Pain Care: Prevention Before Treatment

Author: Harry J. Gould, III, MD, PhD

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When a patient says, “Doctor, it hurts when I do this,” the immediate thought in response to the implied request is “Don’t do that.”  Unfortunately, in today’s society, this seems to be the best and most effective advice that a physician can provide for their patients in pain.

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The United States is in the midst of what the Centers for Disease Control describes as “The worst public health crisis in American history.”

There are reports, almost daily, to enlighten us about the fact that the over-prescribing of prescription painkillers has led to countless overdose deaths and serious consequences associated with misuse, abuse, addiction, and diversion that plague society in epidemic proportions.

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As a result, there has been a strong push by the community and regulatory agencies to limit the prescribing and dispensing of opioid analgesics across the board, while paying little attention to the underlying cause.

Pain is often under-treated or over-treated, but mostly it is poorly treated.

The system’s response has precipitated a reluctance on the part of many physicians to provide pain care for many in need, further exacerbating the primary cause of the problem.

A frequent response is to change clinical focus and redirect efforts to offer one-dimensional assessment and management that relies on interventional modalities.  Unfortunately, not all patients are identical and interventions, if ordered inappropriately or too often, can be costly and have problems of their own.

The observations and policies have mandated change and have heightened the efforts of healthcare providers to find ways to “do no harm” in their efforts to help those in need.

How then can we improve pain care and overall quality of life?  Perhaps it is time to return to basics.

As a starting point, we should consider some important truths about pain.

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The Truth About Pain

  • Pain is subjective and is different for everyone based on culture, situation, experience, genetics, age and gender.
  • Pain is a modality that is essential for survival. It warns us of present and potential tissue injury so that we can respond and minimize damage.
  • The most important reason that chronic pain is so debilitating is less the uncomfortable sensation that is experienced and more the fact that pain robs us of our ability to control of own lives. Unfortunately, many chronic pain conditions are present for a lifetime.  Thus, the realistic goal should be to minimize the effect of the underlying condition causing the pain and reclaim control of our lives rather than to eliminate pain.

Too often, patients surrender responsibility for controlling their pain to friends, physicians, physicians, drugs or procedures.

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Taking Responsibility for Your Pain

As a patient, it is essential for you to take responsibility for your pain and to participate in your own care. This process can begin by considering and implementing some obvious positive behavior changes that can maximize pain control and minimize both physical and fiscal cost.

Things You Can Do to Control Pain

  • Eat a regular healthy diet, avoiding excess, with a goal to optimize body mass index (BMI).
  • Exercise daily — regular activity from baseline to 30-60 min/day tailored to the patient’s ability to tolerate activity without a backward slide. “No pain, no gain” is not always the best approach.
  • Be sure to get enough restorative sleep.
  • Balance life experiences and schedule time for yourself that allows for participation in hobbies and enjoyable leisure activities.
  • Be aware of habitual activities and positions that add undo ergonomic stress, e.g., poor posture, wearing high heels, wearing shoes that lack adequate support, sleeping on an old or non-supportive mattress or pillow, using inadequately supportive chairs and car seats. Tailor work and living environments to minimize but not necessarily eliminate stressors and eliminate high-risk conditions.
  • Learn and take advantage of alternative forms of coping and pain control, e.g., meditation, guided imagery, self-hypnosis and relaxation.

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With proper perspective and attention to basics, one is likely to realize improved general conditioning that enhances:

  • Healing and the immune system’s ability to fight off infection and disease
  • Improved cardiovascular, pulmonary and gastrointestinal health
  • Reduced stress
  • Improved mental health
  • Increased sense of self and well-being and an overall improved quality of life
  • Reduction in pain at any level

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When setbacks occur, first consider the use of topical heat, cooling or massage and prudent physical activity to improve strength, range of motion and endurance and seek counsel for a comprehensive pain assessment early when the basics have not provided adequate results.

Essential Immunizations for Adults

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You want to pass on certain things like family traditions, a grandmother’s quilt or dad’s love of books—but no one wants to pass on a serious illness. Take charge of your health and help protect those around you by asking about vaccines at your next doctor’s visit.

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Vaccines

Vaccinating our children is commonplace in the United States. But many adults don’t know which vaccines they need, and even fewer are fully vaccinated. Every year, thousands of adults in the U.S. become needlessly ill from infectious diseases. Many adults are hospitalized and some even die from diseases that could be prevented by vaccines.

