Very Swollen Leg 4 Days after Hip Replacement Surgery
So the leg suddenly swells up four days out from hip replacement; does this mean a deep vein thrombosis (DVT)?
After my mother’s hip replacement surgery (fracture repair), I thought that the surgical leg looked pretty good; I was surprised it wasn’t swollen up.
The second and third day, same thing: There wasn’t much swelling.
It wasn’t a “fat leg” as I had anticipated.
The nurses and the physician’s assistant mentioned nothing about a delayed swelling.
So when my mother was transferred to the rehab center, and I saw how swollen the entire leg had become, I couldn’t help but think DVT.
Was it normal for such swelling (edema) to occur several days after the hip replacement surgery, skipping the first three days?
She also had a suspicious-looking bulge of retained fluid behind her leg, below the knee.
I couldn’t help wonder about a popliteal DVT, even though the nurse there said it was from the compression stocking.
Furthermore, my mother was complaining of leg pain.
I asked her to place her hand where it hurt, and it went straight to her mid-thigh.
I pushed for an ultrasound. The facility ordered a mobile ultrasound that came in the following morning. Her leg was clear of any DVT.
“The hip and thigh can get quite swollen after a hip replacement,” says Barbara Bergin, MD, board certified orthopedic surgeon at and co-founder of Texas Orthopedics, Sports & Rehabilitation Associates. (Dr. Bergin was not my mother’s surgeon.)
“As long as it is getting better, it may not be something to get too concerned about,” adds Dr. Bergin.
“This is something a patient should really discuss with their doctor, simply because some swelling can be associated with complications like infection or a blood clot.”
I called the orthopedic wing at the hospital to speak to a nurse about delayed swelling in the leg following hip replacement surgery. She said this was perfectly normal.
Bottom line: Swelling several days after a hip replacement may not be a DVT…but it may be a DVT…it can go either way.
So what to do? Do not keep silent. Point it out to nurses and doctors. Ask about it. Have it checked. Trust your gut!
Dr. Bergin is a general orthopedist, surgically and conservatively treating all manner of bone and joint conditions. She enjoys educating patients so they can emerge stronger than they were before their orthopedic injury or surgery.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Shutterstock/Ocskay Bence
Vague Headache Starts Late in Day, Worsens, Gone by Bedtime?
Have you been noticing a very gradual onset of mild headache that gets worse into the evening, but never gets past a level 5 on a 1 to 10 pain scale, and in fact, is usually a level 1 to 3, or even one-half?
I had this experience and was baffled, though early on, I figured it was a low-grade sinus infection, since the character of the headache fit that of a sinus headache.
I had no other symptoms; no stuffiness or congestion in my nose, no runny mucus from my nose or feeling of heaviness behind the nose.
There was no apparent trigger of the headaches.
However, I noticed that in a minority of cases, it was more pronounced or felt more like pressure when I bent over.
It also usually felt worse—noticeably worse—when I lied on my back. This made me think it was a sinus related cause.
It felt like a tension headache or a dehydration-caused headache, but I was getting plenty of water and wasn’t under more stress than usual.
Exercise suppressed it. Sometimes I didn’t realize it was there till it was there, because its onset was so gradual. I never awakened with it.
This was occurring several times a month, up to eight or nine times, but usually four or five or so times.
I eventually figured out a likely, though never 100 percent proven, cause of the headaches:
It was using a Q-tip to “scoop out” dry chunks of mucus from my nose in the morning, and sometimes I’d have to do this later on in the day or in the evening.
The scooping had irritated a nerve located just up a bit in my right nostril.
I accidentally discovered this one morning when I was sticking the Q-tip up the right nostril to pull out some mucus.
BAM! In an instant, like a light going on, the headache appeared.
It felt identical to the headaches I’d been having for several months…except it was stronger.
I felt it in the three key areas I’d been feeling it all along: back of head, behind eyes, across forehead. (Sometimes, the headache would present in just one or two of these areas).
I removed the Q-tip, and like a light switch being flipped off, the headache instantly vanished.
I reapplied the Q-tip, and voila, the light switch went back on instantly. I removed the Q-tip: instantly gone.
I put it in again, and nothing that time. I tried again, and the light went back ON.
