Woodside Family Practice

Archive for the ‘Medical Symptoms’ Category

Depending on how severe your acid reflux symptoms or gastroesophageal reflux disease (GERD) condition is, you may require surgery in order to improve your symptoms, health, and overall lifestyle. Surgery is an option when lifestyle changes and medicine do not help you manage your acid reflux/GERD symptoms. For some, surgery can provide them a reasonable alternative to a lifetime of discomfort and medications.

However, you may be wondering what types of surgeries are available and just how effective they are. The following is a brief overview of the most common surgeries associated with GERD and their general success rate.

Fundoplication Surgery

Nissen Fundopication Surgery is the standard surgical treatment for GERD and was developed over 50 years ago. This procedure is designed to prevent or reduce acid reflux from occurring so that esophagitis (inflammation of the esophagus) can heal.

Fundoplication involves gathering and wrapping the fundus (upper curve of the stomach) around the lower area of the esophagus, and stitching the wrap in place. This enables the lower part of the esophagus to pass through a small channel that has been created out of the wrapped stomach muscle. The objective of the surgical procedure is to strengthen the lower esophageal sphincter (LES) to prevent stomach acid from entering into the esophagus. It is also important to mention that during this procedure if a hiatal hernia is present within the patient, this is also treated. A hiatal hernia is when part of the stomach protrudes through the diaphragm. The condition is believed to weaken the LES.

Fundoplication can be performed in two ways:

1. Laparoscopic fundoplicaiton – this is the most common and less invasive procedure. The surgeon makes a small cut in the abdomen and inserts a laparoscope (thin lighted tube with a videocamera) in the incision. Four additional pinpoint incisions are then made in the upper abdomen, and needle-like instruments are inserted to allow the surgeon to perform the procedure.

2. Open fundoplicaiton – In this procedure, the surgeon makes wide surgical incisions in the abdomen or chest, performs the surgery, and sews up the patient. Open fundoplication is typically only used for obese patients, or if complications occur with the laparoscopic procedure.

How successful is fundoplication surgery? Studies have found that many people who undergo the procedure experience improvement in their symptoms. In more than 50% of cases, patients experienced successful relief from GERD symptoms and esophagitis. However, many of these same patients still required GERD medications to treat remaining symptoms. That being said, medications are often reduced and do not to need to be taken on as regular a basis and most symptoms tend to be less severe than before the surgery.

Studies have found that approximately between 10 and 20% of patients who underwent surgery continued to have regular symptoms, and others who experienced complications from the surgery, required a second surgery within a decade of having the first.

You should be aware that the fundoplication surgery is irreversible and the long term effect of fundoplication for an individual is unknown.

Stretta Procedure

Stretta procedure is designed to reduce the occurrence and severity of heartburn and other acid reflux symptoms by tightening and strengthening the LES.

This procedure is performed with an endoscope and a Stretta device. An edoscope is a small illuminated flexible tube that features different channels where medical instruments can be inserted. A Stretta device is a very thin catheter that has a balloon at the end.

The patient swallows the endoscope and it moves down the esophagus to rest just above the stomach. The Stretta device is then inserted and the balloon is inflated. The outside of the balloon features four sharp probes that are designed to discharge controlled levels of radio frequency energy into the LES and the uppermost region of the stomach known as the gastric cardia. The electrodes make thermal lesions on the selected areas. After these lesions heal, the LES muscle toughens.

How successful is Stretta procedure? Many studies have found that up to 80% of patients who underwent the surgery experienced an improvement in their acid reflux symptoms. Many of the patients had a decrease in heartburn and other acid reflux symptoms within one month of undergoing the Stretta procedure. These patients managed to stop taking GERD medications with only encountering little or no discomfort.

The vast majority of patients stop taking their medications between 1 and 2 months after the surgery, but it is not uncommon for patients not to experience improvement of symptoms until 6 months after the procedure. Furthermore, a number of patients found that a year after their procedure their symptoms were further improved or ceased altogether.

The long term effect of Stretta procedure is unknown.

EndoCinch

The Bard EndoCinch Suturing System, commonly known as EndoCinch, is a procedure designed to help prevent and reduce the occurrence of acid reflux symptoms and heartburn, as well as reduce the need for GERD medications. This is achieved by altering the gateway between the esophagus and the stomach by placing pleats in the LES.

EndoCinch is performed using an endoscope and the Bard EndoCinch Suturing System. The patient swallows the endoscope which rests just above the stomach, and the EndoCinch is inserted. The medical physician than uses the EndoCinch to make a series of two adjacent stitches below the LES, and then pulls the stitches together to create a pleat. Although most patients typically only require one pleat, others may require additional pleats depending on their condition.

How successful is EndoCinch? Clinical trials have found that approximately 70% of patients experienced an improvement in overall symptoms, and 75% reduced their intake of GERD medications.

The long term effect of EndoCinch is unknown.

