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The Doctor Is In

Eden Medical Center physicians offer insight and advice on a wide range of health and wellness issues in these bi-weekly columns that appear in ANG Newspapers (The Daily Review, Oakland Tribune, Alameda Times Star, Fremont Argus, San Mateo Times, and Tri-Valley Herald).

Our physicians also pen a monthly medical column for the Castro Valley Forum and San Leandro Times, local weekly papers that offer a wealth of community information.

If you have a suggestions for a column or a question for one of our doctors that could appear in a future column, send us an e-mail, and we may include the answer in our next health column.

Alzheimer's Caregivers Need Support to Manage Day-To-Day Challenges

by Thomas R. Powers, M.D.
Dr. Powers is a board-certified psychiatrist and is medical director of Eden Medical Center’s psychiatric unit.

When a diagnosis of Alzheimer’s disease is confirmed, family members and friends often fear the worst. They wonder how to cope with the changes and anxiously anticipate loss of memory and independence.

Beyond the pain of seeing a loved one ravaged by this memory-robbing disease, those who care for someone with Alzheimer’s face a host of practical challenges that can be as daunting as the emotional upheaval.

When does an adult child take over a parent’s checkbook? Who will tell a strong-willed dad he can no longer drive; or an independent mom that she must move out of her home? And what will happen when the person who is ill forgets how to button his shirt or brush her teeth?

These questions – and countless others – arise because Alzheimer’s patients need someone else to begin taking over almost every detail of their lives. Taking steps to face the day-to-day issues involved in overseeing the life of another adult can greatly improve the quality of life for everyone involved. This should begin with a proper diagnosis.

If older adults begin to show signs of memory loss or impairment, it is important to bring the problem to the attention of a primary-care physician. In some cases, conditions such as depression, thyroid problems, drug interaction issues, excessive use of alcohol, and certain vitamin deficiencies can cause dementia-like symptoms. These conditions are treatable and can often be reversed.

Once these conditions are ruled out, doctors must discover whether the person is experiencing simple memory lapses or something more serious. For instance, with normal age-related memory changes, people may forget part of an experience but not the entire event; or they might recall something (like the location of car keys) later in the day. Those with Alzheimer’s disease symptoms, however, can forget everything about an event and rarely remember a forgotten item later on.

To sort out these distinctions, primary-care physicians may conduct a simple, 20-question mental test, considered to be 90 percent accurate in making a diagnosis.
Brain biopsy is a rare event but the only absolute diagnosis for Alzheimer’s in a living person. Fortunately, more common tests can be utilized. For example, samples of spinal fluid are taken to check for abnormalities of the presence of a particular protein, Apolipprotein epsilon 4 (strains e2, e3 and e4) which can damage brain tissue. This suggests the likelihood of Alzheimer’s.

The promising news for patients and their families is that newer medications are available and are continuing to be developed to lessen the impact of the disease.

Drugs that preserve acetyl choline (one of the primary neurotransmitters in the brain) can help keep Alzheimer’s disease patients out of institutional care for precious additional years. While these drugs – such as Namenda, Aricept, Reminyl, and Excelon – are readily available, they do not replace the need for patients to be cared for in the home. This responsibility can be difficult, but there are some steps family members can take to prepare for it.

Simple household projects, such as un-cluttering a bathroom, fixing a door lock, or putting safety knobs on stoves, can make the home environment safer for the Alzheimer’s patient and lessen the worries of caregivers.

These practical tips, and numerous others, are explained in one of the best books for caregivers of Alzheimer’s patients: The 36-Hour Day by Nancy Mace and Peter Rabins. The Alzheimer’s Association (www.alz.org) also offers essential information as well as the Safe Return program, which provides bracelets to help identify confused patients who may wander from home. Major drugstore chains also offer similar identity bracelets.

Caregivers can also turn to psychologists, family counselors, geriatric social workers and nurses to supplement a doctor’s care, and the county’s Adult Protective Services unit can help link patients to treatment.

