Injuries

I’m still in pain after a car accident. Why won’t my doctor prescribe more pain medication?

DEAR DOCTOR K: I have been in pain since a car accident a few years ago. My doctor is very conservative in prescribing pain medication. Why not just give me what I need to feel better?

DEAR READER: I don't know the particulars of your case, but I think you are talking about narcotic (opioid) pain medicines. And your doctor probably is reluctant to prescribe opioid medicines for chronic pain -- the kind I assume you now have if your accident was a few years ago.

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Should I have arthroscopic knee surgery?

arthroscopic knee surgery

DEAR DOCTOR K: I'm a lifelong runner with severe knee pain. I hate the thought of surgery, but hear it's not such a big deal these days, using arthroscopy. How do I know if I'm a good candidate for it?

DEAR READER: Arthroscopy is a technique used to diagnose problems in the knees and other joints. If a problem requiring surgery is identified, arthroscopic surgery can be performed. To appreciate how valuable arthroscopic surgery is, you have to understand what things were like back in the "old days" -- like when I was in medical school.

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What is shoulder impingement?

DEAR DOCTOR K: I have pain in my shoulder when I raise my arm above my head. My doctor says it's caused by "impingement." What does that mean, and what can I do about it?

DEAR READER: You know the wide variety of things your shoulder allows you to do -- such as reach for a box of cereal, swing a golf club and wash your hair. Its wide range of motion makes all these things possible. However, the design of a joint that lets you do all of that also leaves the joint vulnerable to injury. Joints are places where two or more bones meet. The shoulder joint is where three bones meet: the clavicle (collarbone), the scapula (shoulder blade) and the humerus (upper arm bone).

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How can I tell if my daughter has a concussion?

DEAR DOCTOR K: Last week my 14-year-old daughter fell while skateboarding. She hit the back of her head and was dazed and had blurry vision for a few seconds. But she felt fine once she sat down and rested a bit. Now the left side of her head hurts, but otherwise she feels normal. Should she see a doctor?

DEAR READER: Yes, she should. In a child, particularly, it is often hard to know when trauma to the head may have caused a brain injury. That's why you should never ignore a head injury, no matter how small it seems. It may sound like I'm overreacting. After all, children bump their heads all the time. And in most cases, this results in nothing more than minor bumps, bruises or cuts in the scalp.

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What is a stress fracture?

DEAR DOCTOR K: What is a stress fracture?

DEAR READER: A patient of mine once asked me the same question, but with a twist: "In the emergency room they said I had a stress fracture. That's ridiculous, right? I mean, they're blaming stress for causing nearly every symptom these days. But how can stress cause a bone to break?" It's not emotional or mental "stress" that the word refers to in a stress fracture. It is stress -- unusual physical pressure -- placed on a bone that causes it to break. And the break typically does not separate the two ends of the bone. The X-ray, CT scan or MRI scan often shows no abnormality in the shape of the bone. Instead, there is a hairline crack inside the bone.

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What’s the treatment for a subdural hematoma?

DEAR DOCTOR K: My mother is in her 70s. She fell a few weeks ago but seemed fine. Then she started to have double vision and some trouble with balance. A CT scan revealed a subdural hematoma. Her doctor advised only bed rest and medication. Does this seem reasonable to you?

DEAR READER: A subdural hematoma (or hemorrhage) occurs when blood vessels near the surface of the brain burst. Blood collects beneath the dura mater. That's the outermost layer of the brain's protective covering. Here is an illustration of a subdural hematoma:

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What can I do to ease the pain from my broken ribs?

DEAR DOCTOR K: I recently broke a couple of ribs, and the pain is so bad I can hardly move. I can't sleep at night and I can't take a deep breath. I went to the doctor, but he said there isn't much he can do. I was surprised that he didn't even tape up my ribs. Is there anything I can do to help my ribs heal quicker and ease my discomfort?

DEAR READER: I understand why you ask the question. If you've ever fractured a bone, it has probably been put in a plaster cast or a splint. Keeping the broken parts of the bone from moving helps the bone heal and reduces the pain. The pain from a fracture generally occurs when the broken parts of the bone move. You know the old joke: "I'm OK, doc. It only hurts when I move."

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How soon can I resume normal activities after an episode of low back pain?

DEAR DOCTOR K: I'm recovering from an episode of low back pain. How quickly (or slowly) should I resume my normal activities? I don't want to reinjure my back.

DEAR READER: You're right: It's a balancing act. Too rapid a return may precipitate a relapse, but too timid a return can delay -- or even prevent -- recovery. I can't give you a definitive answer because I don't know the details of your condition. But here's some general advice.

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