The vertebral column (backbone) is made up of 33 vertebrae separated by spongy disks and classified into four distinct areas. The cervical area consists of seven bony parts in the neck; the thoracic spine consists of 12 bony parts in the back area; the lumbar spine consists of five bony segments in the lower back area; five sacral bones (fused into one bone, the sacrum); and four coccygeal bones (fused into one bone, the coccyx).
Between each vertebra is a fibrous disc with a jelly-like core. These cushions of cartilage allow the body to accept and dissipate load across multiple levels in the spine and still allow for the flexibility required for performing normal activities of daily living. As the body twists, bends, flexes and extends, the intervertebral discs are constantly changing their shape.
Causes
When discs degenerate, becoming less supple due to age or back strain, the disc may prolapse — squeezing out some of the soft core. This loss of cushioning may cause pressure on local nerves and cause back or neck pain, numbness or tingling in the arms, or searing pain down one or both legs. If the prolapse is severe it can damage the spinal cord. As a part of the aging process the discs lose their high water content and their ability to cushion the vertebrae. This is called degenerative disc disease. As the discs deteriorate, the spine can initially become less stable. Bony spurs can develop as a result of this instability and can cause pressure on nearby nerves leading to leg or arm pain. Narrowing of the neural canal by these bony spurs is known as degenerative spinal stenosis.
By the age of 35, approximately 30% of people will show evidence of disc degeneration at one or more levels. By the age of 60, greater than 90% of people will show evidence of disc degeneration at one or more levels on MRI. In some patients, this disc degeneration can be nearly asymptomatic; in others, disc degeneration can lead to intractable back pain.
The outer layer of the discs themselves can also tear. When this occurs, the inner, gelatinous layer can herniate out (a “herniated” or “ruptured” disc) and also cause pressure on an adjacent nerve. If the herniation occurs in the neck and causes pressure there, it can cause pain that radiates into the shoulder and arm; if it occurs in the lower back, the pain produced can radiate down into the hip and leg.
Symptoms
Patients with disc disease in the cervical, thoracic, or lumbar spine experience variable symptoms depending on where the disc has herniated and what nerve root it is pushing on. The following are the most common symptoms of lumbar disc disease:
•Intermittent or continuous back pain (this may be made worse by movement, coughing, sneezing, or standing for long periods of time)
•Spasm of the back muscles
•Sciatica — pain that starts near the back or buttock and travels down the leg to the calf or into the foot.
•Muscle weakness in the legs
•Numbness in the leg or foot
•Decreased reflexes at the knee or ankle
•Changes in bladder or bowel function
The symptoms of lumbar disc disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
In rare cases, patients with large disc herniations may experience weakness in an extremity or signs of spinal cord compression such as difficulty with gait, incoordination, or loss of bowel/bladder control.
Diagnosis
•Spine x-rays are commonly taken after a neck injury in order to rule out a fracture, dislocation or instability. If the x-rays show degenerative changes right after the injury, then we assume they were present prior to the injury. Cervical spine x-rays may reveal congenital narrowing of the cervical spinal canal when present. Thoracic and lumbar x-rays may also show evidence of degenerative disease such as bone spurs and disc space narrowing.
•CT scan of the spine is valuable in assessing bone injury, such as fracture and/or dislocation. Bulging or herniated discs may or may not be visible on CT scan, and may or may not be related to the patient’s symptoms. CT scan is most useful in showing bone structures, and is not as good as MRI in showing spinal cord, nerve roots or discs. CT scan does not show torn ligaments or minor tears of discs.
•MR scanning (MRI) of the spine is the best method of imaging the spinal cord and nerve roots, the intervertebral discs, and the ligaments. However, MRI findings can only be of value when they are interpreted together with and in the light of the entire clinical picture, and exactly match the clinical findings.
•Cervical myelography consists of x-rays taken after the injection of radio-opaque contrast material into the spinal fluid via a lumbar puncture, and is followed by post-myelogram CT scan of the spine (myelo-CT). It may provide useful images of the interior of the spinal canal, and can reveal indentations of the spinal fluid sac caused by bulging or herniated discs or bone spurs that might be pressing on the spinal cord or nerves. MRI provides superior images of the spinal cord, nerve roots and discs.