Ultimately, it may become necessary to place the patient in a more structured setting like assisted living or a nursing home. Even if a patient is not placed in a residential facility full time, these facilities can offer respite to caregivers when they go on vacation or need time away.

Caregivers should also be sure to take a day or an afternoon off and continue to get regular exercise, proper sleep and good nutrition. Support groups, too, can be enormously helpful for caregivers.

Most important, no one person should try to take on the whole job alone. Caregivers do best when they take care of themselves – and each other.

Childhood Allergies and Asthma

by Dionisio Fernandes, M.D.
Dr. Fernandes is board-certified in pediatric allergies and immunology, and is a clinical professor at U.C. San Francisco.

A sneezing co-worker may explain through teary eyes that pollen is causing her allergic reactions. But young children, generally, do not react to pollen in the same way as adults, and years may pass before they show a particular sensitivity to it.

This difference between adults and children is only one of the factors that can make it more difficult to diagnose and treat allergies or asthma in the young.

A child’s runny nose or recurring colds, for instance, might be dismissed as a schoolyard infection that’s “just going around.” Or, children who misbehave and have trouble concentrating in school may be labeled as problem students, or worse, mis-diagnosed as having Attention Deficit Disorder. In fact, those children may only need proper treatment for their allergies.

Because children cannot always accurately describe their problems or be articulate about physical symptoms, it is important for parents, teachers, and other adults to educate themselves about allergies and asthma.

Allergies are quite common and occur in approximately 15 to 20 percent of all children. Asthma affects an estimated 9 million youngsters, and is considered the most common, chronic illness in children.

One problem in recognizing allergies is seen in the very definition of an allergic reaction: it is a hypersensitive response to an otherwise harmless substance. In other words, many people may not have a physical reaction to being in the presence of pets, tobacco smoke, or strong-smelling cleaning products; but in the allergic child, any of these substances can set off a heightened immune system response. That response often involves the release of fluids, as the immune system tries to get rid of a substance perceived to be a foreign agent that does not belong in the body. Consequently, the allergic child may have a runny and itchy nose, sneezing or stuffiness, as well as itchy or watery eyes.

While allergies are an exaggerated reaction of the immune system, asthma is a chronic, inflammatory lung disease. This inflammation leads to a narrowing of air passages in the lungs, which makes it harder for the asthmatic to breathe and results in the “wheezing” sound often associated with the disease. Sometimes allergens, which are substances that set off an allergic reaction, can trigger an asthmatic attack; however, these episodes can also be caused by infections, exercise or cold air.

With asthma it is particularly important to understand the differences between younger and older bodies, because children’s airways are narrower than those of adults. This means that an asthma trigger that causes only a slight response in an adult can lead to much more serious problems in children. Fortunately, medications and inhalers can enable most children with asthma to enjoy normal activities.

Diagnosing Asthma & Allergies in Children

Before those medications can be prescribed, an accurate diagnosis is crucial. By keeping up-to-date records, parents can play an important role in helping their children stay healthy, because physicians use medical history to diagnose asthma. Adult caregivers should track these symptoms and take particular note of how often they occur in a child’s life: coughing (especially at night); labored breathing; whistling or wheezing sounds when a child inhales; frequent colds or other respiratory illnesses; and skin around the ribs or neck pulling in tightly when a child tries to breathe.

In addition to medical history, a physical examination and lung function test are also used to diagnose asthma. Because the lung function test involves blowing forcefully into a tube, it is not often used in children under age six. Pediatricians may therefore refer patients to an allergist, who is trained to recognize symptoms of the disease.

Signs of allergies can be seen early in children’s lives even when they are only a few months old. With infants, it may seem that the child simply has a cold or is spitting up formula, when in fact, those symptoms may indicate a milk allergy. Allergists highly recommend breastfeeding because breast milk contains ingredients that prevent allergies.

