Advertisement

Advertisement

Cervical Radiculopathy: Diagnosis and Management

Teaser: 

Heidi Godbout, MD,1 Sean Christie, MD, FRCSC,2

1Dalhousie University, Dept. Surgery (Neurosurgery), Dept. Medical Neurosciences.
2Associate Professor, Dalhousie University, Dept. Surgery (Neurosurgery).

CLINICAL TOOLS

Abstract: Neck and arm pain are common reasons to seek medical attention, especially in the working population. However, there are several diagnostic pitfalls that must be avoided. Appropriate, conservative management will lead to improvement in a significant number of patients. Knowing when to refer a patient as well as what imaging modalities are indicated is crucial to managing cervical radiculopathy in the primary care setting. The purpose of this review is to help primary care physicians diagnose, investigate and treat cervical radiculopathy and to know when a surgical referral is appropriate.
Key Words: Cervical radiculopathy, neurological exam, imaging, conservative treatment, surgery.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

1. Cervical pain is a common clinical problem; pure cervical radiculopathy is much less frequent.
2. The natural history of cervical radiculopathy is favorable; most patients improve within 3 months.
3. Imaging is only required if there are indications of sinister, non-mechanical pathology or when surgery is being contemplated.
4. Surgery produces beneficial results in 85-90% of cases.
1. A well-constructed musculoskeletal and neurological history and physical examination can distinguish between mechanical neck pain, cervical radiculopathy, cervical myelopathy or shoulder pathology.
2. C5-6 and C6-7 are the most common levels affected.
3. C6 radiculopathy leads to numbness in the thumb and weakness in wrist extension.
4. C7 radiculopathy leads to numbness in the middle finger and triceps weakness.
5. Spurling's manoeuver can be used to reproduce radicular symptoms. It should not be used when myelopathy is suspected.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.

Where's the Beef?

0

No applauses yet

I was sitting in a coffee shop next to table with 5 older women. I could hear one of them say to the group, "I am cutting bacon out of my diet—but I do love it once in a while". "Why are you doing that, one of the woman replied?" "I just read that bacon and salami and hamburgers can cause cancer—didn't you see the paper yesterday—it was also on the news last night—it is almost as bad as smoking cigarettes—who would know—I hope it isn't too late as I have bacon at least once a week on the weekends when we go out for breakfast."

It always amazes me how when something is reported in the media, the response ranges from hyperbolic concern by reporters and the public to complete lack of concern by others. It can be very hard for the public, and at times the medical profession to decipher the real implications of the many reports that focus on public health threats from the world around us. I have watched as items such as eggs, coffee, various fats and oils, alcohol, different types of exercise and where we live and what we breathe become the focus of notices to the public to either "beware," "take heed," "change practice" or "just stop what you are doing".

Some public health warnings are real and immediate and often due to the finding or some food item that is being eaten or prepared in "real time" that poses an immediate threat to consumers. A recent example is the warning and resultant steps taken by the restaurant chain Chipotle where at the time of writing, "More than 40 people have fallen ill with E. coli food poisoning after eating at Chipotle Mexican Grill restaurants in six different states…the outbreak expanded with new Chipotle-linked E. coli cases reported in California, Ohio, New York and Minnesota, the U.S. Centers for Disease Control and Prevention said."

This type of warning is reminiscent of those that are propagated by public health agencies during BBQ season reminding consumers to BBQ their chicken and hamburgers particularly well because of risks of E-Coli outbreaks—a ubiquitous bacteria that can be destroyed by proper cooking but may linger in undercooked or rapidly cooked meet where the necessary bacterial-killing inside temperature is not reached. In 1993 there was a serious outbreak in the Jack in the Box chain of fast-food outlets in the United States that resulted in hundreds of illnesses some of which resulted in chronic and serious illnesses—it had a profound impact on new standards for food preparation in the fast-food industry.

These warnings are different from public health warnings about eating habits—having watched the potential harmful effects of coffee come and go over the years, I was forever grateful that the final estimation of this almost universally consumed drink, is that it probably has more beneficial effects on health parameters than negative ones—for me coffeeophile a public health blessing: yet the European Union recently recommended against drinking more than four cups of coffee a day based on caffeine consumption. In contrast is the recent report that," Hold on tight to that cup of Joe—because it could save your life. New research out of the Harvard School of Public Health says lifelong coffee lovers could be at less risk of dying from type two diabetes, suicide, cardiovascular and neurological diseases. "We found people who drank three to five cups of coffee per day had about a 15 percent lower [risk of premature] mortality compared to people who didn't drink coffee," one of the authors of the study, Walter Willett, told NPR.

