Monday, August 29, 2011

Ask Us Anything: What are the Symptoms and Causes of Pelvic Prolapse?

"I am in my late 20s and believe that I am experiencing the symptoms of pelvic prolapse: painful intercouse, urine leakage and frequent urinary tract infections.

I have always experienced these symptoms, so until I read a description of pelvic prolapse, I thought that they were a normal part of life.

How is pelvic prolapse diagnosed? I've had pap smears, but my physician has never mentioned anything being out of the ordinary.

Are there any other probable causes?

And what are the treatment options? I've read that surgery is a possibility but that it is not a solution for those planning to have children. I haven't started a family yet but plan to in the future."

Doctors Scott Zuccala, Ali Ghomi and Samuel Saleeb Respond:

Dr. Zuccala: Pelvic prolapse, urinary complaints (such as frequent UTI's, leakage of urine, pain with urination), and other associated symptoms such as painful intercourse, can be part of issues with prolapse or they can be different disease processes.

Dr. Ghomi: Pelvic organ prolapse commonly affects women after the fifth decade of life.The risk factors are having had multiple deliveries, hysterectomy and genetic predisposition.

Dr. Zuccala: Prolapse in a young person such as yourself is rare. It is usually, but not always, associated with childbirth. It is most often a process that takes years to develop.

Dr. Ghomi: However, certain connective tissue disorders and neurologic conditions such as spina bifida can cause pelvic prolapse to occur at a young age.

Dr. Saleeb: Vaginal prolapse in young patients may also be due to genetic reasons (someone in the family would have had this condition). A person with vaginal prolapse would feel vaginal pressure, discomfort and heaviness, which increases by the end of the day.

Dr. Ghomi: Urinary incontinence may be present in someone who is experiencing pelvic prolapse, especially cystocele or dropped bladder, but not always.

Dr. Saleeb: One of the common causes of urinary incontinence is bladder infection. Also, interstitial cystitis (a condition that cause painful bladder and urinary incontinence) is common in young patients.

Dr. Zuccala: Treatment of pelvic prolapse may be surgical, but we also offer patient-centered measures, such as keigel exercises, that involve tightening of the pelvic floor by squeezing the vaginal muscles. We can use a pessary, a device that holds up the pelvic floor. But, this is used more in the elderly. Surgery is usually reserved when those measures fail or when they are not appropriate.

Dr. Saleeb: For patients with mild prolapse who want to preserve fertility, we can use a treatment of electrical stimulation and pelvic floor physical therapy.

Dr. Ghomi: Or, uterine-sparing pelvic reconstructive surgical procedures may be performed.

Dr. Zuccala: In your case, I would do a thorough exam, including a detailed neurologic and pelvic exam. I may include a cystoscopy to assess your bladder and urethra. And also a review of any medication, over-the-counter or otherwise that you may be using. We would need to establish a diagnosis before looking at treatment options.

About Our Physicians

Dr. Zuccala

Dr. Zuccala is a gynecologic surgeon at Mercy Hospital of Buffalo.
He practices obstetrics and gynecology, including minimally invasive surgery, and vaginal and pelvic reconstruction for prolapse and urologic incontinence surgery.
He was one of the first surgeons in the Buffalo area to perform minimally invasive gynecological surgery for non-cancerous conditions using the da Vinci® Robotic Surgical System.

Dr. Ghomi

Dr. Ghomi is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital.
He is the only physician in Western New York who performs Sacrocolpopexy Prolapse surgery using the da Vinci® robot. Sacrocolpopexy is a proven “gold standard” procedure worldwide to repair severe pelvic prolapse.

Dr. Saleeb

Dr. Saleeb is a urogynecologist, which is a gynecologist who specializes in the care of women with pelvic floor dysfunction. He practices at the Saleeb Uro-Gynecology Center in Williamsville. He also practices twice monthly at the Ken-Ton FamilyCare Center in Tonawanda (a full evaluation of the pelvic floor is not available at this location).

He provides evaluation and management of pelvic floor disorders and offers clinical exams, urodynamic testing, cystoscopy, pelvic floor physical therapy, and behavioral therapy. He also manages a program for the prevention of pelvic floor disorders in women. At his research center, Dr. Saleeb is currently involved in three different studies.

If you have a question about your health, click here to ask our experts.

Monday, August 22, 2011

Ask Us Anything: Am I Allergic to Exercise?

"Whenever I walk long distances or run for even a few minutes, I become itchy all over, as if I'm breaking out in hives. The itching ceases after I have stopped exercising and there is no rash left behind (aside from red marks where I've itched). Is it possible to be allergic to exercise? How can I minimize my discomfort?"

