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Ask The Doctor: Summer 2016

Q. I often feel like my bladder is full and my doctor thinks I have interstitial cystitis (IC). What is IC and how is it treated? 

A. Interstitial cystitis, or painful bladder syndrome, is a condition involving chronic bladder pain or discomfort. We know little about what causes it, but we do know it is about five times more common in women. Symptoms include urinary frequency and urgency; pain and discomfort while the bladder fills (and relief with urinating); and tenderness with intercourse. IC can have a profound negative impact on quality of life as pain may range from mild pressure to severe and debilitating discomfort. Additionally, many women with IC also suffer from conditions like IBS, endometriosis, vulvodynia, and fibromyalgia. Unfortunately, the medical community has not reached consensus regarding the most optimal treatment approach. First-line therapies include dietary and behavioral modifications. Second-line therapies include medications and pelvic floor physical therapy. Third-line therapies include bladder instillations, in which medications are put directly into the bladder, and cystoscopy with hydrodistention, in which the bladder is filled to a high pressure. Fourth-line therapies include injecting Botox into the bladder muscle or implanting a device called InterStim that sends mild electrical pulses to the nerves controlling your bladder and bowels. Screen Shot 2016-05-19 at 11.05.53 AM

Q. I suffer from vertigo and my friend told me vestibular rehabilitation therapy (VRT) could help. What is VRT?  

A. Vestibular rehabilitation therapy is an exercise-based program designed for patients suffering from dizziness, vertigo, inner ear dysfunction, poor balance, and even migraine headaches. It’s also used to treat patients with brain injuries, strokes, or a high risk of falls. Before you begin therapy, you will need to see a physician for an evaluation. While most cases aren’t serious, dizziness is sometimes due to a serious problem like heart disease, stroke, or another brain disorder. After ruling out serious conditions, a physician will refer you to a physical therapist with specialized training in evaluation and treatment of vestibular disorders. Your PT can determine the most appropriate treatment regimen for you. VRT may include vision stabilization, neck exercises, postural education, and/or balance retraining. Depending on the severity of your condition, treatment length may range from one session to a few months. The good news is that many patients see their symptoms fully resolve after completing VRT. Patients also benefit from decreased fall risk, improved balance, and increased quality of life.
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Q. I’m in my 80s and live by myself. How can I decrease my risk of falling? 

A. First, I would encourage you to receive proper medical care. When I assess a patient, I look at the three M’s: medical status (Are your conditions being treated?), medications (Do they need adjusting?), and mobility (Do you need a walker or wheelchair?). Second, I would streamline your home environment. It’s best to live on one floor with no steps. Pathways from one room to another should be wide, uncluttered, and well-lit. If a pathway is long, it should have a rail. If you tend to get up at night, you should have easy access to a light. I recommend assessing your home and asking yourself: what could trip me? It could be a throw rug, a piece of furniture, or even an animal. You should also focus on improving your bathroom, as it’s the most common place people fall. Most people will need to add grab bars at the toilet and in the shower. I recommend using a curbless shower with a chair or bench, as getting in and out of the tub often causes falls. You can also apply a non-slip additive to the surface of your shower. Finally, if you live by yourself, you should wear an alarm around your neck in case you do fall. In case of an emergency, you can press the button to summon for help.
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Q. I work at a pet-friendly office, and my dog allergy is making me miserable. What can I do?

ask-the-doc.1A. Dog and cat allergy is a major problem for many of our patients. The allergen is found everywhere, and even when pets aren’t around it travels on our clothing! To treat it, I recommend taking a three-pronged approach. Begin by avoiding dogs and cats as much as possible. If you can’t stay away from pets, consider purchasing a high-efficiency particulate arrestance (HEPA) filter to remove the allergen from the air. Next, treat your symptoms with antihistamines (Allegra and Zyrtec) or nasal sprays (Nasacort and Flonase). Finally, consider allergy immunotherapy, or allergy shots. Allergy shots will retrain your immune system to be less allergic to dogs and cats. They are the only proven way to cure your allergy for good!
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Q. My father was admitted to the hospital with a pressure sore over his tailbone. How will he be treated?  

A. Once your father is admitted, medical staff will assign him to a specialty mattress to minimize pressure at the ulcer site. He will then follow a turning schedule to alleviate excess pressure to any one location on his body. Most hospitals utilize wound care nurses to direct wound care. However, depending on the ulcer’s severity, he may also need to consult with a wound care specialist (usually a surgeon). A specialist can determine whether he needs surgical debridement, a procedure to clean away dead or contaminated tissue from his wound. Once his wound is clean, your father may undergo negative pressure wound therapy to speed the healing process.
He may also consult with a dietician, since nutritional status plays a vital role in wound healing.
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