Pain meds, proper breathing will treat rib injuries
DEAR DRS. DONOHUE AND ROACH: I recently cracked two ribs at home. I had a terrible accident, and there was much pain. The doctor treating me would not wrap my chest, and only gave me pain pills. What is the standard treatment for rib fractures? -- L.B.
ANSWER: Rib fractures are not uncommon, and can happen with even a moderate blow to the chest. When a rib fracture is suspected, an X-ray usually is done to confirm the diagnosis, to look for other injuries and to see if the fracture is displaced -- meaning, potentially, that a sharp end of broken rib can do damage to the lung and other tissues inside. Fortunately, usually this happens only in high-impact injuries.
Unlike other bones, ribs cannot be effectively immobilized, even with the tightest chest wrap. The ribs move every time you breathe, so healing can be painfully prolonged. Pain medication is necessary, especially because the body's natural tendency is to "splint" over to one side, causing the affected ribs to move less. This is dangerous, because the lungs don't inflate as well underneath the area of the fracture, and collapse of part of the lung can lead to infection. I have seen several cases of serious pneumonia due to rib fractures. Pain medication and breathing exercises reduce the splinting and the risk of infection.
DEAR DRS. DONOHUE AND ROACH: Twenty years ago, I had surgery on my lower back due to disk disease. Although the surgeon put in plates and screws, the process was not successful. I would have pain all the time, were it not for hydrocodone and tramadol. I take each of these four times a day. I have tried cutting down to three times a day, but it is too painful. I saw a different back surgeon, who said the best hope for fixing the problem correctly would be to go in the front of the body and then in the back, anchoring from both directions. I'm scared to death to do that. I am now 72 years old.
My reason for writing is to ask you if I am harming myself in any way. I worry about it a lot. I do not see any side effects of the medication -- maybe I've become a little immune to them. -- V.W.
ANSWER: Yours is a very common story. Surgery for back pain helps most of the time -- but sometimes it doesn't help or even makes things worse. I consult surgical colleagues who are known to be cautious about the decision to operate, since a back surgery that fails is the worst possible outcome. Before doing back surgery -- especially a second back surgery -- both patient and surgeon need to consider that back pain usually gets better over time, and that surgery occasionally makes things worse. There are certainly a few times when back surgery needs to be done right away: In the case of weakness that is getting worse, back surgery can save nerves, muscles and the ability to function.
If you are able to do the things you need to do, are getting enough pain relief to get you by, even if you still have some pain, then I would be very cautious about getting back surgery.
DEAR DRS. DONOHUE AND ROACH: More than a year ago, my wife was diagnosed with CRP. Tell me more about it. -- L.B.
ANSWER: CRP, C-reactive protein, is a lab test that indicates there's inflammation somewhere in the body. It's not a specific test for a specific disease. It's slipped far down in the rankings of important lab tests.
However, a new test called hsCRP, high-sensitivity CRP, is used to detect inflammation that fosters heart attacks. An elevated hsCRP is a value greater than 3 mg/L. This test has to be interpreted in light of other tests and in light of a patient's symptoms. It can be a deciding factor, for instance, in starting a person on one of the statin drugs, the popular drugs for lowering cholesterol.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions. Readers also may order health newsletters from www.rbmamall.com.
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