When my now-20-year-old daughter was three months old, I broke the small toe on my right foot. My husband and I were going out for dinner for the first time since her birth and being home with her and my then-2-year old was driving me nuts. So, we found a trusted sitter and we were going to go out.

While we were waiting for her to come, I was playing with my son and chasing him in circles around the kitchen and living room. I smashed my foot against his toy stove and broke my little toe. Hard. The problem was – I still wanted to go out! I knew that they don’t do much for broken small toes and I needed this night out really badly. So, we went out anyway.

Our original plan was to have the buffet, but I couldn’t stand or walk very far, so I stayed put. I remember that my foot was hurting but I wasn’t going to let that interfere. Thinking back, I really must have been desperate for that night out. After the dinner, we got home, paid the sitter, saw her home safely and then decided what to do. We figured that I’d go to the emergency in the morning after I’d nursed my daughter and that’s what I did. I was right. They didn’t do anything for my toe other than tape it up. And, because I was breastfeeding, there wasn’t a whole heck of a lot I could do about the pain.

So, should you see a doctor if you thing you broke your toe? It is always best to be safe than sorry. MedicineNet.com recommends that you see a doctor if you have a compound fracture (bone breaking through the skin), you lose feeling in your toe or it gets cold, if the pain gets worse instead of better over time, or if there’s bleeding or drainage from the toe.

Going to the doctor in my case wasn’t necessary, but sometimes you just don’t know what to do. On the MedicineNet site, they say that if you don’t need to see a doctor because you don’t have any of the issues mentioned above, you can likely treat your toe yourself by resting it, elevating it, and using ice packs to reduce the swelling.

Taping may be done, which means taping the broken toe to the neighbor toe to provide some support. This should be done carefully though because if you put the tape too tight, you can cut off the circulation to both toes. Be sure to put a bit of gauze or cotton between the two toes to prevent rubbing and blistering.

Wearing shoes is going to be hard. The temptation is to wear open toe shoes, but this can expose your toe to more trauma if you hit it or if someone steps on it. Try to wear a sturdy shoe that can protect your toe.

Sometimes, toe fractures are more serious and need reduction, or movement to put the bone back into place. This is usually painful and the doctor may give you some local anesthetic to help reduce the pain. If reduction is done, often you’ll get a splint.

Casts are very rarely needed. They may be used if there are more fractures than just the toe or if there are other problems that require the stability of a cast.

We don’t think about our toes much – until they hurt. And then they have a great way of reminding us that they’re still part of us!

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Images: iStock.com

Tags: pain blog, broken toes, taping toes

Post from: Blisstree

Have you ever had a broken toe?

When dressings are changed, the dead tissue needs to be removed; this is called debriding the wound. And, removing the dressing and cleaning the area can also be painful. Back in March, I posted about a finding that a virtual reality game helped patients with burns (Virtual-reality Video Game To Help Burn Patients) and now that’s been taken even further at the on-going American Academy of Pain Medicine meeting in Hawaii.

Physicians presented the cases of two soldiers who were burned badly while serving in Iraq. They were provided with virtual reality glasses to use during dressing changes. This successfully lowered their pain levels during the painful dressing changes. The cases used the same vide game mentioned in the earlier post, Snow World, which helps the patients feel or create an impression of being in a cold environment, cooling them off.

You can read more about the case studies in this article, AAPM: Virtual Reality System Eases Pain of Burn Care for Wounded Soldiers.

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Tags: pain blog, burn pain, pain from burns, burn patients, virtual reality for burn paitnes, burn care, wounded soliers

Source: Maani C, et al "Pain control during wound care for combat-related burn injuries using custom articulated arm mounted virtual reality goggles" AAPM 2009; Abstract 174.

Post from: Blisstree

Virtual reality may help relieve pain during burn treatment

Take, for instance, Ken Griffey Jr. pinching a testicle with his own cup, Cardinals’ kicker Bill Gramatica tears his ACL celebrating a field goal, San Francisco Giants’ manager Roger Craig cuts his hand on a bra, professional disc golfer Ron Russell swung his hand into a tree during a throw at the 2000 PDGA tournament, and Manchester City’s (soccer player) David Seaman broke a bone reaching for the TV remote.

