Category: Medicine Hat News

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Management of “Jeep Disease” Should be Individualized

During World War II, soldiers lost many man hours due to “jeep disease”. Poor personal hygienic conditions plus the trauma of sitting on hard seats of jeeps driving over difficult terrain were the main reasons why these soldiers suffered from “jeep disease”. But most people who have this condition have never been in the army or driven a jeep.

So, what is “jeep disease”?

Medical name for “jeep disease” is pilonidal disease. It is a spectrum of three conditions: acute pilonidal abscess, chronic pilonidal abscess or sinus, and the unhealed pilonidal surgical wound.

The pilonidal disease most commonly occurs between the buttocks, close to the tailbone. This condition has been described since 1847. The term pilonidal means “hair-nest”. It can also occur in other areas such as beard, the armpit, the belly button and the web spaces of the hands (in barbers) and feet.

For many years, experts believed that this was a congenital condition. In 1946, Patty and Scarff challenged this theory and drew attention to the role of hair in the origin of this problem. Current evidence strongly indicates an acquired origin for pilonidal disease, with most infections being related to penetration of the skin by hair through small midline pits.

Where do these pits come from? Some people believe they are congenital while others believe them to be enlargement of hair follicles. These pits have sinus openings through which the hairs penetrate. Hirsutism in the buttock and perineal area appears to be associated with the development of pilonidal disease.

Management of the condition depends on the type of presentation.

Acute pilonidal abscess needs to be drained immediately once the diagnosis is made. The area should be kept shaved. Daily bath or shower will keep the area clean. Once healed, it may become necessary to excise the midline pits under local or general anaesthesia to prevent recurrence.

Chronic pilonidal abscess or sinus – treatment of this condition remains controversial as no one treatment has proved superior. The choices are: non-operative treatment with repeated phenol injections; conservative excision of the sinus openings and midline pits; laying open the sinus tract and stitch the skin margins to fibrous tissue (marsupialization); or wide excision with or without different types of closures of the skin.

At medical conferences, I have listened to many experts of the subject and have found no consensus or strong evidence that one treatment is superior to other. Last year, in October, I was in Washington, D.C. attending the American College of Surgeons annual conference. At a luncheon “Meet the Professor” meeting, the subject of pilonidal disease was discussed in great detail. The consensus was that the treatment for this condition should be individualized to each patient according to the severity of the problem.

The unhealed pilonidal surgical wound and recurrence of pilonidal disease after initial treatment is very common. Management of this problem can be very difficult. To start with, the unhealed wound should be curettaged to control the excessive granulation tissue (healing tissue which fills the wound), and the surrounding skin should be shaved weekly. The wound should be kept clean and dry with gauze. Strapping the buttocks apart may help prevent the continuous shearing movement during walking.

The wound may take six to eight weeks to heal. Quite often healing does not occur. Then a skin graft or some form of plastic flap may help the healing process. Overall, treating pilonidal disease should not be taken lightly.

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Botox for Tennis Elbow?

Have you ever suffered from tennis elbow, golfer’s elbow or pitcher’s elbow?

You may suffer from any one or more of these conditions even if you have never touched a golf club or a tennis racket or ever pitched a ball.

Tennis elbow is in overload injury which causes pain on the lateral (outer) aspect of the elbow joint(s) where the common extensor muscles are attached to the bone (lateral epicondyle of the humerus).

Golfer’s elbow, also sometimes called pitcher’s elbow, affects the medial (inner) side of the elbow, is an inflammatory condition of the elbow which in some ways is similar to tennis elbow.

Tennis elbow, also called lateral epicondylitis, is an extremely common injury. About 50 per cent of the tennis players are estimated to suffer from this condition first described by Runge in 1873. Interestingly enough, the condition is prevalent in people who do not play tennis at all. There is much controversy about the real cause of pain due to this condition and its treatment.

An article on this subject in the Canadian Medical Association Journal (CMAJ) calls this condition a costly disorder that affects one to three per cent of the general population and up to 15 per cent of at-risk workers.

