Managing pain after surgery

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Surgery and pain pills used to go hand in hand. After all, you need a strong prescription pain medication to ensure you aren’t in pain after a procedure, right?

Turns out not only is prescription pain medication not always needed, but often not advisable after surgery, because it can raise the risk of opioid addiction. As a result, surgeons today are rethinking post-surgical pain management strategies. And if you’re going under the knife, you should too.

In the 1990s, the number of opioid prescriptions written for people undergoing surgery or experiencing pain conditions grew — and so did related problems. As a result, “We are in a current opioid epidemic, with 91 substance-related deaths each day, according to the CDC,” says Dr. Elizabeth Matzkin, an orthopedic surgeon and assistant professor at Harvard Medical School.

This is not just a young person’s problem. The Substance Abuse and Mental Health Services Administration estimates that the proportion of older adults who misuse opioids is set to double between 2004 and 2020, from 1.2% to 2.4%. In 2016, more than 500,000 Medicare Part D beneficiaries were given an opioid prescription by their doctor — and the average dose was well above recommended amounts.

Rethinking pain management

“Orthopedic surgeons are the third highest prescriber of opioid analgesics in the United States, and we are therefore in a pivotal position to change the current overprescribing patterns for postoperative pain management,” says Dr. Matzkin. Today, surgeons like her are increasingly turning toward non-opioid medications and other options to manage pain. And they’ve also started having more conversations with patients before surgery to come up with safer treatment plans ahead of time.

If you’re scheduled for a surgical procedure, having a plan to control pain after the surgery may help you avoid unnecessary use of opioids.

4 tips for effective and safer ways to manage your pain

Avoid opioid pain pills whenever possible. In many cases, non-opioid pain relievers, such as ibuprofen (Advil) and acetaminophen (Tylenol), will control postsurgical pain if taken as recommended. “We just completed a study of 163 knee arthroscopy patients who were sent home with non-opioid pain management,” says Dr. Matzkin. Based on the findings of this study, 82% of patients who undergo arthroscopic partial meniscectomy (a common knee surgery) or chondroplasty (a procedure to repair cartilage in the knee) can achieve satisfactory pain control with non-opioid pain management.

Limit opioid medication use. If it is necessary to use an opioid, limit the amount of time you take it, says Dr. Christopher Chiodo, an instructor in orthopedic surgery at Harvard Medical School. Ideally, you should take it for less than a week — and only when other options won’t work, he says. One way to reduce the amount of opioid medication you are taking is to alternate it with non-opioid treatments, such as ibuprofen or acetaminophen, if your doctor approves.

Adjust your expectations. “Orthopedic surgeons are also setting expectations for patients preoperatively. “When people are having surgery, they should expect to have some pain or discomfort,” says Dr. Matzkin. While no one should have to endure excruciating pain, having some pain is okay. “Letting people know that it’s okay to have some pain can actually reduce the amount of pain medications required,” says Dr. Chiodo. Sometimes when people aren’t told to expect some discomfort or pain, they get nervous when they experience it, which leads to more medication use. Think of surgery like you would exercise: you’ll be sore afterward, but you wouldn’t (and shouldn’t) take an opioid pain reliever to address the problem.

Use nonmedication strategies to manage pain. The key to effective pain management is to use a combination of methods. “If you are having surgery on a lower extremity, elevate it after the procedure. This can help substantially with pain relief, swelling, and wound healing,” says Dr. Chiodo. Icing the area can also help in the first 24 to 48 hours after surgery. But be certain to follow your doctor’s instructions carefully when using ice. It can cause tissue damage if used for too long — particularly in people who have reduced sensation in the area while the anesthetic used during surgery is wearing off.

Have a pain management plan in place before your procedure

Don’t wait until after surgery to decide what type of pain management you will use. Discuss pain control with your surgeon before your operation, and agree on a course of action ahead of time.

The post Managing pain after surgery appeared first on Harvard Health Blog.

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In defense of French fries

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I thought it must be a slow news day. The New York Times ran a story about French fries with a conclusion that shocked no one: French fries aren’t a particularly healthy food choice. But is this anything new? And just how bad are they?

Could French fries actually kill you?

Maybe. At least, that’s the implication of the study that triggered the latest news coverage. Researchers found that regular consumers of French fries don’t live as long as those who eat them less often.

Of course, I immediately wondered: is it really the French fries? What else do big-time consumers of French fries do that might affect their longevity? Are they couch potatoes (or should I say couch fries)? Do they drink too much? I’m guessing their other food choices might not be the best. Maybe it’s the Big Macs, cheesecake, and smoking that’s responsible more than the fries? So, let’s take a closer look at the study.

More French fries, more death

In June 2017, researchers publishing in the American Journal of Clinical Nutrition described a study of 4,400 older adults monitored over an eight-year period that found:

Higher potato consumption (including fried and non-fried potatoes) was not associated with a higher risk of death. Eating French fries more than twice a week was associated with a more than doubled risk of death. The findings held up even after accounting for obesity, physical activity, smoking, and alcohol consumption (as reported by study subjects during study enrollment).