To read how these highly paid (and sometimes over-rated!) athletes sustained their injuries, pop on over to The 5 Wimpiest Pro Sports Injuries of All-Time. I’m not sure if you’ll giggle – or wince.

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Tags: pain blog, pro sports injuries, ken giffey jr, kicker bill gramatica, manager roger craig, ron russel, footballer david seaman, torn ACL, pinched testicle

Post from: Blisstree

5 Wimpiest Pro Sports Injuries of All-Time

Winter has returned strong enough to freeze the canals, allowing the people of the Netherlands to once again don their skates and zoom around on the ice as they did generations before. There’s just one problem. They’re out of practice!

According to this article, Dutch skaters a little rusty, in the Montreal Gazette, Dutch skaters have been falling and breaking or spraining limbs, sending many of them to local emergency rooms.

But, at least, they were having fun, right?

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Tags: pain blog, dutch, hans brinker

Post from: Blisstree

Dutch out of skating practice: fractures pile up

Having a collapsed lung is not only dangerous for the obvious reason (limited breathing), but depending on the cause of the collapse, there’s a danger that the other one can collapse as well.

News reports say that 44-year-old actress Mariska Hargitay was recently rushed to the hospital with a collapsed lung. They don’t say how it happened.

If you look up "collapsed lung" on a search engine, you’ll see there are two terms that are used: atelecetasis and pneumothorax. They aren’t quite the same thing.

Atelectasis is the term used when a fully expanded lung collapses, but pneumothorax means that there is air in the pleural cavity (in the chest) that pushes on the lungs, resulting in atelectasis. So, if you have a pneumothorax, it can cause atelectasis, but if you have atelectasis, it doesn’t mean you have a pneumothorax.

What can cause a collapsed lung? Sometimes, it can just happen, without a particular cause. But the major causes include:

• A mass or plug of mucus that was inhaled
• Something pressing on the lung, like pneumothorax, fluid, or blood
• Trauma, injuries, surgery to the chest
• Swelling of the abdomen, which can push up on the lungs
• Lack of surfactant, the coating of the alveoli (the tiny air sacs where oxygen and carbon dioxide are exchanged)
• Scarring of the lungs
• Smoking

Believe it or not, people like fighter jet pilots are also at risk – the high speeds at which they travel can cause a collapsed lung.

Symptoms:

When I had pleurisy, at one point I was convinced I had a collapsed lung (before I was diagnosed properly) because the pain in the side of my chest was excruciating. That’s one of the symptoms, especially if the collapse is very sudden. Other symptoms are:

• Fast, shallow breathing
• Shortness of breath
• Looking bluish or very pail
• Irregular heartbeat
• Drop in blood pressure

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Tags: pain blog, actress mariska hargitay, collapsed lung, atelectasis, pneumothorax, mariska hargita collapsed lung

Post from: Blisstree

Mariska Hargitay and her collapsed lung

So, like I said, I don’t know how I feel about this: research into curing hangovers. After all, the only people who get hangovers are those who get drunk and getting drunk – the last time I checked – isn’t something that happens to you, it’s something you do to yourself.

Researchers found a way of treating drug overdoses. They found a molecule that actually surrounds the foreign substance and makes it harmless. The researchers are hoping that it will help treat other problems, such as snake and insect bites. But they also think it would help treat hangovers.

If you’d like to read more about the findings, check out this article, New treatment for blood poisoning could prove instant hangover

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Tags: pain blog, hangovers, cure for hangovers

Post from: Blisstree

A cure for hangovers?

The 39-year-old hockey player made a classic mistake. Having turned off the machine, he reached into the auger to clear snow but something happened and Sakic ended up with severe tendon damage and a break occurred to one finger and fractures to two others. While he is anticipated to have a full recovery, many others who make the same mistake aren’t so lucky.