As children grow, they are gradually exposed to new foods and other substances to which they may have an allergic reaction. In fact, some researchers theorize that the rise in allergy and asthma cases among children during the past two decades is due to the rapid pace at which humans are being exposed to new industries and accompanying pollutants. To minimize problems, parents can reduce a child’s exposure to common allergens such as dust mites or pet dander as well as to new products such as latex. It is also wise to introduce new foods to infants and toddlers slowly so their reactions can be more closely monitored.

New medications also offer promise to those who suffer from asthma, such as stronger nasal sprays that use steroids with fewer side effects. Further, those with severe asthma may one day be able to use monthly treatments that restrain an over-responsive immune system by cutting down on immunoglobulin (IgE).

But to benefit from these medical advances, children with allergies and asthma need their parents to recognize the importance of early diagnosis and treatment.

Getting The Best Results from Brain Surgery

by Lawrence D. Dickinson, M.D.
Dr. Dickinson is a neurosurgeon with Eden Medical Center’s East Bay Neuroscience Center in Castro Valley, and is medical director of intensive care at Eden Medical Center.

Just 15 years ago, neurosurgeons could spend hours exposing large areas of the brain in order to safely access a specific site to perform the delicate work of operating on the most precious of human organs.

But now, phenomenal breakthroughs in technology are making it possible to remove tumors and treat vascular anomalies of the brain through minimally-invasive surgical techniques using tiny incisions that take far less time and, in some cases, do away with scalpels altogether.

The recent explosion in technological advances began in the 1980s with the introduction of magnetic resonance imaging (MRI) in medicine. The brain was the first organ that benefited from the availability of MRI. This technology greatly increased the clarity and detail of the images compared to other technologies, and for the first time allowed doctors to “see” critical brain structures that could only be seen previously by operating on the brain.

Although hanging 2-demensional MRI film in the operating room was a big advantage compared to looking at CT scans before surgery, the next major revolution was the development of operative navigation systems. Just like GPS systems in your car today, neurosurgeons use cameras in the operating room like satellites in GPS, to allow computers to “map” the patient’s brain and help guide the surgeon through the delicate structures of the brain.

This view of the anatomy lets surgeons see through “virtual” tissue as they operate, so they can determine the precise location of their instruments and avoid damage to healthy tissue. Patients benefit from this technology through the dramatic decrease in risks from surgery, a decrease in recovery time and far less scarring or physical signs of surgery.

In the last decade computer systems in neurosurgeon’s operating rooms have become faster and more powerful, and at Eden Medical Center, images from CT, MRI and PET studies can be navigated in real time while operating on the human brain.

The merging of high definition imaging and high-speed computers has also dramatically improved the delivery of radiation to brain diseases. Neurosurgeons can now safely deliver precise beams of radiation into tumors, destroying them without injuring, or cutting into the brain at all.

Besides improving outcomes in neurosurgical procedures, advances in MRI technology are revolutionizing the way in which we diagnose brain diseases. This newer technology called MR spectroscopy has the potential of allowing physicians to create “fingerprints” of different types of tumors and degenerative disorders of the brain. It is likely in the near future that we will be able to perform a non-invasive MR spectroscopy exam and tell a patient they definitively have a specific diagnosis, eliminating the need for a biopsy procedure and battery of blood and other tests.

Another area where diagnostic tools are having an impact is in the Neuro Intensive Care Unit (NICU). The NICU is where very ill patients with severe head trauma or stroke are monitored very closely. These types of traumas result in brain tissue swelling which can cause pressure to build up in the brain. This pressure can prevent blood from flowing to the injured tissue, causing further damage and even death. New bedside methods of blood flow measurement allow doctors to intervene with swelling-reducing treatments more rapidly, before there is a critical deterioration in the injured tissue blood flow.

All of this new technology, however, succeeds best when it is coupled with the old-fashioned idea of patient education, detailed physical examination and early disease detection. As with any medical condition, brain diseases are best treated during the initial stages, before they have a chance to cause irreversible damage to our most precious organ.

