MAYO CLINIC HEALTH LETTER Neck pain Some causes can be serious

MAYO CLINIC HEALTH LETTER
To o l s f o r H e a l t h i e r L i v e s
VOLUME 27 NUMBER 11 NOVEMBER 2009
Inside this issue
HEALTH TIPS . . . . . . . . . . . . . 3
Avoiding falls.
NEWS AND OUR VIEWS . . . . . 4
Acupuncture or acupressure reduces nausea after surgery. Why
exercise matters after age 50.
HEMORRHOIDS . . . . . . . . . . 4
Blood vessels gone astray.
HEART FAILURE . . . . . . . . . . 6
Proven treatments to extend life.
THE WAY WE PLAY . . . . . . . . 7
Games for better health.
Neck pain
Off the mark
Neck pain can manifest itself in
different ways. You may experience
stiffness in your neck that interferes
with your daily tasks, or a sharp or
dull pain in the neck. Sometimes, the
neck pain is accompanied by shoulder, back or arm pain. Common causes for ordinary neck pain include:
■ Muscle strains — These are
typically triggered by overuse, such
as too many hours hunched over a
desk or computer, or leaning over a
steering wheel. Neck muscles — especially those in the back of the neck
— fatigue and become strained (tension myalgia). If the overuse occurs
repeatedly, the result can be chronic neck pain. ➧
Some causes can be serious
When a necessary task is considered
to be less than fun, it’s sometimes
described as being a “pain in the
neck.” Actual neck pain can be much
more troubling.
Neck pain is a common problem
with many possible causes. Sometimes, simple self-help techniques
can ease the pain. But neck pain can
at times be related to a more serious condition.
Recognizing the difference can
be a critical factor in getting the right
medical care.
SECOND OPINION . . . . . . . . 8
Neck
pain
Coming in December
MAGNETIC STIMULATION
Therapy for depression, chronic
pain and more.
SERVICE DOGS
Greater independence and safety.
EXERCISE TO BURN CALORIES
What does it take?
DYSTONIA
Muscles, nerves and misfires.
Spine
Pain from neckmuscle strains
Narrowed
disk space
Pinched nerve
Herniated disk
A variety of factors can cause neck pain, including muscle strains, narrowed disk spaces,
herniated disks and pinched nerves.
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■ Worn joints — Over time, wear
and tear occurs in the neck joints.
Neck (cervical) osteoarthritis can
result and cause pain and stiffness.
■ Disk degeneration — With
age, the spongy disks that provide
cushion between the vertebrae of
your spine become stiff and provide
less shock absorption. This normal
aging process may cause neck and
upper back pain. Occasionally, the
nerves exiting the spine are affected by a herniated disk or outgrowths
of bone spurs from around neck
joints that are worn. If the nerves are
irritated by the disk or bony outgrowth, it may cause pain in the
shoulder or arm.
Sometimes, pain is related to an
injury such as whiplash. Rear-end
vehicle collisions can stretch neck
muscles and ligaments beyond their
limits. Whiplash injuries often affect
both the neck joints and the disks.
Home care
In most instances, neck pain related to muscle overuse and strain
responds well to home care — usually within a few days — and doesn’t require medical treatment. Selfcare measures include:
■ Nonprescription pain relievers — Creams and gels with camphor
and menthol, such as Flexall and
Bengay, help relieve muscle and
joint pain and may offer temporary
relief. Acetaminophen (Tylenol, others) may relieve pain as well as other
oral medications — but with less
risk of gastrointestinal irritation and
with lower risk to the kidneys. Other
oral options include naproxen (Aleve),
ibuprofen (Advil, Motrin IB, others)
and aspirin.
■ Using either heat or cold —
To reduce inflammation, use an ice
pack or ice wrapped in a towel for
up to 20 minutes several times a day.
MAYO CLINIC HEALTH LETTER
Beyond home care
When simple home care methods alone don’t work, there are other
approaches your doctor might recommend to address neck pain
and provide relief. The addition of specific neck stretches and
exercises may be helpful.