Regardless of the GERD surgery, you need to keep in mind that everyone responds differently to treatment and individual results may vary. Therefore, while some people may no longer need to take medications or restrict their diet, others may be required to continue with medications and lifestyle changes to prevent and relieve acid reflux symptoms.

Before you consider surgery, you need to understand every surgical procedure has some risk, and not everyone who undergoes surgery will obtain successful results in relieving their acid reflux symptoms. Therefore, make sure you know everything about the surgery including what is expected of you, and all possible outcomes. You need to ask your doctor any questions you may have, and after weighing all the risks, carefully determine if surgery is the right option for you.

A bruise gets its deep color from a blood vessel or vessels that break under the skin and leak blood into the surrounding area. As it heals, it becomes paler in color and less painful to the touch. Depending on how many vessels were broken, bruises can be the size of a pencil eraser or 6 or more inches across. A black eye is also bruise-if there is no accompanying eye damage or nose breakage, it can be treated just like any other bruise.

Bruising is bleeding that occurs underneath the surface of the skin. Normally, it is usually caused by injury. In patients with bleeding disorders, however, spontaneous bruising may occur or a bruise may appear with minimal injury. Since bruises are formed from clotted blood, they tend to start out as dark or reddish shadowing close to the surface of the skin. As the trapped blood is broken down and absorbed by the body, it changes color — typically to green and yellow — because of chemical changes in the blood. Eventually the body reabsorbs the blood and the mark disappears.

The injury required to produce a bruise varies with age. While it may take quite a bit of force to cause a bruise in a young child, even minor bumps and scrapes may cause extensive bruising or ecchymosis in an elderly person. Blood vessels become more fragile as we age, and bruising may even occur without prior injury in the elderly.

Bruising (medical symptom): Bruising is the body’s normal response to local trauma or damage. Local bruising needs investigation to diagnose and treat the underlying cause of the bruising. Certain medical conditions such as bleeding disorders can also lead to more generalized or excessive bruising. People with these conditions bruise easily and more than normal. Some possibilities include hemophilia (genetic disease) and the lesser known and often undiagnosed Von Willebrand’s disease. Any unexplained bruising needs medical investigation.

Bruises, on the other hand, do not involve the opening of the skin. While bleeding is present it is kept inside the skin thus creating the black, blue, and purple hue that you see when experiencing a bruise. Bruises are caused by bumping into objects, by being hit with blunt objects, and from falling. The symptoms of a bruise include pain at the site of injury and skin discoloration discoloration from a build up of blood under the skin.

Signs and Symptoms:

Bruises can last from days to months and usually occur in several stages. A bruise generally starts out as a pinkish-red area or as tiny red dots or blotches on the skin. The bruise may be very small and may blend in with the texture of the skin, or it may be large, swollen, and painful. Within days to a week or so, the bruise becomes more purple. As it heals, it becomes brownish-yellow. Generally, bruises heal and disappear within 2 to 3 weeks.

During the first 24 to 48 hours after injury (acute phase), you will probably need to continue using rest, ice, compression bandages, and elevation of the injured area to control bleeding, swelling, and pain. While the injured part heals, be sure to keep exercising the uninjured parts of your body to maintain your overall level of fitness.

Pros and Cons

Of ADHD Medication

On Children

 

 

 

 

 

By Mackenzie Quinn

 

 

June 1st 2009

           

Introduction

            As a parent of a child who has Attention Deficit Hyperactive Disorder (ADHD) you are faced with deciding how to manage your child’s ADHD symptoms. One options for treating the symptoms of ADHD that is highly debated is medication; some people strongly believe it is the best options and other believe medication shouldn’t be used on children. Determining the best option for your child is an important decision that shouldn’t be made without sufficient information. Before you make this decision, you should know that there are pros and cons to ADHD medication and that medication may be right for one child but not another. This article may help you as a parent or caregiver decide if medication is the right treatment method for your child.

Cause of ADHD

            When treating ADHD, it is important to look at the cause. “Scientists now believe that the impulsivity, short attention span and other symptoms associated with ADHD are caused by a specific dysfunction in the brain that is often inherited” (Wilens, 2004, p10). ADHD is a medical diagnosis with a medical cause, and many times medication offers a “straight forward solution” (Wilsen, 2004, p12). Members of the medical community often compare the treatment of ADHD with medication to that of seizures or other health problems with a medical cause and believe that these medical symptoms can be managed with medication. 

Symptoms of ADHD

            The cause of ADHD is a dysfunction in the brain (Wilens, 2004) but parents and caregivers seek treatment to manage the hyperactivity, impulsivity, short attention span and other behaviors associated with ADHD. The symptoms of ADHD are behavioral and many think they should be treated in the same manner as other behavior problems. Stephen Flora writes in his book Taking America Off Drugs “ The best way to improve behavior is with behavior modification techniques” (Flora, 2007)

Overview of Treatment Options

            As mentioned earlier, one treatment method for ADHD symptoms is medication; these medications are prescribed to “diminish the inattention, distractibility, over activity, and impulsivity” caused by ADHD. These medications ideally allow students to perform to their fullest potential such as focus on their homework and listen to directions. For individuals who do not have ADHD and can focus on their work these medications may seen like performance enhancing drugs that are not necessary. As you know ADHD is more than just a little distractibility.

