions including, but not limited to: spinal stenosis, scoliosis, sciatica, cervical or lumbar radiculopathy, spondylolisthesis, degenerative disk disease, degenerative joint disease, and arthritis.  It is also commonly prescribed following whiplash injuries from motor vehicle accidents and after spinal surgery.

If you are looking to regain your active lifestyle and would like to try physical therapy to help understand and manage your back or neck pain, speak with your medical doctor to discuss if physical therapy is the right treatment for your condition.

Shannon Hastings, MSPT, is a staff physical therapist at Holy Cross Hospital's outpatient physical therapy clinic in the Rio Vista neighborhood of Fort Lauderdale, FL (1309 S. Federal Hwy.) and may be reached at 954-267-6819.


Are stem cell injections an effective treatment for knee osteoarthritis?

  • Posted May 29, 2014
  • Francis McCormick, MD

SyringesOsteoarthritis (OA)
Osteoarthritis of the knee is a degenerative disease of articular cartilage resulting in pain and disability that can get in the way of your active lifestyle and simple daily activities. Knee osteoarthritis alone is a leading cause of disability in the U.S., with a recent increase of occurences in young athletes following a sports-related injury. The cartilage may erode completely over time, creating bone-on-bone friction exhibited by a cracking or popping sound, inflammation, and severe discomfort.
   
Current Non-Surgical Treatments for Knee OA
Current efforts to alleviate mild to moderate cases of osteoarthritis include physical therapy, weight loss and low-impact cardiovascular exercise, coupled with pharmacologic agents in order to reduce inflammation and discomfort. Pharmacological agents include the use of non-steroidal anti-inflammatory drugs (NSAIDs), viscosupplementation with hyaluronic acid, corticosteroid injections, and now stem cells and biologics. Cartilage cannot readily repair itself when damaged; the injection of stem cells and other biologics (i.e. Platelet Rich Plasma) from the body may solve this dilemma.

More on Biological Interventions for Knee OA
Historically, as the disease progresses, the efficacy of non-surgical treatments decrease, usually leaving a partial or total joint replacement as the only curative treatment for end-stage disease. In recent years, however, mesenchymal stem cells (MSCs) have been a topic of great interest as a biological intervention to regenerate damaged knee cartilage from OA. MSCs can differentiate into many types of connective tissues, including chondrocytes (the cartilage-building cells) as well as the capacity to self-renew, migrate toward injured tissues to repair them, an inhibit inflammation. Sources of MSCs include the bone marrow, fat tissue, umbilical-cord blood and amniotic fluid. Current debate exists in which source is the best to use in the regenerative scope of orthopedics and sports medicine. Many animal and early clinical studies show the effectiveness of MSCs in suppressing the pain and a possibility of regenerating cartilage, though further investigation is needed.

Is it Covered by Insurance?
For insurance to cover a medical intervention, the U.S. Food and Drug Administration (FDA) must first approve the treatment. Currently, there is no FDA approval for “Stem Cell” injections or treatments. This is an ongoing problem due to stem cells being considered a pharmacological treatment and currently lacks a consistent means of acquiring, culturing and administering to patients. Because of this, MSC therapy is very expensive with out of pocket expenses ranging from $450-$3,000. Therefore, current research aims to find the most feasible source of MSCs that creates the least amount of discomfort for the patient and increases cost-effectiveness, and also to further study the ability of the MSCs to efficiently differentiate and expand into a cartilaginous lineage. Our goal is to keep our active South Floridian out of the operating room and out in the sun.

Frank McCormick, MD is an orthopedic sports medicine surgeon who specializes in biological approaches to joint preservation. For more information on Dr. McCormick, visit his online physician profile: Francis McCormick, MD. To discuss your options in the treatment of osteoarthritis, Dr. McCormick may be reached for an appointment at 954-958-4800.

Co-Author: Emmanouil Kiriakopoulos, BS, research volunteer at the Holy Cross Orthopedic Institute.


Avoiding Weight Gain During Menopause

  • Posted May 14, 2014
  • Anele R. Manfredini, MD

Why am I gaining weight?
Despite all their efforts, most women gain weight during the menopause transition, especially around the abdomen, even while eating correctly and exercising. This weight gain is usually related to a variety of lifestyle and genetic factors, not just hormonal changes.

Menopausal women tend to be less physically active, which can lead to weight gain. Muscle mass naturally diminishes with age and decreased activity. If a woman continues to eat as she always has but reduces her activity level, she will gain weight. Furthermore, unlike body fat, lean body mass decreases with age.

Apple and Pear PhotoFor many women, genetic factors also play a role in this weight gain. If their parents or close relatives carry extra weight around the abdomen, they are likely to do the same.

Apples and Pears
Menopause plays a role in many women's midlife transitions from a pear-shaped body (wide hips and thighs, more weight below the waist) to an apple-shaped body (wide waist and belly, more weight above the waist). However, further study is needed on the exact role of menopause in body composition.

