The Salina Journal from Salina, Kansas on January 25, 1996 · Page 11
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The Salina Journal from Salina, Kansas · Page 11

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Salina, Kansas
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Thursday, January 25, 1996
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Page 11
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, THE SALIN^JOURNAL Health MONEY/ C2 CLASSIFIED / INSIDE c BRIEFLY T PERSONAL HEALTH T MEDICINE Surgery without scars? Idea looks promising « That would be nice. Surgery iwithout scars. •, That's what interventional radiologists are promising in a new technique that works especially well for appendectomies and oth- ,e,r surgery. ; In the procedure — called endo- luminal full-thickness'resection — catheters and other small instruments are inserted through the rectum to the inside of the intestine, where, with X-ray guidance, surgeons can remove the appendix or tumors in the colon. This procedure also holds promise for the treatment of early-stage sessile cancers — those with a broad base on the wall of the colon — because it enables the removal of the entire wall where the tumor is located, thus reducing the risk of leaving cancer cells behind. .' According to the Radiological Society of North America, this innovative type of surgery has these advantages: less invasive, no general anesthesia required, fewer complications, less expensive and the patient usually can return home sooner. Walking sharpens seniors' reaction time On your feet, seniors. A little 20-minute walk a day can keep your reaction time in the pink. In a study of more than 9,000 adults in Great Britain, researchers found those oldsters who walked for 20 minutes or more each day experienced significantly less age-related deterioration in reaction time than those who walked less strenuously or not at all. "People who were older and walking regularly demonstrated somewhat better performance in cognitive function, particularly in reaction time," said Charles F. Emery, associate professor of psychology at Ohio State University in Columbus. Continued Emery, "If your reaction time is faster you may be able to respond more effectively to the unexpected." Unexpected problems might crop up during driving or in situations that could result in falls. Nicotine patches help you quit for good : What if the fortuneteller looked in the crystal ball and said you will have more energy, your eyes and throat will be less irritated, your sense of taste and smell will return and you will have fewer bouts of cold and flu? Well, all those things can come true — without the aid of the occult. All you have to do is quit smoking. That's easier said than done, of course, and the myths surrounding the difficult task of quitting are as thick as the smoke that fills the air. The fact is, most smokers practice quitting — maybe three, four or five times — before they quit for good.. Smoking is a drug dependence, and the nico'tine is the drug. Nicotine replacement therapy (NRT) — a temporary aid that provides nicotine to the system in the form of gum or a patch — is the only proven way to wean a smoker who is ready to quit from qigarettes. • To dispel some of the smoking- cessation myths, SmithKline Beecham has prepared a brochure: "The Final Cut: Quitting Smoking for Good," available free of charge by sending a self-addressed stamped envelope to The Final Cut, P.O. Box 731, Radio City Station, New York, NY 101010731. Kids get moving in simultaneous project All Children Exercise Simultaneously — ACES — is a project that has kept kids hopping for eight years now. Its goal is to get youngsters from all over the world to exercise in unison to promote proper fitness habits and nutrition. This year millions of children from 50 countries will exercise, walk, jog, dance and do aerobics on the morning of May 1. Each school organizes its own activity for the 15 minutes the program runs. The program has been highly praised by President Bill Clinton. If you want to make Project ACES part of your child's school activities, contact ACES coordinator Len Saunders: Valley View School, Montville, NJ 07045; please include a self-addressed stamped envelope. From Wire Service Reports Pediatric Painkillers, an area long neglected RICHAE MORROWAThe Salina Journal An analgesic lollipop could take the pain out of medical procedures for children. Doctors could remove the drug from the child's mouth when a sufficient dose has been absorbed through the mucous membranes. JANE BRODY The New York Times Children's aspirin has been on the market for decades, joined more recently by children's acetaminophen. Both are mild pain relievers, although mainly used to reduce fevers. But when it comes to quelling severe pain - the kind, for example, associated with sampling bone marrow, setting a broken arm or sewing up a bad cut - children have long been * therapeutic orphans. Drug companies feel that the pediatric market does not offer enough economic incentive to warrant the costly testing and approval process required to license pain medication in a form suitable for small children. Most potent painkillers are administered by injections that are themselves painful and frightening for children. And when doctors want to reduce anxiety in children undergoing painful medical procedures, they are often forced to reformulate into an oral preparation a drug called Versed that is marketed only in an intravenous form. The drug