Vitamin D

June 15th, 2013

Along with calcium, vitamin D helps maintain bone health by ensuring that the body creates and reabsorbs bone tissue at roughly the same rate, thus avoiding a net loss of bone.  About 8% of Americans are deficient in vitamin D, and most of these are elderly.  While adequate (but not excessive) intake of calcium and vitamin D has been proven to maintain good bone health, the evidence is less clear when it comes to other medical conditions.  Among those are uproven claims of vitamin D lowering the risk of the common cold, high blood pressure and even cancer.

Another commonly held belief is that the supplemental use of vitamin D would slow the progression of osteoarthritis.  However, a recent study published in the Journal of the American Medical Association found that vitamin D supplements given to people with osteoarthritis of the knee were not effective in relieving their knee pain or slowing the damage to the knee joint.

Osteoarthritis is often a mild condition and is widely known as “wear and tear” arthritis.  It may cause no symptoms or only occasional joint pain and stiffness.  The most severe form of osteoarthritis is the type that affects the joints that bear the body’s weight, such as hips and knees, which can progress to a point which makes walking difficult.

If you have osteoarthritis of the hip or knee and are obese or overweight, losing weight often can be the most effective treatment.  Weight loss should be achieved through a combination of diet and exercise.  Exercise should put an affected joint through its full range of motion while gently avoiding excessive stress on the joint.  Swimming and walking are particularly helpful, but avoid running on hard surfaces, which can aggravate the condition.

If your pain persists despite weight loss and gentle exercise, oral medications also can be used to treat the pain of osteoarthritis.

It is important to remember that other conditions can have similar symptoms.  These include rheumatoid arthritis, gout and joint infection.  Accordingly, if you have a joint that is suddenly swollen, or one that is hot and red, with a fever higher than 100 degrees, seek medical attention immediately.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

Prescription Pain Killer Roberries

February 5th, 2013

We have a prescription drug problem in our country, as illustrated in Sunday’s Post & Courier cover story on pain pills, and it is not an easy fix.  Americans make up only 4.6% of the world’s population, but we consume 99% of the global supply of hydrocodone (Lortab, Vicoden), and 80% of the global supply of all pain medications.  As physicians, we share some of the fault for this problem, but there’s plenty of blame to go around.

The use of pain killers accelerated in 1999 when, prompted by a couple of pain societies, one of the primary healthcare oversight organizations (JCAHO) mandated that pain be given equal importance as heart rate, blood pressure, temperature and oxygen saturation.  They promoted pain as the “Fifth Vital Sign”.  Hospitals and healthcare providers had to prove they were recognizing and treating pain appropriately or face penalties.  But there was a conflict of interest.  The very pain societies pushing for these new regulations were being funded by the pharmaceutical companies manufacturing pain killers.

What must not be lost in this discussion is that many patients depend on prescription pain killers to relieve horribly debilitating pain that has eroded their quality of life.  These medications are also vital in treating acute pain, such as after surgery.  The vast majority of these patients use their medications appropriately and as prescribed.  But, we do worry about doctor shopping, patient deception and forged or altered prescriptions.  Just last week, a new patient came to my office wanting a prescription for oxycodone.  A computer search revealed the patient not only was receiving fairly large quantities of this medication from one of my local pain management colleagues, but was also doctor shopping in Florida and Georgia for the same drug.

These medications are frequently prescribed in amounts that lead patients to save unused amounts in the medicine cabinet for later use.  Recently I had surgery and was given 85 pain killers and used only 30.  What about the patient who was given 30 pills for a kidney stone, tooth extraction or back injection?  If my experience is typical of most (and I think it is), then there are a lot of pain killers stored in the home, which increases the chance of one of our children using them recreationally.  Prescription pain killers are increasingly becoming the drug of choice for our children.  Every day, approximately 2,500 teens use prescription drugs to get high for the first time, and more than half of them are under the age of 15.  They are easy to get from our homes and are perceived to be safer because they are a prescription product from an FDA regulated industry.

Healthcare providers have little, if any, training in controlled substances. It wasn’t offered to me in my 8 years of medical school and anesthesiology residency, or my one year pain fellowship.  To the best of my knowledge, it still isn’t offered now in any medical or pharmacy training programs.

Disposal of prescription medications has been confusing.  Many patients don’t want to throw unused or expired medications away, or flush them down the toilet, for fear of the medications winding up in our water supply.

The public, in general, has become more insistent on getting prescriptions for our ailments, particularly antibiotics and pain killers.  A 2005 CASA (National Center on Addiction and Substance Abuse) study identified that about half of all physicians surveyed thought patients tried to pressure them into prescribing a controlled drug.

Fortunately, there has been some progress on addressing this epidemic.  Most states, including South Carolina, have privacy-protected prescription monitoring programs, allowing physicians to rule out doctor shopping in most instances.  In 2005, Congress passed a bill (NASPER) to allow states to share their databases.  And last year, the state of Washington implemented a promising, but controversial, law requiring doctors (and other prescribers) with patients who surpass a preset pain pill limit to seek a second opinion from a pain specialist.  If Washington’s law proves successful, many other states will likely follow.