The authors had some theories on why French fries might raise the risk of death, including:

French fries have a lot of fat and salt that could raise the risk of cardiovascular disease. During the years of this study, trans fat (a particularly unhealthy type of fat) had not yet been banned from the US market. High consumption of French fries could increase the risk of future high blood pressure, diabetes, or obesity (which are known risk factors for cardiovascular disease and other health problems), High consumers of French fries might also be high consumers of other high-fat or high-salt foods, sweetened beverages, and red meat. So, as suspected, this study does not prove that the higher rates of death among higher consumers of French fries were actually due to the fries. But are French Fries really a “death food”?

This brings us to the real question raised by this new research: must you swear off French fries forever? I say no. Here’s why:

The higher risk of death was noted among those who ate French fries more than twice a week. Eating them once a week or less would likely have a negligible effect on your health. Portion size matters. This study didn’t provide details of how many fries study subjects ate at one sitting, but an “official” serving is just 10 to 15 individual fries (130–150 calories). Most fast food establishments serve three to four times that amount! Stick with one serving, or share a restaurant serving with a couple of meal mates. Homemade “baked fries” using minimal olive or canola oil aren’t French fries, but they’re close… and much healthier.

The coverage of this new research (“A weapon of dietary destruction!”) made it sound as though having fries with your meal is a death sentence. But let’s not overstate the “danger” of French fries. And let’s also face this irrefutable fact: they’re too good to give up.

But, if we think of them as an occasional indulgence and understand what a single portion of French fries looks like, there’s no reason to eliminate them from your diet. And they go great with a salad.

Follow me on Twitter @RobShmerling

The post In defense of French fries appeared first on Harvard Health Blog.

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4 things everyone needs to know about measles

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We are in the midst of a measles outbreak here in the US, with cases being reported in New York City, New York state, and Washington state. In 2018, preliminary numbers indicate that there were 372 cases of measles — more than triple the 120 cases in all of 2017 — and already 79 cases in the first month of 2019 alone. Here are four things that everyone needs to know about measles.

Measles is highly contagious

This is a point that can’t be stressed enough. A full 90% of unvaccinated people exposed to the virus will catch it. And if you think that just staying away from sick people will do the trick, think again. Not only are people with measles infectious for four days before they break out with the rash, the virus can live in the air for up to two hours after an infectious person coughs or sneezes. Just imagine: if an infectious person sneezes in an elevator, everyone riding that elevator for the next two hours could be exposed.

It’s hard to know that a person has measles when they first get sick

The first symptoms of measles are a high fever, cough, runny nose, and red, watery eyes (conjunctivitis), which could be confused with any number of other viruses, especially during cold and flu season. After two or three days people develop spots in the mouth called Koplik spots, but we don’t always go looking in our family members’ mouths. The characteristic rash develops three to five days after the symptoms begin, as flat red spots that start on the face at the hairline and spread downward all over the body. At that point you might realize that it isn’t a garden-variety virus — and at that point, the person would have been spreading germs for four days.

Measles can be dangerous

Most of the time, as with other childhood viruses, people weather it fine, but there can be complications. Children less than 5 years old and adults older than 20 are at highest risk of complications. Common and milder complications include diarrhea and ear infections (although the ear infections can lead to hearing loss), and one out of four will need to be hospitalized, but there also can be serious complications:

Five percent of people with measles get pneumonia. This is the most common cause of death from the illness. One out of 1,000 get encephalitis, an inflammation of the brain, that can lead to seizures, deafness, or even brain damage. One to two out of 1,000 will die. There is another possible complication that can occur seven to 10 years after infection, more commonly when people get the infection as infants. It’s called subacute sclerosing panencephalitis or SSPE. While it is rare (four to 11 out of 100,000 infections), it is fatal. Vaccination prevents measles

The measles vaccine, usually given as part of the MMR (measles-mumps-rubella) vaccine, can make all the difference. One dose is 93% effective in preventing illness, and two doses gets that number up to 97%. In general the first dose is usually given at 12 to 15 months and the second dose at 4 to 6 years, but it can be given as early as 6 months if there is a risk of exposure (as an extra dose — it doesn’t count as the first of two doses and has to be given after 12 months), and the second dose can be given as soon as 28 days after the first.

The MMR is overall a very safe vaccine. Most side effects are mild, and it does not cause autism. Most children in the US are vaccinated, with 91% of 19-to-35 month-olds having at least one dose and about 94% of those entering kindergarten having two doses. To create “herd immunity” that helps protect those who can’t get the vaccine (such as young infants or those with weak immune systems), you need about 95% vaccination, so the 94% isn’t perfect — and in some states and communities, that number is even lower. Most of the outbreaks we have seen over the years have started in areas where there are high numbers of unvaccinated children.

If you have questions about measles or the measles vaccine, talk to your doctor. The most important thing is that we keep every child, every family, and every community safe.

Follow me on Twitter @drClaire

The post 4 things everyone needs to know about measles appeared first on Harvard Health Blog.

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