As a neurosurgeon, I spend more than half my time helping patients cope with a surprisingly unremarkable problem: back pain. Despite the life-and-death challenges of treating complex brain tumors, vascular malformations and spinal trauma, it is this most commonplace of ills that consumes more than half my patient hours and that can be one of the most stubborn conditions for any neurosurgeon to manage.
Often the source of persistent back woes is sciatica, caused by a herniated, slipped or protruding disc that impinges on the sciatic nerve, sending pain all the way down the leg. Back pain, including sciatica, is one of the leading causes of workplace absenteeism and is the fifth leading cause of expenditures in U.S. hospitals each year. Given the ubiquity of the condition, you'd think doctors might have reached some consensus on the best ways to treat it, but you'd be wrong— and a new study released in late May may only make things less clear.
Patients with sciatica often complain not only of symptoms in the leg and back, but also of numbness and sometimes weakness. The pain can be absolutely unbearable, even likened to childbirth by one Mrs. Gupta, who is looking over my shoulder as I write this. Sometimes patients come into my office vigorously kneading their thigh in the hope it will bring some relief. They occasionally report that they are taking multiple pain medications— causing some of them to doze off as I try to take a medical history. People like this are tired of suffering and want the quickest fix possible. Often that means surgery. Around the world, approximately 1.5 million people each year undergo operations to relieve pressure on the sciatic nerve, a procedure that usually brings them the relief they seek. But new research suggests that over the course of time, surgery may be no better than nonoperative therapeutic methods.
In the study, published in the New England Journal of Medicine, researchers followed 283 patients who had suffered with sciatic pain for at least six weeks. Half of them were scheduled for surgery, and the other half were told to get conservative treatments— principally rest, gentle stretching and back-strengthening exercises, and, when needed, anti-inflammatories. Using various scales to measure dysfunction and disability, the investigators found that 95% of participants in both groups reported significant recovery after one year. That's good news for sciatica sufferers who are concerned about the risks of surgical complications, which can include bleeding or, worrisomely, accidental nerve damage that may only exacerbate the pain. What's more, surgery can cost a few thousand dollars, will leave you sore for a few weeks and requires a couple of months for full recovery.
So why would you opt for an operation at all? Speed, for one thing. In most cases, pain relief and perceived recovery come faster via a trip to the operating room than through exercise and medications. In fact, even in the current study, 39% of the patients who were initially assigned to receive conservative care opted for surgery anyway because they could no longer tolerate the pain.
Which course is right for you depends on the nature of your case. If you are getting progressively weaker or have pain that is searing and uncontrollable with conventional pain medications, you may need to go under the knife. Short of such extreme cases, most surgeons will wait a few weeks before pulling out the scalpel— often just long enough for patients to notice improvement with less invasive techniques. Whichever direction you choose to go, it's nice to know that if you must have a problem like sciatica, at least it's one of those rare conditions that have not just one good solution, but two. And in case you're curious, Mrs. Gupta opted for the operation and has never felt better.
1. neurosurgeon: A kind of doctor who is expert on take care of people's nerve.
2. tumor: It is a bad thing in the body which with blood and muscle.
3. vascular: The pipe in the body which be used to transform blood.
4. malformations: It means the heart grows strange.
5. numbness:It means no feeling.
6. exacerbate: Make things more serious.
7. scalpel: The knife be used in the surgery.
This article is found from CNN News website. It is about the pain of back and it also tell us the way to solve this problem: to get a surgery or do some exercisesto make the back feel better.By the way, according writer's opinion, the author suggests us not to take a surgery is better.
Although this article does not talk about how to do the exercise, but I think it still tell us a good direction to recover the pain of back. I think it is an important imformation.
In this article, I find the word "numbness" is an useful word, this wordcan be used in a lot of places.
2008年3月27日 星期四
Herbal Remedies' Potential Dangers
We've all heard about herbal supplements that have worked for someone we know. People swear by them: echinacea for a cold, ginkgo biloba for memory or the peppermint in the salve your aunt believes can ease chest congestion. Over the past decade, use of herbal supplements has jumped 83%, going from $12.2 billion in U.S. sales in 1996 to a whopping $22.3 billion last year. While many of those users may be skeptical, they figure, Hey, these things are natural; what harm could they do?