Because the brain is the center of our self-perception, frequently brain problems to go unnoticed by the individual. If there is a malfunction in the part of the brain that enables a person to be perceptive, one might ignore such critical symptoms as blurred vision, hearing loss, changes in speech, dizziness, light-headedness, numbness, tingling, or loss of coordination and strength. These are all symptoms that indicate the need for a neurological exam. If confronted by these symptoms, or if they are appreciated in a family member or friend, one should consult their primary care physician.

Early diagnosis and improved treatment have dramatically improved patient neurological outcome and survival from brain diseases. The ability of a patient to return to normal function is far better now than in decades past, and the future is bright as we continue to make advancements in care.

But it should be re-emphasized that the length of recovery is often based on how sick a person is when treatment begins. The longer a symptom, such as numbness in the foot is ignored, the longer the recovery will take. The sooner a diagnosis is made, the better the outcome. When a basic bodily function starts to deteriorate, it needs to be addressed as soon as possible. And when early diagnoses, advanced technological tools, and neurosurgeon’s skills are all combined, a patient has the best opportunity to live a longer, healthier life.

Our Feet

by Ronald A. Hull, DPM
Ronald Hull is a podiatrist at Bay Valley Medical Group in Hayward and is on staff at both Eden Medical Center and San Leandro Hospital.

Although they are further away from our brain than any other body part, it is important to remember our feet and give them the respect and care they deserve. Each foot has 26 bones which when walking must support 1.5 times our body weight. We walk about 1,000 miles per year. The muscles and tendons move our feet and the ligaments that hold the bones together provide stability and support.

Common Foot Problems
Bunions are an enlargement of the bone at the base of the big toe and can become very painful. They are often inherited but can also be associated with faulty biomechanics and can be aggravated by the type of shoe we wear. Hammertoes are an abnormal curvature of a toe that can result in a painful corn on the top or tip of the toe. An important treatment for both hammertoes and bunions is to wear a properly sized shoe that conforms to the shape of your foot. Sometimes padding and antiinflammatory medication will help. Surgery is an option for both bunions and hammertoes should conservative care fail.

Ingrown toenails are an abnormal curvature of a nail, which results in pain and inflammation along the side. These can be the result of tight shoes, injury, disease of the nail or improper nail care. Treatment includes trimming or removing the abnormal part of the nail as well as properly fitting shoes.

Plantar fasciitis is an inflammation of the plantar fascia, a ligament-like structure that supports the arch of the foot. It can become inflamed as a result of poorly supportive shoes, excessive periods of weightbearing and weight gain. Pain will occur in the bottom of the heel or along the inside of the arch, and is often most painful when getting out of bed in the morning. Treatment often includes stretching exercises, anti-inflammatory medications, night splints, supportive shoes and arch supports. For the few people who don’t have success with these treatments, surgery is also an option.

Susceptibility for Foot Problems
Excessive running, jumping and overtraining can lead to overuse injuries of the bones, ligaments and tendons, especially when wearing shoes that lack proper support. Obviously, direct trauma can also result in foot injury. The risk of injury can be minimized by warming up before any physical activity, running or walking on a flat, even terrain, wearing properly fitting shoes in good condition and stopping when pain develops. The first step in treating an acute overuse injury is to rest, ice the painful area, apply an elastic bandage, and keep the foot elevated.

Proper Shoes & Pedicures
Choosing the proper shoe is key to avoiding and treating most foot problems. Even if surgery is indicated, choosing a proper shoe after the surgery will help avoid a recurrence of the problem or development of another problem. Again, choosing a shoe with a shape that is complimentary to your foot is recommended. A lot of foot pain is due to improperly supportive shoes.