            Along with medication, there are other ways to treat ADHD symptoms such as behavior therapy. Behavior therapy is a form of psychological treatment method that stems from behaviorism and focuses on observable and measurable behaviors. When applying behavior therapy to students who have ADHD the family works with the counselor to increase the occurrence of positive behaviors through routines and a better understanding of what the student needs. Some students can be treated with behavior therapy but for many children their symptoms are severe enough that behavior therapy isn’t enough. Behavior therapy may not be enough because it treats the symptoms of ADHD not the cause of the problem. Students who have ADHD have aspects of their brains that are malfunctioning, these malfunctions cause the hyperactivity, inattention and other symptoms that behavior therapy attempts to control. For these students medication can help supplement the therapy or other forms of treatment being used.

Common Medications and Routines For Taking Medication

            There are a wide variety of medications that are prescribed for the treatment of ADHD symptoms and you should discuss the specifics with your health care provider. Briefly, three of the top brands of medication are Ritalin, Concerta and Adderall.

            Depending on the type of medication your child is taking they will have to take the medication anywhere from once a day to three or four times a day. Some medications are longer lasting and only need to be taken once a day while others are short term and must be taken more frequently. Both are safe and effective options.

Pros of Medication

            The most important pro to ADHD medication is the reduction or elimination of the behavioral symptoms associated with ADHD.  By reducing students hyperactivity and giving them the ability to focus, medication gives many students the ability to perform better in school, make friends and participate in extra curricular activities.

            Many parents worry that their children will become addicted to the ADHD medication. However, there is no physical way for children to become addicted to ADHD medication because addiction comes from a high or state of euphoria and the medications used to manage ADHD symptoms do not cause students to have a high.

            There have been numerous studies indicating that psychotropic drugs are safe, tolerable and useful for children. As of 2004 there have been “over 250 scientifically controlled studies of the stimulant medications for ADHD” (Wilen, 2004, p 91) These studies suggest that if children take the prescribed dosage indicated by their doctor, then the medication is safe and that the majority of the side effects are mild.

Cons of Medication

            Now that we have looked at some of the pros of ADHD medication lets examine some of the cons. One aspect of ADHD medication that should be of concern to parents is that there are very few studies done on the long-term affects of the medication. So, while we know that these medications are safe in the short term the prospect of giving students medication without knowing the long-term effects bring cause for hesitation.

            There are also mild side effects associated with many of the medications including loss of appetite, difficulty falling asleep, dizziness, moodiness and growth problems. These side effects should be monitored but for the most part are easily managed. For specific side effects consult your health care provider.

            And even though students cannot become physically addicted to these forms of medication, they can form a psychological dependency. This dependency can develop when students feel they need medication for everything or when they are afraid to go off their medication.

Decision Making

            When deciding whether medication is right for your child there are 4 things to consider; side effects, the severity of your child’s symptoms, if your child’s symptoms are being managed with other forms of treatment how your child feel about medication. Before you make this decision talk, with your child’s teacher, the school counselor or psychologist, your health care provider and most importantly your child. While this may seem overwhelming now, the more information you can gather the easier this decision will be.

Conclusion

            As you can see there are pros and cons to ADHD medication and what is right for one child and family will not necessarily be right for another. When choosing whether to try medication as a way to manage the symptoms of your child’s ADHD make sure to consider the pros and cons along with your child’s characteristics and the attitude of the school.

 

References

Flora, Stephen Ray. Taking America Off Drugs (2007) State University of New York Press, Albany

 

Wilens, Timothy E. Straight Talk About Psychiatric Medication For Kids, (2004) TheGuilford Press, New York

 

 

Appendix

Resources For Parents To Get More Information

Straight Talk About Psychiatric Medication For Kids- This book was written for parents who have questions about the affects and risks of psychiatric medication on children. It is a basic guide for what parents need to know about a wide variety of psychiatric medications including ADHD medications. Wilens, Timothy E. Straight Talk About Psychiatric Medication For Kids, (2004) TheGuilford Press, New York Taking America Off Drugs; Why Behavior Therapy is More Effeftive for Treating ADHD, OCD, Depression, And Other Psychological Problems- This books presents behavior therapy as an alternative treatment method for ADHD instead of medication. The book does a good job of showing the other side of treating psychological problems. Flora, Stephen Ray. Taking America Off Drugs (2007) State University of New York Press, Albany CHADD- this website is a support system for parents of children with Attention Deficit Disorder and Attention Deficit Hyperactive Disorder. Children and Adults with Attention Deficit Hyperactive Retrieved May 12, 2009,  http://www.chadd.org/