This was freaky. I removed it, realizing that this nerve obviously went to the back of my head (or at least towards it) and was sending signals there when its tip in my nose was getting irritated.
My theory:Years and years of scooping finally caught up with me. I began scooping several weeks after having a nose job many years ago, but this was also shortly after I moved to a very dry climate, which can cause a buildup of dry mucus in the nose overnight.
Scooping would irritate the nerve.
The reason the headache was delayed (it would come on later in the day or even later in the evening) was because — according to my theory — the scooping caused a situation that invited a very mild infection or micro-trauma.
If it was an infection, then it must have buzzed the nerve, making it send referral pain to the back of my head and behind my eyes.
I finally saw an ear, nose and throat doctor.
He didn’t go for my theory, but thought it might be related to seasonal allergies and told me to take Allegra, which did no good. He also prescribed an anti-bacterial ointment.
Application of this ointment at both nostrils before bedtime seemed to be preventing the headaches for the most part.
I’ve also been scooping less aggressively (the doctor had told me to stop scooping; but it’s the only way to clear my nose).
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Shutterstock/Tero Vesalainen
mayoclinic.org/diseases-conditions/sinus-headaches/basics/symptoms/con-20025426
Tomosynthesis vs. Regular Mammogram for Dense Breasts
Is the 3D (tomosynthesis) mammogram worth it for dense breasts vs. the 2D (regular) mammogram?
“3D mammography vs. 2D mammography showed increased cancer detection, clinically significant for women with scattered and heterogeneously dense breast tissue (cat II and III),” says Anjali Malik, MD, a board certified diagnostic radiologist with Washington Radiology in Washington, DC. She interprets mammograms, breast MRIs and ultrasounds, and performs biopsies.
“Digital mammography offers screening benefits over film mammography for women with dense breasts,” adds Dr. Malik.
If your HMO doesn’t cover tomosynthesis, and you have dense breasts, you should still have it done at a separate facility that provides this procedure – even if you have to pay out of pocket.
3D vs. 2D: the ASTOUND Study
In a study of more than 3,000 women with dense breasts for whom regular (2D) mammograms did not show cancer, the addition of 3D mammograms (or ultrasound) detected 24 extra cancers.
This report appears in the March 2016 Journal of Clinical Oncology.
Dense breast tissue appears white on a mammogram. But so do tumors.
This makes it more challenging for a radiologist to spot a tumor.
If breasts are mostly fatty, the image has a lot of black in it.
A white patch (that’s actually a tumor) will stand out much more.
However, the issue isn’t just about how keen a radiologist’s eye is for “catching something.”
The high concentration of fibrous and glandular tissue, that creates the density, actually raises the risk of breast cancer – though just why this is has not yet been determined.
One theory is that the more of this tissue there is, the more cells there are to start growing awry in the first place.
ASTOUND stands for Adjunct Screening with Tomosynthesis or Ultrasound in Mammography-negative Dense breasts.
Researchers had asymptomatic women with dense breasts (C and D) undergo a regular mammogram and then the tomosynthesis or ultrasound in the same visit.
It’s scary: Twenty-four women who thought their 2D mammogram cleared them of breast cancer were informed that the tomosynthesis or ultrasound detected a possible malignancy.
Twelve cases were by tomosynthesis and ultrasound; one by only tomo; and 11 by only ultrasound.
This translates to four additional cancerous tumors per 1,000 women being detected by tomosynthesis (and an extra seven BCs picked up by ultrasound per 1,000).
More research is warranted, but ASTOUND is indeed the first prospective trial that compares additional screening for dense breasts.
Ongoing Research with 3D Mammograms
“The Tomosynthesis Mammographic Imaging Screening Trial (TMIST or study EA1151) is a randomized breast cancer screening study,” says Dr. Malik.
“The ECOG-ACRIN Cancer Research Group opened the trial on July 6, 2017, and is currently enrolling [as of November 2022].
“TMIST aims to help move towards a more personalized approach that tailors mammography for each woman based on her own genetics and individual risk factors for developing breast cancer.”
Update on the Study
TMIST has completed patient enrollment. The primary results are expected to be published as early as 2027.