According to a study recently published in the Annals of Plastic Surgery, there were 22 people who underwent surgery for snowblower injuries to the hand between 2002 and 2005.

You can read more about this issue in the Globe and Mail article, Hands off: Getting stuck in this snow job will hurt.

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Tags: joe sakic, photo joe sakic, colorado avalanche captain joe sakic, snowblower injury, snow blower injury, pain blog

Post from: Blisstree

Winter injuries even side line athletes, like Joe Sakic

When I read about Ms Rupprecht and what the award stands for (recognizing individuals for excellence in caregiving and for their devotion to helping those living with pain), I knew I had to try see if I could interview her. According to the press release issued by the NPF, "The National Pain Foundation is proud to pay tribute to Christine Rupprecht for her groundbreaking achievements in the field of pain management as well as her dedication to, and passion for, providing exemplary care to patients coping with life-altering injuries and the family members who care for them."

 There is also a video that was filmed for the award, which shows you what an amazing person Ms Rupprecht is.

Here is the interview:

As a nurse, what type of background do you have specifically in pain care?

I have 15 years of experience as a pain management nurse.  My career started at Mount Vernon Hospital in Alexandria, Virginia.  The Director of Nursing called me into her office and encouraged me to apply for a position with the Anesthesia Department.  Apparently they had been looking for a nurse to work with patients in the pain clinic for six months but no one wanted to work with patients in pain. 

I interviewed, accepted the position and fell in love with the challenging and rewarding field of pain management.  I stayed at Mount Vernon for five years, received my Masters Degree as an Advanced Practice Nurse in Pain Management.  From there I went on to Georgetown University Hospital’s Pain Center and from there to Walter Reed.

What made you interested in pain as a particular area of health care? Was this something that was an original interest or something that grew as you practiced?

As I mentioned above pain management is extremely rewarding.  You can impact your patient’s life because sometimes the patients pain is so severe that their life has become "OBLITERATED" BY THE PAIN".  My interest still continues to grow.  It’s fascinating.

Do you have a particular person you see as a role model or mentor in the field of pain management?

I have been so fortunate to work with wonderful people.  COL Deborah Brown, MD, and COL Buckenmaier MD, the director of our program, whose voices you hear in the video taught me so much and supported through my journey.

Because the majority of your patients have severe limb injuries and/or amputations, is most of the pain you see and manage neurologic?

Pain management is multimodal and multidisciplinary. 92% of patients who have an amputation experience phantom limb pain which is neuropathic in nature and very difficult to treat.

How did you come about creating the Pain Process Improvement Team? What was the basis of the team, who comprises the team and are you looking to improve on it?

I think you are referring to the Pain Management Task Force.  It takes a village to raise a child; it takes a team to treat the pain.  This is an Interdisciplinary group which includes physicians, nurses, pharmacists, chaplains, social workers, nutritionist etc.  I started this group at Mount Vernon and also had one at Georgetown.  It serves as an educational format for the members but also makes pain management very visible in the institution.  Consequently the patients benefit.

What is the basis of the Pain Champions – are they preceptors to new nursing staff? What is the biggest benefit to this program?

The PAIN Resource Nurses or Champions serve as resources to the nurses on the unit and of course act as patient advocates.

As we know, chronic pain affects more than just the patient, but also the family members and friends who feel they’re helpless. Do you work with them as part of the pain program?

Of course, we treat the whole family at Walter Reed.

What is the biggest breakthrough that has come about since you’ve been working in pain management?

Believe it or not it’s that most health care providers now believe the patients’ self report of pain.

Can you think of a specific failure that was thought would be great for pain management but ended up not being very helpful?

No

I’m a former palliative care nurse, so I’ve seen the severe pain that can affect patients at the end-of-life stages. Can you see your program helping people in these situations?

Our chronic pain service is more involved in end of life issues.  Many patients are benefiting from implantable pain pumps, which have greatly improved their pain control and quality of life.  I worked with many of these patients at Georgetown.

How do you feel about alternative therapies, such as acupuncture?