When evaluating a shoe, look for a firm heel counter, which is the area behind the heel. The shoe should not flex or twist in the arch area and the heel should be slightly higher than the ball of the foot. The number inside the shoe indicating the size should be used as a guide. If the shoe feels too tight or too loose try on a different size. For women, if your feet tend to swell, it is better to buy your shoes later in the day and wear the same type of hose when trying on the shoe that you will be wearing when you actually wear the shoe. There should be about half-an-inch of space between your longest toe and the end of the shoe, and plenty of room in the toe area. Try to pick a shoe store will that employs sales associates trained in proper shoe fitting, and has a reasonable return or exchange policy.

For women who enjoy pedicures, especially during the summer months, be sure to check for overall cleanliness; make sure the pedicurist is sterilizing all instruments in bactericidal fluid and not retrieving them from a drawer.

Remember: When your feet feel good, your whole body feels good.

Bypass the Nearest ER…Go Straight to the Trauma Center

by Dr. James Hinsdale
Dr. James Hinsdale is the medical director for Eden Medical Center’s Trauma Center. He also serves as medical director for California Shock Trauma Air Rescue.

When a car crashed into three cyclists who were riding in tandem, instead of being taken to the nearest emergency room (ER) for severe facial and head injuries the victims were airlifted to the county trauma center 20 miles away. While hospital emergency rooms are equipped to treat a variety of medical conditions, from headaches to heart attacks, an ER is not a trauma center.

The advanced medical and surgical capabilities of a trauma center are called for when a patient is suffering from an injury so severe that the body’s systems could begin to shut down leading to eventual death. Trauma centers provide the best possible chance of survival.

The Alameda County Trauma System was developed after a landmark study in 1985 showed that approximately 50 percent of people killed in motor vehicle accidents during the previous year in the Bay Area would have likely survived with a higher level of care.

After detailed planning, the Alameda County Board of Supervisors established the emergency medical system, and the trauma centers opened in 1987. There are three trauma centers in Alameda County: Eden Medical Center covering south county; the Highland Campus of Alameda County Medical Center in the north; and Children’s Hospital in Oakland for trauma patients under age 14.

To maintain the status of “trauma center,” these three hospitals meet strict standards based on the guidelines of the American College of Surgeons.

Trauma vs. An Emergency – What’s the Difference?
Trauma is a medical term for a class of severe injuries that include amputations; penetrating injuries to the head, neck or torso (i.e. gunshot or knife wounds); blunt injuries to the head, neck or torso (most often associated with motor vehicle accidents); ejection from a moving vehicle; certain vehicle accidents and rollovers; falls (the most common cause of traumatic injury to seniors); multiple bone fractures; and other potentially serious injuries to the head, spine or vital organs.

The need for immediate trauma care is often referred to as “the golden hour” -- that first hour after the patient has been critically injured and when he or she has the best chance of recovery with definitive medical treatment.

There are several factors involved in determining whether a patient should be transported to a trauma center and bypass a hospital emergency room even if it’s closer to the scene of the accident. The most important factors are the severity of the injury and the need for immediate treatment.

While most ERs have an emergency medicine physician on duty, they do not have an entire medical team and surgical capability at any moment, 24 hours a day. It would require valuable time to assemble the appropriate staff, equipment and support in a basic emergency room – time that trauma patients do not have. The trauma center has a dedicated trauma room and staff, and must maintain a readily available surgical suite, critical care beds and essential diagnostic equipment such as a CT scanner.

The Patient is in the Trauma Center… Now What?
If a patient has suffered a sudden and devastating injury and is determined to be a trauma, he or she may require experts from every department as well as specialized equipment. These experts make up the trauma team, which is notified in advance and is ready to provide immediate care the moment the patient is wheeled through the doors and as the paramedics relay the patient’s status.

What truly sets a trauma center apart is this team of caregivers, available around the clock and at a moment’s notice. This team includes a board-certified trauma surgeon, emergency department physician, anesthesiologist, trauma nurse, emergency room nurse, operating room nurse, critical care nurse, trauma technician, lab technologist, respiratory therapist, radiology technologist and many others depending on the nature of the injury.

A neurosurgeon, vascular surgeon, orthopedic surgeon and other surgical specialists are always on-call. All trauma medical staffers go through constant training to stay abreast of the latest techniques and treatments.

