A world-first transitional pain program that aims to stop pain from becoming chronic after surgery is being pioneered at Toronto General Hospital, University Health Network.

The one-year pilot program is designed to treat complex pain patients who have had surgery by helping with pain control, monitoring and weaning patients off excessive amounts of opioid medications for pain, and providing much-needed support for patients after they are discharged from the hospital. Follow-up care is provided by a diverse team of clinicians who specialize in pain control. Program specialists are not aware of any other such program in scientific publications.

Poorly controlled postsurgical pain is a risk factor for hospital re-admission and increased use of health care resources.
The program, which began in June 2014, also hopes to answer compelling questions of which risk factors cause chronic pain, what works best to stop or modify the “pain pathway” for patients, and how interventions can prevent hospital re-admissions of complex patients after surgery.

“We want to break the cycle of pain with multiple pain strategies,” says Dr. Hance Clarke, Medical Director of the Pain Research Unit and Director of The Transitional Pain Service in the Anesthesia Department and Pain Management at Toronto General Hospital (TGH). He adds that after about three months, post-surgical pain can develop into chronic pain, therefore it is important to intervene before this happens. As many as 30% of surgical patients develop chronic pain after surgery, and are at an increased risk for long-term opioid use. 50% of patients after major surgery are discharged from hospital with a prescription for opioids.

Challenging Hernias Postgraduate Course
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In this video, Drs. Schechter, Logan, Coakley and Chambers discuss the role that psychologists play in the treatment of pediatric chronic and procedural pain.

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Meet Katie, who has struggled with pain for most of her life. After participating in the Pain Program for Active Coping & Training, a study funded by the National Institutes of Health Common Fund, Katie now has the support and skills to take a more active role in managing her pain.
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A visual explanation of the cells of the immune system and their different functions that provide an immune response to an invading pathogen.

Written notes on this topic are available at: https://zerotofinals.com/physiology/immunology/cells/

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This animation shows how the body naturally responds to and destroys invading bacteria.

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It’s the most common cause of back and neck pain. A herniated disc can happen from an injury, exertion, or over time.

Dr. Dean Lin, a neurosurgeon with Lee Health, says sometimes there are options other than surgery that can help patients manage the pain. “A herniated disc is when part of the disc material that’s in the body that separates the vertebra actually comes out of that area where it normally lives. The problem with that is there are nerves that run right past this area so it ends up pinching a nerve.”

A pinched nerve can cause pain throughout different parts of the body. “A herniated disc, if it happens in the neck, will cause shooting pain down the arm to the fingers. The same with the lower back except it goes down to the leg, typically just one leg,” said Dr. Lin.

In addition to the back or neck pain, a herniated disc can also cause numbness, tingling, even weakness. “If there’s a weakness there then this is something we typically operate on sooner rather than later but if there’s no weakness and we are primarily dealing with a pain issue then we can try to treat this conservatively first,” said Dr. Lin.

Patients experiencing pain can try physical therapy, rest, or medication like epidural injections to manage the pain. Doctors say there are times a herniated disc can repair itself. “But if the pain gets worse and they develop a motor deficit like we talked about then surgery is indicated,” said Dr. Lin.

Doctors say it’s a very common injury that can happen at any age. If you have any of the symptoms check with your doctor about managing the pain.

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Lee Health in Fort Myers, FL is the largest network of health care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For more than 100 years, we’ve been providing our community with personalized preventative health services and primary care to highly specialized care services and robotic assisted surgeries. Lee Health – Caring People. Inspiring Care.

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In this animation we explain what a hernia is and that this condition can involve discs in the spine. Although in many cases herniated discs recover without intervention, sometimes surgery is necessary. In the animation we explain the different types of surgical treatment of a herniated disc, such as an open discectomy, a laminotomy and a laminectomy.

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Before we talk about treatment, let’s start with a discussion about the human body and about your medical condition. Your doctor has told you that you have a hernia. But what does that actually mean?
Patient Education
In general terms, we can say that a hernia occurs when the layers that make up the abdominal wall weaken. In other words, the fabric of muscle and other tissues which protect the gut, develops a defect, or weakness. Through that defect the peritoneum (PER-IT-TA-NEE-UM) – and perhaps other organs – push their way outward, forming a lump which can be felt – and sometimes seen – protruding from the abdomen.
During normal childhood development, boy’s testes slowly descend from the interior of the abdomen, down into the scrotum. They pass through the abdominal wall by way of a natural passageway called the inguinal canal.
In men, the inguinal canal contains blood vessels that supply the testes, as well as the vessel that carries sperm to the penis. Hernias that occur due to a weakness in the abdominal wall at the inguinal canal, are called inguinal hernias. And not surprisingly, men are 25 times more likely than women to experience a hernia in this area.
Some inguinal hernias press directly through the floor of the inguinal canal.
Others follow the route taken by the blood vessels that supply the testes. This kind of hernia – called an indirect hernia – can even push all the way into scrotum.
Patient Education
Perhaps you’re wondering: what causes a hernia to develop? There’s no single cause. Most people understand that hernias can sometimes occur following sudden, forceful lifting. But most often, hernias develop gradually …

… and finally make their appearance when the abdominal wall is under somewhat less dramatic pressure. Pregnancy, constipation, straining during urination – even repeated coughing – any of these actions can, in fact, put enough pressure on an abdominal weak spot to cause a hernia.
Patient Education
Symptoms of hernias can vary. If you have a mild hernia, you may not even be aware of it. But in most cases, a hernia causes a noticeable lump or swelling. There may be some pain or discomfort – often increasing when standing, and subsiding when lying down.

