May 22, 2009

arthritisGood news came this week from Annals of Internal Medicine, http://content.nejm.org/cgi/content/short/360/21/2165, to those of us who have arthritis in our hands, specifically in the thumb joint. Not rheumatoid arthritis, the one that often causes deformed joints and is the result of the immune system gone awry, but osteoarthritis, that very common condition usually affecting knees and hips. Turns out that the very simple intervention of using a splint to immobilize the thumb, worn only at night, resulted in significant pain reduction and increased ability to use the thumb joint over time.

The splint itself, pictured here, was custom made, and is designed to keep the thumb immobilized but allow use of the fingers and hand. Participants liked it, and kept using it. Rick and I think we'll get one, too, since we both have this condition and there are no downsides to using it. A win-win all around!

Speaking of win-wins, looks like hospitals that do lots of bypass procedures (high volume) may not always win out over low volume hospitals in terms of how well patients do over time. The missing factor here is quality- do patients get proper medications following the procedure? How good is nursing care? Also in this issue of Annals of Internal Medicine, http://www.annals.org/cgi/content/abstract/150/10/696, this study looked at CABG- coronary artery bypass grafting, and found that if quality measures were in place, patients in low volume hospitals did just as well as those in high volume locations. So perhaps not to worry if you need heart bypass surgery and you don't live near a major heart center. But pay attention to those other factors.

Since we're on hearts, this week's New England Journal of Medicine, http://content.nejm.org/cgi/content/short/360/21/2165, took at look at the treatment of acute coronary syndromes. That's when someone comes in to the emergency department with chest pain or other symptoms of a possible heart attack. Do these folks need an immediate trip to the cardiac catheterization lab for a stent or balloon procedure? Not most of the time, and they also don't need to get powerful anti-clotting drugs while they're in the ED but can safely wait until they're needed. This is good because if someone does need to go to the cath lab it can be done at a time when all the appropriate personnel are there (not the middle of the night or on weekends, as often happens) or even at another hospital. Rick is an editorialist on this one and says that these studies will help define who needs urgent attention.

Our last study this week focused on the use of a commonly prescribed medication for older men called Flomax, designed to manage benign prostatic hypertrophy, or BPH, and its negative effects on cataract surgery. That's in the Journal of the American Medical Association. http://jama.ama-assn.org/cgi/content/full/301/19/1991 Turns out men who were taking Flomax had a higher rate of complications when they had cataract surgery, and since millions of men are taking this drug as well as having such surgery, this is potentially a big problem. For now, we know that Flomax helps men initiate urination more easily because it relaxes the muscle called the sphincter. But is also relaxes tiny muscles in the eye, and this gives rise to more problems after cataract surgery. What can be done? That's not known, but possibly stopping the medication a few weeks prior to cataract surgery may help. Men taking Flomax now should advise their ophthalmologist prior to having the procedure- yet one more example of how very important it is for your physician to know ALL of the medications you are taking.

More details on all of these studies in our podcast. As Rick says, until next week, Y'all live well.

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Anonymous August 30, 2009 at 8:48 pm

My ultra inexpensive nighttime thumb splint: take a glove and sew shut the thumb (or just push it inside if sewing is too much for you). Put your hand in the glove with your thumb against your palm. Use this during the daytime too to keep you from using a sore thumb.

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