Dr. Malik is a frequent public speaker and advocate for breast health awareness. She has lectured on the latest advances in breast cancer screening including 3D Mammography™. Follow her on Instagram: @AnjaliMalikMD
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Bill Branson/Cancer.gov
.
Sources
N Engl J Med. 27;353(17):1773-83, 2005
jamanetwork.com/journals/jama/fullarticle/2516698
ncbi.nlm.nih.gov/pmc/articles/PMC5883365/
ajronline.org/doi/full/10.2214/AJR.14.13554
sciencedaily.com/releases/2016/03/160309101058.htm
Best Exercises for Prehab Before Major Surgery
There are certain exercises and a certain WAY to work out that will give you the best prehab for your body to prepare for major surgery.
So let’s look at it this way:
Even the most devoted gym rat could end up under the knife due to an unexpected diagnosis or accident.
How well can intense strength training and vigorous cardio exercise prepare the body for the trauma of surgery?
It’s common sense to know that the more physically fit a person is, prior to undergoing invasive surgery, the less likely there will be serious complications.
“Yes, a hard workout is a stressful event that can help a person’s body cope with future stress,” says Carolyn Dean, MD, ND; Medical Advisory Board Member of the non-profit Nutritional Magnesium Association.
Dr. Dean, a medical doctor and naturopath, adds that “many people who undergo surgery, for the most part, are already ill and will not be able to engage in heavy exercise.
“Also, one-half to one-quarter of surgeries are emergency procedures and not elective.”
Hmmm, that raises a riveting question:
Why would a person who slams their body at the gym on a regular basis need invasive surgery in the first place?
Well, even the most physically fit trainee could end up on the operating table due to a vehicular or sporting accident or bullet wound.
Secondly, though strenuous exercise goes a very long way at lowering the risk of disease, there’s no 100 percent guarantee of prevention.
Surprise diagnoses do happen, but all of that exercise is never in vain.
For example, the mountain runner who lifts weights, but mysteriously develops colon cancer, is more likely to breeze through the surgery, than if this individual were a couch potato.
Every time you work out, your body gets damaged and traumatized.
What happens post-workout? The repair process kicks in. This happens optimally when you get adequate nourishment, sleep and rest in between workouts.
Over time, your body becomes proficient at recovering from trauma. It gets lots of practice at recouping and replenishing from the injury and stress incurred by hardcore workouts.
So if you ever undergo major surgery, your body will “think” it’s another gym workout!
Your body already has an idea of what to do following this trauma, thanks to all your gym sessions; your body will go to work at healing.
The stress of surgery and the stress of hard exercise involve the same physiological systems in the body.
The trained body, following surgery, is less likely to respond with complications such as a blood clot, cardiac arrest, stroke or renal failure, among others.
The untrained body, however, doesn’t know what to make of the trauma from surgery. It’s at a loss. It has no concept of repair and recovery mode. It panics.
This is the patient who, despite a highly skilled surgical and post-op team, suffers some kind of major setback or complication, and/or the road to full recovery is long and bumpy.
If you’ve been struggling to adhere to a workout regimen, perhaps reminding yourself that you’re preparing for a possible invasive surgery one day will jumpstart your motivation. The preparation is sometimes referred to as prehab.
A prehab mindset is key. You may think you’ll never need major surgery, but remember, unexpected medical conditions can strike people who consistently train hard, and serious accidents do happen to the fittest.
Dr. Dean points out a very overlooked element in all of this: Working out causes mineral loss, especially magnesium.
“So, if this is not addressed before surgery, you can actually have a worse outcome because the heart absolutely needs to be saturated with magnesium when it’s under the massive stress of surgery,” she explains.
“Add to that the drain on magnesium by the drugs used in surgery. I recommend my patients take magnesium every day and increase their magnesium intake with magnesium citrate powder before any stressful event.”
WOMBATS for Prehab
This is an acronym devised by Dr. Raymond Rocco Monto, an orthopedic surgeon from Nantucket Cottage Hospital, MA.
Weight. “One of the most critical things you can do before surgery (if your BMI is 30 or over) is to get your weight down as much as possible,” says Dr. Monto.
