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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 954-900-6653.


Platelet Rich Plasma (PRP) Therapy

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

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 954-900-6653.


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 954-900-6653.


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 954-900-6653.


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 954-900-6653.


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.


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.


Rehab, Relax and Restore

  • Posted Feb 17, 2014
  • Rafael Gutierrez DPT COMT

Orthopedic manual physical therapy is a hands-on approach to treating musculoskeletal and neuromuscular dysfunction. Physical therapists trained in manual therapy use specific techniques, such as joint mobilizations, manipulations, soft tissue techniques and therapeutic exercises for improving mobility and function throughout the body.

Conditions Treated

Manual therapy is effective for a wide range of ages and can be used to treat many conditions, including:

• Orthopedic and sports injuries
• Cervicogenic headaches
• Neck and back pain
• Radiculopathy
• Sacroiliac dysfunction
• Postural dysfunction
• Postsurgical issues
• Osteoarthritis
• Ligament sprains
• Muscle strains
• Tendinopathies

How it Works

Manual therapy is effective because it helps restore normal mobility to affected joints and muscles. Joint mobilizations and manipulations help reduce stiffness, increase circulation, decrease pain, and restore mobility in joints to improve biomechanical motion. Soft tissue techniques also increase circulation and relax muscles so they can move through the normal range of motion without restrictions.

Therapeutic Exercise

Therapists who have undergone advanced training in orthopedic manual therapy have also received training in therapeutic exercise geared specifically toward rehabilitation. These exercises may differ from your typical exercise routine because they are dosed and targeted specifically toward the problem areas. Therapists will also address other areas in the body that may be adding to the problematic site during the therapy sessions. Through manual therapy and therapeutic exercise, physical therapists can help patients reduce pain and restore normal function to help patients return to their daily activities.

Rafael Gutierrez, DPT, COMT, is a staff Physical Therapist at Holy Cross Hospital’s outpatient physical therapy clinic in Boca Raton. He may be reached at 561-483-6924. Meet our other therapists and learn how we can help you get moving again at www.HolyCrossOrthoRehab.com.


Holy Cross Hospital Receives UnitedHealth Premium® Cardiac Services Specialty Center Designation

  • Posted Apr 08, 2013
  • By Holy Cross Administrator

Holy Cross Hospital in Fort Lauderdale has received the UnitedHealth Premium® specialty center designation in recognition of quality care.

UnitedHealthcare® developed the UnitedHealth Premium specialty center program to give its members information and access to hospitals meeting rigorous quality criteria. Designed to help members make informed decisions should they need cardiac services care, the designation is based on detailed information about specialized training, practice capabilities, outcomes and cost efficiency of care.

To receive this designation, the non-profit hospital met extensive quality and outcomes criteria based on nationally recognized medical standards and expert advice. The criteria incorporate measurements of breadth and depth of care, staff experience, emergency care, quality and outcomes reporting.

“We are proud to be one of the leaders in cardiac care,” said Patrick A. Taylor, M.D., President and CEO of Holy Cross Hospital. “Our focus on clinical excellence, leading edge technology and state-of-the-art procedures continues to be recognized nationally.”

Holy Cross Hospital offers comprehensive cardiac services through the Jim Moran Heart and Vascular Center and progressive research at the Jim Moran Heart and Vascular Research Institute.

About Holy Cross Hospital
A member of Catholic Health East, Holy Cross Hospital in Fort Lauderdale, Fla. is a full-service, non-profit Catholic hospital, sponsored by the Sisters of Mercy. Since opening its doors in 1955, the 559-bed hospital has offered progressive services and programs to meet the evolving healthcare needs of Broward County. Today, Holy Cross has more than 600 physicians on staff representing more than 40 specialties and more than 3,000 employees. To learn more about Holy, visit holy-cross.com, “like” Holy Cross Hospital, Fort Lauderdale on Facebook, or follow @holycrossfl on Twitter.

Holy Cross Hospital  is a participating hospital in the UnitedHealthcare network but is not owned or otherwise affiliated in any way with UnitedHealthcare: a UnitedHealth Group company.

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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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