Cat Bite

Hey Docs,

I was at a friends and got but by her cat. I ended up in the ER the next day with a bad infection and they took an X Ray of my hand. I didn't say anything at the time but now I'm wondering if I got ripped off? Why do an X Ray?

Just Curious,
Ben in Portland, ME


Hey Ben,

Great question. Cat bites, as you discovered, are very dirty bites and often get infected. One of the WORST things that can happen is for the cat to break a tooth off under your skin. This is why they did the X Ray... To look for a cat tooth in the wound. Evidently you didn't have one or they would have had to get it out and that can be an unholy mess, but you DID NOT get ripped off. You got good care.

Hope you have fully recovered.

Doc1

An APP for healthy choices

Hi Doc1,

I was reading your blog today and wonder you could give me an opinion
on a diet/fitness app I'm making right now ?

For me, I think the problem with being healthy is motivation. It's an
abstract, overwhelming goal. I think the best way to counter this is
to have concrete, winnable games and small victories.

So, this app will makes living healthy, and fitness into a RPG game,
where users earn points, and "level up' as they achieve their goals.
Everytime they eat something healthy like vegetables, they earn
points. Everytime they complete a workout, they earn points. Each
level will present different challenges.

The challenges will follow a certain structure. First will come
changing your environment such as getting rid of junk food. Then,
reducing stress, as stress leads to eating comfort food. Then concrete
goals like keeping track of everything you eat, or taking the stairs
for a week. Small, concrete goals rather than abstract ones like "be
healthy" or "exercise more".

The whole point is to create a holistic framework/game so people will
rely less on willpower, and more on fun, achievement, and changing our
environment.

What's your opinion on this idea? Would you want to know when I'm done
with it? If this sounds too silly, or absurd, just ignore what I just
said, hehe =)

Best,
Christine

Hi Christine, Doc 2 here. That is a GREAT idea. There are tons of health and fitness apps out there for this thing or that thing. One of the most popular that I see and sometimes use in my weight loss practice is "MyFitnessPal" and the "C25K" (aka Couch to 5K). However, I don't think that there is one with a roll-playing game approach. That would be VERY cool. When I was in medical training, I lost weight because I was in a competition with a patient who was a newly-diagnosed diabetic. The camaraderie and competition that we had in the process gave us BOTH benefit. Perhaps a mode of partnering or grouping people together (just like in an RPG) for a common goal is ALSO something to think about. I personally think that this is a GREAT idea.

I would be interested in collaborating with you on such a project if you are game for it. (No pun intended.) Think about it and get back with me.

-Doc 2

Post Mortem Question

A friend of mine just died in a car crash. It was a terrible crash and evidently not survivable under any circumstance. The cause of death was confusing to us, 'uncal herniation causing respiratory arrest'. What does this mean?

 

Jim S.

Phoenix

 

___________________________________________________________

 

Jim, so sorry about your friend. An 'uncal herniation' is merely describing a situation in the head where pressure builds up, usually from bleeding (in the case of trauma), and this pressure forces the brainstem down into the formen magnum, and when this happens our brains can no longer instruct the lungs/ diaphragms to breathe, so breathing stops and the person dies. THIS link is a pretty good one to describe this process in more detail. Again, so sorry to hear about your friend. 

Doc 1

Plantar Fasciitis and its Consequences (pending question)

I was diagnosed with Plantar fasciitis June 2010. The doctor gave me some excersises to do and then said stay off of it as much as possible. So I spent the summer not really over stressing my foot and doing the excersises. 

 

I'm a teacher and school started in September and I'm back on my feet and it's still sore. Sore enough that it takes me a while to get down the stairs in the middle of the night to get to the bathroom. Again this summer I didn't do much walking or over excert myself but I kept busy. 

 

So now I'm gaining weight because I'm trying to keep the foot from getting worse. So this September after all summer of being a slouch (again more or less) I got back on the treadmill and am running again. but it really really agravates the foot. I can't keep babying this foot it's been long enough so I just run through the pain. The first ten minutes are pretty painful and then it smooths out. But when I sit later it's very, very stiff. I'm told theres nothing else to do for this other than Aleve.  I can't take Aleve every day it upsets my stomach.

 

I own the treadmill and can't afford a gym membership. We also have a great bike trail nearby and I bike that as well but it doesn't tone like running does. Is there anything else I can do and why doesn't this get better? I would think after a year and a half it should have improved somewhat.  Am I missing something? I'm a 55 year old woman who is about 30 lbs overweight which I can get off but just need to be active. I have no other illnesses. It may sound trivial and not dramatic enough for your blog but it's really starting to get to me. 

 

Thanks for your input.