“This helps with diminishing stress on your heart, lungs, muscles and joints. Can’t run or do heavy exercise? No problem, watch your diet and add walking or stationary bike use 20 minutes a day in the three weeks prior to surgery.”
Rudd Center
Surgical preparation via exercise need not be only aerobic. If you’re facing knee replacement surgery, for example, you can really crank up your body’s resilience to physical stress by lifting weights while lying and seated: chest and shoulder presses, and pulling movements for the back and arms.
An 8-12 rep max of these compound resistance exercises, with one minute between sets, will help shave off excess body fat while improving the body’s durability.
Outlook. “Prepare yourself mentally for your surgery by visualizing your surgery and recovery,” says Dr. Monto.
Medication. Make sure your surgeon knows of all your medications and also non-pharmaceutical supplements.
Bad habits. In the weeks leading up to surgery, cut out vices like drinking, smoking and recreational drugs. “They can wreak havoc with your liver and kidneys trying to process and eliminate all the anesthetic drugs you will receive at surgery.”
Timing. “Don’t schedule your elective surgery unless you have sufficient time blocked out in your busy life to devout your full effort and focus on recovering.”
Strength. Dr. Monto says, “This is the most important issue. Surgery is very stressful on your body. Getting as strong as you can before your surgery will make your recovery easier and faster.”
The best time to get as strong as possible is before you even need surgery.
Think “prehab” to kick up your motivation.
Best exercises include the deadlift, squat, bench press, overhead press, bent-over dumbbell row, chin-up, sled work, tire flip, hill dash, parking lot sprints (or any HIIT mode) and hybrid movements such as the squat-to-overhead press.
Dr. Monto’s expertise is in sports medicine, and reconstructive surgery of the knees and shoulders.
Dr. Dean, in practice for 35+ years and author of “The Magnesium Miracle,” is also a naturopath, nutritionist, herbalist, acupuncturist, lecturer and consultant.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Freepik.com, teksomolika
Just What IS Sarcoplasmic Hypertrophy?
Here is your simple explanation for what sarcoplasmic hypertrophy really is.
Sarcoplasmic hypertrophy is the goal of bodybuilders, because bodybuilders want to get as big as possible – in terms of muscle belly size, a sculpted appearance, and a “bulging” appearance for some competitive bodybuilders.
The muscle belly is the main part of a muscle that you see in someone with pronounced development.
Sarcoplasmic hypertrophy is also the goal of people wanting to gain mass and have impressive musculature, though not necessarily as big as possible (e.g., the look of modern-day action movie stars).
In a muscle cell, sarcoplasm is the fluid-like substance that surrounds the filaments that contain the proteins responsible for muscle contraction.
When this fluid becomes more filled up with its components, it causes the entire muscle fiber unit to increase in size.
The components of sarcoplasm are what enables a person to train hard to fatigue. Those components include microscopic blood vessels and glycosomes; glycosomes store sugar that the muscle cell needs for fuel.
For maximal hypertrophy gains, the general rule is that one should train in the 8-12 rep range, to muscle failure for most sets.
This means that if they can perform a 13th repetition, the weight load needs to be increased to reset them back into the 8-12 rep max range.
Training like this forces muscle cells into a very fatigued state. As a response, the number of blood vessels (capillaries) and glycosomes, plus other “metabolic machinery” inside the sarcoplasm, increases in number.
This fills out the sarcoplasm, making it expand, and hence, making the muscle get bigger.
The muscle fiber also becomes more capable of training with heavier weights, as the athlete keeps pushing and gritting through the uncomfortable fatigue or “burn.”
The 8-12 rep max, or bodybuilding protocol, involves sets that last at least 8-10 seconds.
This is about how long it takes for a muscle cell to use up energy before hitting fatigue.
The athlete becomes stronger, but not maximally strong; however, the athlete experiences a lot of mass gain.
Sarcoplasmic Hypertrophy vs. Myofibrillar Hypertrophy
Some schools of thought will argue that the 8-12 RM isn’t absolute when it comes to sarcoplasmic hypertrophy, but as mentioned already, this is the general rule—in combination with short rests in between sets: anywhere from about a minute to 90 seconds.