•Electrodiagnostic studies(EMG and nerve-conduction velocities) are useful in evaluating weakness of hand and arm or leg muscles, and can indicate whether the weakness is due to abnormality or compression of a nerve root, or to some other cause.
Treatment
Treatment for disc disorders must be closely tailored to the patient, based on:
•The history and severity of their pain
•Whether or not they have had prior treatments for this problem and how effective they have been and
•Whether or not there is any evidence of neurologic damage such as weakness of an extremity or the loss of reflexes
Some of the treatments used include
•Activity modification
•Patient education on proper body mechanics (to help decrease the chance of worsening pain or damage to the disc)
•Physical therapy, which may include ultrasound, massage, conditioning, and exercise programs
Weight control
•Medications (to control pain and/or to relax muscles)
Surgery for patients with disc disorders of the spine is usually reserved for those who have failed exhaustive attempts at conservative treatment over a period of 6-12 weeks. An exception to this is the patient with a neurologic deficit; in this patient, it is wise to consider early surgical decompression to maximize the likelihood of neurologic recovery.
Surgery is done under general anesthesia. An incision is placed in the lower back over the area where the disc is herniated. Some bone from the back of the spine is removed to gain access to the area where the disc is located. Typically, the herniated part of the disc and any extra loose pieces of disc are removed from the disc space.
After surgery, restrictions may be placed on the patient’s activities for several weeks while healing is taking place to prevent another disc herniation from occurring. Your physician will discuss any restrictions with you.
Sunday, October 24, 2010
Patient handouts for BKA and AKA
Below the Knee Amputation and Above the Knee Amputation
PVS
--------------------------------------------------------------------------------
Our Services
Heart and Vascular Care
This handout will tell you how to take care of yourself at home after your Below the Knee Amputation (BKA) or Above the Knee Amputation (AKA). Your nurse will review this sheet with you before you go home.
Care of the Incision
There are several layers of stitches holding your incision together on the inside and outside. You may get the stitches wet in the shower. Do not swim or take tub baths. Clean the area gently with mild soap and water. Do not rub. Remove any dried drainage. Gently pat the incision dry. Leave the incision open to air unless told otherwise by your health care team.
At your first clinic visit or even before you leave the hospital, your stitches may be removed. Small pieces of tape called Steri-Strips® may be placed along the incision to help the edges of the incision heal. You may shower with the Steri-Strips® in place. Do not soak them in water for any length of time. Do not rub the incision; just allow the water to flow gently over the site. Gently pat the incision dry. After 2 – 3 days, as your wound heals, the Steri-Strips® will begin to curl up at the ends. You may trim the curled ends with a scissors. In time the Steri-Strips® will fall off on their own. If they do not, you can remove them after one week by gently peeling back the strips.
When to Call Your Doctor
At least twice each day you should look at your incision site for signs of infection or breakdown.
Call your doctor if you have these signs of infection or skin breakdown.
•An increase in redness at the site or red streaks on your skin that extend from the site.
•Increased warmth around the site.
•Increased pain that becomes constant or tenderness around the site.
•Bulging or swelling at the site.
•New drainage or bleeding from your site (drainage may be cloudy, yellow, or foul-smelling).
•Open spots between the stitches where the skin is pulling apart.
•A temperature of more than 101.5° F (38.5° C), by mouth; taken twice a day 4 hours apart.
•If you notice the skin along the site is getting darker or turning black.
With these symptoms you should contact a doctor right away (go to the emergency room if your doctor cannot be reached).
•Sudden increase in pain that is not controlled by your pain medicine.
•Uncontrollable bleeding from incision or anywhere else.
•Sudden increase in tenderness or swelling in leg.
•Sudden increase in redness, warmth, or even a bluish skin discoloration in leg.
•Please refer to Health Facts For You: Deep Vein Thrombosis and Pulmonary Embolism.
Care of the Residual Leg
•Look at your entire leg, front and back, each day. Use a mirror to look for skin abrasions, blisters, or red marks.
•Wash your leg everyday. It is very important to keep the leg clean. This prevents skin problems and bacteria from growing.
•Do not soak the leg.
•Use warm water.
•Use mild soaps without fragrance (Example: Dial® soap).