A physical therapist can teach you stretching techniques and
specific exercises. Generally, you can perform these on your own
at home. Doing so helps restore muscle function and reduce tightness experienced as muscle spasm. Increasing neck-muscle strength
and endurance is particularly important once you feel ready to participate in these exercises, as they may decrease chances of future
neck pain flare ups. However, flare-ups are common, and a large
percentage of the population has recurrent neck pain problems.
For some, oral medications — particularly prescription pain
medications, muscle relaxants or tricyclic antidepressants — may
be helpful. Another option may be to inject corticosteroid or
numbing medication near nerve roots, small neck joints or muscles. Traction done under the supervision of a medical professional
may provide relief, especially if neck pain is related to nerve irritation. Relief may last hours or even days. If traction helps your pain,
you may want to talk with your doctor about home-traction devices.
Although surgery isn’t a common treatment for neck pain, it
may be an option if the problem stems from nerve compression or
causes serious complications — such as arm weakness — or if
other treatment options have had little impact on your pain.
Surgery to relieve nerve compression is successful most of the time.
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Alternate cold with heat by taking
a warm shower or using a microwaveable heat pack. However, use
heat with caution for the first 48 to
72 hours after injury, as it can sometimes aggravate inflammation.
■ Resting your neck — During
the day, lie down for short periods
— 10 to 30 minutes — to take a
load off your neck from holding up
your head. Relaxation and stressreduction techniques, such as progressive muscle relaxation, can help,
as can massaging neck muscles.
■ Gentle stretching — Certain
stretches done slowly and held for
at least 30 seconds can be helpful.
However, be aware that there’s a
balance between aggravating arthritis and losing your range of motion,
so start slowly with any stretches.
You might try slowly rotating
your head from side to side, keeping your chin level as you turn your
November 2009
Managing Editor
Aleta Capelle
Medical Editor
Robert Sheeler, M.D.
Associate Editors
Carol Gunderson
Joey Keillor
Associate Medical Editor
Amindra Arora, M.D.
Medical Illustration
Michael King
Customer Service
Manager
Ann Allen
Editorial Research
Deirdre Herman
Proofreading
Miranda Attlesey
Donna Hanson
Administrative Assistant
Deborah Adler
EDITORIAL BOARD
Shreyasee Amin, M.D., Rheumatology; Amindra
Arora, M.D., Gastroenterology and Hepatology; Brent
Bauer, M.D., Internal Medicine; Julie Bjoraker, M.D.,
Internal Medicine; Lisa Buss, Pharm.D., Pharmacy;
Bart Clarke, M.D., Endocrinology and Metabolism;
William Cliby, M.D., Gynecologic Surgery; Diane
Dahm, M.D., Orthopedics; Mark Davis, M.D.,
Dermatology; Timothy Hobday, M.D., Oncology; Lois
Krahn, M.D., Psychiatry; Amy Krambeck, M.D.,
Urology; Suzanne Norby, M.D., Nephrology; Robert
Sheeler, M.D., Family Medicine; Phillip Sheridan,
D.D.S., Periodontics; Peter Southorn, M.D., Anesthesiology; Ronald Swee, M.D., Radiology; Farris
Timimi, M.D., Cardiology; Aleta Capelle, Health
Information. Ex-officio: Carol Gunderson, Joey Keillor.
Mayo Clinic Health Letter (ISSN 0741-6245) is published
monthly by Mayo Foundation for Medical Education
and Research, a subsidiary of Mayo Foundation, 200
First St. SW, Rochester, MN 55905. Subscription price
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POSTMASTER: Send address changes to Mayo Clinic
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Neck alignment in a forward-facing world
In a perfect world, your head would rest on the top of your neck, much like a golf ball
placed atop a tee. But the reality is your head is much heavier than a golf ball. With
our orientation being forward — picture yourself sitting in front of your computer
— it’s much more likely your head is tilted forward and perhaps downward as well.
Or, if you wear glasses, you may find yourself tipping your head back to better see the
computer screen. Either way, this can put a real strain on your neck and upper back
muscles. To find your head and neck neutral spine position, start by standing up.