If rests between sets are too lengthy, then the training effect will shift away from sarcoplasmic hypertrophy and towards myofibrillar hypertrophy.
People who focus on maximal strength for a one rep max or say, four or five rep max, will take breaks from two to four or more minutes between sets.
You’ll note that most competitive powerlifters (whose training is based on longer rests and fewer reps per set including one rep maxes) are smaller in musculature than same-height bodybuilders.
Some powerlifters, though, are also bodybuilders, which is why some champion powerlifters are huge.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
.
Top image: Freepik.com, Racool_studio
Should You Stop Your Children from Screaming when Playing ?
Few people enjoy hearing kids screaming during play, though many parents who don’t like hearing this kind of noise from their own children will claim there’s nothing they can do about it.
Parents must ask themselves: “If my child is in serious trouble (e.g., dog attack, abduction attempt) and screams as a result, will I recognize this or will I think she’s just letting out another play-scream?”
“Parental disciplining of children appears to have declined,” says Gloria S. Rothenberg, PhD, clinical psychologist and school psychologist in New York with over 25 years’ experience working with children and families.
“Many parents confuse setting limits with inhibiting their child’s self-esteem. But children do need guidance to learn self-control and how to modulate their behavior to fit the situation.”
Screaming during play becomes a problem when:
1) Neighbors are subjected to it
2) It occurs in a public lobby or waiting area, and
3) It’s indistinguishable from the screams a child would emit if threatened with bodily harm.
Remember, neighbors do not want to hear your children screaming any more than you want to hear your neighbors’ dog frequently barking or your neighbors’ cranked-up disco music.
Screaming indicates lack of self-restraint in kids.
Dr. Rothenberg says, “I often recommend that parents play some of the old-fashioned games with their kids like Simon Says, Red Light-Green Light, Freeze Tag, Musical Chairs because they have to listen, pay attention, and practice starting, stopping and controlling their bodies during these games.
“It would be easy to incorporate vocal elements into some of these games to practice control of volume.”
However, just a few passes with an authoritative “Do Not Scream,” may be enough to do the trick.
After all, when’s the last time you heard a parent announce with authority and downward inflection, “Do NOT scream”?
Instead, they either do absolutely nothing, or elicit a feeble “Shhhhh,” that sounds more like the air being gently let out of a tire, than an order to stop yelling.
The “Shhhhh” approach never works.
Have you ever witnessed this work? It fails. Imagine that you’re a child who delights in yelling and shrieking, and Mommy leans towards you with this sea-breezy “Shhhhh.” Why on earth would this make you quiet down?
For Kids Outside Screaming
Shutterstock/Anastasiia Markus
March outdoors and call the kids over to you. With strong authority in your voice, inform them that the next one who loudly yells will have to come inside and do some cleaning or stand in a corner for timeout.
Then follow through if you hear a violation.
If you can’t tell who the culprit was and nobody will fess up, then tell the group the next time you hear screaming, playtime is over for everybody.
Then follow through, no matter how beautiful the day is. This need happen only a few times before the message sticks good and hard.
Another warning could be that you’ll remove their playthings (water guns, balls or whatever else they’re playing with). Then follow through.
Dr. Rothenberg suggests, “A traffic light metaphor provides an easy, simple way to give kids feedback and warnings when they are getting a bit unruly.
“A green light, as displayed by a card or drawing, means an appropriate level of noise; a yellow light signals a warning that volume is getting too high and needs to tone down; a red light means the noise level is excessive and play stops for a specified period.”
The key to teaching kids to stop screaming during play is to follow through on your warnings.
This means you mean serious business, and very soon, your kids will be playing without all the needless racket.
Instruct them that screaming is permitted only if there’s an emergency, and then explain what constitutes an emergency (dog attack, abduction attempt, fire). Otherwise, “No screaming is permitted.”
And say it like you mean it. Screaming during play is a learned behavior rather than an automatic reflex, so the idea that children cannot be trained to eliminate screaming during play is flawed.
Little girls have been known to let out ear-splitting shrieks simply while being pulled along in a wheeled wagon by an older child, or when they simply pedal their bicycles around in a cul-de-sac or get squirted with a water gun.
Again, this is learned behavior rather than a reflexive reaction from, for instance, pain sustained after falling off a bike and onto hard concrete.
