What Are the Symptoms of Brain Injury?

What is Brain Injury?

Brain injury is a deterioration of the cells inside the brain. There are two distinct types of brain injury that can cause the symptoms. These are Traumatic Brain Injury and Acquired Brain injury. The former is caused by an external force – such as concussion – which causes the brain to bruise against the wall of the cranium. The latter is more commonly associated with pressure on the brain. This could come in the form of a tumor or a stroke. Often, the two terms are used interchangeably.

But What Are the Symptoms?

Moderate and severe instances of TBI are easier to diagnose. Problematically, mild cases often go unnoticed as symptoms scale with the severity of injury. With ABI it is difficult to judge the severity of damage caused as a judgement is made post damage. With TBI, we are able to judge the severity using a time-scale of unconsciousness after an impact.

The Glasgow Coma Scale

                        GCS                                         PTA                                          LOC

Mild                13-15                                       less than one day                    0-30 mins

Moderate       9-12                                         1 to 7 days                              30 mins to 24 hours

Severe             3-8                                           more than 7days                    more than 24 hours

Where GCS = verbal rating after damage, PTA = how long post-trauma amnesia lasts, and LOC = period in which the victim is unconscious.

From here, let’s walk through the main symptoms we can look out for. There are two prominent behavioural symptoms that can manifest after a brain injury: emotional and memory.

Emotional Behaviour

Brain injury is associated with a number of emotional challenges such as depression, self-control, anger management. Victims can also find themselves struggling in social situations where they did not before, that is, they may have lower levels of self esteem and anxiety. These psychological manifestations can lead to isolation, a reduced ability to function in society, martial difficulties, and keeping his or her job.

Memory

The most common post-brain-trauma experience is a loss of memory, or at the very least, a reduced capacity for memory. As memory is intrinsically linked to attention, it can be difficult to diagnose the symptom as physicians need to be careful to distinguish between memory loss and poor attention. Almost all cases of brain trauma come with a reduced memory capacity compared to people who have not experienced brain trauma; and, although patients usually experience significant recovery during the initial recovery phase, there is often an element of permanent damage.

There is a myriad of ways of dealing with this patterned change of behaviour, but it is best to contact your physician to ensure a bespoke plan that will deal with your specific case. Brain injury recovery plans are not one-glove-fits-all. The brain is a complex organism, and no two people can be expected to experience the same difficulties. As it controls every aspect of human life, when it is damaged any part of a human life could be affected.

If you would like a plan on how to deal with a recent brain injury, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 241-6321

Brain Injury - The Healing Process

Brain Injury has a traumatic effect on not the only the victim, but also the victim’s family. Often, cognitive, behavioural, and emotional changes can be difficult to witness - especially as victims tend to be in a state of denial about their injury. You may feel as though the person you knew has been replaced by someone else. But rest assured, you can help a loved one fight back against brain injury by having an understanding on how their symptoms work and having a structured method of reclaiming their life. This week, we will look at dealing with the life transition after someone you know suffers from brain injury.

Please remember to create a bespoke plan of action to ensure your loved one receives optimal help. As brain injury is an umbrella term, it is important you know how much to focus on distinct aspects of rehabilitation. Please consult your physician for guidance.

After brain injury, the victim’s lack of control over their mood and behaviour is a common consequence of any serious brain injury. Frequent and notable behavioural changes are anxiety and depression, but also extend to poor behaviour and a loss of memory. Their behaviour may drastically change after suffering, and depending on the severity of damage – they may never be the same again. It may be necessary to see a psychiatrist if depression or anxiety gets out of hand, and ensure they are in an appropriate support group.

Some victim’s behaviour can be unrecognizable – and they may begin acting up and misbehaving. The most effective ways of dealing with bad behaviour is in a firm but fair way. Set limits around their behaviour and how you allow them to treat you.

The first three months are the most essential when recovering from brain injury; and starting early means you can optimize success. During this time ensure you have started all physiotherapy programs, exercises, and seen your occupational therapist. This will aid in regaining communication, social, and personal skills alongside aiding with any emotional struggles you may be experiencing. It can take time adjust to changes – be patient and support each other during the process.