A
B
C
Tuck your chin down slightly and pull your head back and up as if to flatten your neck
against a wall (A). Next, look straight ahead and jut your chin forward as if you
were moving your neck away from the wall (B). Now repeat these movements slowly five times to find your neck’s range of comfortable movement. After the last repetition, allow your head to find a comfortable position between the two movements
(C). That’s it — you’ve found the neutral position for your head and neck.
head from one shoulder to the other.
Another option is to flex your neck
forward, as if to touch your chin to
your chest. Then slowly raise your
head to a level position. From there,
tilt your head slowly to one side
until you feel a gentle stretching of
muscles on the opposite side of your
neck, and then do the same motion
for the other side of the neck.
Another exercise involves slowly circling your head. Imagine your
face to be the hands of a clock as
you tip your chin to the 6 o’clock
position, then slowly circle upward
and stretch your chin up to the 12
o’clock position, continuing in a circle back down to 6 o’clock.
See your doctor if self-care doesn’t result in neck pain letting up
within a week or two.
When to seek medical care
If your neck pain is due to muscle overuse, the cause is usually
apparent and it typically gets better
with self-care at home. The majority of neck pain problems are not
serious. But in certain rare circumstances, neck pain warrants immediate medical care, including:
■ Severe pain or pain related to
a head or neck injury may indicate
a fracture or other structural damage.
■ Pain that radiates to your shoulder, shoulder blade or down your
arm with or without numbness, tingling or weakness — or leg weakness and walking (gait) difficulties
— may indicate that you have a herniated disk or nerve injury.
■ Pain that gets worse at night
or is present along with a fever or
weight loss may indicate infection
or a possible tumor.
■ Throbbing neck pain may be
related to a cardiovascular or heart
problem.
■ Neck pain before or with a
headache can be due to problems
in arteries in the neck, which can
lead to stroke. ❒
November 2009
Health tips
Avoiding falls
Falls are by far the leading cause
of hip fractures among older
adults. Steps that you can take
to minimize your risk of falling
include:
■ Fall-proof your home —
Keep your home well lit. Avoid
area rugs and exposed electrical cords or wires. Arrange
furniture pieces so that bumping into them is unlikely. Use
handrails and stair treads. Put
nonslip mats on bathtub and
shower floors, and consider
installing grab bars in the bathroom. Plug night lights into
bedroom, hall and bathroom
outlets. Avoid using ladders.
■ Stay active — Exercise
improves strength, muscle tone,
balance and coordination. Efforts to improve balance are
particularly important, as poor
balance is a major cause of
falls. Simply walking can help
improve your balance. In fact,
regularly walking is a package
deal — you get aerobic exercise, strengthen your leg muscles and reinforce your balance skills. Practicing the ancient Chinese tradition of tai
chi (TIE-chee) also has been
shown to prevent falls. Standing on one foot and walking
heel-toe, heel-toe as if walking on a line also can help improve balance. Do these near
something you can steady yourself on if need be.
■ Dress for your own good
— Avoid wearing high heels,
sandals with light straps or
shoes that are either too slippery or too sticky. ❒
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3
News and our views
Acupuncture or acupressure reduces nausea after surgery
If you’ve had general anesthesia, you may have also experienced nausea or vomiting after surgery. A recent review of medical studies finds
that relief from this common problem may be as simple as stimulating the pericardium 6 (P6) acupuncture point located about two inches — three finger widths — above the crease of the wrist. Stimulating
this point is already known to reduce nausea from other causes.
The review, published in the April 15, 2009,
issue of The Cochrane Library, analyzed 40 studies of P6 stimulation involving a total of nearly
4,900 participants. The studies analyzed used many
different methods of acupoint therapy, including
traditional needle acupuncture, electric or laser
stimulation, and different forms of acupressure,
P6
including using elastic wristbands.
Overall, P6 stimulation was just as effective
as anti-nausea drugs, reducing nausea and vomiting by about 30 percent. In addition, P6 stimulation may have fewer
side effects than do anti-nausea drugs. Still, acupuncture can sometimes result in bleeding, bruising and discomfort at the needle site.
Mayo Clinic experts say that P6 stimulation appears to be another option for preventing postoperative nausea that could be used
instead of — or in addition to — anti-nausea drugs. Acupuncture is
becoming more widely available, especially in larger centers.
