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Q.
Why is a splint used after an injury?
A.
When a fracture or sprain occurs, it is important to immobilize the injured bone or joint for the dual purpose of maintaining comfort and preventing further injury. Let’s discuss a hypothetical ankle injury. Our x-ray tech will take computerized images of the ankle. These images are viewed by both me and an off-site NY-licensed radiologist. If a broken but stable ankle is seen on the x-ray images, our nursing staff will apply a fibercast splint; the patient will see orthopedics within the next couple days. For sprained ankles, we often place an ace wrap and an ankle stirrup. With simple toe fractures, splinting can be as basic as buddy taping one toe to another.


Q.
After sustaining a deep laceration is it always necessary to suture the injury?
A.
Superficial cuts do not require stitches, but deeper wounds require adequate closure to prevent infection and to ensure a good cosmetic result. I will typically stitch wounds that are actively bleeding, near joints, or irregular in shape. If a wound has clean edges and is subject to minimal tension, then I will consider using Dermabond, a skin glue. For scalp lacerations, I often use the hair apposition technique: I grab hair strands from each wound edge, make one twist, and then apply a drop or two of Dermabond on the twisted hair to hold the wound edges together. This technique often works better than suturing.


Q.
I had shingles four years ago - can I get it again, or am I immune? Do I need the vaccine?
A.
Shingles is a re-eruption of the chicken pox virus.  A red, bumpy painful rash will occur on a band of skin on one side of the body. Start antiviral treatment within the first 3 days of the rash to decrease the severity if not the duration of the illness.  The shingles rash lasts about 4 weeks; the pain can be for much longer. Yes, shingles can recur at another location.  The vaccine, indicated for most people age 60 and older, has been found to decrease the incidence of Shingles by half.  Because pain from shingles can be quite debilitating, please get vaccinated if you qualify.


Q.
What is done for a urinary tract infection?
A.
A urinary tract infection (UTI) is characterized by increased frequency, increased urgency, and burning on urination. This condition is more common in females. If left untreated, a UTI could lead to a kidney infection. In our office, we will test for a UTI by performing a dipstick on a urine sample. At times, we will send the urine for culture at an offsite laboratory. Antibiotics are quite helpful for most UTIs. Most UTIs require antibiotic treatment for a duration of only 3 days. Antibiotics used for UTIs include Macrobid, Bactrim, and Cipro. Avoiding sugary foods and drinking plenty of fluids may shorten the duration of the infection. Drinking cranberry juice may have some limited benefit in preventing recurring UTIs.


Q.
How is a cold or flu treated?
A.
Viral infections become more common as winter closes in. As per the CDC, now is the time to acquire a flu shot. The common cold can produce irritating symptoms of nasal congestion, postnasal drip, sneezing, and general malaise. The flu is more serious, involving fevers, muscle aches, and tremendous fatigue. With the flu, elderly patients and very young children are at risk for the complication of bacterial pneumonia, which often requires hospitalization. Rest, fluids, acetaminophen, and ibuprofen are the mainstays of treatment for viral respiratory infections. Tamiflu is an antiviral medication that can be started within the first 48 hours of the flu. Tamiflu might reduce the duration of illness by one day; the typical duration of the flu is 6 days.


Q.
How should an earache be treated?
A.
Ear pain has many causes. Moderate-to-severe pain warrants a visit to a medical professional (i.e. Urgent Care). The skin of the outer ear can become infected, requiring oral antibiotics. The ear canal is prone to getting inflamed, particularly after swimming. This condition, known as swimmer’s ear, requires antibiotic ear drops. The younger pediatric population is prone to getting infections of the ear drum. Many such infections, if not most, will clear up within 24 hours. If the eardrum isn’t ruptured, I will often initially prescribe anesthetic ear drops to numb the pain. I will have the parent call me if the patient hasn’t improved by the next day. I rarely get that call.


Q.
I recently developed hives when taking Aleve. Am I also allergic to other anti-inflammatory medications like ibuprofen?
A.
Possibly. Typically, when a patient develops an allergy to a particular medication in a drug class (i.e. penicillin), the patient will be advised not to take other medications within the same drug class (i.e. amoxicillin). It is not typically advisable to experiment on oneself to check one’s allergy status to other meds in the same drug class.  However, there may be rare situations where other medications in the same drug class would provide such benefit as to outweigh the risks.  In such cases, it would be necessary to be monitored by a physician while taking drugs in the same class.


Q.
What can be done for a severe nosebleed?
A.
Due to a good blood supply, the nose can bleed heavily. Bleeds originating from the back of the nose (posterior bleed) have led to hospitalizations. Most nosebleeds stem from the front of the nose (anterior bleed). With an anterior bleed, squeeze the nostrils for about 10 minutes and lean forward. Insertion of a cotton ball covered in petroleum jelly into the nostril for 12-24 hours can prevent further bleeding. In Urgent Care, minor bleeds can be managed via cautery by a silver nitrate stick; more severe bleeds require packing. We use a Rhino RocketTM packing (‘nasal tampon’) which is typically removed after 24 hours. Posterior bleeds require intervention by an Ear, Nose, and Throat (ENT) specialist in the emergency room setting.


Q.
What is done for someone who suffers from an abscess?
A.
An abscess (pus pocket) requires drainage.  Using antibiotics for an abscess is not sufficient.   Abscesses can occur in any number of places within the body.  I will specifically discuss treatment for skin abscesses.   In the office, I will numb up the area with lidocaine.  A scalpel is used to make an incision into the abscess.  The contents of the abscess are squeezed out.  Traditionally, skin abscesses have been packed with gauze, however, many surgeons have been moving away from this practice; I don’t generally pack abscesses.   Typically, if an abscess has been fully drained, there is no need for antibiotics.  I rarely prescribe antibiotics for an abscess. 


Q.
After a fall produced a ‘pop’ in my chest, I feel neck pain with movement and painful breathing. What could be the cause?
A.
With any symptom presentation, physicians need to consider both common causes and infrequent but often more serious causes. Most likely, you have injured your chest wall in some manner, with possibilities ranging from a minor bruise to a rib fracture. Treatment objectives would be to alleviate the pain with anti-inflammatory medication like ibuprofen and narcotic pain killers if needed. We have to also consider the possibility that you fractured a vertebrae. A referral to a spinal specialist might be needed. Another possibility is an issue with internal chest organs. Overall, an Urgent Care evaluation could put your mind at ease.


This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
 

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