A strong clue that screaming is learned behavior is the fact that it’s uncommon for little boys to scream while playing — even when being chased by older boys in a game of tag or sprayed with a water hose.
Ask the kids what they think you mean by “screaming,” especially younger kids.
Make sure they understand what you mean by “screaming,” or “shrieking.”
Offer rewards for a “No Scream Event,” meaning, if the entire time the children are playing and nobody screams, they all get a nice surprise.
Do you know any women who scream and shriek over events that don’t justify all the vocal noise, such as winning a small prize (or even a large prize, for that matter), seeing a spider or mouse, being on an airplane with a little turbulence, finally fitting into a pair of “skinny jeans,” stepping on a scale and seeing a 10 pound weight loss, or seeing a favorite celebrity unexpectedly appear on a TV show?
Chances are pretty good that these adults were allowed to scream as children during play.
Dr. Rothenberg specializes in the treatment of mental health conditions in children.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Shutterstock/ Pressmaster
How Much Exercise Can Elevate ALT or AST?
Heavy exercise prior to a liver enzyme blood test can elevate the ALT or AST, but just how much exercise are we talking here?
“AST and ALT elevation after exercise is related to inflammation of the muscles, or muscle cell damage, says Hwan Yoo, MD, a board certified gastroenterologist in Baltimore, MD.
“AST or ALT are called transaminases,” continues Dr. Yoo. “These are present mainly in liver cells, but as well as in any muscle cells.
“Therefore, any level of exercise or physical activity causing muscle cell damage could cause elevation of these enzymes by being released from the inflamed or dead muscle cells.”
This phenomenon has gained some attention as a result of the CrossFit craze. In fact, it even has a mascot: Dr. Rhabdo.
“Rhabdo” is short for rhabdomyolysis, a condition of lethally injured muscle fibers that leak their contents into the athlete’s or gym enthusiast’s bloodstream.
This condition is very serious, and a classic symptom is tea or cola colored urine.
James Heilman, MD
Dr. Yoo continues, “One of the well-known pathological conditions related to high AST elevation is heart attack or acute myocardial infarction.
“This phenomenon is known to happen in weightlifters, marathon runners or soldiers who perform heavy duty labors.
“This is relative for each individual depending on the tolerance of the individual to exercise.
“This type of AST and ALT elevation are not considered to be a type of liver disease.”
Are CrossFit competitors the most physically fit athletes on the planet?
Some say so, while others insist that the following other kinds of athletes are the most physically fit: surfers, MMA fighters, marathon runners, sprinters, gymnasts, extreme mountaineers, triathletes and bodybuilders.
Must a person perform CrossFit workouts to be super fantastic fit? No.
When’s the next time you’ll need to do 100 pull-ups in a row followed by 100 switch-jumps, 50 burpees and then loads of barbell cleans, all in 20 minutes?
Though CrossFit athletes are in phenomenal shape, they’re putting their joints at high risk of permanent injury down the road.
As for Dr. Rhabdo, death from this is rare, but possible. Very prompt treatment is key to full recovery.
Just how much exercise, or how intense the exercise needs to be, to merely elevate the liver’s ALT and AST, without accompanying symtoms, is not specifically known.
For example, will a 45 minute bodybuilding routine do it for next-day’s liver enzyme blood draw?
Will a 30 minute, medium intensity jog on a treadmill do it?
To avoid an exercise-induced elevation of ALT and AST for a scheduled blood draw, try to avoid structured exercise the day before.
This way, you’ll more likely have a more “true” enzyme result.
However, the enzymes may still turn out to be elevated.
In fact, one study showed that in healthy men, the ALT and AST remained elevated seven days after exercise — which consisted of an hour-long weightlifting session.
The report by Pettersson, et al, concluded: Intensive muscular exercise, e.g. weightlifting, should also be considered as a cause of asymptomatic elevations of liver function tests in daily clinical practice.