Hernias become more serious problems if abdominal contents – such as part of the small intestine or another organ – slide into the hernia sack and become trapped there.
Patient Education
If those organs cannot slide easily back into the abdomen,the hernia is said to be irreducible. Irreducible hernias are often painful and can lead to complications.
For example, if the intestine becomes trapped in the hernia sack it is said to be incarcerated.
If the neck of the hernia sack actually pinches off the supply of blood to those organs which have become trapped inside, the hernia is said to be strangulated.

These are both considered to be medical emergencies and if left untreated, an incarcerated or especially a strangulated hernia can lead to very severe illness and even death.
Patient Education
Luckily, the vast majority of hernias are not considered to be emergencies. However, if you should ever feel a sudden onset of severe pain in your hernia, you should definitely seek immediate medical attention.

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In this video, spine surgeon Michael Hasz, MD from StoneSprings Hospital Center explains why over-the-counter pain medications are an important part of managing post-operative pain.
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Dr. Peter Geller, surgeon emeritus at Columbia University Medical Center, explains the anatomy of the abdominal wall, the causes of abdominal wall hernias, and methods of hernia treatment.

You can learn more about hernia at Columbia University Department of Surgery at: http://columbiasurgery.org/hernia
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Hernias are considered by some to be a ‘manly’ health condition, often caused by excessive or heavy lifting.

“A hernia is essentially a defect or a hole in the abdominal wall that allows contents from inside the abdomen to push through the abdominal wall and usually present with a bulge or a mass in the tissue between the skin and the muscle,” says Dr. Darren Miter, a laparoscopic surgeon with Lee Memorial Health System.

They’re more commonly treated in men. Women make up only 8% of those diagnosed.

“The most common hernias that we hear about are hernias that develop in the groin or inguinal hernias. Women are less likely to develop the inguinal or groin hernias,” says Dr. Miter.

Most frequently identified hernias in women are ones that occur along scars from previous surgeries.

“Women end up undergoing more surgical procedures than men especially younger in life, so I see more incisional hernias in women than in men,” says Dr. Miter.

But many women may be women hiding a secret, a hernia they never suspected. Experts find women with pelvic pain may be misdiagnosed as having ovarian cysts, fibroids, even endometriosis when in fact they have a hidden hernia, one that was missing an outward sign.

“The typical or classic presentation of a hernia is someone feels a sudden tearing sensation either in the groin or perhaps the belly button and then develops a bulge in that area,” says Dr. Miter.

Unlike hernias in men, ones that afflict women are usually small and internal and rarely cause that obvious bulge. The good news is, once detected, they are fairly simple to fix.

“All we need to do is push whatever is pushing out of the abdomen back in and usually we reinforce the area with a piece of mesh or graft to make that area stronger,” says Dr. Miter.

Your best advice it not to expect the tattle of the bulge, women with chronic, severe abdominal pain should ask their doctor if it could be a hernia.

View More Health Matters video segments at leememorial.org/healthmatters/

Lee Memorial Health System in Fort Myers, FL is the largest network of medical care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For nearly a century, we’ve been providing our community with everything from primary care treatment to highly specialized care services and robotic assisted surgeries.

Visit leememorial.org
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Pain after surgery is traditionally management using standardized “one-size-fits-all” treatment protocols. Physicians generally select analgesic drugs and doses to treat surgical pain based on their own or institutional preference without extensive patient consultation or involvement. I will present a series of studies that we have conducted that challenges this paternalistic, standardized treatment approach. The feasibility and potential benefit of seeking input from patients regarding their personal preference for analgesic drugs and doses will be explored. Physician’s role should be to only present evidence-based pain treatment options and their potential side effects. Patient input prior to surgery can facilitate individualized perioperative pain treatment protocols based on patient’s preferences, expectations and needs. I believe this patient-centered surgical pain treatment model needs to be replace the existing “one-size-fits-all” model, and should be offered to all patients undergoing surgery.
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Marshmallow root is an effective way of cooling off heartburn or acid reflux you may be suffering from. Learn how to incorporate this herb into your diet with the helpful tips provided by an expert herbalist in this free video on natural herbs for treating acid reflux and heartburn.

Expert: ROBERT LINDE
Bio: Acupuncture physician and registered herbalist Robert Linde has studied herbs since 1975 and has practiced Traditional Chinese Medicine for more than six years.
Filmmaker: Christopher Rokosz

Series Description: Many common ailments can be treated with ingredients found in the home. Learn how to treat these ailments in a natural and affordable way with the helpful advice from an expert herbalist in this free video series on natural at home remedies.
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