Tennis elbow affects men more than women. People of any age can be affected but it most often affects people between the ages of 30 and 50. The condition also affects other athletes and people who participate in leisure or work activities that require repetitive arm, elbow and wrist movement.

People at risk are golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics and assembly-line workers.

Current treatment of this condition is aimed at reducing inflammation and pain. These involve rest and avoid any activity that causes pain. Apply ice or heat to the affected area. Painkillers like ibuprofen are helpful.

A splint or a brace to reduce strain at the elbow can be tried. See an occupational therapist. If nothing works then see your doctor to try injection of local anaesthtic or cortisone. If this does not work then surgery may be an option.

The CMAJ article says that there is limited evidence for the effectiveness of current approaches to treatment. Although recent studies report that 90 per cent of patients in primary care improve or recover completely after one year, tennis elbow results in substantial disability, use of health care resources, loss of productivity and high costs. New, more effective therapies are needed so people can continue to be productive.

Espandar and colleagues present (in CMAJ) the results of a randomized placebo-controlled trial that investigated the efficacy and safety of botulinum toxin type A (Botox) for the management of tennis elbow in 48 patients. Botox, a neurotoxin, is a poisonous protein complex that acts on the nervous system to paralyse it. Here, the idea is to paralyse the affected muscles temporarily to allow them to rest and heal. Botox is also thought to have some pain killing properties.

Three other similar trials with Botox have had conflicting results.

The trial reported in the CMAJ shows significant reductions in pain at rest at four, eight and 16 weeks. In the treatment group the intensity of pain during maximum pinch decreased at all time points. However, there was no significant difference in pain during maximum grip or in grip strength at any point between the two groups. The limiting factor was the expected paralysis in the muscles of the third and fourth fingers.

So, is Botox injection the treatment of choice for tennis elbow? It depends on your symptoms and how far you want to go. The good news is, 90 per cent of patients in primary care improve or recover completely after one year with non-surgical and non-Botox treatment.

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Good-bye 2010, Welcome 2011

The year 2010 was not good. We were blasted by earthquakes, heat waves, floods, volcanoes, typhoons, blizzards, landslides and drought.

What was the toll on human lives?

According to Associated Press, nearly 260,000 people died. The year 2010 was the deadliest year in more than a generation. More people were killed worldwide by natural disasters in than have been killed in terrorism attacks in the past 40 years combined.

What was the toll on our economies?

Natural disasters in 2010 caused $222-billion (U.S.) in economic losses. The reason it was not higher because some of these disasters hit poor countries like Haiti. These areas are without heavy insurance.

According to experts, this is a classic sign of man-made global warming. Mother Nature is just doing its thing – reacting to the damage we have done to our environment. These statistics do not take into account the collateral damage to mental and physical health of the people who survived these disasters.

The current world population has reached 6.8 billion. Population in the world is currently growing at a rate of around 1.15 per cent per year. The average annual population change is currently estimated at over 77 million. If you visit http://www.worldometers.info/population/ you will find out everything you need to know about the growth of human population on this planet.

In spite of all the disasters we talked about, life goes on for most people. So do not give up hope.

Look at the amount of money spent in the month of December to celebrate Christmas and New Year all over the world. Probably billions of dollars were infused into the economies of the world thus helping people continue to work and make a living.

About one million people were in Times Square in New York on New Year’s eve with champagne bottles spreading bubbles of cheer and hope all over the place. I was in Las Vegas with my family where half-a-million people jammed the Strip to watch the fireworks at midnight. The cost of fireworks was estimated to be U.S. $ 500,000.

Wow, that is some kind of money to blow it away in smoke. But, the idea was to make people happy and give them hope for the future.

While I was waiting at the Las Vegas airport for my flight, I picked a magazine to see if there is life after 2010. The magazine was Men’s Fitness with Ashton Kutcher on the cover showing off his biceps. The exclusive article about him is titled, “Ashton Kutcher fights back!” It is not about his wife, it is about his exercise program.