Cause and Effect
Cause of weight gain include:
• Certain drugs
• Insulin resistance
• Emotional eating: depression and stress
• Estrogen loss
• Thyroid imbalance
• Cushing's syndrome
• Lack of exercise
• Excessive eating
• The natural course of aging

Most women in the U.S. and Canada are overweight at midlife. Additional weight gain increases risk of:
• Cardiovascular disease
• Type 2 diabetes
• High blood pressure
• Osteoarthritis
• Some types of cancer, including breast and colon

What You Can Do
Make physical activity a priority. Aerobic activity can help you lose weight or maintain a healthy weight. Strength training is also important: Gain muscle, and your body burns more calories. Women should exercise for a minimum of 2.5 hours per week of moderate exercise or 1.25 hours per week of vigorous exercise (or a combination of vigorous and moderate activity), as recommended by the American Heart Association in the April 2014 Update of the Guidelines for Cardiovascular Disease Prevention in Women. Thirty minutes per day, five days a week is an easy way to break up this exercise and manage your time.

Eat less, and eat right. Reduce calories without skimping on nutrition. Eat fruits, vegetables, whole grains and lean sources of protein. Don't skip meals, which may lead you to overeat later.

Seek support from friends and family.

Turn to your doctor for support in guiding you to a healthy diet, increasing physical activity and ruling out any disease that causes weight gain.

Anele R. Manfredini, MD, is a Family Medicine physician who specializes in Women's Health.


To Stretch or Not to Stretch?

  • Posted May 06, 2014
  • Rafael Gutierrez DPT COMT

People stretch because it feels good or because they think it will increase flexibility and maybe prevent injury. Static stretching has been shown to improve flexibility, but these effects are usually temporary and may only become permanent with a consistent stretching program. For most individuals, however, stretching before exercise does not have many benefits. Much research has demonstrated an increase in flexibility following a stretching regimen because our bodies, via the nervous system, have adapted to tolerating the stretch; however, stretching did not necessarily increase joint range of motion (ROM) or muscle elasticity.

People wonder if stretching prevents injury or if it decreases muscle soreness, strength or peak sports performance (specifically in sports where flexibility is not required, such as running).

What’s the verdict?
Whether or not to stretch is entirely up to the individual, but based on the literature, it is not necessary unless you are someone who requires consistent flexibility, like dancers or hockey goalies.

There is contradictory information on stretching recommendations, but if you decide to stretch, it should be done following a warm-up or after performing low to moderate activity. It also may be more beneficial to move the joints involved in an activity through the required ROM and movement pattern for that specific activity as opposed to any type of stretching.

Although there are few studies on the correlation of warm-up and injury prevention, some research show it is possible that warming up can assist in preventing injuries. Active individuals who participate in strength or dynamic performance activities should wait to stretch after their activity is finished because of the immediate decreases in strength and performance following stretching. If you do stretch, the American College of Sports Medicine recommends the following guidelines:

• Adults should do flexibility exercises at least two or three days each week to improve ROM.
• Hold each stretch for 10-30 seconds to the point of tightness or slight discomfort (should not be painful).
• Repeat each stretch two to four times, accumulating 60 seconds per stretch.
• Static, dynamic, ballistic and PNF (proprioceptive neuromuscular facilitation) stretches are all effective.
• Flexibility exercise is most effective when the muscle is warm. Try light aerobic activity or a hot bath to warm the muscles before stretching.

Rafael Gutierrez, DPT is a staff physical therapist at Holy Cross Hospital’s outpatient physical therapy facility in Boca Raton. He may be reached at 561-483-6924.

References
Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011 Jul;43(7):1334-59. doi: 10.1249/MSS.0b013e318213fefb.

Herbert RD, Gabriel M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic review. BMJ. 2002 Aug 31;325(7362):468.

Kamandulis S, Emeljanovas A, Skurvydas A. Stretching exercise volume for flexibility enhancement in secondary school children. J Sports Med Phys Fitness. 2013 Dec;53(6):687-92.

McHugh MP, Cosgrave CH. To stretch or not to stretch: the role of stretching in injury prevention and performance. Scand J Med Sci Sports. 2010 Apr;20(2):169-81. doi: 10.1111/j.1600-0838.2009.01058.x. Epub 2009 Dec 18.

McNeal JR, Sands WA. Stretching for performance enhancement. Curr Sports Med Rep. 2006 May;5(3):141-6.

Pope RP, Herbert RD, Kirwan JD, Graham BJ. A randomized trial of preexercise stretching for prevention of lower-limb injury. Med Sci Sports Exerc. 2000 Feb;32(2):271-7.

Safran MR, Garrett WE Jr, Seaber AV, Glisson RR, Ribbeck BM. The role of warmup in muscular injury prevention. Am J Sports Med. 1988 Mar-Apr;16(2):123-9.

Safran MR, Seaber AV, Garrett Jr WE. Warm-Up and Muscular Injury Prevention An Update. Am J Sports Med Oct 1989, Volume 8, Issue 4, pp 239-249.

Sainz de Baranda P, Ayala F. Chronic flexibility improvement after 12 week of stretching program utilizing the ACSM recommendations: hamstring flexibility. Int J Sports Med. 2010 Jun;31(6):389-96. doi: 10.1055/s-0030-1249082. Epub 2010 Mar 22.

Shrier I. Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med. 2004 Sep;14(5):267-73.

Wallmann HW, Christensen SD, Perry C, Hoover DL. The acute effects of various types of stretching static, dynamic, ballistic, and no stretch of the iliopsoas on 40-yard sprint times in recreational runners. Int J Sports Phys Ther. 2012 Oct;7(5):540-7.

Weppler CH, Magnusson SP. Increasing muscle extensibility: a matter of increasing length or modifying sensation? Phys Ther. 2010 Mar;90(3):438-49. doi: 10.2522/ptj.20090012. Epub 2010 Jan 14.


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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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