Since families play a vital role in the patient’s recovery, some trauma centers have specially trained volunteers to support the family. When a loved one is injured and emotions run high, these volunteers are there to relay information, answer questions and provide comfort to patients until the trauma team can communicate directly with the family.

In the care of severely injured patients, every minute counts. While TV medical shows sometimes depict the urgency and drama of trauma care, no case is easily and neatly concluded in 60 minutes. The road to recovery is a long one, but having a trauma center gives patients the best chance of survival right from the beginning.

Improve Appearance, Ease Pain of Vericose Veins

by Michael Ingegno, M.D.
Dr. Michael Ingegno is a vascular surgeon in San Leandro with privileges at Eden Medical Center and San Leandro Hospital.

Because they appear on the surface of the skin, it may seem that varicose veins only pose a cosmetic problem – especially during swimsuit season.

But these enlarged, bulging veins can reveal unhealthy conditions that are more than skin deep.

For some people, varicose veins can cause painful throbbing in the legs or itchy ulcers near the ankles. They can also point to possible problems with the circulatory system or even lead to life-threatening blood clots (called thrombophlebitis).

In mild cases, tiny sub-surface lines appear on the face or legs indicating the presence of spider veins, a common type of varicose vein considered medically insignificant.

Health consumers need to know that insurance companies distinguish among the various types of varicose veins, and may only cover treatment for them when pain or other serious problems arise.

Whether they are highly uncomfortable or merely unsightly, varicose veins are primarily a condition in which too much blood pools in a restricted space. Basically, in the cardiovascular system, the arteries carry blood away from the heart to the rest of the body; veins are the avenue for the return trip, bringing blood from the body back to the heart.

Tiny one-way valves regulate the ebb and flow of this journey. When they malfunction, blood is pushed down, causing it to pool, and branch veins close to the surface of the skin swell up. Because the valves are not working properly, blood is forced to go backward, creating a bulging varicose vein. (Malfunctioning valves typically do not play a role in the development of spider veins, although they too, can be caused by a backup of blood.)

One reason this condition is commonly seen in the legs is that the veins within the lower extremities have to fight against gravity in order to return blood to the heart. As a person ages, veins often lose elasticity and valves weaken, giving gravity the upper hand in this battle. That explains why an estimated one out of two people age 50 or older have varicose veins.

Women – especially pregnant women – are also prime candidates for developing this condition, in part because of the hormonal changes females experience over a lifetime. In the United States, up to 25 percent of women, compared to only 15 percent of men are affected by varicose veins, according to the Mayo Clinic. When women get pregnant, the volume of blood in the body increases to support the growing fetus. That change is accompanied by a decrease in the flow of blood from the lower part of the body to the pelvis and that, in turn, causes leg veins to expand. Further, the hemorrhoids that can accompany pregnancy, are actually a type of varicose vein.

Besides age and gender, genetic factors also come into play, and varicose veins can run in families pre-disposed to this condition. In addition, people who are obese or who must stand for long periods of time put added pressure on the circulatory system, and that can result in the appearance of these veins.

In the past, treatment of varicose veins could involve an open operation to remove deeply-imbedded veins, or a session of “vein stripping” in which a long vein is removed through small incisions. With the huge advances in medical technology in the past five years, most patients can now be treated on an out-patient basis using minimally-invasive procedures in a doctor’s office.

Treatment Just Got a Whole Lot Easier
One of the biggest breakthroughs in removing varicose vein is applying laser technology or radiofrequency energy to remove the saphenous vein, one of the deeper varicose veins of the leg. Instead of removing this vein surgically, doctors guide a catheter into the vein via ultrasound technology. The catheter then uses laser or radio frequencies to cause the vein to contract and seal.

Patients may hear medical personnel refer to some of these treatments by their commercial names such as the VNUS® Closure® procedure, which uses radio frequencies, or the EVLT® by Diomed which employs lasers.