As it turns out, in some cases they can do a lot of harm, and a surprising number of people are putting themselves at risk by using herbal supplements without being informed about their actual benefits and potential dangers. A new study conducted at the University of Iowa and published in the June issue of Mayo Clinic Proceedings reveals just how widespread the problem has become.
Researchers found that the most common mistake users of herbal remedies make is believing that the substances they take actually work. An earlier National Institutes of Health study showed that about 19% of Americans take herbal supplements and more than half the time they're using the substances to treat a specific health condition instead of just for general well-being. That's fine, provided the supplements treat those conditions, but in more than two-thirds of cases, the preparations have never been clinically proved to be effective for those uses. And as any scientist will tell you, clinical proof— a randomized, controlled trial— is the gold standard for establishing a drug's usefulness and safety. So a lot of dollars— not to mention medical faith— are being spent on potentially useless treatments.
Aside from making you think you're doing something to alleviate your health problem (and not really treating the ailment at all), herbal supplements present other possible pitfalls. "If a supplement is not effective and not harmful, most physicians probably won't have a problem with it," says Aditya Bardia, an internist at the Mayo Clinic and lead author of the study. "It's when it's not effective and also harmful that it's going to be a cause of concern."
Certain supplements can have adverse effects ranging from nausea and vomiting to life-threatening conditions like liver or kidney dysfunction. For example, in 2002 the U.S. Food and Drug Administration (FDA) released a warning about potential liver damage from kava root, then one of the 10 most popular herbal supplements sold in the U.S. And in 2004 the FDA banned ephedra, a Chinese weight-loss herb, after it was linked to more than 100 deaths. Equally troubling, some Ayurvedic supplements, medications based on Indian and South Asian practices, may be adulterated and thus could be contaminated with dangerous heavy metals, including lead and mercury.
Perhaps the greatest potential risk, however, lies in possible interaction with pharmaceutical drugs you are already taking. Saint-John's-wort, which has been shown to help in treating mild to moderate depression, is also known to reduce the effectiveness of some HIV medications and heart drugs such as digoxin and warfarin— life-and-death meds that it doesn't pay to fool with.
To avoid such complications, ask your doctor before you decide to try an herbal supplement, and be sure to disclose any supplements you're taking even if you're not asked. That can be particularly important when you're being prescribed a new medication. The message here is not to avoid all herbal supplements. Increasingly, Western medicine is improving because of discoveries about these alternative treatments. However, it's important to remember that they are essentially drugs, and the best way to use them is to separate fact from fiction first.
1. salve: The ointment.
2. wooping: Means huge.
3. skeptical: It means doubtful.
4. alleviate: To moderate.
5. pitfall: Means danger.
6. disclose: It means to show up.
This article is talk about the herbal supplement. It is talk about what difference between herbal supplement and western medicine, and then talk about how bad the herbal supplement is.
Maybe the herbal supplement is not so good, but I believe it is still have some healing.
As it turns out, in some cases they can do a lot of harm, and a surprising number of people are putting themselves at risk by using herbal supplements without being informed about their actual benefits and potential dangers. A new study conducted at the University of Iowa and published in the June issue of Mayo Clinic Proceedings reveals just how widespread the problem has become.
Researchers found that the most common mistake users of herbal remedies make is believing that the substances they take actually work. An earlier National Institutes of Health study showed that about 19% of Americans take herbal supplements and more than half the time they're using the substances to treat a specific health condition instead of just for general well-being. That's fine, provided the supplements treat those conditions, but in more than two-thirds of cases, the preparations have never been clinically proved to be effective for those uses. And as any scientist will tell you, clinical proof— a randomized, controlled trial— is the gold standard for establishing a drug's usefulness and safety. So a lot of dollars— not to mention medical faith— are being spent on potentially useless treatments.