P6 stimulation won’t work for everyone, but neither do anti-nausea drugs. The difficulty of using acupuncture around the time of
surgery is that the P6 area may not be accessible because of your position, identification wristbands, blankets or intravenous tubes. ❒
Why exercise matters after age 50
If you’re over 50 and assume it’s too late to benefit from starting a regular exercise program, think again. A recent study published in the
British medical journal BMJ found that late starters to regular exercise
can actually enjoy some of the same benefits of exercise — in particular, a longer life expectancy — enjoyed by those who had regularly exercised since their younger years.
The most active men, who did at least three hours a week of active
sports or heavy gardening prior to and at the start of the study, had
the lowest death rates during the first five years of the study. Sedentary
men who in their 50s shifted to a high level of activity for 10 years,
had comparable death rates to those of men who’d been highly active
all along. Although it took a decade to catch up, these formerly sedentary men experienced benefits in extended life. Researchers estimated the net gain in life expectancy for men who exercised at the
highest level to be about 2.3 years.
Mayo Clinic doctors say the study backs the notion that it’s never
too late to get more physically active to promote a healthier life. ❒
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November 2009
Hemorrhoids
Blood vessels gone astray
Hemorrhoids can be an embarrassing problem. If there’s any comfort
in numbers, you’re hardly alone —
by age 50, about half of adults have
encountered hemorrhoids.
Treatment is dependent upon
their location and how severe they
are. In many instances, lifestyle
changes and home treatments can
relieve symptoms, but sometimes
the best route for relief is surgery.
Anatomy of a problem
Hemorrhoids are blood-engorged
veins in the lower rectum (anal
canal) that form tiny sacs (anal cushions) when too much pressure is
exerted on veins serving the pelvic
and rectal areas.
Factors that may increase pressure on these veins and thereby promote the increase in size of hemorrhoids include straining during
bowel movements, sitting on the toilet for an extended time, chronic
diarrhea or constipation, obesity, lifting heavy objects, sitting or standing for long periods, and pregnancy. Age also can be a factor. As you
get older, tissues supporting the
veins in your rectum and anus tend
to weaken and stretch.
Signs and symptoms related to
hemorrhoids depend on whether
they’re located internally or externally. Internal hemorrhoids occur
inside the anal canal and typically
don’t cause discomfort. You can’t
normally see or feel them, although
they may bleed if the surface is irritated due to straining or passing
stool. Sometimes, straining will push
an internal hemorrhoid outward
through the anal opening. This is
called a prolapsed hemorrhoid. It
may be felt as a lump or mass and
possibly cause pain, irritation and
rarely, more-serious complications.
External hemorrhoids are located under the skin around the anus
and can itch or bleed if irritated. If
blood pools in an external hemorrhoid and forms a clot (thrombosed
hemorrhoid), you may have severe
pain, swelling and inflammation.
Additional signs and symptoms
may include:
■ Painless bleeding during bowel
movements, noticed either as small
amounts of bright red blood on toilet tissue or in the toilet bowl
■ Leakage of feces and mucus
Hemorrhoids generally don’t
cause serious problems, but rarely,
chronic blood loss can occur that
might result in anemia. Another
more serious complication can occur if an internal hemorrhoid becomes prolapsed and the blood supply is cut off (strangulated). This can
cause extreme anal pain and lead
to tissue death (gangrene). This is a
surgical emergency that requires
immediate care.
Embarrassment aside, it’s important to talk with your doctor if you
experience rectal bleeding. A doctor can determine whether you’re
dealing with hemorrhoids or if the
bleeding is due to a more serious
problem, such as polyps, cancer or
inflammatory bowel disease. A colonoscopy may be needed to further
evaluate bleeding.
Steps you can take
Flare-ups of mild pain, swelling
and inflammation due to hemorrhoids often can be managed with
self-care measures. Nonprescription
hemorrhoid creams, suppositories
containing hydrocortisone, or pads
containing witch hazel or a topical numbing agent may provide
relief. Generally, these readily available products aren’t designed for
use longer than a week, unless your
doctor directs otherwise.