The most effective way of supporting a loved one is to help them form new habits. Depending on the victim’s need, you can help them improve mobility or gain function of certain parts of their body. This type of therapy will allow the patient to reclaim their life in the long term. It is important that you know your limits, and ensure there is a professional program in place. For example, a neurologist can work with your psychiatrist to help improve concentration and mood swings. Your primary doctor will refer you if necessary.

You can also aid in their recovery by encouraging a healthy diet. A healthy body is fertile ground for success, ensure the brain has all the nutrients it needs available to it. You physician will advise you on foods to avoid and alternatives if chewing/shallowing is a problem.

Finally, you can encourage writing things down to encourage neural pathways to heal. In the long-term, this will aid in allowing the victims brain to heal. More importantly, it allows the patient to keep track of calendar appointments, medications, addresses, and an emergency contact number. You could even label things in the patient’s house depending on the severity of damage.

If you would like a plan on how to deal with a recent brain injury, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 241-6321

How To Cope With Brain Trauma - Introducing Dr Kirk Lercher, MD

Recently, we have given Mount Sinai readers some insights into how brain injury can form, and some basic coping mechanisms to help loved ones along the way to recovery. However, we strongly advise you to seek professional medical attention after experiencing brain injury - you don’t need to go at it alone. Dr Kirk Lercher - our Assistant Professor at Mount Sinai’s Department of Rehabilitative Medicine – is our brain damage specialist; he can help guide you and your loved ones to reclaiming your former life.

Anoxic brain injury is the effect of oxygen starvation to the brain. Brain injury can have different effects on the patient depending on how long the brain went without oxygen. Kirk Lecher has undergone extensive medical training in how the brain functions post-concussion, as such his bespoke advice will help you along any stage of the healing process. Ranging from sports concussions, to spasticity management, and neuropharmacology – Dr Lercher is an expert in tackling brain damage.

Beginning his study at New Jersey Medical School, Kirk Lercher continued into an Internship, then residency at the University Hospital (UMDNJ). He finalized his studies with a fellowship in brain trauma at the Mercy Hospital of Pittsburgh.  During this time, Dr Lecher specialized in the research field of brain trauma. His research posited that synchronizing occupational and physical therapy improves recovery outcomes after strokes, and furthermore, that larger doses of therapy are associated with superior outcomes.

His research also states that many patients receive sub optimal care after a concussion and associated brain injuries. His work encourages telecommunication agencies to address the unmet needs and encourages families to seek immediate attention via this medium or directly with their physician. It is because of this that Dr Lercher understands the importance of patient care and relationships. As his research shows that a strong connection between the family of the victim and the physician optimizes recovery, Dr Lercher has incredible client satisfaction ratings with a 4.9/5 average.

Dr Lercher tackles anoxic brain injury using two synchronized methodologies. Dr Lercher himself focuses on in-clinic visits for patients, and advises on tele-rehabilitation. This combinatorial process effects as double the therapy than one would get if they solely saw their physician, or solely used telecommunications.

In practicing fantastic patient care, frequent in-clinic visits, and tele-rehabilitation, Dr Lercher sees fantastic results in patient recovery from brain injuries. His bespoke approach is the optimal support you can provide to a loved one during this difficult period.

If you would like to schedule a visit with Dr Lercher, please contact us at Mount Sinai Department of Rehabilitative Medicine. Contact our switchboard on: (212) 241-6321

How Can Traumatic Brain Injury Affect Your Life?

Traumatic Brain Injury (TBI), is the result of an external force, such as a knock to the skull that injures the brain. Brain injury could affect anyone, but people who are in the military, sportspeople, old and young, and people who suffer from strokes are most likely to experience problems. Brain injury has a range of life altering traumatisms from Dementia to Parkinson’s, to loss of memory and facial recognition. Damage will scale will the level of trauma suffered from a knock.

Brain damage (TBI) is a result to a blow to the head. A knock to the head makes the brain move inside and bruise against the skull causing damage to the brain. Depending on the severity of the knock, the patient will experience a range of symptoms as the brain is starved of oxygen for a period of time.

