Medical Mailbox – air bag safety
Cory SerVaas
“The health of the people is really the foundation upon which all their powers as a state depend.”–Disraeli
Sit Far Back From Air Bags
In October 1995, Robert Sanders was driving near his Baltimore home with Alison, his seven-year-old daughter, when their minivan skidded into an intersection and bumped another car at less than 15 mph. The father’s first reaction was that he would have to have some body work done on the brand-new vehicle. Then he looked at Alison. Though she was wearing a seat belt, the powerful “punch” of the passenger-side air bag had knocked her unconscious. Brain-dead, she died the next day.
Small children and women under 5’4″ are at risk of a serious air bag injury. Safety experts recommend that driver and front passenger seats should be moved as far back as possible from steering wheels and dashboards; everyone should wear the lap and shoulder belts. Children 12 and under should ride buckled up in a rear seat.
Those who sit close to the steering wheel are likely to be struck with great force by an inflating air bag. Tilting the steering wheel down and raising the seat up will allow most drivers, even shorter ones, to sit at least ten inches from the steering wheel and still drive comfortably. Some cars have telescoping steering wheels or foot pedals that can help.
Has anyone heard of neurological damage from contact with an air bag? We have one 75-year-old reader who developed a tremor and hypertension after having been severely struck by an inflating air bag. She had two very black eyes that she learned were the typical “raccoon eyes” of an air bag victim. The swollen black eyes were followed by a persistent infection of the meibomian glands (blepharitis).
The jolt to the brain left Alison brain-dead. Our reader believes that the shock to the brain and the brain stem is severe enough to have caused the tremor to develop. She compares her sequelae to that of boxers who develop Parkinson’s disease or intellectual deficits after blows to the head.
While researching air bags, we learned another little-known fact: the “smoke” that comes forth on deployment is dust from the air bag and not the car. Many accident victims erroneously believe their car is on fire.
Air bags save lives. Seats should be moved back as far as possible and seat belts kept securely in position. Drivers are advised to grip the steering wheel at the sides or bottom, with thumbs resting on top of the wheel. This enables hands to come off the wheel easily as the bag inflates to full size.
Promising Stroke Research
Dear Dr. SerVaas:
My sister has had a series of small strokes over the years. As a result, her hands and feet have become numb, and her hands are clumsy.
Is there any help for this condition? It would be great if she could recover the mobility of her hands and feet.
Sylvia Neubecker Cadillac, Michigan
Dear Dr. SerVaas:
An article appeared in your Jan./Feb. ’99 “Medical Mailbox” concerning an experimental therapy to repair brain damage from stroke with transplanted nerve cells.
I am wondering if researchers at the University of Pittsburgh Medical Center have reached any conclusions or success regarding this project. My husband had a stroke in November 1997 which damaged his left leg.
Mrs. Frances Kobernick Pompano Beach, Florida
Dr. Douglas Kondziolka and his colleagues at the University of Pittsburgh report that 8 of 12 stroke patients in their study noted improvement in strength, sensation, and coordination. Scores on objective assessment scales improved in 6 patients.
In the groundbreaking research, doctors injected millions of healthy nerve cells into the brains of stroke victims. A larger, multicenter trial is being planned to study the effectiveness of nerve cell transplants. For more information, interested readers may e-mail Dr. Kondziolka at kbell@neuronet.pitt.edu.
Other evidence suggests that a new form of rehabilitation can help restore function and mobility even years after a stroke. Constraint-induced movement therapy utilizes thick mitts or slings to limit use of “good” limbs. Patients then practice repetitive tasks with their disabled arms or legs. Doctors at the Birmingham VA Medical Center say the intensive therapy–six hours a day for two to three weeks–may be stimulating healthy nerve cells to sprout new connections to those affected by stroke.
Rare Lung Infection: PIE Syndrome
Dear Dr. SerVaas:
I have had three cases of pneumonia in the past 2 1/2 years. The pulmonary specialist has now diagnosed “PIE” syndrome from my recent sputum test. He stated he knew very little about this condition, as he had seen few cases.
In my 82 years, I have had reasonably good health, although prone to bronchitis following a cold. I have had many and varied reactions to drugs, as well as allergies to perfumes and environmental exposures.
Is this curable? At present I’m being treated with prednisone and an inhaler twice a day. Any information would be greatly appreciated.
Virginia Norford Dayton, Virginia
PIE syndrome refers to a group of rare lung diseases called “pulmonary infiltrates with eosinophilia,” or eosinophilic pneumonias. The eosinophil, a type of white blood cell, helps destroy parasites and plays a major role in allergic reactions. In people with PIE syndrome, the cells accumulate in the lungs and may cause cough, fever, and difficulty in breathing.
Chronic PIE syndrome occurs more often in women than men and has been described in white patients only. About 60 percent of patients report allergies and asthma. Most are nonsmokers.
PIE syndrome may be caused by parasites, drugs, and fungi. In most cases, however, the cause is unknown. Blood, sputum, and stool tests help doctors diagnose the condition. A chest x-ray, CT scan of the chest, bronchoscopy, and lung biopsy may also be performed.