•Wear ace wraps or a shrinker sock at all times. This will reduce swelling, unless you are wearing a prosthesis.
•Reduce the swelling to speed up the amount of time it takes to heal the incision.
•Reduce the swelling to keep the stump the right shape when finding a prosthesis to use.
•If you are using ace wraps, rewrap every 2 – 4 hours while awake to compress the stump. Make sure there are no creases.
•Wear a leg protector when out of bed.
•Do not put too much weight or clothing on one side of the residual leg and not the other. Keep it equal.
•Avoid rubbing the leg against other surfaces or clothing.
Activity
Your doctor would like you to keep doing your exercises the way you learned in Physical Therapy. If you are able, you should also walk with your walker as much as you can. Inspect your walker to be sure it is safe. Check the rubber stoppers for signs of wear. All of the walker legs should be same height. You may notice that you tire quickly as you do more. This is normal. It should lessen as you get your strength and energy back. Take rest periods as needed but be as active as you can be to maintain your strength.
•Do not sit with your legs crossed.
•Do not place pillows under the stump to increase comfort; this can increase the chance that the muscles will shrink.
Pain Control
It is normal to have pain at the incision site, but not all people have this. Your doctor may have prescribed pain medicine for you to use at home. If you needed pain medicine in the hospital, this is often the same. If you have pain, your pain should in time lessen and may be managed with something you can buy over-the-counter. Be sure to ask your doctor which is best for you.
You may also have one or both of the problems listed here.
•Phantom sensation: This is the feeling that you still have the amputated part (leg or toe). Often, only the farthest part is felt, and although not painful, there may be tingling, numbness, or pressure. It may disappear as you get stronger, or it may last throughout life. Almost all people who have had an amputation have phantom sensation.
•Phantom pain: This is actual pain (most often the burning, cramping, squeezing, or shooting type) in the amputated part. It may be present all the time or it may come and go. Phantom pain may be relieved with pain medicine. If severe phantom pain is a problem for you, talk to your doctor about something else for pain relief. Many people report they have more relief from the medicine called Neurontin, which your doctor can discuss with you.
•(Please refer to Health Facts For You: Neuropathic Pain)
Diet
You may resume your regular diet when you return home. You should avoid constipation Decreased activity as well as some prescription pain medicines can cause constipation.
You can try to prevent constipation by trying these methods:
•Drink several glasses of fluids (8-10 8-oz. glasses of water or fruit juice per day)
•Eat foods high in fiber (whole grain breads and cereals, fresh fruit and vegetables)
•(Please refer to Health Facts For You: Suggestions For Relieving Constipation).
If these do not work, an over-the-counter stool softener or laxative (something that loosens and softens bowels) may be used. If the problems do not go away, call your doctor.
Maintain a stable body weight; this is very important for overall success.
Care of Your Other Leg
If you have diabetes or have peripheral vascular disease it is even more important now to take good care of your other leg and foot and protect it from being damaged in any way.
Ways to care for other leg:
•Look at legs and feet daily for sores, scratches, cracks, blisters or reddened areas. Report them to your doctor or nurse.
•Wash your legs and feet daily with mild soap and water. Avoid soaking. Dry well.
•Put lotion on dry skin daily.
•Let a doctor or nurse clip your toenails or show you how to clip toenails.
•Wear shoes that fit well.
•Wear white cotton or wool socks.
•Check shoes and socks for stones, sharp things, or holes.
•Do not use heating pads or hot water bottles on legs or feet.
•Never go barefoot.
Are You at Risk for Poor Blood Flow to the Legs and Feet?
You are more likely to have poor blood flow to the legs if you:
•Smoke
•Have high blood pressure
•Have high cholesterol
•Have diabetes
•Are over age 50
•Do not exercise
•Have heart disease in your family
PVS
--------------------------------------------------------------------------------
Our Services
Heart and Vascular Care
This handout will tell you how to take care of yourself at home after your Below the Knee Amputation (BKA) or Above the Knee Amputation (AKA). Your nurse will review this sheet with you before you go home.