Not only can vaccine-preventable diseases make you very sick, but if you get sick, you may risk spreading certain diseases to others. That’s a risk most of us do not want to take.

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Babies, older adults and people with weakened immune systems (like those undergoing cancer treatment) are especially vulnerable to infectious diseases. They are also more likely to have severe illness and complications if they do get sick.

You can help protect your health and the health of your loved ones by getting your recommended vaccines.

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The good news is that getting vaccinated is easier than you think. Adults can get vaccinated at their primary care doctor’s office, pharmacies, workplaces, health clinics and health departments.

Most health insurance plans cover the cost of recommended vaccines—a call to your insurance provider can give you the details.

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What vaccines do you need?

All adults should get:

  • Annual flu vaccine to protect against seasonal flu
  • Td/Tdap to protect against tetanus, diphtheria and pertussis (whooping cough)

Some additional vaccines you may need (depending on your age, health conditions and other factors) include:

  • Hepatitis A
  • Hepatitis B
  • Human Papillomavirus (HPV)
  • Meningococcal
  • Pneumococcal
  • Shingles

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Traveling overseas?

There may be additional vaccines you need depending on the location. Find out here. 

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Still not sure what vaccines you may need?

Take this short quiz.

Open Up: The Truth About Oral Cancer

Author: Rohan Walvekar, MD, Co-Director of ENT Services at UMC

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Oral cancer will be responsible for over 10,000 deaths and will affect over 50,000 people in the United States in 2018.

These numbers may surprise you, because, in general, oral cancers are not thought of as commonly occurring; however, Louisiana is one of the states with highest incidence of oral and pharyngeal cancers in the United States.

What is the rate of these cancers in Louisiana?

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April honors Oral Cancer Awareness, and is a good time to learn about the signs, symptoms and treatment of oral cancer, as well as the importance of early detection.

What are oral cancers and why should we care about these cancers?

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Oral cancers are cancers that affect parts of our mouth such as the gums, tongue or palate. They are most commonly caused by tobacco use and alcohol consumption. There is a new threat called Human Papilloma Virus (HPV-16) that can also cause certain types of oral and oropharyngeal cancers.

These cancers are important because they have a devastating effect on a person’s ability to communicate with the world around them by affecting speech and swallowing, breathing and appearance; treatment, which is most commonly involves surgical removal, may also have an serious impact on these functions that are so vital to us.

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Surgical management is the ideal treatment for oral cancers but comes with the possibility of a disfiguring operation (e.g. removal of jaw bone or tongue affecting appearance or speech) and loss of function.

Early detection of oral cancer plays a vital role improving quality of life and function by limiting extent of surgery and consequently side effects of treatment.

In addition, it’s important to note that early-stage tumors (i.e. tumors detected at an earlier stage of the disease) have better chances of cure (5-year disease-free survival: 60-80 percent) as compared to cancers diagnosed when they are too large or advanced (5-year disease-free survival rates: 30-40 percent).

Unlike other types of cancers that may miss detection until they are too advanced; oral cancers can be diagnosed earlier with inspection and a biopsy – both of which can be easily done during an oral cavity examination by an expert in the clinic or at a cancer-screening event.

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Patients who notice a sore, ulcer or growth in the mouth that has not responded to treatment or a lump in the neck (oral cancers can spread to lymph nodes in the neck) that does not go away either after treatment or spontaneously in 2-3 weeks, should get check by an oral cavity expert such as an ENT surgeon or Head & Neck Cancer Surgeon.

The slogan that the Head Neck Cancer Alliance (OHANCAW) promotes –“All you have to do is open your mouth” is a testament to how a simple cancer screening can save lives and improve outcomes for oral cancer patients who are diagnosed early.

Get screened – promote screening – save lives!

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Click here to learn more about our Cancer Services and future screenings.

To make an appointment with an ENT, visit our website here. 