Aside from making you think you're doing something to alleviate your health problem (and not really treating the ailment at all), herbal supplements present other possible pitfalls. "If a supplement is not effective and not harmful, most physicians probably won't have a problem with it," says Aditya Bardia, an internist at the Mayo Clinic and lead author of the study. "It's when it's not effective and also harmful that it's going to be a cause of concern."
Certain supplements can have adverse effects ranging from nausea and vomiting to life-threatening conditions like liver or kidney dysfunction. For example, in 2002 the U.S. Food and Drug Administration (FDA) released a warning about potential liver damage from kava root, then one of the 10 most popular herbal supplements sold in the U.S. And in 2004 the FDA banned ephedra, a Chinese weight-loss herb, after it was linked to more than 100 deaths. Equally troubling, some Ayurvedic supplements, medications based on Indian and South Asian practices, may be adulterated and thus could be contaminated with dangerous heavy metals, including lead and mercury.
Perhaps the greatest potential risk, however, lies in possible interaction with pharmaceutical drugs you are already taking. Saint-John's-wort, which has been shown to help in treating mild to moderate depression, is also known to reduce the effectiveness of some HIV medications and heart drugs such as digoxin and warfarin— life-and-death meds that it doesn't pay to fool with.
To avoid such complications, ask your doctor before you decide to try an herbal supplement, and be sure to disclose any supplements you're taking even if you're not asked. That can be particularly important when you're being prescribed a new medication. The message here is not to avoid all herbal supplements. Increasingly, Western medicine is improving because of discoveries about these alternative treatments. However, it's important to remember that they are essentially drugs, and the best way to use them is to separate fact from fiction first.
1. salve: The ointment.
2. wooping: Means huge.
3. skeptical: It means doubtful.
4. alleviate: To moderate.
5. pitfall: Means danger.
6. disclose: It means to show up.
This article is talk about the herbal supplement. It is talk about what difference between herbal supplement and western medicine, and then talk about how bad the herbal supplement is.
Maybe the herbal supplement is not so good, but I believe it is still have some healing.
Should Baby Be Scanned?
"Doctors make the worst patients," the obstetrician told my wife and me as we waited anxiously for the results of an ultrasound on our second baby, due any day. He was only half joking. All along, I'd been asking him a lot of questions—as I tend to do when I'm nervous—about something called first-trimester prenatal screening. When our first child was born, almost two years earlier, this test for Down syndrome and other birth defects was still brand new. Wary and unsure about its value and accuracy, we decided to pass. This time around, however, we had done our homework, which was slightly frustrating for our doctor.
The first thing we learned was that in the two years since the birth of our first child, the new test had become part of standard medical practice. In fact, on Jan. 2 the American College of Obstetricians and Gynecologists recommended that all pregnant women get the test regardless of age. This is an important change, mostly because of what it means for amniocentesis.
Amniocentesis, as every mom-to-be of a certain age can tell you, is a medical procedure in which a doctor inserts a long needle through the belly and into the placenta to withdraw amniotic fluid—which is then screened for birth defects. It used to be that once a woman turned 35, she was always counseled about amniocentesis. The cutoff at 35 was, by just about everyone's admission, pretty arbitrary; it was the age at which the risk of Down syndrome seemed to increase. For example, the risk of Down for a 25-year-old woman is about 1 in 1,250. By age 40, that risk has jumped to 1 in 100. What makes the decision so difficult for many parents is that the test carries a slight but real risk of miscarriage.
The new test, by contrast, is noninvasive. It combines two routine blood tests and an ultrasound that measures something called nuchal translucency, a property of the fluid at the back of the baby's neck that tells doctors with better than 90% accuracy whether the baby is at increased risk of Down syndrome. If the test is positive, you still have to decide whether to undergo amniocentesis or another test, chorionic villus sampling, to confirm the diagnosis one way or the other. But if it's negative, you're out of the woods.
Almost. As we were sitting there in the office, we realized we still faced an enormously difficult decision. Whenever you have a medical test, you have to ask yourself, What am I going to do with this new information? Some parents will choose to terminate a pregnancy if a diagnosis of Down is confirmed. Some will start putting dollars into tax-free health-savings accounts to help defray the cost of caring for a child with Down. Others may change the hospital where they plan on having the baby, opting instead for an institution that specializes in high-risk pregnancies.