Big Fan. We have had great success using acupuncture to treat phantom limb pain.  I just completed a Reiki class from the department of Integrative medicine at the  University of Maryland Hospital in Baltimore.

Although there have been so many people and so many issues, does any one person or situation in particular stay with you?

Max was my first patient at Walter Reed.  I learned so much from him.  He was a paratrooper and thought that was over when he lost his leg but he parachuted in for the opening of the MATC.

Although you work with adults, has your research and hard work been adopted in the pediatric milieu?

Pediatric pain management is a whole different field but good work is being done. At least now they believe that infants do experience pain.

What would you advise if someone has been living with severe chronic pain but they feel that they aren’t being taken seriously or their healthcare team isn’t able to help them effectively?

To find a pain management physician who believes and respects them.

How can a family member help someone who is living with chronic pain that isn’t getting relief, despite trying many types of treatment?

Don’t give up.  Use the Internet to learn about new treatment options.

Where do you see the whole field of pain management headed?

Our population is ageing and we have a whole new population of pain patients in the military it’s just going to keep growing.

Is there anything particular you would like to add for the readers of Help My Hurt? The majority of the readers live with fibromyalgia, migraines, and back pain. Other issues they have run from CRPS, interstitial cystitis, cancer, to fractures and repetitive stress injuries.

Go to organizations like the National Pain Foundation for help. They are doing a fantastic job.

My thanks to Chistine Rupprecht for taking the time to share her story with Help My Hurt. It goes to show that there is some hard work being done in the pain field and maybe, one day, everyone will get they help they need. I also would like to extend my thanks to the Gigail "Gail" Cureton, CTR, Media Relations at Walter Reed Army Medical Center for making this interview possible.

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Tags: chronic pain blog, pain blog, acute pain, pain specialists, christine rupprecht, walter reed army medical center, amputations, phantom limb pain, celina field caregiver award, national pain foundation, pain management

Post from: Blisstree

An interview with Award-winning pain nursing specialist, Christine M. Rupprecht, MSN, RN

We experienced it here about five years ago, when my teen-aged daughter developed it and had to have an emergency appendectomy. Luckily for her, it hadn’t burst, so she was able to go  home after only one night in the hospital. But, appendicitis can be very serious. Besides being very painful, iIf the appendix bursts, it can cause peritonitis, an infection in the abdomen. People have died and still die from this if it’s not caught and treated in time.

Oddly enough, right now in the Canadian province of Saskatchewan, there appears to be an outbreak of appendicitis. According to the Medbroadcast.com article, Small Sask. town wonders why it has 6 appendicitis cases since mid-October, the town of Avonlea has seen six cases in the past few weeks. What makes this more staggering is there are only 400 people in the town – and there has only been one case of appendicitis in the preceding five years.

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Tags: chronic pain blog, pain blog, appendicitis, appendix, appendectomy

Post from: Blisstree

Appendicitis outbreak in Saskatchewan?

About two months ago, we began a reno in our house to get it up to speed in order to sell it. The biggest project, by far, was to remove four walls of horrible stucco off the dining room walls. The only way to do that is to chip if off manually. So, I did.

I began doing it, the rest of the family chipped in (sorry about the pun!) from time to time. It was slow going – took about a month to get the whole room done, but we did it. I worked with a floor scraper type of tool (like a very broad chisel) and a mallet. Unfortunately, it turns out that the hammering and chiseling has injured my shoulder.

I noticed it about four weeks in so I more or less stopped working on the walls. I did a bit here and there, but I had a sharp pain in my shoulder that I thought at first was my regular type of pain, but it really wasn’t. We don’t have a firm diagnosis yet, I still have to get scanned, but I spoke with my doctor when I saw him last week, and that’s very likely what it is.

So, on top of everything else, now my shoulder hurts. Sigh.

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Image: iStock.com

Tags: chronic pain blog, pain blog, shoulder pain, torn rotater cuff, pain in my shoulder, shoulder hurts

Post from: Blisstree

No good deed goes unpunished – torn rotater cuff