Questions

• I have neck pain with tingling in my arm, but a neurosurgeon told me I don’t have a pinched nerve. How can that be?
• My elderly mother is on several prescription medications, and I worry that she is not following the dosing instructions. How can I help ensure that she is taking her medications properly?
• My arthritis makes it difficult for me to exercise. Any suggestions?

I have neck pain with tingling in my arm, but a neurosurgeon told me I don’t have a pinched nerve. How can that be?

Numbness and tingling symptoms in the extremities can also occur. Some people experience chest and abdominal pain in the neck or back, too, and will visit the emergency room with these complaints.

Workups can be extensive but unrevealing. Patients will seek answers from their primary care provider and many different specialists. Many tests and procedures, such as cardiac and nerve tests and all sorts of X-rays and MRIs, will be performed to make sure there isn’t an emergency or surgical issue. When all the tests come back negative (showing no problem), patients may be told there is nothing to do, that it’s in their head, or they may be referred for yet another test. Some may even undergo surgery in the hope that an incidental finding, such as arthritis of the spine, is actually the cause. It probably isn’t.

The truth is that the culprit may be the muscle itself. The pain and numbness are triggered by muscles but may be felt in other areas. The source of myofascial pain is called a trigger point. Trigger points in the neck can cause headaches, while trigger points in the upper back can cause pain and numbness down the arm to the hand. When the trigger point is in the chest wall, it can seem like a heart attack. One can understand how easy it would be to overlook the “muscle” as the source of these symptoms that seem very serious, but are annoying at best and debilitating at worst.

What I find on exam are taut, tender bands within muscles that can twitch and trigger a recurrence of symptoms. The problem usually comes from an overuse or repetitive strain, or holding patterns that people develop related to posture and stress. Treatments such as acupuncture, local injections and physical therapy help to restore the muscle length and function and to reduce pain. Postural work is usually important, too.

The lesson is to keep muscles conditioned in a balanced way. Relief comes when abnormal muscle holding patterns are broken and balance is restored.

My elderly mother is on several prescription medications, and I worry that she is not following the dosing instructions. How can I help ensure that she is taking her medications properly?

Medicare agrees that medication management is a key issue affecting the quality of patient care. “Improvement in the management of oral medications” is among the outcomes measures that are posted on Medicare’s Web site, Home Health Compare. Consumers can check this site to see how home health agencies perform on this and nine other measures.

In an effort to develop best-practice standards to address medication issues, FirstHealth Home Health has created a Medication Management Task Force, a multidisciplinary team that has developed a series of strategies to improve a patient’s ability to safely and effectively manage medications. On admission to FirstHealth Home Health, patients are assessed for their potential risk for medication errors and individualized strategies are developed based on that assessment. For example, our occupational therapist may work with the patient to improve his manual dexterity if he is having trouble opening his medication bottles.

Medications can be overwhelming and confusing for many elderly and ill patients. Our job is to educate our patients and their caregivers how to manage their medications in the home safely and effectively.

For more information on this subject, see the story here.

My arthritis makes it difficult for me to exercise. Any suggestions?

• Relaxation: Exercising in warm water temperatures increases blood flow to muscles, allowing them to relax.
• Improved flexibility: Buoyancy (our ability to float in water) helps reduce the stress on our joints. For example, when someone is in waist-deep water, 50 percent of his body weight is displaced to allow for easier movement.
• Strength: Water resistance gives our muscles a great low-impact workout.

As with all exercise programs, talk to your doctor first to see if aquatic exercise is right for you. For information on aquatic exercise programs offered by FirstHealth of the Carolinas, contact the Center for Health & Fitness nearest you.