Dr. Yoo is an experienced liver specialist, has 40+ years of medical experience, and has been affiliated with Mercy Medical, and Hackensack Meridian Health. He has worked with his patients to best manage their liver disease through innovative pill therapy.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: ©Lorra Garrick
Source: ncbi.nlm.nih.gov/pmc/articles/PMC2291230/
Colon Cancer vs. IBS: Alternating Constipation & Diarrhea
Constipation alternating with diarrhea is a classic symptom of irritable bowel syndrome, but also can be caused by colon cancer.
What if you find that lately, you’re experiencing this troubling symptom?
“Alternating constipation with diarrhea with abdominal pain is very classic of IBS,” says Pankaj Vashi, MD, Lead National Medical Director, National Director, Gastroenterology/Nutrition/Metabolic Support, Cancer Centers Treatment of America.
Dr. Vashi continues, “When it occurs in anyone above the age of 40 with normal bowel habits prior to that, should be evaluated for other conditions like colon cancer.
“Again, in colon cancer these symptoms will be more acute and associated with other concerning symptoms.”
“Acute” means a sudden, notable onset as opposed to a gradual, quieter onset.
However, the “other concerning symptoms” that can be caused by colon cancer can also be caused by IBS.
They include stomach/abdominal discomfort or pain, a feeling of having to void but nothing comes out, fatigue, unexplained weight loss and bloating.
However, a symptom that can be caused by colon cancer, but is never caused by irritable bowel syndrome, is blood in the stools.
This can appear as fresh, red blood, or as a dark or black “tarry” substance in the BMs. Ever see melted tar? This is what “tarry stools” means.
Shutterstock/Ronald Plett
This doesn’t always mean colon cancer (other possible causes of blood in the stools are ulcers and hemorrhoids), but it DOES mean this:
Don’t waste another moment in getting evaluated by a gastroenterologist.
IBS is a diagnosis of exclusion. All other causes of diarrhea alternating with constipation, including colon cancer, should be ruled out before a diagnosis of IBS is made!
For 20 years Dr. Vashi was instrumental in developing robust gastroenterology, and nutrition and metabolic support programs in all five Cancer Treatment Centers of America centers.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Freepik/tonodiaz
When Chronic Subdural Hematoma Symptoms Begin in Young Adults
Are symptoms of chronic subdural hematoma in people under 65 more likely to occur sooner within 90 days when compared with elderly patients?
Anyone who clicked on this article probably already knows that by definition, the symptoms of a chronic subdural hematoma begin anywhere from three weeks to three months after the initial trauma to the head.
If the symptoms begin presenting themselves a few days to 21 days after, the condition is termed subacute.
If the symptoms begin kicking in sooner than a few days, it’s an acute case.
Some medical schools of thought define subacute as symptoms occurring between a few and only seven days.
When do symptoms of a chronic subdural hematoma begin appearing, usually, in elderly people vs. adults under age 65 within that 90 day grace period?
Would it be more typical for the symptoms in someone under 65 to begin appearing sooner, say, in the first one to two months?
“This is plausible,” begins Charles Park, MD, Director of The Minimally Invasive Brain and Spine Center at Mercy Medical Center in Baltimore, and a neurological surgeon.
Dr. Park explains, “As we get older, the brain shrinks and gets smaller. So, the symptoms from the subdural hematoma may not be evident early for the elderly patients because they have more room to ‘accommodate’ the extra mass of the subdural hematoma.
“Younger patients will show symptoms earlier due to the ‘full’ brain.”
Younger Adults Have Bigger Brains
The younger, bigger brain has a tighter fit within the skull, reducing the space between the brain and the dura mater tissue.
With this much less space, if blood begins leaking within it, it will more quickly, within that chronic phase timeline, begin producing symptoms—usually a very bad headache (though other neurological symptoms can also result).
However, the elderly person’s brain is typically smaller (sometimes referred to as age-related brain atrophy).
This makes more room, as Dr. Park says, for a collection of blood and other fluid to fill up.
So it takes longer for this increasing collection or mass to begin putting pressure on the brain, and hence, causing symptoms.
Another thing to consider is that in the elderly, symptoms can be missed, making it seem that the symptoms “began” later than they actually did.
For example, suppose an elderly person (who struck his head a few months before) has been showing signs of a little dementia for the past year.
If the chronic subdural hematoma is now causing impaired cognition, family members might attribute this to the pre-existing dementia getting worse.