The people most susceptible to TBI are military personnel, high-impact sportspeople, old people who often fall, and 15-24-year-old males, due to the heightened chances of taking a damaging blow to the head. However, it is important to note that anyone could be a victim.

The most common causes of brain injury are car accidents, blows to the head, sports injuries, falls or accidents, and physical violence. As we can see, there is a correlation between the most common causes, and the most vulnerable. For example, studies indicate 15-24-year-old males are the most reckless drivers of all demographics; consequently, they have a higher chance of putting themselves in situations where they could get a brain injury.

Not all impacts are life altering. Light to medium knocks to the head cause confusion, lack of spatial awareness, and sometimes nausea. In both cases, patients usually make a good recovery. With more serious brain injury, people suffer life changing and debilitating problems. Depending on where the damage is localized, the patient will experience different symptoms.

But how can brain injuries affect your life? Brain damage symptoms scale with the severity of impact. More serious ramifications include relearning to walk, loss of personal memories and facial recognition – with patients forgetting who they are. Also, depending on where the damage is localized, patients could lose motor skills or in most severe cases not know how to speak. The more severe the impact, the more severe the consequences.

If you are suffering from any of the symptoms listed, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 241-6321

Brain Injury – Who and How Does It Affect?

Traumatic Brain Injury (TBI) is indiscriminate in who it impacts. Although this is true, certain people are more vulnerable than others. A person who is more susceptible to taking traumatizing hits to the head is far more likely to have their lives affected by this severe injury. For example, you are more likely to experience this injury if you are a professional boxer than an office manager.

TBI is a head injury that results in the brain moving inside the skull and bruising due to the impact with the cranium. Depending on the severity of the hit, the patient will experience a range of symptoms due to the brain not receiving adequate oxygen. An important note about TBI is that it is always the result of an external force, such as a head trauma that injures the brain. This is opposed to an Acquired Brain Injury (ABI), which is the result of pressure to the brain on a gene level, like a stroke.

The most common causes of TBI are car accidents, sports injuries, falls or accidents, and physical violence. The people most susceptible to TBI are military personnel, high-impact sportspeople, an elderly who often falls, and 15-24-year-old males, due to having “high-risk behaviour”. As may be obvious, there is a correlation between the most common causes and the most vulnerable people.

It is not always immediately obvious that there has been serious trauma. Often, in contact sports, people will undergo TBI and not realize it. If you have been concussed, it is important you see a specialist.

Not all impacts are life-altering as some instances of TBI pass away relatively quickly. Light to medium knocks to the head cause confusion, lack of spatial awareness, and sometimes nausea. Patients usually make a speedy recovery. Although the brain has undergone some damage, the symptoms will only be short term. With more serious brain injury, people suffer life-changing and debilitating problems.

Depending on where the damage is localized, the patient could experience different symptoms. Brain damage symptoms scale with the severity of the impact. More serious ramifications include relearning to walk, loss of personal memories and facial recognition – with patients forgetting who they are. The patient may experience extreme emotional states and denial that they are experiencing TFI. Patients could lose motor skills or in most severe cases not know how to speak. The more severe the impact, the more severe the consequences.

If someone you know has been affected by a hard hit to the head and suffered a concussion, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on (212) 241-6321

Why SAD affects us in the winter

Seasonal Affective Disorder (SAD) is a state of depression that stems from the changing of the season, specifically – the summer to winter. In the winter, the days get shorter, it is cloudy and cold – but SAD isn’t a prophetic fallacy – it’s a physical reaction to a lack of vitamin D. Although there is a myriad of reasons as to how this depressive state can be triggered, none is more widely accepted than the vitamin D deficiency the body undergoes during the winter. A lack of vitamin D will create a chain reaction with other symptoms of SAD, which then feed into other depressive behaviours, in turn worsening the state of affairs. Let’s look at what vitamin D deficiency does to the human body.

Vitamin D, like all vitamins, it is a nutrient we make in our body; and most it comes from the sun. But vitamin D is unique as it is a hormone and not a nutrient like other vitamins. It works with calcium and phosphorus to create and maintain healthy bones, muscles, and teeth. Without enough vitamin D, your body will not be able to absorb calcium and other important nutrients that allow our body to function. In turn, many people with low levels of vitamin D will experience rickets, osteomalacia alongside other muscle and bone deficiencies. This leads us to be being tired, frustrated that our bodies are not functioning as it should be, and possibly lowering our immune system.