Renee

 

___________________________________________________

Dear Renee, 

 

Doc1 here, and this is a great question. I think my friend Doc2 can add some to this but you have clearly failed to improve with the conventional therapy for plantar fasciitis. 

 

In my current practice I see tons of young folks with this problem. Recently I learned that our friends in Podiatry have a new weapon against this sometimes debilitating problem and it is borrowed from the Urologists. It's called ECSWT (extra corporeal shock wave therapy), and uses focused sound waves to promote healing of the inflammation in the plantar fascia. 

 

This therapy, by report from patients of mine who have had it, can be dramatic and curative. So, I would recommend seeing a Podiatrist to see if this might be an option for you 

 

Also, a more traditional therapy which DOES work but can only be done once or twice is injection of steroids into the plantar (bottom) surface of the foot. 

 

In any case, take a good look at the Mayo Clinic link I sent and look how many options for treatment there are. There is hope and there's more to do for you. Time to step up the treatment regimen. 

 

Will let Doc2 weigh in (no pun intended) on the weight issue. 

 

Thanks!

Cannot go to the bathroom.

Hello doctors. This is all new to me, but my daughter showed me how to set this blog question up. She told me about this spot and I think it is very neat that you provide this service.

Anyway, I am 67years, a man and I have been having increasing problems with having regular bowel movements. I feel completely stuffed up after eating a little bit of food at a meal. So I am not eating a whole lot. I think I eat a variety of foods. I enjoy vegetables and I drink a good bit of water.

I don't have any medical problems except for some high blood pressure, and that is controlled with Diovan. I have some allergy issues in the spring and a little in the fall. My doctor tells me that my cholesterol is good. My weight is ok I think. Otherwise, everything is just fine.

I have tried a few things to help. All of the old people are using Metamucil on tv. So I tried that. It helped a little. I tried some exlax but that made me hurt a little bit and i do not want to get hooked on that stuff.

I'm not sure what else to do even though there is a lot of stuff out there. Any tips?

Bob, Michigan.

DOC2 Here:

Bob I apologize for getting to your question today after posting it yesterday. I was kidnapped by a cadre of children who share my last name yesterday for a trip. So, here are my comments.

Constipation can be a terribly uncomfortable problem. It is well recognized that the likelihood of constipation increases over time as we get older, but let's set that aside because we have yet to discover the fountain of youth and couldn't do anything about that. (Of course there are people who say on the internet that they HAVE found the fountain of youth, but I think that they may be telling a fib.)

The mechanics of the GI tract are dependent on several factors: lubrication ("gastric juices"), mechanical movement ( spurred by vascular, muscular and nervous system involvement), some substances to go through it (food products), and good absorption of nutrients in the proper areas of the gut just to name a few.

You must be drinking enough water and not caffeinated products. (Some people say that coffee makes them have a bowel movement. This may be true, but it's not the caffeine that spurs it on.) Generally liquids spur movement. Another thing that spurs movement is regular food intake. Skipping meals is a no-no. Eating fibrous foods is important. Vegetables are important. Metamucil or other "fiber laxatives" are stand-ins for vegetables, but they are not the best. The payback is that fibrous foods tend to be gas-formers also. So, don't go overboard. CHEWING your food is important. This is especially important with foods that don't normally absorb very well (such as beef or pork products). What you want to think about when you eat with regard to constipation is "How can I help my gut turn this food into a paste?" I know, sounds far-fetched but it's true.

Physical activity is also an important part of keeping regularity.

I am going to shorten this post by pointing you to an excellent website on constipation. The URL is http://digestive.niddk.nih.gov/ddiseases/pubs/constipation.

This site is EXHAUSTIVE but easily understandable. Any lay person can walk away from the computer after looking at this site and know almost everything that they need to know about constipation.

I hope that this helps. Shoot me back a comment if you have any further questions, and I will help you sort through it.

Have a "regular" day!!

Hydrogen Peroxide

Hey Docs,

I have a cut I got on my hand and it was on a fishing trip and I have been treating it with hydrogen peroxide for ten days now but it still seems red and won't close over. Is it infected? What should I do? I do not have any other medical problems.

_________________________________________________________


Hello and thanks for your question. Doc1 here. Wound care. Simple. Really, it is, but with the MRSA ("flesh eating bacteria") and the Listeria outbreaks everyone is all about antiseptics and hand washing and wound cleansing and in this particular case you are a victim of some overzealous wound care. 

First of all, take a look at this link HERE, as you can see, after that initial use of Hydrogen Peroxide (H2O2) you are actually preventing healing of the wound because it is toxic to the new skin cells forming to heal the wound. It kills the bacteria, it kills the good cells. Use it once on initial injury then put it aside. 