Treatment with prednisone usually improves symptoms within one week. In general, patients are treated with the steroid at least six months; some may require treatment for years. Patients should not discontinue prednisone without the physician’s knowledge. Prognosis is good.
Help for Vertigo
Dear Dr. SerVaas:
My problem is vertigo, and I am wondering if there is any cure. I’ve undergone many ear operations, and up to now I’ve had no history of vertigo.
I am 85 and generally in good health. I wear hearing aids in both ears and take Valium to try to correct the imbalance.
Thomas Bailey Pioneer, California
Dear Dr. SerVaas:
Has anyone ever had dizzy spells when walking? I was laid up with a bad back for several weeks and now can’t keep my balance. It is a dreadful nuisance, as I have lost my independence. Yes, I am ancient, but very full of it, in spite of 82 years. I am well otherwise and want to get moving again.
Kathyrn Parks Haslett, Michigan
People with a common type of vertigo feel that either they are spinning or the room is spinning. Symptoms of benign paroxysmal positional vertigo (BPPV) are usually due to a problem within the fluid-filled balance organs in the inner ear.
Mayo Clinic researchers recently reported that an outpatient therapy can effectively treat patients with BPPV. The Epley maneuver, also called the canalith repositioning procedure, guides the patient’s head through a five-position cycle of gentle, specific movements.
“This procedure can be done by properly trained primary-care physicians,” says principal investigator Dr. David Froehling, a Mayo Clinic internal medicine specialist. In the study, the cycle was repeated until there was no dizziness or until a total of five cycles had been performed. Twelve of 24 subjects who were treated with the tilt-and-turn technique reported resolution of symptoms. The median age of participants was 64.
Doctors sometimes prescribe antihistamines, antivomiting drugs, and low doses of tranquilizers to decrease vertigo. Other people find relief with desensitizing movement exercises supervised by specially trained physical therapists. For more information on the Epley maneuver, physicians and patients may call the Mayo Clinic at 507-284-2511.
Breast Reconstruction: No Regrets
Dear Dr. SerVaas:
I am responding to Janine Black’s letter about breast reconstruction (Sept./Oct. issue). In 1976, after being diagnosed with cancer, I underwent a radical mastectomy. There was no “hang-up” with wearing a breast form, and I did not experience a negative body image; however, when I found I would be able to have reconstruction, I made the decision in 1980 to do so.
The Latissimus Dorsi technique was performed. The surgery was completely successful, the result very pleasing, and I have a natural-looking breast. There is a loss of sensation in the underarm area, but nothing to compare with the discomfort Ms. Black described.
Ms. Black is correct that we must investigate all options before making our personal choices. After 20 years, I feel my choice was the right one for me. I lead an active life, my activities are not restricted in any way, and I have no regrets.
Anne Palmer Houston, Texas
Restless Legs Syndrome: Advice From Readers
Dear Dr. SerVaas:
In the March/April “Medical Mailbox,” someone asked a question relative to restless legs syndrome.
I had leg cramps for years, and the medicine I was taking for it was dropped and not made anymore. Someone suggested taking a good full teaspoon of vinegar each night 1 1/2 to 2 hours before bedtime. This is really effective, and I never have them anymore.
Try it, Emilee Jenko; you will love the results.
Thelma Trimpe Seymour, Indiana
Dear Dr. SerVaas:
I suffered from restless legs syndrome for six months. By rubbing my legs with Aspercream, I did get some temporary relief.
My restless legs proved to be a symptom of a non-working thyroid gland. Not long after I started taking thyroid medication, my restless legs syndrome disappeared.
Please repeat the necessity of thyroid testing for all adults. Doctors need to include this test as part of every physical.
Nancy Peters Fort Gratiot, Michigan
Reader Remedies for Burning Feet
Dear Dr. SerVaas:
A vascular surgeon said I should try taking one tablet of Amitriptyline HCL 10 mg at bedtime to calm the nerves in my feet. After the first dose, I was much relieved and completely relieved in a week. Now after one year of the “little pink pill” telling my burning feet to “sit down and shut up,” the burning comes only on very hot days in the summer, when my feet and ankles sometimes swell.
I hope my experience will help someone with this same problem–burning feet are really torturous!
Peggy Meyer Falls Church, Virginia
Dear Dr. SerVaas:
I have also had the foot-burning sensation and have arrived at a solution. My dermatologist prescribed Spectazole, to be applied once every 24 hours. After a shower or bath, dry feet thoroughly, apply Spectazole. I wear socks after that or some sort of hosiery so the Spectazole won’t wear off immediately. That has virtually eliminated the problem.
I also had good luck with magnetic insoles in shoes. Ignore the naysayers about magnets, because if it works, who cares whether there’s scientific basis for it? I found them cumbersome, so went back to using only Spectazole.
Marian Erdman e-mail
Dear Dr. SerVaas:
I had suffered with burning feet for the past five years. After I visited a neurologist, he prescribed 200 mg of neurontin a day. Also, vitamin [B.sub.12] was increased to 800 per day. After the first day, I have not had any burning.