Lastly, there are efforts underway to allow pharmacies to collect unused or expired medications.  For the time being, however, the DEA holds Drug Take Back programs across the country.  Twice a year, the general public can take these medications to their local police station, where a DEA agent will collect and dispose of them properly, no question asked.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

Whiplash Injuries

January 9th, 2013

Whiplash is a term that describes injury to the neck that most often occurs as a result of a motor vehicle accident in which a vehicle is rear ended, but can also result from a side impact collision or a fall injury.  In a typical case, the victim’s body is initially pushed forward, causing the head to move up and backward, which can stretch or tear muscles, tendons and ligaments.  Then the head snaps forward very quickly, further stretching these structures.  This traumatic over-stretching may take several months to heal.

A whiplash injury usually takes 12-24 hours to develop.  Typical symptoms include neck stiffness and pain, headaches and reduced range of motion of the neck.  Other possible symptoms are dizziness, ringing in the ears, blurred vision, fatigue, muscle spasms, sleep disturbances and pain in the arms.

There are several factors that affect the body’s ability to withstand a whiplash injury:  good posture at impact, good overall physical condition, awareness of impending impact and male gender.

A common misconception about whiplash injury is that if the vehicle does not sustain damage in a low speed impact, then whiplash injury to the occupant does not occur.  In reality, low impact collisions can produce correspondingly higher dynamic loading on the  occupants because the lack of crushing metal to absorb the forces results in a greater force applied to items or occupants within the vehicle.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

Sciatica Pain and Weakness: Is Surgery The Answer?

November 29th, 2012

When patients seek medical care for a painful disc herniation and a motor deficit (muscle weakness, limping, or a dropped foot), the motor deficit sometimes becomes an overriding concern, steering patients toward early surgery.  A recent Netherlands study has disputed that notion.  While the motor deficit did improve significantly faster with surgery, the long term recovery was the same.  At one year, complete recovery of motor deficit was found in 79% of subjects treated surgically and 83% of subjects receiving conservative nonsurgical treatment.  However, these results do not apply to all patients with motor deficits.  Patients with cauda equina syndrome (severe compression of nerves below the spinal cord) and rapidly progressing motor problems often do require earlier surgery to resolve.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

Dr. Joye and Dr. Folk contacted all patients with exposure to tainted medications from New England Compounding Center

October 28th, 2012

InterveneMD contacted all patients with exposure to New England Compounding Center’s tainted lots of methylprednisolone acetate in accordance and cooperation with the SC Department of Health and Environmental Control and the Centers for Disease Control.

The only patients identified by the CDC to be at risk of developing an infection are those that received methylprednisolone acetate from one of the 3 lots produced after May 21. According to the CDC, other patients are not at risk of developing fungal meningitis.

However, any patient of InterveneMD concerned about the medication they received or their procedure is invited to contact InterveneMD at 843-216-4844.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

InterveneMD doctors notified of possible patient illness. Doctors concerned, responsive to specialists providing treatment to patient

October 24th, 2012

We have learned that one of our patients, who received an epidural injection of methylprednisolone acetate implicated in the national fungal meningitis outbreak, displays symptoms consistent with the Centers for Disease Control (CDC) assessment of “possible fungal infection,” meaning that they have a probable, but not confirmed, case of fungal meningitis. The individual has been admitted to hospital for further evaluation. We have provided all details regarding their exposure to the recalled medicine to South Carolina Department of Health and Environmental Control (DHEC), the hospital, the patient’s medical care team and the family. Our thoughts and prayers are with this patient and their family.

We, as do all doctors, rely on the safe production and sterility of the medications used in our treatments. It is deeply alarming to us that a provided medication was possibly tainted and may cause an illness in our patient. We fully support and urge DHEC, the CDC and the U. S. Food and Drug Administration (FDA) to track down the source of contamination and certify that this will not occur again. As doctors we must have complete confidence in the sterile production of medicines and depend on the FDA to ensure the safety of all medicines.

While we cannot reveal any personally identifying health information regarding this patient, the individual is under the supervision of medical specialists who are providing and managing care. We are in ongoing communication with officials at DHEC and assisting them in every way with regard to the care of this individual.

After being notified on Wednesday, September 26th by the New England Compounding Center of the urgent voluntary recall of methylprednisolone acetate which had been shipped to our practice, we immediately removed all vials of the medication from use and returned them to the manufacturer. On Wednesday, October 3, DHEC confirmed this with us and we immediately began notifying 257 epidural injection patients by phone, in-person and by follow-up letter. Additionally upon notification by DHEC, we identified and notified 78 patients who received this suspect medication by injection into a peripheral joint.

We have been and continue to be available to speak with our patients. Our deepest concerns are for our patients and their families. We invite them to phone us with any questions, issues or anxiety. We are providing medical counseling and following all CDC recommendations.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

InterveneMD physicians address issues related to recall of drugs implicated in fungal meningitis

October 6th, 2012

We want to address the outbreak of fungal meningitis which you may have heard about and is in the national news. Tragically, cases of a rare form of meningitis have been implicated nationwide in the illnesses of 35 people and in the deaths of five people who have received epidural pain relief injections to help them manage back pain.