Care of the Incision
There are several layers of stitches holding your incision together on the inside and outside. You may get the stitches wet in the shower. Do not swim or take tub baths. Clean the area gently with mild soap and water. Do not rub. Remove any dried drainage. Gently pat the incision dry. Leave the incision open to air unless told otherwise by your health care team.
At your first clinic visit or even before you leave the hospital, your stitches may be removed. Small pieces of tape called Steri-Strips® may be placed along the incision to help the edges of the incision heal. You may shower with the Steri-Strips® in place. Do not soak them in water for any length of time. Do not rub the incision; just allow the water to flow gently over the site. Gently pat the incision dry. After 2 – 3 days, as your wound heals, the Steri-Strips® will begin to curl up at the ends. You may trim the curled ends with a scissors. In time the Steri-Strips® will fall off on their own. If they do not, you can remove them after one week by gently peeling back the strips.
When to Call Your Doctor
At least twice each day you should look at your incision site for signs of infection or breakdown.
Call your doctor if you have these signs of infection or skin breakdown.
•An increase in redness at the site or red streaks on your skin that extend from the site.
•Increased warmth around the site.
•Increased pain that becomes constant or tenderness around the site.
•Bulging or swelling at the site.
•New drainage or bleeding from your site (drainage may be cloudy, yellow, or foul-smelling).
•Open spots between the stitches where the skin is pulling apart.
•A temperature of more than 101.5° F (38.5° C), by mouth; taken twice a day 4 hours apart.
•If you notice the skin along the site is getting darker or turning black.
With these symptoms you should contact a doctor right away (go to the emergency room if your doctor cannot be reached).
•Sudden increase in pain that is not controlled by your pain medicine.
•Uncontrollable bleeding from incision or anywhere else.
•Sudden increase in tenderness or swelling in leg.
•Sudden increase in redness, warmth, or even a bluish skin discoloration in leg.
•Please refer to Health Facts For You: Deep Vein Thrombosis and Pulmonary Embolism.
Care of the Residual Leg
•Look at your entire leg, front and back, each day. Use a mirror to look for skin abrasions, blisters, or red marks.
•Wash your leg everyday. It is very important to keep the leg clean. This prevents skin problems and bacteria from growing.
•Do not soak the leg.
•Use warm water.
•Use mild soaps without fragrance (Example: Dial® soap).
•Wear ace wraps or a shrinker sock at all times. This will reduce swelling, unless you are wearing a prosthesis.
•Reduce the swelling to speed up the amount of time it takes to heal the incision.
•Reduce the swelling to keep the stump the right shape when finding a prosthesis to use.
•If you are using ace wraps, rewrap every 2 – 4 hours while awake to compress the stump. Make sure there are no creases.
•Wear a leg protector when out of bed.
•Do not put too much weight or clothing on one side of the residual leg and not the other. Keep it equal.
•Avoid rubbing the leg against other surfaces or clothing.
Activity
Your doctor would like you to keep doing your exercises the way you learned in Physical Therapy. If you are able, you should also walk with your walker as much as you can. Inspect your walker to be sure it is safe. Check the rubber stoppers for signs of wear. All of the walker legs should be same height. You may notice that you tire quickly as you do more. This is normal. It should lessen as you get your strength and energy back. Take rest periods as needed but be as active as you can be to maintain your strength.
•Do not sit with your legs crossed.
•Do not place pillows under the stump to increase comfort; this can increase the chance that the muscles will shrink.
Pain Control
It is normal to have pain at the incision site, but not all people have this. Your doctor may have prescribed pain medicine for you to use at home. If you needed pain medicine in the hospital, this is often the same. If you have pain, your pain should in time lessen and may be managed with something you can buy over-the-counter. Be sure to ask your doctor which is best for you.
You may also have one or both of the problems listed here.
•Phantom sensation: This is the feeling that you still have the amputated part (leg or toe). Often, only the farthest part is felt, and although not painful, there may be tingling, numbness, or pressure. It may disappear as you get stronger, or it may last throughout life. Almost all people who have had an amputation have phantom sensation.
•Phantom pain: This is actual pain (most often the burning, cramping, squeezing, or shooting type) in the amputated part. It may be present all the time or it may come and go. Phantom pain may be relieved with pain medicine. If severe phantom pain is a problem for you, talk to your doctor about something else for pain relief. Many people report they have more relief from the medicine called Neurontin, which your doctor can discuss with you.