Second of all, if your tetanus booster is not up to date (within ten years) then you need to get one. 

Third of all, and this is for other readers more than you... Notice what else is mentioned in the link..... The recommendation of wound cleansing with tap water. This is what we do in the ER too for all but the most contaminated and complex wounds.... Yes, I'm talking about wounds that we are going to suture (sew).... The key is irrigation under pressure and the method is to use a large syringe with an 18 gauge splash guard or similar and to really blast out the laceration. 

This is the key to decontaminating superficial wounds, NOT soaking in betadine, NOT scrubbing, and not Hydrogen Peroxide (though mixed with water it IS great to dissolve blood clots out of matted hair). 

Hope this helps! Stop the H2O2 and this should heal right up. 

Best

Pending Case: Clots and Clots

Docs,

History: 43y/o Male 6’10”, 400lbs. (yes I am a big boy). BP 130ish/70ish, Last fasting glucose 94, total cholesterol around 180. On 120 mg Cymbalta and 6mg klonopin for panic disorder/agoraphobia/depression. 50mg? Aciphex for GERD and 7.5 mg warfarin for 2 Episodes of DVT’s & PE’s. First episode of PE showed no outward signs of DVT ( I was told a concussion I suffered a few days before the onset of the first episode was unlikely related). Took my Doc three weeks to finally believe me when I told him it felt like blood clots in my lungs. Second episode showed significant swelling in the leg to the degree that it was almost unbendable at the knee. Initial blockage was complete from the ankle to the groin. Last sonogram indicated complete blockage remains except for a small area somewhere in the middle of my leg. Told that DVT was likely caused by low cystine? (not sure of the spelling or the correct name) levels rather than the obesity or the typical Factor V or Leiden. At about 16 months after the last DVT the swelling has resolved to a baseline of about 110% - 120% of my unaffected leg. However I do have occasional periods where the swelling is increased. The swelling is intermittent and I have not determined a contributing cause. It just starts to happen. I am not wearing a compression stocking.

Question: In the past year I have had intermittent knee and hip pain in the leg with the repeated DVT. I have had the knee pain off and on since an injury 20 years ago. However, except for long car rides in which I am cramped I have never experienced hip discomfort, let alone pain. While I have read that hip pain generally is felt in the groin, mine is clearly on the side to side/butt area. The pain can be strong enough that I am unable to sleep on that side. I have not yet determined if the period of increased swelling in my leg matches up with the bouts of pain. Could this pain be related to the continued blockage and swelling? Or is it more likely my fat ass or even less likely, my age? One last possible clue. When I swim, as you may have guessed I am very buoyant, so I have virtually no weight on the hip. Yet the pain remains.

DOC2 here:

Yes, you are a big fellow, and at an age greater than 40 you certainly can have some joint problems without the added "benefit" of a DVT or the resulting swelling.

Let's run through the list of contributing problems:

1. Old injury

2. DVT

3. Lower extremity swelling due to the DVT

4. Obesity

You have a confluence of baddies that can impact that hip.

My best answer is that it's not necessarily a hip joint issue (although it certainly COULD be early arthritis of the joint). If you can point to a specific spot almost at the midline on the side of the hip, I would say that you most likely have a bursitis. A bursa is a thickened, fluid-filled sack that lies under tendons to allow for an easier slide of the tendon to reduce friction. When having to take on more stress these sacks can become inflamed, and the more you use the hip the worse it hurts regardless if you are weight-bearing or not. You intermittently take on more weight with the edema (swelling) of the leg than you are used to. (However, you could also argue that you already have more leg than your joint can or should withstand.) This increased stress can cause the bursa to become inflamed. Secondarily, the fluid from the swelling can enhance the inflammation. I found this picture on www.aidmybursa.com that does a great job of showing you the location of the hip bursae. (By the way, I don't endorse anything on that site. I just wanted to show you the picture.)

So, what can you do about it? Resting the leg is important. Ice therapy can help sometimes. Your size is a problem, and you certainly need to lost weight. That's a fix in terms of chronic treatment of course and not an acute treatment, but it will matter a LOT for you now and down the road.

You could use an over-the-counter anti-inflammatory medication such as naproxen or ibuprofen, but I shouldn't have to remind you that using these medications can be problematic for someone on Coumadin (warfarin) for a couple of reasons. First, you could alter the balance of warfarin in your body. Second, these medications can cause esophagitis or gastritis which could cause upper gastrointestinal bleeding in someone who is especially on coumadin. The Aciphex could protect you somewhat, but I wouldn't make a medication move without the recommendation of YOUR doctor.

I hope that this is helpful. If you have any further questions, shoot them back to me. Good luck to you. -DOC2