Some of the articles in the magazine gave me hope that future should be good. One article is titled, “Build Muscle Burn Fat All Year Long!” Wow, I should be able to lose 52 lbs in one year if I follow the exercise and diet program they recommend.

And there is an article called, “Her Secrets for Better Sex!” I wondered whether this was about losing weight or building muscles while having sex. So I went to that article first. It was neither. It was a survey “to discern just how couples are handling the invasion of gizmos in the bedroom.”

Here is some info from the survey: 39 per cent women would rather give up sex for a year than part with their cell phones, 70 per cent of women have “sexted” with their lover, 80 per cent of women agree that technology creates intimacy faster and there is more but we will leave that for another time. One article is titled, “Balls.” It is about the Chicago Blackhawks star Patrick Kane. Does this give you hope for 2011?

Anyway, let us start the New Year with the hope that there be good health, peace and happiness all over the world. And we should all do something about it.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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What is new for the New Year?

For the last 13 years, I have been writing this column, I find it very difficult to write the last column of the year. Do I write about the year gone by or about the year to come? Should I write about good things or bad things? Should I make it light hearted or serious? Then I ask myself, “Does anybody really care what I write at this time of the year?”

My mind is never empty. It is always constructing opening and closing paragraphs of my future articles. The buzz in my head goes on for days until I sit down and start writing. But, sometimes I do get mental block or writer’s cramp. But I don’t think I get a swollen head.

This reminds me of a quote by Coulson Kernahan (1858–1943), an English novelist, “There are two literary maladies – writer’s cramp and swollen head. The worst of writer’s cramp is that it is never cured; the worst of swollen head is that it never kills.” I think I am safe.

This brings me back to the title of the column, “What is new for the New Year?”

It is the same old, same old.

This includes the tradition of making New Year’s resolutions. These resolutions are almost always the same. Mine do not change from year to year. One resolution never goes away is my prayer, “Oh God, take away 20 lbs from my girth so I can fit into my pants.” The prayer never gets answered and my resolution stays on the board for the next year.

Studies have shown that people understand their health risks but do not necessarily change their lifestyle. Surveys have shown that 57 per cent of people are not motivated to stay healthy. Don’t they care? Thirty four per cent of people have no time and 30 per cent have financial barriers to pursue a healthy life style.

Here are five resolutions I would be interested in:

1. Move to an island where I can find Robinson Crusoe and Friday. I would like to know where “No man is an island” is. Is it in Bow Island? I would like to spend more time with my family and friends if Friday does not mind.

2. I would like to be 18 again. Fit and healthy. Run 10 km a day and pump iron every day. I would like to look like Charles Atlas (does anybody remember him?) or Arnold Schwarzenegger. It would be cool just to know how to spell Arnold’s last name. That, in itself, would be lot of heavy lifting. I would like to have sexy accent like his – then I can run for an elected office against Sarah Palin. But I am a Canadian and that will never happen. Dang!

3. Tame the bulge so I can get into my pants and keep my cardiologist happy. And I don’t get my shoes wet. Why is this so difficult? It is not like taming a lion or Elizabeth Taylor. Some say it is the gluttony. Shame on me. I will see if Santa can fulfill my wish this Christmas – Santa, get me some will power. Not a drill dummy, I said “will power.” Ok Santa, the “drill” should help my bulge. Right?

4. I don’t need to quit smoking because I…do… not… smoke! Ah, that is smart or what? If you are a smoker, better quit before you turn into ashes. Right now your dollars are burning. Then your lungs will go black…ok…ok…I will stop now before you throw up.

5. Do not drink and drive. Drinking and driving is not funny. You are not only putting yourself in danger but you are putting lot of innocent people in danger. Chronic drinking hurts your family and friends. Quite likely, chronic drinking will make you a lonely person and in the long run, perhaps a street person or a number in jail.

So, be smart. Have a safe and happy New Year!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!