companies' reluctance to develop pediatric analgesics has been tacitly supported by doctors who have long harbored many myths" about pain in children, including the notions that they do not feel pain as much as adults, that they do not remember then: pain and that they might become drug addicts if given narcotics. Such beliefs account for the failure of doctors to use painkillers when circumcising newboms. Barbaric restraints Too often, instead of being given pharmacological or other forms of relief, frightened children about to undergo painful procedures are simply restrained physically, a practice pain specialists call barbaric. Infants may be unable to verbalize pain and small children may be afraid to, but there is no longer any doubt that children suffer as much as adults, and it is clear from their response to repeated procedures that they remember the pains of the past all too well. In fact, as noted by Dr. Lynda J. Means, an anesthesiologist at James Whitcomb Riley Hospital for Children in Indianapolis, "infants . may actually have a heightened re- sponse to pain because inhibitory mechanisms, while present, have not fully matured." Dr. Kathleen M. Foley, chief of the pain service at Memorial Sloan- Kettering Cancer Center in New York, said pain in children might be worse than pain in adults because children are often unable to understand that '.'the pain may be short- lived, that relief is possible or that the pain associated with treatment or diagnostic procedures can have long-term benefits." Dr. Foley added, "Some children, especially those with chronic disease, become desperately afraid of needles and those who wield them.". Furthermore, anxiety and unrelieved pain can complicate recovery, prolong hospitalization and even increase the risk of dying from a medical procedure, said Dr. Myron Yaster, a pediatric anesthesiologist at Johns Hopkins Hospital in Baltimore. The nervous system circuitry for feeling pain is present in fetuses from 30 weeks of gestation onward. There are several ways to measure the pain of children too young to describe accurately how they feel. Mil remove the remaining drug from the child's mouth when a sufficient dose has been absorbed. But Fentanyl Oralet, as the analgesic lollipop is called, has yet to be used for most of the procedures for which it is intended. That is not because it is unsafe or ineffective, but because some outspoken doctors have raised concerns about possible subsequent drug abuse by patients who receive it, as well as its potential for abuse as a street drug. Yaster maintains that these are empty arguments that simply deprive children of the kind of comfort readily provided to adults undergoing painful medical procedures. He also noted that addiction and drug abuse do not result from "the judicious use of analgesics" and that the frightening situations under which children would be given the opiate lollipop "are not the type of life experiences that children will want to voluntarily repeat." There is another new medication to reduce the pain and resulting fear of needle injections and other external procedures for adults as well as for children. It is topical anesthetic called EMLA Cream, manufactured by Astra Pharmaceutical Products Inc. of Westborough, Mass. It combines two local anesthetics, lidocaine and prilocaine, and rather than being injected, it is first smeared on the skin; the area is then covered until the drug is absorbed. First of two parts Deadens nerve end|ngs Pain profiles have been developed for infants based on such physical symptoms as breathing and heart rate, skin color and facial expression. Babies as young as 18 months can express pain. For preschoolers there are facial scales, like the "Oucher" Scale, that allow them to point to a picture that best describes how much they hurt. Other scales use poker chips or colors to indicate the intensity of pain. In 1994 a small company, Anesta Corp. in Salt Lake City, won approval for the first potent analgesic specifically designed for and tested in children. The drug, fentanyl, an opiate, acts fast but is short-lived, making it an ideal medication for providing relief during painful medical procedures. It has the added virtue of being absorbable through the mucous membranes in the mouth and so could be formulated in a "lollipop" that makes it easy and painless and not frightening to administer. This form also enables doctors to It temporarily deadens nerve endings, providing pain relief for several hours after the cream is removed. It reduces pain significantly in children undergoing insertion of an intravenous line, a spinal tap or aspiration of bone marrow. It may.also help to diminish the distress associated with immunizations and circumcision. For children 6 and older who are experiencing chronic or prolonged pain, there is now also the option of using patient-controlled analgesia. Patients give themselves medication by triggering a microprocessor-controlled infusion pump that is designed to prevent overdosages. This technique allows drug doses to be individualized, prevents anxiety-inducing delays in relieving pain and gives children a sense of involvement in and control over their own care. Experts in pediatric pain urge parents to be aggressive in assuring that their children do not suffer unnecessary pain during medical treatment. Metamucil, roughage help prevent pain from diverticulosis Dear Dr. Donohue: Recent pains in my abdomen led me to the doctor, who ordered colon X-rays, which led to a diagnosis of di- verticulosis. I have already started taking Meta- mucil. What more can I do to prevent a recurrence of pain, or what's worse, ».