So what about the bacon, hot dogs, corned beef and pastrami? What about the BBQ steaks and hamburgers? Does everyone who is not an life-long vegetarian or subscribe to the Mediterranean diet run the risk of sudden death from a BLT or hot dog at their favorite ball game? That a recent study in the US reveals that 57% of American Jews eat pork in one form or another (http://www.pewforum.org/files/2015/11/201.11.03_RLS_II_full_report.pdf)—should not necessarily be interpreted as a sure sign of anti-religious drift or impending doom, but rather the way surrounding cultures and practices influence people of all ethnic and religious backgrounds.

The final message should be: Most things can be eaten in a moderate and balanced fashion, unless there are specific health-related concerns for an individual—more important than how much bacon, meat and pastrami one eats, is that the portions are in keeping with one's individual nutritional needs, that they are balanced with other non-meat foods, including vegetables and fruits and that they are prepared and cooked well Food is one of the most enjoyable aspects of life—we should not make ourselves obsessively concerned every time a new "warning" comes out about the dangers of life and what we eat—hang in there—likely the recommendation will change over time—take it all in stride- with a dollop of mustard.

This article was originally published online at http://www.cjnews.com/perspectives/ideas/wheres-the-beef

JCCC 2016 Issue 2

Table of Contents

Navigating the Gender Spectrum: A General Overview of Transgender Health Care

Navigating the Gender Spectrum: A General Overview of Transgender Health Care

Teaser: 

Dr. Adam C. Millar, MD, MScCH, FRCPC,

Mount Sinai Hospital, Assistant Professor, Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, ON.

CLINICAL TOOLS

Abstract:Transgenderism is common, with quoted prevalence rates of between 0.5-1% of the population.1,2,3 The term "transgender" reflects a broad spectrum of identities, including agender, pangender, genderqueer and genderfluid. Although there is increased public recognition of transgender issues, many physicians remain uncomfortable managing matters of transgender health. There is a paucity of high quality, long term randomized controlled trials on many transgender health topics, requiring physicians to rely largely on consensus guidelines. Integration of transgender-related subject matter into medical school curricula is one of the first steps towards enabling future physicians to increase their comfort in transgender health care.
Key Words: Transgender, trans, testosterone, estrogen, androgen blockade.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

1. Transgenderism is not limited to the binary gender constructs of male and female. The term "transgender" includes a broad spectrum of identities, including agender, pangender, genderfluid and genderqueer.
2. Lack of physician comfort with medical management of the transgender patient has been linked to increased rates of refusal of medical care, as well as verbal harassment and in extreme cases physical assault.
3. Due in part to a lack of large randomized controlled trials, many transgender guideline recommendations are based on expert opinion and relatively low quality evidence.
Rather than assume one's gender identity, it is advisable to ask the patient how they identify, and what pronouns are preferred.
There are no specific hormonal targets during transition therapy. Instead, treatment targets are defined by the patient's goals and overall sense of well-being.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.

Benign Prostatic Hyperplasia—Medical and Surgical Treatment Options

Benign Prostatic Hyperplasia—Medical and Surgical Treatment Options

Teaser: 

Dean S. Elterman, MD, MSc, FRCSC,1 Udi Blankstein, MD,2

1Attending Urologic Surgeon, Toronto Western Hospital, University Health Network, Assistant Professor, Division of Urology, Department of Surgery, University of Toronto, Toronto, ON.
2Department of Urology, McMaster University, Hamilton, ON.

CLINICAL TOOLS

Abstract: Benign prostatic hyperplasia (BPH) affects the aging male. Treatment options vary widely. Some men will elect to conservatively monitor their symptoms and make alterations to their lifestyle choices. Pharmacotherapy options exist as well, and include alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase-5 inhibitors. Lastly, surgical options are also a viable treatment option, with many types at the disposal of the caregiver. Technological advancements have changed, and will continue to change the field in the near future. This review outlines the important aspects of this common affliction.
Key Words:Benign prostatic hyperplasia, management, treatment, referral.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

You can take quizzes without subscribing; however, your results will not be stored. Subscribers will have access to their quiz results for future reference.

There is a spectrum of bother ranging from mild nuisance to significant decrease in quality of life – this is largely associated with how the patient perceives the problem.
Physical exam and medical history are imperative in the initial assessment of BPH.
Conservative measures and lifestyle changes should be the first line treatment choice.
Surgical intervention should be attempted after failure of medical therapy to alleviate symptoms and prevent kidney injury or infection.
Ensure that there are no other causes that may cause LUTS such as various medications, and other comorbidities.
When considering more invasive intervention, ensure that the surgical team knows the patient's anticoagulation status.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.