Vitamin D also has a role in maintaining stable brain hormones. Serotonin, the hormone associated with happiness, rises with the exposure to bright light – and drops in correlation with decreased sun exposure. As understood by research in medical science, people with lower vitamin D are 11 times more prone to be depressed than those with healthy does. A low level of vitamin D will cause a deficiency in serotonin, causing depressive-like behaviours to occur.

If we amalgamate these two factors, we see instantly that low vitamin D, caused by reduced sun exposure, is responsible for making us tired and unhappy. These physical deprivations feed into mental manifestations of psychological dispositions – such as bipolar – or other types of depression. It also suppresses the immune system, which can have a knock-on effect on making us ill, and then beginning the “cycle of depression”.

If you would like to learn more about how the cycle of depression works, click here.

SAD can have an extremely negative impact on your quality of life. If you need a consultation or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

The Light at The End of The Tunnel

Seasonal affective disorder (SAD) is a type of depression stimulated by the changing of the season. In previous articles, we have reviewed what SAD is, how it manifests itself, and the physiological and psychological approaches to understanding the disorder. The best ways to deal with SAD are to ensure you are aware of it, sleep well, and eat well. However, your physician may recommend you use a light box. This week, we will investigate light therapy and explain its uses when fighting SAD.

Light box therapy is an effective and non-invasive treatment for SAD – it stimulates your brain as much as sunlight does. It probably will not cure SAD, “nonseasonal” depression, or other conditions – but it may ease symptoms, increase energy levels, and make the condition more bearable as it has a positive effect on mood and helps with vitamin D deficiency.

Here are some tips on ensuring you get the most out of your lightbox:

·        Get the right light box. Brands like Lumie make fantastic products, but you need to know what specifications to look for.

·        Be consistent by sticking to daily routines of light therapy sessions. It’s better to do more frequent but shorter sessions than fewer but longer sessions.

·        Never look directly into the light as it can severely damage the retina. Ensure that you only look at something the light reflects off, such as a book or magazine.

·        Do not interrupt your schedule as the symptoms could return stronger. Ensure you follow a plan set out by your physician.

Your physician will advise you on how to best purchase and use a lightbox. They will explain to you: which brands are most suited for your personal condition, how long you should sit under it, at what point in the day, and how far from the box you should be positioned. Like any other prescriptive medicine, light box therapy should be taken in “doses,” and there is not a “one size fits all” approach. Each dose should be appropriately prescribed as per your personal situation.

If your symptoms do not improve you may need to consider additional therapy. Your physician will advise you about other treatment options, such as antidepressants or psychotherapy.

To see whether a lightbox could improve your quality of life, contact your physician or book into Mount Sinai for expert advice.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

SAD – Nature’s Effect on Nurture

Historically, Seasonal Affective Disorder (SAD) has been understood as being the result of one of two binary positions: biological (your genetic composition) or environmental (learned behaviours and other external influences). In more recent years, it has become widely accepted that the two elements feed into each other. That means that while people have predispositions toward depression, that depression is simultaneously affected by an external influence (in this case winter). SAD is made distinct from other types of depression due to its temporal pattern. Major episodes begin in the winter, and there is always a full emission in the spring.

Let’s take a quick look at the two factors before seeing how they link into each other.

Is It in The Genes?

The bracket of “Biological Vulnerability” covers a vast field of potential reasons one experiences SAD – but is generally understood as a rhythmic abnormality in the winter. This simply means, a biological composition or a natural disposition to biological changes in winter causes SAD. Some of the most well understood reasons are as follows: there could be a delay or advance in the release of melatonin (the hormone that tells us it’s time to sleep), a retinal sensitivity to light, a dysfunction between neurotransmitters (the chemical substance which sends messages between nerves), a genetic variation in brain composition, and a reduced release of serotonin. 

SAD can be a result of one or more of these biological aspects, but more often than not, they are emphasized by psychological factors.