•(Please refer to Health Facts For You: Neuropathic Pain)
Diet
You may resume your regular diet when you return home. You should avoid constipation Decreased activity as well as some prescription pain medicines can cause constipation.
You can try to prevent constipation by trying these methods:
•Drink several glasses of fluids (8-10 8-oz. glasses of water or fruit juice per day)
•Eat foods high in fiber (whole grain breads and cereals, fresh fruit and vegetables)
•(Please refer to Health Facts For You: Suggestions For Relieving Constipation).
If these do not work, an over-the-counter stool softener or laxative (something that loosens and softens bowels) may be used. If the problems do not go away, call your doctor.
Maintain a stable body weight; this is very important for overall success.
Care of Your Other Leg
If you have diabetes or have peripheral vascular disease it is even more important now to take good care of your other leg and foot and protect it from being damaged in any way.
Ways to care for other leg:
•Look at legs and feet daily for sores, scratches, cracks, blisters or reddened areas. Report them to your doctor or nurse.
•Wash your legs and feet daily with mild soap and water. Avoid soaking. Dry well.
•Put lotion on dry skin daily.
•Let a doctor or nurse clip your toenails or show you how to clip toenails.
•Wear shoes that fit well.
•Wear white cotton or wool socks.
•Check shoes and socks for stones, sharp things, or holes.
•Do not use heating pads or hot water bottles on legs or feet.
•Never go barefoot.
Are You at Risk for Poor Blood Flow to the Legs and Feet?
You are more likely to have poor blood flow to the legs if you:
•Smoke
•Have high blood pressure
•Have high cholesterol
•Have diabetes
•Are over age 50
•Do not exercise
•Have heart disease in your family
Osteosarcoma
Osteosarcoma is a common type of bone cancer that affects mostly children and teens between the ages of 10 to 19. It occurs during periods of rapid bone growth and is more common boys than in girls. Osteosarcoma cab diagnosed in adults, but it extremely rare.
Symptoms of Osteosarcoma
The shin, thigh, and upper arm are common tumor sites in children and adolescents with osteosarcoma. It is in these areas that pain and swelling occur with the disease. Osteosarcoma can develop in other bones, but it is much less common.
Bone pain is a common symptom of osteosarcoma that may become worse during exercise or at night. Bone pain is more often related to a benign condition, like an injury, than it is to cancer. Keep in mind that not all bone tumors are cancerous as some are benign.
Other symptoms of osteosarcoma include:
•joint tenderness or inflammation
•fractures due to bone weakness
•limited range of motion
Non-specific symptoms like fever, unintentional weight loss, fatigue, and anemia can also be symptoms of osteosarcoma. But they are also indicators of other less severe conditions.
Diagnosing Osteosarcoma
Symptoms combined with other findings during a physical exam may suggest the presence of osteosarcoma, but additional tests are needed to confirm any suspicion.
Imaging tests, like x-rays, MRIs, and CT scans help identify any bone abnormalities. Other tests may include a bone scan, a specialized nuclear imaging test that allows doctors to see the metabolic activity of the bone. Bone scans identify areas in the bone that have new growth or have broken down -- excellent indicators of conditions.
Ultimately, it is a bone biopsy that will rule out or confirm the presence of cancer. A bone biopsy involves the removal of a small amount of bone tissue to be examined under a microscope. It usually takes less than an hour and can be done as an outpatient or surgical procedure.
Doing a biopsy on someone with primary bone cancer can be complex because there is a risk of spreading the cancer during the procedure. The procedure should be done by a surgeon who has experience performing bone biopsies on those with suspected bone cancer. Note that biopsies a common way to worsen these cancers and potentially spread into other tissues.
If cancer is detected, it is then graded and staged by a pathologist. Grading and staging classifications vary based on the type of bone cancer. Ideally, the pathologist examining the sample will be experienced in diagnosing bone cancer.
Treatment of Bone Cancer
The key to successful treatment is having a treatment team that is experienced in bone cancer. Many types of bone cancer are very rare, and having a team that is highly experienced in managing bone cancer is a necessity. Several types of doctors make up these unique treatment teams and include medical oncologists, radiation oncologists, radiologists, surgical oncologists, orthopedic oncologists, and specialized pathologists.