We, as do all doctors, rely on the safe production and sterility of the medications used in our treatments. This is a very rare and unusual situation.

Unfortunately, our practice was one of those provided medications from the manufacturer. We were notified by the South Carolina Department of Health and Environmental Control (DHEC) on Friday, September 21st that we had received suspect medicines from lots produced between July 31 and September 16. We immediately removed all vials of the medication from use and returned them to the manufacturer.

Because we are concerned, we have made every effort to determine each and every patient who may have received epidural treatment with this medication. We have personally spoken with almost all of the 189 people affected. We continue to call and work to get in touch with each person who received this medication by epidural injection. There are a few patients we’ve not been able to reach by telephone, despite multiple attempts, and we are sending follow-up letters that detail signs and symptoms to watch for until the possibility of illness passes. Each person has been asked to seek immediate emergency treatment if they have any symptoms. According to the Centers for Disease Control (CDC), this illness takes from one week to one month following exposure to develop.

It is a relief that none our our patients are showing any signs or symptoms of meningitis. Two — at our urging — have gone to the emergency room for further examination. Tests determined that they do not have meningitis.

We have been and continue to be available to speak with our patients. We invite them to phone us with any questions, issues or anxiety. We are providing medical counseling and following all CDC recommendations.

We urge anyone who has recently had epidural treatment for back pain to contact their doctor. If you are our patient and have questions, we want you to call us.

Epidural steroid injections for the management of pain have been used for many years and have relieved pain in thousands. This treatment has allowed many individuals to experience an improved quality of life and be more productive.

We have been safely providing effective relief from back pain for patients with problems using treatment with epidural injection for 35 (collective) years.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

How do I get rid of unused, expired medications?

September 8th, 2012

As patients start to feel better with our treatments, we are often asked how to get rid of unused or old medication.  Well, medication disposal is a hot topic in medicine today.  The Environmental Protection Agency (EPA) has detected multiple pharmaceutical products in various ecosystems.  Although these products tend to be present in relatively low levels, and the results of short term exposure seem to be minimal, the results of long term exposure to these low levels of pharmaceutical waste remain unknown.  The presence of certain drug classes in particular have caused the greatest concern:  antimicrobials, natural and synthetic steroids, antidepressants, and heart medication.

The majority of the concern relates to our drinking water.  A 2008 Associated Press article reported both prescription and over-the-counter drugs were detected in the drinking water of at least 41 million Americans.  Many water treatment systems are unable to remove all pharmaceutical products from tap water, and testing for these products is not a regular practice because it is not required by the federal government.  While levels of drug contamination in tap water are considerably low, there remains much speculation as to what risk is associated with long-term, chronic exposure to these drug products.

The White House Office of National Drug Control Policy (ONDCP) released an official guide in 2007 (and updated in 2009) for proper medication disposal that advises the public to discard this waste in the trash rather than flushing them down the toilet or washing them down the drain.  There are certain exceptions to the “no flush” rule, and the FDA’s website contains a list of drugs for which the FDA still does recommend flushing.  Most of these drugs are narcotics or controlled substances, which are especially dangerous if accidentally ingested by children or pets.

The best way for medication disposal is through a community drug take back program.  Fortunately, most areas (including Charleston’s Tri-County) have participated in national take back days, usually held in September and once again in the spring.  This year, it is being held on Saturday September 29 from 10am-2pm.  These events have a strict “no questions asked” policy where the public can simply drop off unused, expired, unlabeled medications at their local police station for collection.

If you do not participate in a drug take back program, then the ONDCP recommends removing prescription medication from their original containers and mixing them with an undesirable substance, such as cat litter, coffee grounds, or sawdust inside of a sealed container (a plastic bag or empty margarine container) and placing it in the trash.  The original prescription bottles can also be placed in the trash, but remove all personal information from the container, including the prescription number.  Liquid medications should be mixed with salt, flour, charcoal, or a nontoxic powdered spice (such as tumeric or mustard) to give the mixture an unappealing smell and texture.

For more information, please see the following resouces:

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

Epidural Experts for Pain Management in Charleston SC

May 13th, 2011

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink

Spinal injections relieve pain and return patients to daily activities

April 17th, 2011

Spinal injections, or epidurals, for low back pain have been found to help relieve pain and aid patients in returning to performing daily activities according to the results of a recent study.  The study, conducted by the Accreditation Association for Ambulatory Health Care Institute for Quality Care, reported that more than 78% of patients receiving spinal injections reported their pain improved and 82% reported they were able to return to performing daily activities. Additionally, 52% of patients were able to reduce their pain medication after the procedure.

The report went on to say that the amount of time a patient spends in the facility can be an indicator of patient safety and satisfaction.  The average facility time (the time from patient check in to patient discharge) for a patient getting a spinal injection was 86 minutes, with the longest being 179 minutes.

You have more important things to do than waiting for an injection.  At interveneMD, we value your time – our facility times are less than half of the national average.

0 Comments   |   Share   |   Subscribe to this post   |   Trackback   |   Permalink