How Our Environment Can Make Us SAD

Depression is understood as an interaction between a cognitive vulnerability to depression (as we looked at above) and a stressor. There are different cognitive models that propose different vulnerabilities, let’s take a look at the main ones.

Alongside the genetical predisposition, it is common for the sufferer to also be affected by one of the following: a dysfunctional attitude (learned negative attitudes and outlook on the world), rumination (focusing attention on dysphoric moods and/or potential negative consequences), and a negative attributional style (catastrophizing negative events to a global scale). These aspects are usually interwoven.

Once a predisposition is influenced by one of these negative cognitive aspects, this combinatorial (see below for a visual representation of this process). All of these cognitive aspects are stressors.

Combining the Two. 

Source: Biological and Psychological Mechanisms of Seasonal Affective Disorder: A Review and Integration. Kelly J. Rohan, Kathryn A. Roecklein, and David A.F. Haaga. Current Psychiatry Reviews, 2009, 5., 37-47

As we can see following the graph, the environmental aspect (on the left) can run its own path to SAD, as can the biological (on the right). It is widely accepted that the psychological vulnerability and the physiological vulnerability feed into each other (as seen with the double-arrow that links the two sides together).

If you would like to learn more about the symptoms of SAD click here.

If you would like an introduction to one of our physicians that specializes in SAD click here.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

A Physician That Can Stop You Feeling SAD – Dr Wayne A Gordon (PhD)

In a previous article, we explored Seasonal Affective Disorder (SAD), its manifestations, and some ways in which you can cope with this type of depression. As we said, symptoms tend to get better on their own, but sometimes they don’t. That is why this week we introduce Dr Wayne A Gordon, Mount Sinai’s response to SAD in the Department of Rehabilitation Medicine.

Dr. Gordon is the Jack Nash Professor and Vice Chair of the Department of Rehabilitation Medicine at the Icahn School of Medicine. He holds a PhD in Psychology from Yeshiva University alongside an internship in Neuropsychology from Rusk Institute. His specialization in Rehabilitative Psychology has finessed his clinical expertise toward dealing with SAD.

His clinical focus is centred around brain rehabilitation. That extends to fields of Anxiety, Concussion, Dementia, Insomnia, Parkinson’s, and all manifestations of Depression. His work in academia prove his profound understanding of how to help deal with SAD, and other types of Depression. He has published more than 100 articles and book chapters, and has received several awards during his career including recognition for “visionary work” in TBI (Traumatic Brain Injury).

When is the best time to see a physician about SAD?

One of the primary concerns with SAD is that it is difficult to diagnose, and equally sensitive to manage. The first step to dealing with SAD is diagnosis. This job is best done by a physician such as Dr Gordon, who can remove possibilities of other disorders that have similar symptoms. At this stage, it is possible to manage SAD using the step-by-step we supplied here. 

It is also important to see a physician if you feel the disorder is unmanageable. The step-by-step is helpful to some patients, but not to all. The symptoms of SAD don’t need to be managed alone. Dr Gordon has dedicated his life to helping people deal with SAD and equipping them with effective bespoke methods to deal with their personal battles. This can range from learning to deal with your symptoms to understanding what your symptoms are. SAD can manifest itself in “cycles” and become self-feeding. Dr Gordon can give you a metaphorical manual to your disorder which will help you understand what you are going through. This makes SAD manageable.

SAD can have an extremely negative impact on your quality of life. If you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How Can We Deal with Being SAD?

We all feel unhappy sometimes, but depression is more than a feeling of unhappiness. It is a mental disorder that makes someone feel persistently sad for several weeks or months. Depression can be hereditary, triggered by another mental disorder such as a “low” in bi-polar disorder, a side-effect of drug abuse, but it can also be triggered by external forces, like the season. Seasonal affective disorder (SAD) is a type of depression that occurs at a certain time of the year, usually in the winter.

SAD manifests itself similarly to other types of depression. There is no way of accurately diagnosing depression without knowing a patient’s history and state-of-mind, as there is no “test” for SAD. Your health care provider can make a diagnosis by asking about your symptoms. There are two main ways SAD can affect your life, mentally and physically.