Other steps include keeping the
anal area clean. Taking baths in
which only the hips and buttocks
Beyond self-care
Internal
hemorrhoid
Prolapsed hemorrhoid
Internal hemorrhoids occur inside the anal
canal. If an internal hemorrhoid is pushed
outward through the anal opening, this is
called a prolapsed hemorrhoid.
are immersed (sitz baths) in warm
water several times a day can offer
relief. This can be done in a bath tub
or using a plastic tub that fits over
the toilet. These are available from
medical supply stores and pharmacies. Use moist towelettes or wet
toilet tissue that doesn’t contain perfume or alcohol to cleanse the anal
area after a bowel movement.
To help relieve swelling, use ice
packs or cold compresses on the
anus. Nonprescription pain relievers such as acetaminophen (Tylenol,
others) or ibuprofen (Advil, Motrin
IB, others) also may provide relief.
To help soften and bulk up stool
for easier passage, drink plenty of
water — aim for six to eight glasses
of water or other nonalcoholic liquids every day — and increase your
intake of high-fiber foods. You can
also help boost fiber intake by using
fiber supplements such as Metamucil and Citrucel. Exercise and physical activity also can be helpful if
your hemorrhoids are mild, but during a flare-up, avoid heavy lifting
and strenuous exercise.
Finally, don’t delay visiting the
bathroom when you feel the need
to go. And, when you do go, avoid
straining or holding your breath
when passing stool, as this strains
veins in the lower rectum.
November 2009
See your doctor if self-care measures aren’t successful after a month
or if you encounter severe pain or
persistent bleeding. Several minimally invasive procedures may be
considered.
Generally, these procedures can
be done in your doctor’s office or as
an outpatient:
■ Rubber band ligation — This
involves placing a rubber band
around the base of a hemorrhoid
that’s inside the rectum. Blood circulation to the hemorrhoid is cut off,
and it withers and falls off in a few
days. Ligation success rates are high,
but more than one visit to your doctor may be needed, and rare, serious complications do occur.
■ Sclerotherapy — This involves
injecting a chemical solution into
the hemorrhoid tissue in order to
shrink it. It’s more often used for
smaller hemorrhoids. There may be
some drainage from the injected site
after the procedure. Generally, sclerotherapy is much less effective than
is rubber band ligation.
If you have large hemorrhoids
or other treatments haven’t been
successful, surgical procedures may
be considered. Typically done on an
outpatient basis, they include:
■ Hemorrhoidectomy — Excessive tissue that’s causing bleeding is
removed. It’s generally the most
effective surgical approach. However, hemorrhoidectomy can result
in more complications than other
procedures. Urinary retention may
be a problem in the first 12 to 24
hours after surgery. In addition, it
can be quite painful for as long as
two weeks afterward.
■ Stapling or hemorrhoidopexy
— This surgical technique is designed to block blood flow to the
hemorrhoidal tissue. There’s generally less postoperative pain after this
procedure than after a hemorrhoidectomy, but recurrence rate for hemorrhoids is slightly higher. ❒
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5
Heart failure
Proven treatments
to extend life
Heart failure is an ominous sounding disease. However, what many
people don’t realize is that three key
classes of drugs — and sometimes
a pacemaker or defibrillator device
— can make a big difference in how
you feel and how long you live.
Despite this knowledge, studies
have shown that fewer than onethird of those with heart failure are
taking the three main types of drugs
that are most effective in prolonging life and improving quality of life.
Stop the process
The process of heart failure generally begins when heart muscle
becomes damaged — such as from
a heart attack — or otherwise weakened by some factor. Factors may
include high blood pressure, heavy
alcohol use, diabetes, heart infections, faulty heart valves, obesity,
thyroid problems, heart rhythm
problems and sleep apnea.
The sooner you and your doctor
recognize heart failure, the sooner
you can take steps to reduce the burden on your heart, possibly slowing
or stopping its progression.
Keeping it simple
There are many heart failure
treatments. However, national guidelines recommend the following
drugs as the foundation of care in
the vast majority of treatment plans:
■ A n g i o t e n s i n - c o nve r t i n g
enzyme (ACE) inhibitors — Drugs
in this class — enalapril, lisinopril,
others — reduce production of angiotensin, a substance that causes
blood vessels to narrow and blood
pressure to rise. This lowers blood
pressure and reduces workload on
the heart. The main side effect is an
irritating dry cough for some.