Physical Therapist Jeff Castiglione Responds:

Physical Therapist Jeff CastiglioneIt sounds like you are experiencing exercise urticaria, a physical allergy that is also known as exercise allergy or itchy legs.

Symptoms include itching and possibly swelling or hives. These can occur during or after exercise and may be experienced on the legs, arms, torso or neck.

Exercise urticaria is not caused by your age or health.

You may, however, be more susceptible based on the medications you take prior to exercising or the foods that you eat. Foods that can encourage exercise urticaria include seafood, celery, wheat and cheese.

In most cases, you can take an antihistamine before exercise or reduce the intensity of your workout to ward off the symptoms.

If you exercise regularly (every day or two), the symptoms should decrease in intensity.

In extremely rare cases, exercise urticaria can be life-threatening. If you experience severe symptoms, your doctor may prescribe a medication that you would take when the symptoms occur and that will stop them from progessing.

I would recommend an evaluation by your physician to make sure that it is safe to exercise.

— Jeff Castiglione, Doctor of Physical Therapy, Certified Strength & Conditioning Specialist

Jeff is the manager of AthletiCare - Amherst, which provides Physical Therapy and Sports Training and Injury Prevention services in Amherst, NY.

If you have a question about your health, click here to ask our experts.

Monday, August 15, 2011

Ask Us Anything: Why Do Children Develop Motor Tics?

"My eight year old daughter seems to have a motor tic. She jerks her head back, and she can't control the action. She doesn't jerk her head constantly throughout the day, but when she gets into a spurt, she'll do it every five seconds (and she has had at least one spurt every day since school ended). What could be the cause?"

Dr. Anthony Vetrano Responds:

Dr. Anthony VetranoMany children will have isolated tic disorder where tics occur during periods of emotional stress or pressure-filled situations (tests or performing in front of a crowd). Sometimes the stressors are not immediately obvious, so verbal investigation may be necessary.

At age 8, the stressor may be related to body image or self-esteem, as these are the two biggest emotional issues for all children in this age group.

A psychologist may be helpful in figuring out triggers and a plan. Medications are not usually helpful for benign tic disorders.

Motor tics may also be a sign of Tourette's Syndrome. Usually, this syndrome presents with some vocal tics as well (like throat clearing or swearing or jibberish). There may also be a component of OCD behaviors. OCD is Obsessive Compulsive Disorder; this includes being very rigid about where things are or how things are done. Tourettes can be helped by prescription medications which are relatively safe. Neurologists are often involved in the care of these patients; psychiatrists may be helpful as well.

Rarely, motor tics will be a sign of seizure disorders or other underlying neuro-muscular disease; so a visit to the neurologist may be helpful in shedding light on this subject.

Bill Hyland, MS, OT, Adds:

Bill Hyland, OTIf the tic is caused by a nervous reaction, this behavior can wax and wane depending on the presence and severity of the stimulus that is causing her to be nervous. Modifying her behavior and routine can be useful in reducing the motor tic.

Another likely cause of a tic in a healthy 8 year old would be that the reaction is behaviorial or attention seeking.

This behavior will be reinforced each time you comment on her having tic movements, thereby prolonging her episodes. This behavior is often eliminated or extinct on its own over time by ignoring it.

Two unlikely causes of a tic in a healthy 8 year old would be side effects from medication or a neurological disorder such as Tourette's Syndrome. If you suspect this, then she should be evaluated by a neurologist.

Also, if she has any developmental disorders such as cerebral palsy or epilepsy, this should be looked into as well.

About Our Experts

Dr. Vetrano

Anthony Vetrano, M.D. is chairman of Mercy Hospital’s Pediatrics Department and was named a Top Doctor in Western New York (2008-2010) in Buffalo Spree Magazine.

Bill Hyland

Bill Hyland is an Occupational Therapist at Partners In Rehab Sisters Hospital, which provides Physical Therapy, Occupational Therapy and Speech Therapy in Buffalo, NY.

If you have a question about your health, click here to ask our experts.

Monday, August 8, 2011

Ask Us Anything: What's Causing My Missed Periods?

"Ever since I was a teenager, my period has been irregular. My period will sometimes skip one month, two months or even three. It lasts on average for about four or five days. Is this something that I should be worried about or see a doctor for?

Will the irregularity impact my ability to get pregnant? My mom experienced the same irregularity when she was my age and was told that she could not have children...but she ended up having two.

Also, I've heard of women being prescribed birth control to regulate their cycles, but I've also heard that the pill causes weight gain. Is this true?"

Dr. Ali Ghomi Responds:

Dr. Ali GhomiMenstural cycle irregularity is a common condition. This is especially common in teenagers since it takes a few years for the physiologic mechanism responsible for the process to mature.