The mental effect of SAD can be as follows. As with all types of depression, sufferers will tend to experience a feeling of hopelessness in all facets of life and catastrophize events past and present. Due to this, sufferers of SAD will be unhappy and irritable, and may begin to withdraw themselves socially. The disorder may begin to make the patient feel the need to eat more (as weight loss is more common with other forms of depression).

SAD manifests itself physically as a need for more sleep, a loss of energy and ability to concentrate.

There is a loss of interest to the sufferer’s work, his partner and friends, and other activities (especially social activities). Their movements may become sluggish and, they will more likely than not become socially reclusive.

These symptoms are not mutually exclusive, and they usually feed into each other which make the disorder more difficult to cope with. The mental facets of SAD will reinforce the social behaviour and vice-versa.

If you, or someone you know, is suffering from a handful of these symptoms then it is worth visiting your physician. Your health care provider can make a diagnosis by asking a series of questions about your symptoms and history. They can also perform physical exam and blood tests to rules out other disorders that are similar to SAD such as chronic fatigue.

If you are struggling to make an appointment, or are unable to see a physician for whatever reason, we have some tips that will help manage your depression at home. Remember, it is always better to see your physician.

Some tips on dealing with SAD

Firstly, make sure you are getting enough sleep. A fully-grown adult should get between seven to eight hours a night – although some people may need as few as five, and some as much as ten. Know how much sleep you need, and make sure you are getting it. Oversleeping is never advised.

Make sure you are eating healthy foods. This doesn’t mean you need to eat bland food, it means you need to have a balanced diet. For example: make sure you are getting a healthy dose of vitamins and minerals every day and avoid binging on sugar and hydrogenated fats.

Do not use alcohol or illegal drugs, these often make depression worse – and have been correlated to suicidal thoughts during episodes of SAD.

Try to exercise often. Proven time and time again, exercise is a fantastic way of battling depression. Force yourself to start a social sport or activity, but most importantly – do activities that make you happy.

Learn to watch your symptoms and understand that you are dealing with a disorder. This is especially effective in the early days of SAD, it will allow you to take control of your disorder, change your routine, and book in to see your health care provider.

Finally, if you have seen your health care provider, make sure you take your medicines right away, and ensure you ask your provider how to manage any side effects. There is a multitude of ways of dealing with SAD that your health care provider can offer. Symptoms tend to get better on their own, but there is no “cure” for SAD. Tackling SAD is a matter of managing symptoms and learning to with the disorder.

Get medical attention immediately if you have thoughts of hurting yourself or anyone else.

Laminectomy, The Surgical Response to Sciatica

Laminectomy, the surgical response to sciatica

Sciatica is a symptom of spine damage that can usually be remedied at home. There are a myriad of steps you can take in tending to sciatica without needing surgery. However, in some cases patients need to undergo surgery to alleviate their symptoms. This procedure removes the lamina (a small vertebra in the spine), it may also remove bone spurs in your spine and takes anywhere between 1 and 3 hours. This process has the aim of reducing pressure in your spinal column; in turn lessening the symptoms of sciatica. 

The procedure is often done to treat spinal stenosis. It removes damaged bones or discs. As we explored in last week’s blog, sciatica is a symptom, and not a cause – and the best way to cure sciatica is to tackle the underlying problem. 

It is important to have an x-ray or MRI of your spine before making any decisions to undergo surgery. You must divulge any medication you are taking to your health provider.

Before you leave your home, ensure you leave it prepared for when you return. You must refrain from smoking in the days leading up to your surgery. It is imperative you do not smoke after the surgery is complete. You must speak with your doctor if you have been drinking lots of alcohol, especially if your consumption could be considered alcohol abuse. 

You will likely be asked to not drink or eat anything for 6 – 12 hours before the procedure. With everything prepared, you are ready undergo your Laminectomy. 

Laminectomy opens your spinal column with the aim of giving spinal nerves more space to move. You will be asleep and feel no pain. The procedure begins with you lying face down on the operating table. Once the anaesthetic kicks in, the surgeon makes an incision in your back.

The skin, muscles, and ligaments are moved to the side. Depending on the cause of sciatica, part or all of the lamina bones may be removed on both sides of your spine. Your surgeon may then remove small disc fragments, bone spurs, or other soft tissues. The muscles and other tissues are back in place. The skin is sewn together.