Most of the new treatments for varicose veins take an hour or less, and patients can be up and walking immediately. In fact, except for runners who should wait about a week after treatment before resuming, patients should do a great deal of walking after undergoing these procedures.

Even those people who do not seek treatment for varicose veins can benefit from a walking regimen because it improves circulation and vein strength. There are no conclusive studies showing that alternative remedies such as cider vinegar or high doses of vitamin C can eliminate varicose veins, although patients can benefit from lowering their salt intake to avoid water retention adopting a high-fiber diet to reduce the chance of constipation which can add pressure to veins.

Other measures to improve this condition include taking breaks several times a day to elevate the legs above the level of the heart; avoiding long periods of sitting or standing; and leaving legs uncrossed when sitting. Tight fitting clothing that constricts the waist or legs should also be avoided, and elastic support or compression stockings can also be helpful.

While there is no perfect way to avoid this condition, basic good health practices – and the continuing breakthroughs in treatment – can help improve a person’s appearance and reduce the pain of varicose veins.

Hand Therapy Delivers Hope and Healing

by Lynn Brechtel, PT, CHT
Lynn Brechtel, PT, CHT; is a certified hand therapist with Eden Medical Center’s Hand Therapy Clinic. The clinic is located at 14207 East 14th Street (at 141st Ave.) in San Leandro, at the Comprehensive Outpatient Rehabilitation Facility (CORF).

Our hands are expressive in ways words can never match. They are tools for achieving even the simplest goals. They can elicit emotion, inspire music and create a world of opportunities. Our hands are delicate structures. Even a minor injury can limit everyday activities and take years to resolve.

Restoring health and function to the hands and upper extremities requires the special knowledge and advanced training of a Certified Hand Therapist.

Hand therapy helps a patient regain maximum use of his or her hand after traumatic injury, repetitive stress injury, surgery, amputation, burn or the onset of disease. While many rehabilitation centers offer a wide range of therapies, a specialized Hand Therapy Clinic focuses solely on the upper extremity (hands, wrist, forearm, elbow and shoulder), due to the unique and often complex injuries to these areas.

Benefits of Working with a CHT

People value the use of their hands, and any loss of function through injury or accident may have a devastating effect on their lives. Anyone with an injury wants the very best of treatment to assure maximum recovery. The Certified Hand Therapist (CHT) credential offers assurance that the therapist has achieved the highest level of competency in the profession and stays up to date with practice within the field.

Certification is voluntary and difficult to attain. It involves meeting rigorous standards, developing a long-range career path, and acquiring the advanced study and training required to pass the certification examination. The CHT credential is recognized by many professionals as a benchmark for excellence in advanced specialty credentialing in health care.

Hand therapists are dedicated to the treatment of traumatic, surgical, inflammatory, cumulative disorders and other pathological conditions of the upper extremity

After carefully evaluating a patient’s injury, hand therapists design a treatment program specifically for the patient. The therapist looks at how the injury affects independence at home and at work, and will modify treatment as needed to help the patient return to normal activities without risk of further injury. Therapists work closely with the patient’s referring physician to ensure the best outcome.

A Hand Therapy Clinic provides specialized care such as:

Generalized upper extremity rehabilitation

Wound care

Soft tissue procedures

Desensitization

Modalities: electrical, ultrasound, heat/cold, light therapy,

Therapeutic exercise and functional Conditioning

Management of neural tension and edema

Custom splints

Ergonomic Work Site Evaluations

Functional Capacity Evaluations

Physical Capacity Evaluations

Prostate Health

by Roland J. Wong, M.D.
Dr. Roland Wong is a urologist at Eden Medical Center and San Leandro Hospital. His office is located at Bay Valley Medical Group in Hayward.

All prostate-related diseases, both benign and malignant, stem from the progressive growth of this walnut-shaped gland, located at the base of a man’s bladder. The prostate is vital to reproduction since it produces the seminal fluid that nourishes the sperm during ejaculation. As men age, the prostate is often a source of problems related to this uncontrolled growth.