About Dr. Walvekar

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Rohan R. Walvekar, MD, earned his doctoral degree from the University of Mumbai. After graduating in 1998, he completed a residency in Otolaryngology and Head Neck Surgery at the TN Medical College & BYL Nair Charitable Hospital, Mumbai, India, with triple honors. Subsequently, he completed two head neck surgery fellowships, and trained at at the Tata Memorial Hospital, Mumbai, which is India’s most prestigious cancer institute, catering to over 5000 new head neck cancer registrations a year. After completing an Advanced Head Neck Oncologic Surgery fellowship at the University of Pittsburgh, he became an Assistant Professor in Head Neck Surgery within the Department of Otolaryngology Head Neck Surgery at the University of Pittsburgh/VA Medical Center, prior to joining the LSU Health Sciences Center in July 2008. His clinical interests are head neck surgery and salivary endoscopy. His research interests include evaluating prognostic markers and clinical outcomes of head and neck cancer therapy and treatment of salivary gland disorders.

Give to Live: How My Son Saved 54 Lives

Author: Amy Deubler Foy, Mother of former UMC patient Cameron Dice 

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On Sunday, March 11, my son, Cameron Dice, was riding his 4-wheeler across a piece of land near our home until it flipped over on him and crushed his skull. He was brought by ambulance to a small hospital in Franklinton, LA and from there, he was air lifted by helicopter to University Medical Center New Orleans. Upon arrival, he was on a ventilator and the outlook did not look very promising, but still, we prayed for a miracle to happen.

He arrived at UMC Sunday afternoon around 3 p.m. Their amazing nurses and doctors worked on him to try and save his life. But, unfortunately, the damage to his brain was too severe and there was little that they could do. On Monday night, March 12 at 7:28 pm, at the age of 19, he was legally pronounced dead.

My family and I made the decision prior to the final apnea test that would determine whether his brain had any activity:

If Cameron did not have any chance at survival, we wanted him to be an organ donor. 

This was a decision that Cameron had made not long before his accident –  just 2 years prior at the DMV when he received his driver’s license.

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The decision to save other’s lives when yours cannot be saved seems, to me, to be the only decision. I stand firm in this decision even more so now after Cameron’s death. Why would you not want to save someone else’s child, mother, father, brother, sister, etc.?

Cameron becoming an organ donor was not only the right decision for others, but it also gave me 50 more hours to hold his hand, kiss him, stroke his hair and tell him everything I needed to tell him before he was taken into surgery.

Those 4 days were the absolute hardest days I have ever experienced, but that little bit of extra time has made the pain of all this a little easier. I am so grateful that I had those days to just hold my baby and tell him goodbye.

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If Cameron would have been on the other side, needing a transplant for an organ to save his life, I would hope and pray that others would give the gift of life to save my baby.

My Cameron, my angel, now lives in 54 different people between his organs, bones, skin, muscles, tendons, veins, arteries, etc. 

While he was here on earth, he touched so many people’s hearts and lives and now that he has passed on, he still is doing the same.

I cannot explain how proud I am that my baby is truly a hero to these people that now have a chance at life because of Cameron. There is little to no comfort that anyone can provide to a mother that loses their child, but knowing that my baby is still around me physically walking around in all of these people helps tremendously.

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If you are an organ or tissue recipient, please – I beg you – reach out to the family who saved your life.  I pray for the day to meet the people that my child now lives through!

There is no reason, in my eyes, for people to not be an organ donor.  If you can save another person from going through the pain that my family is enduring, why wouldn’t you?

The people with LOPA (Louisiana Organ Procurement Agency) were absolutely amazing.  Everyone was very considerate of me and my family the whole time while they prepared Cameron for his surgery.  They have kept in touch with me and have offered me support with their kind words.

I just received a letter from them giving me the sex and age bracket that Cameron’s major organs went to. I pray to meet every single one of them!!

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April is National Donate Life Month, which honors organ, tissue and eye donors and their loved ones. One organ donor can save the lives of up to nine people.  

At University Medical Center, our dedicated professionals have helped, in coordination with LOPA, to save the lives of over 95 organ recipients in the past year.

Please join us on April 16 at 1:30 p.m. near the flagpole at UMC’s Galvez Street entrance for a LOPA flag-raising and butterfly release to honor the silent heroes at UMC and their families.

Have Your Cake…and Your Hair, Too!

UMC Offers FDA-Cleared DigniCap Scalp Cooling System to Minimize Hair Loss During Chemotherapy

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For patients recently diagnosed with cancer, it often feels like there is much to lose: time, energy, money, perhaps hope. Hair doesn’t have to be among the mix. Because of the DigniCap scalp cooling treatment, cancer patients across the United States are undergoing chemotherapy and seeing less hair loss. Now patients at University Medical Center New Orleans can do the same.