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As an alternative, angiotensin II
receptor blockers (ARBs) may offer
many of the same benefits of ACE
inhibitors, but these drugs are less
likely to cause a persistent cough.
■ Beta blockers — Drugs in this
class — metoprolol, bisoprolol, others — slow the heart rate and lower
blood pressure. They may also help
widen (dilate) blood vessels and
lessen the risk of developing certain
abnormal heart rhythms. Beta blockers are the single most effective drug
at improving heart function and
symptoms and prolonging life in
those with heart failure.
■ Aldosterone antagonists —
Drugs in this class — spironolactone
and eplerenone — have some diuretic effects, which cause the kidneys
to remove more sodium and water
from the bloodstream than usual.
Aldosterone antagonists also block
aldosterone, a hormone that can
stress the heart of those with chronic heart failure. Aldosterone contributes to formation of scar tissue
in the heart, and blocking it may
improve longevity and quality of life
November 2009
in those with heart failure. Monitoring potassium levels in the blood is
recommended, as aldosterone antagonists can raise potassium to dangerous levels, especially if the kidneys aren’t working properly.
As many as half of those with
heart failure have abnormalities in
their hearts’ electrical systems that
cause their already-weak heart muscles to beat in an uncoordinated,
inefficient fashion.
Implanting a type of pacemaker that coordinates heartbeats (cardiac resynchronization therapy) can
improve the heart’s efficiency. Implantable cardioverter-defibrillators
also may be recommended — alone
or as part of a combined pacing
device — to detect and stop dangerous heart rhythms.
Added improvements
A healthy lifestyle also is important and includes reducing sodium
intake, beginning a doctor-supervised exercise program, not smoking, avoiding or limiting alcohol,
and managing stress. ❒
The way
we play
Games for better health
Recreational games can be a rich
source for challenge and fun throughout life. However, with age and
physical limitations, how you play
may be altered. Fortunately, technology and virtual game systems are
providing new options.
Advanced interactive game systems and their growing popularity
are changing the dynamics of play.
For example, it’s now possible to
compete actively in video gamebased bowling competitions even if
your ability to stand or hold a bowling ball is limited.
Interactive gaming has also
found its way into rehabilitation. It’s
creating new incentives, social opportunities and exercise motivation
for people who might otherwise settle for less activity due to barriers
such as limited range of motion or
mobility restrictions.
Activity-based video games are making their mark
When Nintendo’s Wii video game system came out in 2006, health
professionals working in rehabilitation and retirement living centers
recognized the potential for it being another way to help get
people active while having fun. The Wii combines virtual environments and wireless motion-sensitive remote controllers that allow
you to play a variety of virtual games.
For instance, you might choose to bowl while sitting down, or
you could stand and get into the actual movements while sighting
the pins and taking careful aim on the virtual bowling alley. There
are also Wii games that simulate daily living skills, such as driving
and cooking. The Wii games
encourage physical activity
while drawing on cognitive and
perceptual skills. Therapists can
create a virtual environment
with the Wii that’s suited to an
individual’s therapy needs and
abilities.
The Wii Fit was released in
2008 with an added base unit
to stand on. The base unit
tracks progress as you use the
fitness game package for
aerobics and yoga to strengthen
and improve balance. The base
unit is also adaptable for
A woman practices her golf swing using
people who require use of a
the Nintendo Wii. Photo Courtesy of
Nintendo of America.
walker, cane or wheelchair.
Playing to your strengths
These interactive and deeply
engaging game worlds are not only
fun, but they’re also ripe settings for
learning, skill rehearsal and development. With that in mind, therapists specializing in interactive
media see many opportunities for
potential uses that can result in significant health improvement and
behavior modification.
Numerous research efforts are
under way related to games that can
increase physical activity and improve the ability to care for yourself.
Study participants range in age from
children to older adults, and there’s
a wide variety of subjects being
examined — from people dealing
with chronic health conditions to
those who deal with chemical or
substance abuse.