Norma Williams LaPlata, Maryland
Herpes Simplex Infection
Dear Dr. SerVaas:
After more than 45 years of marriage, I developed a herpes simplex type 1 infection in the vaginal area. Neither my husband nor myself have had other sexual contacts.
Please list any possible cause, since sex is not, in my case. I was given a ten-day prescription of Valtrex, but it appears to be coming back. Are there other treatments?
What are the signs of recurrence, and how can I know when it would be contagious to my husband? How often can it recur?
name withheld Honolulu, Hawaii
Two closely related types of the herpes simplex virus (HSV) can cause genital infections. HSV-2 accounts for most cases and is spread by sexual contact. HSV-1, however, may be contracted much like the common cold. Small blisters appear within about six hours of tingling discomfort or itching.
Dr. William Hanke, clinical professor, Indiana University School of Medicine, and medical director, Laser & Skin Surgery Center of Indiana, responds to your questions:
“Herpes simplex is a human-specific virus that infects individuals across the globe. HSV-1 usually causes nongenital infections (of the mouth, lip, and eye) and is contracted through exposure to it, much like the common cold. The incubation period is from three to ten days following exposure. Painful lesions may develop on the mucous membranes for one to three weeks.
“Patients with acute outbreaks, can infect others through physical contact. Mature lesions usually appear as pustules on top of redness and swelling on the skin. Once the lesions begin to crust and heal, the herpesvirus appears to be latent within the nerves. It can reactivate in the epidermis of the skin and cause recurrent lesions. Twenty to 45 percent of people infected with HSV-1 develop recurrent infection.
“Physical and emotional stress, sunburn, and systemic infections contribute to recurrence. Fortunately, effective anti-herpes drug treatment is readily available. Some patients are required to take medication continuously in order to suppress frequent outbreaks.”
Many Post readers have told us that they successfully treat cold sores and other HSV-1 lesions with lysine, an inexpensive amino acid available without prescription. As we have previously reported, longtime lysine researcher Dr. Richard Griffith recommended that cold-sore sufferers take 500 mg per 22 pounds of body weight daily. Treatment is most effective if begun when symptoms first occur.
Possible Treatment for Burning Mouth
Dear Dr. SerVaas:
I have a dear friend who was diagnosed with Bell’s palsy two years ago. She developed a burning mouth at that time and still has it today. She tried acupuncture, and that did not help.
Do you have any information you can give or suggestions on what she can do for this?
Freda Raker McConnellsburg, Pennsylvania
Dr. Linda Bartoshuk, an experimental psychologist at Yale University, and Dr. Miriam Grushka, a dentist who currently practices oral medicine in Toronto, Canada, say that up to 70 percent of people with burning mouth syndrome (BMS) may find relief with low-dose clonazepam, an antiseizure medication. Research on the promising therapy is ongoing.
For more information, contact Dr. Grushka at 416-488-1776 or mgrushka@yahoo.com. Dr. Grushka recommends that BMS patients seek treatment from a dentist who specializes in oral medicine. For a referral in or near your area, contact the American Academy of Oral Medicine at 410-602-8585.
Named for Scottish surgeon Sir Charles Bell, who first described the nerve ailment, Bell’s palsy is characterized by sudden weakness or paralysis of facial muscles. Researchers suspect that facial nerve inflammation may be due to the same herpesvirus that causes cold sores and fever blisters. Most people with the disfiguring condition recover within six months.
We would like to know if your friend tries the clonazepam remedy and with what results.
Medical Progress
Patients with chronic neck pain report relief with use of the Pronex Cervical Traction device. Pronex is designed for use in a reclining position at home. The patient’s head and neck rest on foam cushions connected by an air-inflated bellows. The patient increases traction by squeezing an inflator bulb. As the bellows expands, it lifts the head up and gently stretches cervical muscles. Available by prescription only.
Faculty from the University at Buffalo School of Dental Medicine soon will begin a pilot study of a mouth rinse that claims to discourage people from smoking by distorting the taste of cigarettes. The new mouth rinse doesn’t affect the taste of other foods or drinks. Readers in western New York State who are interested in testing the new smoking deterrent may call 829-3850.
The Mayo Clinic now offers disposable hearing aids and digital hearing aids with disposable sleeves. The disposable hearing aid, which can be worn for about 40 days, eliminates some ongoing maintenance typically required with hearing aids. A year’s supply costs about $400 per device. Digital hearing aids start at around $1,600. The disposable sleeve is replaced every two weeks and includes a soft cushion. (See “Living With Hearing Loss,” page 64.)
Doctors and nurses in New Zealand report that honey is an effective wound treatment. They say honey painlessly removes pus, scabs, and dead tissue from wounds and stimulates new tissue growth. Traditional treatments failed to treat a British teenager with multiple skin lesions from a blood infection. Dressing pads impregnated with sterilized honey, however, healed the infected lesions within ten weeks.
Readers may send their letters to 1100 Waterway Blvd., Indpls., IN 46202 or via e-mail: satevepst@aol.com. Please include mailing address.
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