•Find a Bone Cancer Physician
There are three standard forms of treatment for osteosarcoma: surgery, radiation therapy, and chemotherapy. Many times, more than one treatment method is required, such as surgery along with radiation therapy. Treatment varies based on type of bone cancer, if it has spread (metastasized), and other general health factors.
Surgery: Osteosarcoma is most commonly treated with surgery. Surgical treatment for bone cancer that has not spread involves removing the cancerous tissue and a small margin of healthy bone tissue surrounding it. Some tumors may require chemotherapy or radiation therapy in addition to surgical treatment.
Radiation Therapy: Radiation therapy uses specific types high energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.
Chemotherapy: Chemotherapy is often prescribed to treat osteosarcoma. Chemotherapy drugs work by eliminating rapidly multiplying cancer cells. However, other healthy cells in the body multiply just as quickly, such as hair follicle cells. Unfortunately, many chemotherapy drugs may not be able to discern the two, attacking healthy cells and causing side effects like hair loss.
Note that most teams offer neoadjuvant therapy for the sarcomas and there is adjuvant therapy, too.
Symptoms of Osteosarcoma
The shin, thigh, and upper arm are common tumor sites in children and adolescents with osteosarcoma. It is in these areas that pain and swelling occur with the disease. Osteosarcoma can develop in other bones, but it is much less common.
Bone pain is a common symptom of osteosarcoma that may become worse during exercise or at night. Bone pain is more often related to a benign condition, like an injury, than it is to cancer. Keep in mind that not all bone tumors are cancerous as some are benign.
Other symptoms of osteosarcoma include:
•joint tenderness or inflammation
•fractures due to bone weakness
•limited range of motion
Non-specific symptoms like fever, unintentional weight loss, fatigue, and anemia can also be symptoms of osteosarcoma. But they are also indicators of other less severe conditions.
Diagnosing Osteosarcoma
Symptoms combined with other findings during a physical exam may suggest the presence of osteosarcoma, but additional tests are needed to confirm any suspicion.
Imaging tests, like x-rays, MRIs, and CT scans help identify any bone abnormalities. Other tests may include a bone scan, a specialized nuclear imaging test that allows doctors to see the metabolic activity of the bone. Bone scans identify areas in the bone that have new growth or have broken down -- excellent indicators of conditions.
Ultimately, it is a bone biopsy that will rule out or confirm the presence of cancer. A bone biopsy involves the removal of a small amount of bone tissue to be examined under a microscope. It usually takes less than an hour and can be done as an outpatient or surgical procedure.
Doing a biopsy on someone with primary bone cancer can be complex because there is a risk of spreading the cancer during the procedure. The procedure should be done by a surgeon who has experience performing bone biopsies on those with suspected bone cancer. Note that biopsies a common way to worsen these cancers and potentially spread into other tissues.
If cancer is detected, it is then graded and staged by a pathologist. Grading and staging classifications vary based on the type of bone cancer. Ideally, the pathologist examining the sample will be experienced in diagnosing bone cancer.
Treatment of Bone Cancer
The key to successful treatment is having a treatment team that is experienced in bone cancer. Many types of bone cancer are very rare, and having a team that is highly experienced in managing bone cancer is a necessity. Several types of doctors make up these unique treatment teams and include medical oncologists, radiation oncologists, radiologists, surgical oncologists, orthopedic oncologists, and specialized pathologists.
•Find a Bone Cancer Physician
There are three standard forms of treatment for osteosarcoma: surgery, radiation therapy, and chemotherapy. Many times, more than one treatment method is required, such as surgery along with radiation therapy. Treatment varies based on type of bone cancer, if it has spread (metastasized), and other general health factors.
Surgery: Osteosarcoma is most commonly treated with surgery. Surgical treatment for bone cancer that has not spread involves removing the cancerous tissue and a small margin of healthy bone tissue surrounding it. Some tumors may require chemotherapy or radiation therapy in addition to surgical treatment.