Awakening with weakness in a limb might also be passed off as part of old age.
In fact, even a really bad headache might not trigger suspicions in family members of any bleeding in the brain.
When my elderly mother woke up one day with a “crown of thorns” headache, my father was convinced this was due to eye strain the night before at her sewing machine.
And he thought nothing of her leg weakness; he thought it was just another transient setback of “overworking herself,” because the day before she had attended her first Silver Sneakers exercise class.
I pointed out that when she walked, her left foot kind of dragged. My father denied this and said I was imagining it.
So you see how the symptoms of a chronic subdural hematoma can be missed by a spouse?
He wasn’t even concerned that she had upchucked a little bit, thinking it was something she had eaten the day before.
(It’s possible that the nightmare of my mother’s quintuple bypass surgery a few months prior had desensitized my father).
All day long I pressed for the ER visit, and finally my father relented, and soon after she arrived, my mother was diagnosed with a chronic subdural hematoma.
Her symptoms came on suddenly, however, so the delay in diagnosis was only by hours, not days or weeks.
Had my mother been living alone with nobody aware of these symptoms, it’s anybody’s guess how long it would have been before she got medical attention, because she herself had not been worried over these symptoms.
This apathy might have been due to the chronic subdural hematoma.
But when a young person awakens with these symptoms, it’s typically very alarming and they waste no time seeking medical attention.
With that all said, a person under age 65 is more likely than an elderly person to begin experiencing the symptoms of a chronic subdural hematoma one to two months out from the initial trauma, since there is less space in their bigger, tighter-fitting brain to accommodate the increasing collection of blood and cerebral spinal fluid from the damaged veins.
Dr. Park specializes in minimally invasive surgical techniques for treatment of conditions affecting the brain and spine. He’s skilled in advanced procedures and techniques that utilize innovative computer technology and image-guided surgery systems.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: ©Lorra Garrick
Very Elderly on Coumadin Hits Head but NO Subdural Hematoma?
Can it be possible for an advanced elderly person on a blood thinner to escape a chronic subdural hematoma after a hard hit to the head?
Well, I don’t know what really constitutes a “hard” hit to the head, but when my father at age 89 fell in the middle of the night (nobody witnessed it), the result was a “goose egg” hematoma (collection of blood) on his forehead (a bulging bruise), plus immediate neurological symptoms.
The hit to his head must have been pretty good because he was irrational, then exhibited perseveration (repeatedly asking if he had fallen, despite my mother answering affirmatively every time he asked).
Then the amnesia over the past two weeks was exhibited. The week prior he had had a knee replacement surgery, and he at times thought it had not yet occurred, then was asking if he’d had it.
In addition to advanced age and the neurological symptoms, my elderly father was also on the blood thinner Coumadin at the time.
So we have an ugly recipe for a chronic (and even subacute) subdural hematoma.
I was pretty sure he was going to eventually—weeks down the road — begin exhibiting symptoms of a chronic subdural hematoma, even though the CT scan a few hours later, and 12 hours after that, was normal.
So I was on edge for the next 90 days, and warned my father to limit his driving, in case a neurological symptom suddenly appeared while he was behind the wheel.
But amazingly, 90 days went by without a single neurological symptom.
How is it that an elderly person on a blood thinner who fell and hit his head never developed a chronic subdural hematoma?
I asked this to Charles Park, MD, Director of The Minimally Invasive Brain and Spine Center at Mercy Medical Center in Baltimore.
Dr. Park explains, “It’s always better to be lucky than good. The mechanism of injury is very important.
“If the injury was just local and didn’t involve the sudden acceleration/deceleration, there may not be a breaking of veins and resulting in SDH.”
There is also the possibility that my father does not have a lot of the age related brain shrinkage (atrophy) that many elderly people have, which puts them at risk for a brain bleed.
Two ways to help stave off the so-called age related brain atrophy is to use the brain a lot (which he has always done) and exercise (he’s been doing upper body exercise for years and keeping busy with household projects).
Dr. Park specializes in minimally invasive surgical techniques for treatment of conditions affecting the brain and spine. He’s skilled in advanced procedures and techniques that utilize innovative computer technology and image-guided surgery systems.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