Even parents who would never consider termination may still want to be more emotionally prepared. The hardest part, we are told, is waiting for results, which can take several long days.
So from now on, all pregnant women in the U.S. will be offered a choice of tests. My advice, as a doctor who has wrestled with the decision, is that if you choose the relatively new ultrasound test, you should also choose a hospital where the technicians have been trained to perform it. That can have a big effect on the trustworthiness of the results. As for my wife and me, we opted for the minimalist approach. We don't even know the sex of the child. We are hoping for a boy ... or a girl.
1. obsterician: A kind of doctor who give baby birth.
2. prenatal: Before the baby come to the world and still in mother's body.
3. miscarriage: It means lose the baby who in the mother's body.
This is an article about the baby. The author use his own experience to tell us how dager and difficult to make a baby birth, and also tell us how danger that a woman who older than 35 years old want to take a baby. The author also tells us that we can choose to see our baby clearly or see he or she after he or she cometo world.
I think this article is useful to the people who will have a child, and I like this article very much.
Obsterician is a special word, maybe it is not usual to be used in a sentence but it is a word I think very special.
The first thing we learned was that in the two years since the birth of our first child, the new test had become part of standard medical practice. In fact, on Jan. 2 the American College of Obstetricians and Gynecologists recommended that all pregnant women get the test regardless of age. This is an important change, mostly because of what it means for amniocentesis.
Amniocentesis, as every mom-to-be of a certain age can tell you, is a medical procedure in which a doctor inserts a long needle through the belly and into the placenta to withdraw amniotic fluid—which is then screened for birth defects. It used to be that once a woman turned 35, she was always counseled about amniocentesis. The cutoff at 35 was, by just about everyone's admission, pretty arbitrary; it was the age at which the risk of Down syndrome seemed to increase. For example, the risk of Down for a 25-year-old woman is about 1 in 1,250. By age 40, that risk has jumped to 1 in 100. What makes the decision so difficult for many parents is that the test carries a slight but real risk of miscarriage.
The new test, by contrast, is noninvasive. It combines two routine blood tests and an ultrasound that measures something called nuchal translucency, a property of the fluid at the back of the baby's neck that tells doctors with better than 90% accuracy whether the baby is at increased risk of Down syndrome. If the test is positive, you still have to decide whether to undergo amniocentesis or another test, chorionic villus sampling, to confirm the diagnosis one way or the other. But if it's negative, you're out of the woods.
Almost. As we were sitting there in the office, we realized we still faced an enormously difficult decision. Whenever you have a medical test, you have to ask yourself, What am I going to do with this new information? Some parents will choose to terminate a pregnancy if a diagnosis of Down is confirmed. Some will start putting dollars into tax-free health-savings accounts to help defray the cost of caring for a child with Down. Others may change the hospital where they plan on having the baby, opting instead for an institution that specializes in high-risk pregnancies.
Even parents who would never consider termination may still want to be more emotionally prepared. The hardest part, we are told, is waiting for results, which can take several long days.
So from now on, all pregnant women in the U.S. will be offered a choice of tests. My advice, as a doctor who has wrestled with the decision, is that if you choose the relatively new ultrasound test, you should also choose a hospital where the technicians have been trained to perform it. That can have a big effect on the trustworthiness of the results. As for my wife and me, we opted for the minimalist approach. We don't even know the sex of the child. We are hoping for a boy ... or a girl.
1. obsterician: A kind of doctor who give baby birth.
2. prenatal: Before the baby come to the world and still in mother's body.
3. miscarriage: It means lose the baby who in the mother's body.
This is an article about the baby. The author use his own experience to tell us how dager and difficult to make a baby birth, and also tell us how danger that a woman who older than 35 years old want to take a baby. The author also tells us that we can choose to see our baby clearly or see he or she after he or she cometo world.
I think this article is useful to the people who will have a child, and I like this article very much.
Obsterician is a special word, maybe it is not usual to be used in a sentence but it is a word I think very special.
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