The benign growth that is a normal part of aging is referred to as benign prostatic hypertrophy (BPH). It typically begins at age 40 and slowly progresses. Most men in their 60s and 70s have one or more of the symptoms of BPH, which can include trouble getting a urine stream started and stopped, a sense of urgency to urinate, a weak urine stream or more frequent urination.

An enlarged prostate can be a nuisance, but it is usually not a serious problem, and there are many medications available for treatment if needed.

Unlike BPH, prostate cancer usually has no warning signs in its early stages, which is why it is very important for otherwise healthy men to have regular prostate exams.

Prostate cancer is the most common cancer in American men, with more than 200,000 new cases diagnosed each year. However, most prostate cancers are discovered in their early stages and the 5-year survival rate is almost 100% when the cancer is found early.

Doctors use a digital rectal exam (DRE) to feel for any abnormalities in the prostate gland. The DRE should be done once a year after age 40. Another simple blood test, called or prostate specific antigen (PSA) should be taken annually after age 50. Men who are at high risk – including African American men and men with a family history of prostate cancer – should begin PSA testing at age 40.

In many situations prostate cancer has been found to grow quite slowly. It is possible that the doctor could find prostate cancer and a patient could go many years untreated with no adverse effect.

In other cases, prostate cancer can be treated with several available therapies, including surgery or radiation. Brachytherapy, or implanting small radioactive pellets into the prostate to kill the cancer cells, is gaining popularity. Hormone therapies are usually reserved for more advanced prostate cancer.

A diagnosis of prostate cancer usually means that you will see your doctor regularly for years to come, so it is a good idea to develop a relationship that is based on full and honest information.

Reset Your Bio-Clock & Get a Good Night’s Sleep

by Ratnasothy S. Rajah, M.D.
Dr. Rajah is the medical director of the Sleep Lab at San Leandro Hospital.

Our 24x7 nation is wreaking havoc on our sound, restful sleep. We are waking up at 3:00am to check e-mail, working odd shifts, suffering from jet lag or burning the midnight oil then getting up too early. Even adolescents are overworked and missing out on essential sleep time.

Today’s jam-packed lifestyle is disrupting our circadian rhythm – the internal clock that regulates our biological processes throughout the day and night. Our internal clock operates on a 24.18-hour period, relying on equal cycles of darkness and lightness. When these cycles are out of balance, we can develop circadian rhythm disorders (CRD), which are at the heart of many sleep problems.

Some body functions, such as production of cortisol, thyroid, growth hormones and digestive system activities take place during sleep. When sleep is interrupted, these functions are interrupted as well.

The good news is that we can reset our internal body clocks via behavioral techniques and good sleep hygiene.

Chronotherapy is a behavioral technique used to manipulate the sleep-wake cycle in an attempt to change the patient’s underlying circadian rhythm. For this therapy, the bedroom must be pitch black and silent. The CRD patient is then put on a five-day sleep regimen.

If the patient tends to go to bed late, she is instructed to gradually shift the timing of sleep three hours later each day until the usual bedtime of 11:00pm is reached. If her typical bedtime is 2:00am, the following night (or morning) she would go to bed three hours later at 5:00 a.m., and continue this pattern until the desired sleep pattern is achieved.

Bright-light therapy is another technique employed to reset a person’s circadian rhythm to a desired pattern. Early morning exposure to bright light tends to lead to an early wake time and advance sleep onset at night. We recommend either being exposed to natural sunlight – sitting in front of an open window -- or being exposed to halogen light measured at 400 lux for at least one hour in the morning. When combined, cronotherapy and bright-light therapy may produce significant results for people with CRD.

In addition we should practice good sleep habits:

go to bed and get up the same time each night, including weekends

exercise regularly

avoid large meals, caffeine, alcohol and cigarettes near bedtime

use the bed exclusively for sleep and intimacy.

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