Radiation Therapy: Radiation therapy uses specific types high energy beams of radiation to shrink tumors or eliminate cancer cells. Radiation therapy works by damaging a cancer cell's DNA, making it unable to multiply. Although radiation therapy can damage nearby healthy cells, cancer cells are highly sensitive to radiation and typically die when treated. Healthy cells that are damaged during radiation are resilient and are often able to fully recover.
Chemotherapy: Chemotherapy is often prescribed to treat osteosarcoma. Chemotherapy drugs work by eliminating rapidly multiplying cancer cells. However, other healthy cells in the body multiply just as quickly, such as hair follicle cells. Unfortunately, many chemotherapy drugs may not be able to discern the two, attacking healthy cells and causing side effects like hair loss.
Note that most teams offer neoadjuvant therapy for the sarcomas and there is adjuvant therapy, too.
Osteomyelitis
Osteomyelitis is an acute or chronic bone infection.
Symptoms
•Bone pain
•Fever
•General discomfort, uneasiness, or ill-feeling (malaise)
•Local swelling, redness, and warmth
•Nausea
Additional symptoms that may be associated with this disease:
•Chills
•Excessive sweating
•Low back pain
•Swelling of the ankles, feet, and legs
Treatment
The objective of treatment is to eliminate the infection and prevent it from getting worse.
Antibiotics will be given to destroy the bacteria that are causing the infection. You may be given more than one antibiotic at a time. Often, the antibiotics are given through an IV (intravenously, meaning through a vein) rather than by mouth. Antibiotics are taken for at least 4-6 weeks, sometimes longer.
Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. If there are metal plates near the infection, they may be removed. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue.
Infection of an orthopedic prosthesis may require surgical removal of the prosthesis and infected tissue surrounding the area. A new prosthesis may be implanted in the same operation or delayed until the infection has gone away.
If the patient has diabetes, it will need to be well controlled. If there are problems with blood supply, surgery to improve blood flow may be needed.
Causes
Bone infection can be caused by bacteria or fungi.
•Infection may also spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).
•The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.
•A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.
In children, the long bones are usually affected. In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.
Risk factors are recent trauma, diabetes, hemodialysis, poor blood supply, and IV drug abuse. People who have had their spleen removed are also at higher risk for osteomyelitis.
Tests & diagnosis
A physical examination shows bone tenderness and possibly swelling and redness.
Tests may include:
•Blood cultures
•Bone biopsy (which is then cultured)
•Bone scan
•Bone x-ray
•C-reactive protein (CRP)
•Erythrocyte sedimentation rate (ESR)
•MRI
•Needle aspiration of the area around affected bones
Prognosis
When treatment is received, the outcome for acute osteomyelitis is usually good.
The outlook is worse for those with long-term (chronic) osteomyelitis, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation.
The outlook is guarded in those who have an infection of a prosthesis.
Prevention
Prompt and complete treatment of infections is helpful. High-risk people should see a health care provider promptly if they have signs of an infection anywhere in the body.
Complications
When the bone is infected, pus is produced within the bone, which may result in an abscess. The abscess steals the bone's blood supply. The lost blood supply can result in a complication called chronic osteomyelitis. This chronic infection can cause symptoms that come and go for years.
Other complications include:
•Need for amputation
•Reduced limb or joint function
•Spread of infection
Symptoms
•Bone pain
•Fever
•General discomfort, uneasiness, or ill-feeling (malaise)
•Local swelling, redness, and warmth
•Nausea
Additional symptoms that may be associated with this disease:
•Chills
•Excessive sweating
•Low back pain
•Swelling of the ankles, feet, and legs
Treatment
The objective of treatment is to eliminate the infection and prevent it from getting worse.
Antibiotics will be given to destroy the bacteria that are causing the infection. You may be given more than one antibiotic at a time. Often, the antibiotics are given through an IV (intravenously, meaning through a vein) rather than by mouth. Antibiotics are taken for at least 4-6 weeks, sometimes longer.
Surgery may be needed to remove dead bone tissue if you have an infection that does not go away. If there are metal plates near the infection, they may be removed. The open space left by the removed bone tissue may be filled with bone graft or packing material that promotes the growth of new bone tissue.
Infection of an orthopedic prosthesis may require surgical removal of the prosthesis and infected tissue surrounding the area. A new prosthesis may be implanted in the same operation or delayed until the infection has gone away.