After waking, you will be encouraged to get up and walk around as soon as the anaesthesia wears off. You will be allowed to go home around 1 to 3 days after their surgery.

You will be able to drive within a week and resume light work after around 4 weeks. The surgery should relieve the patient of all symptoms of sciatica due to addressing the root cause of the problem.

As we have stressed in previous blogs, surgical procedure is not recommended as a treatment for sciatica – it should be a last resort and not a go-to when the symptoms of sciatica kick in. Before thinking about surgery, you should consult your physician and discuss options. Alternatively, you can read our blogs on living with sciatica found here.

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

How to Deal With Sciatica, The Do’s and Don’ts

How to deal with sciatica, the do’s and don’ts

This week, we are going to look at ways of managing sciatica. In our previous blog we looked at what sciatica is, and suggested some causes of the problem. To quickly recap, sciatica is the compression of the sciatic nerve – which in turn causes pain down the lower back, through the hamstring all the way to the foot. What is most important to remember when dealing with sciatica, is that is a symptom, and not the underlying problem itself.

The first step when dealing with sciatica is diagnosing the underlying issue. The root of the problem can be anything from a slipped disc in the spine, to a spinal stenosis, or in more serious cases, a tumor. It could even come from a small fracture in the hip. Although we can treat sciatica without dealing with the genesis of the problem, you are more likely to experience a reoccurrence of sciatic pain if we do not.

We recommend that if you suffer from sciatica, get a diagnosis on what caused it. That way we can deal with the pain alongside remedying the original problem, and reduces the chances of it reoccurring.

For now, let’s look at some of Mount Sinai’s recommendations for dealing with sciatica at home.

Conservative (non-surgical) treatment is best in most cases. When you are suffering from sciatica, or begin suffering due to some other cause, apply heat or ice to the painful area. Try the ice first (48-72hrs); then use heat on the pain. Over the counter pain relievers such as ibuprofen or acetaminophen can also help with inflammation and general pain relief.

Surprisingly to a lot of patients, bed rest is not recommended. Although short term bed rest may be needed for patients in extreme pain, staying inactive and reclined for long periods of time weakens the body and extend the life of agonizing symptoms.

Upon first suffering the symptoms of sciatica, it is recommended to tone down your physical activity for the first few days, and gradually work your way back to your daily routine.

You should reduce your activity in the first couple of days – and gradually adjust your body to your usual activities. This will ensure you do not overstress any of the damaged components, and give your body time to adapt.

Patients are recommended to start exercising again after around 2-3 weeks. You should include exercises to strengthen your abdominal muscles and improve flexibility in your spine.

If weightlifting or contact (collision) sports such as American Football are part of your usual exercise routine, you should not return to your sport/hobby for at least 6 weeks since the pain began. Do not lift heavy objects or twist your back. Your physician can help identify good exercises to remedy sciatica.

More serious complications depend on the causes of sciatica, such as slipped discs or spinal stenosis. Call a provider immediately if you have:

·        Unexplained fever with back pain

·        Back pain after a severe blow or fall

·        Redness or swelling on the back or spine

·        Pain traveling down your legs below the knee

·        Weakness or numbness in your buttocks, thigh, leg, or pelvis

·        Burning with urination or blood in your urine

·        Pain that is worse when you lie down, or awakens you at night

·        Severe pain and you cannot get comfortable

·        Loss of control of urine or stool (incontinence)

Also call if:

·        You have been losing weight unintentionally (not on purpose)

·        You use steroids or intravenous drugs

·        You have had back pain before, but this episode is different and feels worse

·        This episode of back pain has lasted longer than 4 weeks

Sciatica usually goes away on its own if you follow our guidelines. However, if you need a consultation, or are suffering from any of the symptoms outlined at the end of the article, please contact us on (212) 241-6321 to book an appointment.

Causes and manifestations of sciatica

Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve. The sciatic nerve stems from the back of your pelvis, and runs through your buttocks, down the legs, and ends at your feet. It is the longest and widest nerve in the human body. It supplies sensation to most of the muscles and ligaments in the lower body – this ranges from the hamstring all the way to the sole of the foot.