If you’re a patient looking to have your cake, and your hair, too, here’s what you need to know:

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How It Works

The DigniCap scalp cooling treatment is a proven approach to reduce chemotherapy-induced hair loss that has been used successfully by tens of thousands of patients worldwide. The reduced temperature results in a reduced blood flow to the scalp area so that less chemotherapy reaches the hair cells. Hair cells are therefore not exposed to the full dose of chemotherapy and may be able to survive the chemotherapy treatment. In addition, cellular metabolism within the hair cells is slowed down.

As a result, hair is less likely to fall out.

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How It Feels

We sat down with one of our patients, and the term she used was “pain-free.” The DigniCap is designed to comfortably fit patients’ heads and comes in varying sizes. Although it can get a little cold at times, most patients tolerate scalp cooling with DigniCap® scalp cooling system very well because the system cools the cap down gradually from room temperature. The cap temperature never drops below freezing to help make the treatment more comfortable for patients.

Common Side Effects

Side effects, as a result of the DigniCap, are minimal. They include feelings of coldness, headaches, scalp pain and/or light-headedness, which is rare. Your doctor can provide a pain reliever if you develop a headache.

What It Costs

Scalp cooling costs roughly $350-400 per treatment. The number of treatments required is determined by a patient’s physician.

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How You Can Receive Treatment

For more information, or to express your interest in being treated with the DigniCap scalp cooling system, contact the UMCNO Cancer Center at (504)702-3113 or visit www.umcno.org/dignicap.

Mammo Is Ammo: How Early Screening Saved My Life

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Author: Tamira Armwood, Breast Cancer Survivor, University Medical Center New Orleans

I clung to the words like I do to my rosary when I pray: tightly. What was supposed to be a routine mammogram screening at age 40 turned into a quick discovery of a mass on my right breast. Immediate emotions of fear and worry consumed me. But then a moment of relief came: After the biopsy, we determined the mass was benign.

That was July 2014, but the start of my journey against cancer did not begin until six months later.

Fast-forward to January at my follow-up appointment. My radiologist performed another biopsy, but this time, the results were not so favorable. “Stage 2 Breast Cancer,” she said, which means the cancer inside of me was growing, but still contained in the breast and nearby lymph nodes.

Because of the cancer’s aggression, a treatment plan was immediately created.

I can’t remember any thoughts that weren’t concerned with my own disbelief.

I couldn’t have cancer. I have no family history of it! Did she really just say those words? How am I going to tell my daughters? What if I don’t make it?

I prayed for strength, courage, wisdom, hope and support, and the amount of each of these needs I received from my husband and daughters was nearly two-fold. Like me, they had no certainty of what was going to happen. Unlike me, fear was not their focus but, rather, the fight.

When my treatment plan was established, my breast surgeon informed me I would need a lumpectomy performed to remove the lump from my breast. In addition, I would have to experience 18 weeks of chemotherapy treatment plus 33 days of radiation. The information, tests and costs were overwhelming, but then I meditated on Jeremiah 29:11, which says, “For I know the plans I have for you. Plans to give you hope and a good future.”

What this told me was that I was not near my end.

In my diagnosis, there was hope. After my treatment, there would be a good future.

If there is anything this disease has taught me, it is how to embrace the little things in life.

On this journey, I experienced a great degree of setback: hair loss, excessive weight gain, nail discoloration, lymphedema and periods of extreme fatigue. What I gained, however, was far greater. After my diagnosis, I smiled more. I shared more information with family and, even, strangers. I got excited more. I displayed courage more.

In the most unexpected way, I have become more grateful for the little blessings this experience has given me. It has brought my family closer together, mended broken relationships and been a common cause for which we can all show passion and compassion.

If you are someone who has recently been diagnosed with cancer, my advice to you is this:

Know there is hope. Stay the course. Stand in Faith. And never quit.

I didn’t have a family history of breast cancer, but genetic breast cancers only account for about 15%-20% of all breast cancers. That’s why it’s so important to get screened.

Because of this mantra, I preserved through the fight.

Because of my annual mammogram, I became a breast cancer survivor.

Thank you so much for allowing me to share my story with you.

Tamira Armwood

 

For more information about mammograms at UMC, visit http://www.umcno.org/mammograms.