One pilot study demonstrated
that people with Parkinson’s disease
who played the Nintendo Wii a few
times a week for a month experienced improvement of their symptoms. Rigidity, movement, fine motor
skills and energy levels all improved,
and most saw depression levels
decrease to zero.
In Scotland, a study is under way
with people over 70 to determine if
their balance and risk of falling
might be improved with regular use
of the Nintendo Wii (pronounced
WEE) and its activities package
called Wii Fit.
Another study is using physical
activity games — such as the Wii
and Dance Dance Revolution, which
is a video game that gets players up
and dancing to musical and visual
November 2009
cues — as therapy for people who
have had a stroke. Researchers want
to see if study participants find the
games to be a fun means of ongoing therapy beyond the actual carecenter setting.
Increasingly, video game technology is finding its way into physical, occupational and recreational
therapy settings. Mayo Clinic therapists say interactive game systems
are useful in improving balance,
eye-to-hand coordination, problemsolving skills and social interactions.
They find that game systems make
it easier and more fun for their those
they work with to progress.
People who have led active lives
are enjoying the opportunity to get
back into leisure activities that allow
them to overcome limitations. ❒
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7
Second opinion
Questions and our answers
Q: In recent months, I’ve started
taking several new medications. I
was shocked at the cost difference
between a generic drug that’s been
prescribed and one of the brand
name drugs, which cost over $100.
How can I get generic drugs prescribed instead of the expensive
brand-name drugs?
A: Awareness of the value of generics is key, so you’ve already taken
an important step in recognizing
that. You might start by telling your
doctor that you’re willing to work
together on an ongoing basis to
identify medications that meet your
needs but aren’t necessarily the latest heavily marketed prescription
brand-name drugs on the market.
After all, just because something
is new doesn’t always mean it’s better, but it’s often more expensive.
If your doctor recommends a prescribed brand-name drug, ask whether a generic drug in the same drug
family or in a related one might
work just as well for your needs.
If a drug prescription is needed,
consideration may be given to the
product that has the lowest risk of
side effects or the most convenient
dosage form. For instance, if you
have high blood pressure, your doctor may be inclined to prescribe an
angiotensin II receptor blocker (ARB)
because side effects are uncommon
— but these brand-name medications can be costly.
As an alternative, a generic
angiotensin-converting enzyme (ACE)
inhibitor might be prescribed at a
much-reduced cost. ACE inhibitors
cause few side effects, although a
small percentage of people who take
them develop a dry cough.
You may be able to experience
significant savings if you’re willing
to try a generic
drug first to see
if you have a
problem with
the slightly higher chance of side
effects or the less friendly dosing
options. Ask your doctor if there are
comparable generic drugs that might
work for you. ❒
Q: What’s the difference between
corticosteroid and hyaluronic acid
injections for arthritis?
A: A corticosteroid injection into a
joint can dramatically reduce pain
and inflammation for weeks to several months. However, it’s best to
limit injections into the same joint
to two or three a year due to potential side effects with frequent use.
A hyaluronic acid injection
(Hyalgan, Synvisc, others) — also
called visco-supplementation — is
thought to restore more normal joint
lubrication. This may improve mobility and reduce pain. Relief may
last for six months or longer.
One key difference is that corticosteroid injections can be performed in those with osteoarthritis
or rheumatoid arthritis, and can be
done at multiple joint sites, including the elbows, shoulders, knees,
hips ankles and wrists. In contrast,
the Food and Drug Administration
has approved the use of hyaluronic
acid injections only for the knee
joint in people with osteoarthritis.
Even with knees, corticosteroid
injections are typically chosen over
hyaluronic acid as the first line injection therapy. Corticosteroid treatment involves only one injection
and is much less expensive.
A round of the more costly
hyaluronic acid injections requires
a series of three to five injections
over several weeks. With hyaluronic acid, it’s also important that your
doctor can confidently get the medication into the knee joint, as an
injection that misses the mark can
result in a painful red knee.
Either type of injection may be
recommended when pain-relieving
drugs, physical therapy, exercise,
bracing or other treatment techniques have failed. If the injection
doesn’t work the first time, subsequent injections of the same drug
probably won’t work, either. ❒
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