When the sciatic nerve is compressed or irritated it can cause pain, numbness, or a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes. Some sufferers also report a weakness in the calf muscles or the muscles that move the foot and ankle. Sciatica can range from being extremely painful to a mild annoyance, usually exaggerated by sneezing, coughing – or any involuntary or sudden movements. The pain of sciatica is localised in the lower body region, stemming from the top of your buttock downward, people also report suffering from back pain. Although this is most likely related to the problem, it will not be the sciatic nerve causing the pain.

Most cases of sciatica stem from a slipped disc. Injury or weakness can cause the inner portion of the disk to protrude through the outer ring. This is known as a slipped, herniated, or prolapsed disc. If the slipped disc compresses the sciatic nerve then we have sciatica. Most people with sciatica experience unrelated back pain. But a slipped disc is an injury in its own right; we should see sciatica as a result of this injury. We can summarise this as: Sciatica often occurs from a slipped disc; however, not all cases of sciatica are from slipped discs; and you can get sciatica without having a slipped disc. There are a myriad of ways a disc can slip. 

You can help prevent sciatica by adopting better posture and lifting techniques at work, stretching before and after exercises, and exercising regularly.

Although most cases of sciatica pass within 6 weeks, sciatica can become extremely dangerous. If you are experiencing a tingling or numbness between your legs and around your buttocks, and have recently lost bowel/bladder control, and have sciatica in both your legs – you must contact a physician immediately. Our physicians can confirm a diagnosis of sciatica based on your symptoms and recommend appropriate treatment.

If you are suffering from any of the symptoms listed, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 241-6321

How we can help diagnose Carpal Tunnel Syndrome

The carpal tunnel is the space between a group of eight small bones in the wrist joint, and the ligament that links them to the lower neck. Carpal Tunnel Syndrome (CTS) is a medical condition which compresses the median nerve as it travels through the wrist at the carpal tunnel. The median nerve starts at C5 to T1 (the middle lower part of your neck), and travels down the front of the elbow, and into your hand. The nerve gives feeling to parts of your hand. Symptoms materialise as pain, numbness, and tingling in the thumb, index finger, middle finger, and the thumb side of the ring fingers. Due to this, sufferers tend to lose grip strength and if the problem persists, muscles at the base of the thumb may begin to waste away. 

Chances of suffering from CTS increase with obesity, repetitive wrist work, pregnancy, and arthritis. Diabetes has also been shown to have a weak correlation with CTS. There are some things you can do at home to help with CTS. But how can you know if you have CTS?

It has been suggested that there are exercises you can do at home to trigger the median nerve to exaggerate the symptoms. By placing our hands together as if one were praying, and ensure our forearms to our elbows are in a horizontal line, people suffering from CTS are said to feel their symptoms exaggerate. However, this is not a full diagnostic – and will not suffice to tell you if you are suffering from CTS.

We offer full a diagnostic test. An electrodiagnostic supplies us with objective evidence that will tell us if you are suffering from CTS or another medical condition. This helps rule out other medical conditions that mimic the symptoms of CTS, such as cervical radiculopathy.

The symptoms of CTS are equivalent in many ways to cervical radiculopathy (a neurological condition characterized by dysfunction of cervical spinal cords). With home tests, it is easy to conflate the two. Both issues result in numbness pain and weakness in the hand. With an electromyography, physicians can identify not only if you are suffering from CTS, but also – exactly where along the median nerve the problem lies. The root of the problem could be proximal to your lower neck, the median nerve itself, or the three fingers. Our diagnosis will precisely pinpoint the genesis of the condition.

The electrodiagnostic also identifies if patients are suffering from what is called double crush syndrome, where patients suffer from both CTS and cervical radiculopathy – which is increasingly common.

It is important that if you are experiencing the symptoms, you contact us immediately to discuss options. CTS is most easily treatable in the early days, the longer it is left, the higher chance of irreparable damage being caused. Get an accurate diagnosis.  

Mount Sinai specialize in CTS and pain management. If you experience any of the symptoms listed, please contact us as it is important you speak to your physician as soon as possible. Contact our switchboard on: (212) 659-8551 or (212) 590-3300