«uip occurrence of DONOHUE diverticuli- NorthAmerica tis?Iama47- fr"**"" year-old man. "* — A.P. Dear A.P.: A diverticu- lum is a protrusion of a small area of the inner colon lining out through the muscle wall. Such a wall wraps around the entire digestive tract, but the colon is a favored place for the little protrusions to form. Diverticulosis becomes more common with age and more so in societies that favor refined foods. Refining removes roughage from various grains, for example. What your grandparents enjoyed is now denied to much of the population, which has as a result become diverticu- losis-prone. You have taken the first sensible preventive step by being sensitive to your need for fiber. Metamucil supplies it along with natural sources such as bran. Roughage leaves behind digestive residue that holds on to moisture and facilitates food passage through the colon while relieving pocket-forming pressure. That can help prevent further diverticula formation. Such control also goes a long way toward avoiding di- verticular inflammation, a serious complication that would call for a soft, low- fiber diet for a while. T WOMAN'S HEALTH You are on the right track, and you apparently got on it early. Dear Dr. Donohue: The doctor told me I have Sjogren's disease. I am 67. Is this a disease that strikes older people? — Mrs. G.E. Dear Mrs. G.E.: This is one of the autoimmune diseases, illnesses wherein the body has been fooled into attacking its own tissue, which we believe it somehow mistakes as alien. More and more hitherto mysterious illnesses have been loosely identified as examples of such immune system mistakes. A waning immune system can explain a proneness among older patients to autoimmune diseases. With Sjogren's syndrome, we can identify tear salivary glands as targets of the process, with resulting dryness a feature. The eyes become gritty, and you need moisturizers, such as artificial tear products. Tearso and Liquifilm are two examples. Water might be carried for throat discomfort. Rheumatoid arthritis is one of several illnesses that can come on with Sjogren's syndrome. You should sit down with your doctor to discuss such possibilities. Dear Donohue: I have asthma. Is it safe for me to become pregnant? — Mrs. J.I. Dear Mrs. J.I.: By and large, women with ordinary asthma can have babies. Women should be warned, though, that asthma tends to worsen during pregnancy. It does in about a third of patients. We're not sure why that's so, but modern medicines usually can control things without harming the fetus, whic is the chief concern. IUD might be good choice when your family is complete Many women have misconceptions about the intrauterine device, or IUD. The IUD is a safe, effective * contraceptive method for many women. It is more effective than the condom, diaphragm or spermicides, and also more conve- GEORGE D. WILBANKS OB/GYN nient than these meth- 9 ods because it doesn't interfere with sexual activity. The IUD is a small, T- shaped plastic device containing either copper or the hormone progesterone which is inserted by a doctor into a woman's uterus. A thin plastic thread (one to two inches long) protrudes through the cervix so that you can check to make sure the device is in place. Small amounts of copper or progesterone, depending on the IUD type, are slowly released to prevent fertilization of the egg or a fertilized egg from attaching to the uterine wall. The IUD with progesterone must be replaced once a year. The IUD with copper may be left in for up to 10 years. The IUD is a good choice for women who can't take oral contraceptives and for women who have completed their families but don't want surgical sterilization. Because the IUD carries a slightly higher risk of ec- topic pregnancy, it is not usually recommended for women who have had a pelvic infection, previous ec- topic pregnancy, multiple sex partners, or who have never had children. Common side effects with the IUD include some discomfort while the IUD is being inserted and some cramping and spotting during the first few weeks after insertion. Menstrual periods usually become slightly longer and heavier in women using the copper IUD; lighter in women using the progesterone IUD. Occasionally, the IUD will slip partially out of the uterus or be expelled entirely in the first few months. Pregnancy, or complications during insertion, rarely occur with the IUD. If you do get pregnant, see your doctor immediately since the IUD poses serious risks for you and the fetus. The IUD does not protect against HTV/AIDs or other sexually transmitted diseases (STDs), so also use a latex condom for such protection. Any unusual vaginal discharge or odor or pelvic pain may signal an STD or pelvic infection and should be checked immediately. If you cannot take the pill or have finished your family but don't want to be sterilized, consider the IUD and talk to your physician to learn more. Single, free copies of "The Intrauterine Device" are available by sending a stamped, self-addressed, business-size envelope along with the name of the booklet to: The American College of Obstetricians and Gynecologists, Resource Center, AP014, 409 12th Street, SW, Washington, DC 20024. Wilbanks is president of the American College of Obstetricians and Gynecologists. SUGGESTIONS? CALL SHERIDA WARNER, LIFE EDITOR, AT (913) 823-6363 OR 1-800-827-6363

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