Hormonal conditions, such as thyroid abnormalities, could be the cause. Other common causes of menstrual irregularity include obesity, extreme exercising, low body fat, and stress.

Birth control pills and hormonal supplementation are often used to regulate the mestural cycle once medical causes are excluded. There is an anecdotal notion that birth control pills may cause weight gain; however, this has not been proven scientifically.

Menstural irregularity may be associated with infertility. As found in your mother's case, most often women with menstural irregularities conceive spontaneously.

I would recommend discussing your particular situation with a gynecologist.

— Dr. Ali Ghomi

Dr. Ghomi is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital. He is the only physician in Western New York who performs Sacrocolpopexy Prolapse surgery using the da Vinci® robot. Sacrocolpopexy is a proven “gold standard” procedure worldwide to repair severe pelvic prolapse. Click here to learn more about Catholic Health's OBGYN services.

If you have a question about your health, click here to ask our experts.

Tuesday, August 2, 2011

Social Workers Can Help Ease the Transition to a Nursing or Adult Home

Jennifer Martone, Director of Social WorkRemember the feeling of seeing your child off for their first day of school? That fear of the unknown can be similar when planning for skilled care for your parents.

Catholic Health's Jennifer Martone, Director of Social Work, shares how social workers can be your best allies when considering long-term care.

Ask Questions

As you search, visit multiple homes and meet with the social worker.

Ask many questions – take a pen and pad for notes. You can ask how often physicians visit or about regular visiting hours, salon services, meal times and choices, and whether you are able to take your parent out of the facility for day trips.

The social worker can provide guidance and help you understand the type of experience your parent can expect. Focus on finding a home that will be the best fit.

Involve Your Parent and Siblings

Social workers can also provide insight on how to discuss the need for skilled care with your parents and out-of-town siblings.

Take the time to involve your parent in the process as much as possible. Transitions are easier when they can make the choice – it offers them a feeling of control. Not all parents can be actively involved in choosing their new home, but showing them brochures or viewing the facility’s website may help.

Conversations about this decision with your siblings can be very emotional and difficult, especially if they live out of town and have not been part of the day-to-day care. Be honest, and provide as much detail as possible. Everyone may not be in agreement, but ongoing communication is important.

Get to Know Your Social Worker

Once your parent has moved into their new home, always get to know your social worker. They are your advocate and liaison to all the other departments.

Attend Family Meetings

Family meetings are an opportunity to meet with the interdisciplinary team – ask when will they take place. At anytime, you should be able to call and speak with the assigned nurse or unit manager, therapist or social worker for updates.

Most facilities offer a Family Council and have monthly or quarterly meetings. This is an additional support system for the family. Ask questions as you have them.

Visit Often to Help Mom or Dad Feel at Home

An adjustment period during the transition is normal – an average of three months can be expected. Change is not easy. Rely on the expertise of your social worker and the interdisciplinary team. During this time, visit as often as you are able and get to know the staff and the other families.

Getting involved will help you and your parent feel more at home!

Monday, August 1, 2011

Ask Us Anything: What's Causing My Knee Pain?

"I run about 1 mile four days a week. I experience pain in my knee when I run and also when I walk upstairs or downstairs. What could be the cause? Will the pain go away on its own? Is there anything that I can do to speed up the healing process?"

Physical Therapist Richard Szabala Responds:

Physical Therapist Richard Szabala
Generally, the knee pain that you are describing can come from one of two different things.

First, it could be a mild tendonitis. A tendonitis will usually get sorer with activity such as running and jumping. If this is the case, rest and ice, along with gentle stretching of your quadriceps muscles for 2-3 weeks will allow it to heal.

The other source of pain could be from wear and tear of the cartilage in your knee.

Cartilage soreness feels more like a constant toothache and is affected more by squatting and bending activities.

In your knee, you have two types of cartilage:
  • a thick piece of cartilage called the meniscus that lays on the surface of your tibia bone and acts as a shock absorber for your knee;
  • and articular cartilage which covers the surface of your bones and acts as the lubrication system for knee.
If either of these are involved, again, rest and ice is in order. However, you may benefit from a specialized exercise program designed by a physical therapist.

Cartilage damage can take a long time to heal and is very prone to becoming worse if not handled properly. Cartilage injuries may require a doctor's visit, especially if  they do not respond to conservative treatment.

Sometimes surgery may be required if the damage to the cartilage is severe.

– Richard Szabala PT, OCS

Richard Szabala is the senior physical therapist at AthletiCare Orchard Park.

If you have a question about your health, click here to ask our experts.
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