If the patient has diabetes, it will need to be well controlled. If there are problems with blood supply, surgery to improve blood flow may be needed.
Causes
Bone infection can be caused by bacteria or fungi.
•Infection may also spread to a bone from infected skin, muscles, or tendons next to the bone, as in osteomyelitis that occurs under a chronic skin ulcer (sore).
•The infection that causes osteomyelitis can also start in another part of the body and spread to the bone through the blood.
•A current or past injury may have made the affected bone more likely to develop the infection. A bone infection can also start after bone surgery, especially if the surgery is done after an injury or if metal rods or plates are placed in the bone.
In children, the long bones are usually affected. In adults, the feet, spine bones (vertebrae), and the hips (pelvis) are most commonly affected.
Risk factors are recent trauma, diabetes, hemodialysis, poor blood supply, and IV drug abuse. People who have had their spleen removed are also at higher risk for osteomyelitis.
Tests & diagnosis
A physical examination shows bone tenderness and possibly swelling and redness.
Tests may include:
•Blood cultures
•Bone biopsy (which is then cultured)
•Bone scan
•Bone x-ray
•C-reactive protein (CRP)
•Erythrocyte sedimentation rate (ESR)
•MRI
•Needle aspiration of the area around affected bones
Prognosis
When treatment is received, the outcome for acute osteomyelitis is usually good.
The outlook is worse for those with long-term (chronic) osteomyelitis, even with surgery. Amputation may be needed, especially in those with diabetes or poor blood circulation.
The outlook is guarded in those who have an infection of a prosthesis.
Prevention
Prompt and complete treatment of infections is helpful. High-risk people should see a health care provider promptly if they have signs of an infection anywhere in the body.
Complications
When the bone is infected, pus is produced within the bone, which may result in an abscess. The abscess steals the bone's blood supply. The lost blood supply can result in a complication called chronic osteomyelitis. This chronic infection can cause symptoms that come and go for years.
Other complications include:
•Need for amputation
•Reduced limb or joint function
•Spread of infection
Treating an acute gout attack
Medication Choices
Medication treatment for gout usually involves some combination of:
Short-term treatment, using medicines that relieve pain and reduce inflammation during an acute attack or prevent a recurrence of an acute attack. These medicines may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), except for aspirin, which should never be used to relieve pain during a gout attack. Aspirin may change uric acid levels in the blood and may make the attack worse.
Colchicine, which may also be used for long-term treatment.
Corticosteroids, which may be given in pills or by a shot for cases of gout that do not respond to NSAIDs or colchicines. They may also be given to people who cannot take NSAIDs for other reasons, such as those with chronic kidney failure, heart failure, gastrointestinal bleeding or those using a blood-thinner, such as warfarin.
Long-term treatment, using medicines to lower uric acid levels in the blood, which can reduce the frequency and severity of gout attacks in the future. This may include:
Uricosuric agents, to increase elimination of uric acid by the kidneys.
Allopurinol or a newer medicine called febuxostat, to decrease production of uric acid by the body.
Colchicine, to prevent flare-ups during the first months that you are taking uric acid-lowering medicines
Medication treatment for gout usually involves some combination of:
Short-term treatment, using medicines that relieve pain and reduce inflammation during an acute attack or prevent a recurrence of an acute attack. These medicines may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), except for aspirin, which should never be used to relieve pain during a gout attack. Aspirin may change uric acid levels in the blood and may make the attack worse.
Colchicine, which may also be used for long-term treatment.
Corticosteroids, which may be given in pills or by a shot for cases of gout that do not respond to NSAIDs or colchicines. They may also be given to people who cannot take NSAIDs for other reasons, such as those with chronic kidney failure, heart failure, gastrointestinal bleeding or those using a blood-thinner, such as warfarin.
Long-term treatment, using medicines to lower uric acid levels in the blood, which can reduce the frequency and severity of gout attacks in the future. This may include:
Uricosuric agents, to increase elimination of uric acid by the kidneys.
Allopurinol or a newer medicine called febuxostat, to decrease production of uric acid by the body.
Colchicine, to prevent flare-ups during the first months that you are taking uric acid-lowering medicines
Subscribe to:
Posts (Atom)