Laboratory MedNews

By: Arvie Vitente, MPH, PTRP

Have you already experienced frequent cramping pain on your muscles mostly at the upper back area? That even with enough rest and massage the pain still persists? Maybe you are suffering from myofascial syndrome. Myofascial syndrome is included in the long list of chronic musculoskeletal pain disorder. In myofascial syndrome, there are palpable nodules in the muscles that are called the trigger points that cause pain upon application of pressure on them. This could also be felt in other parts of the body.

Causes of Myofascial Syndrome

Myofascial syndrome classically occurs among individuals with chronic faulty posture in which the muscles are contracting repetitively resulting initially to simple muscle soreness, then later on to a bothersome condition, which is the condition myofascial syndrome.

Clinically, the exact cause of myofascial syndrome is still not known. There is a theory associating it to connective tissue diseases but this is much generalized. Other theories state that this could be due to accumulation of lactic acid in muscles among individuals with jobs or other activities that require repetitive motions like in carpentry, typist, among others.

Another probable cause of myofascial syndrome are stress-related conditions. Individuals working in the academe are particularly prone to myofascial syndrome since aside from their true job, which is to prepare lessons and deliver these in their classes, they still have other school-related responsibilities which come with great pressure that would in turn result to muscle tension. Likewise, bank managers, typists and bus drivers are also prone to myofascial syndrome.

Difference between Myofascial Syndrome and Fibromyalgia

Myofascial syndrome and fibromyalgia both affect skeletal muscles but the difference is that, myofascial syndrome affects muscles on one side of the body that radiates on other parts, which include the neck and shoulder areas, while fibromyalgia affects muscles on a broader distribution.

Red Flags of Myofascial Syndrome

The signs and symptoms of myofascial syndrome may include deep, aching and cramping in the muscles involved. The description of pain in myofascial syndrome is usually pain that persists and is aggravating. The pain is elicited by applying pressure on the muscles affected which are called the trigger points. Patients with myofascial syndrome mostly complain of having a hard time to sleep primarily because of pain. If these symptoms are present, make an appointment with your doctor.

Treatment

Mostly, patients with myofascial syndrome are advised to undergo physical therapy and trigger point injections. Oral analgesics and relaxation techniques are also included in the treatment options.

Headache is probably the most common of all migraine symptoms. The question is, how will you be able to determine that what you are experiencing is really migraine? How are going to identify a migraine as compared to all other causes of headache?

Knowing the other associated migraine symptoms would help you differentiate migraine from headache caused by tension headache, sinusitis or cluster headache. If you are diagnosed with migraine, it is helpful to be familiar with such migraine symptoms so that you will be able to provide immediate care to decrease the pain that you are experiencing. Some migraines have auras, which are described as visual, olfactory or auditory perceptions that occur prior to a migraine attack. To be exact, auras may be experienced for 10-15 minutes before the occurrence of the actual migraine attack. Those who experience these auras describe them as flashes of light or visions of zigzag lines.

However, not all people who have migraine experience the auras mentioned above. In the absence of an aura, it is more integral to be familiarized with the different migraine symptoms. You will know if you are having a migraine if you experience any of the following:

• Usually, one-sided headache. Although pain of both sides can also occur, this is less frequent than one-sided pain.

• Throbbing type of pain. Intensity of this type of pain may range from moderate to severe. For most cases, the person will not be able to continue with his physical activity due to this debilitating intensity of pain.

• Nausea or vomiting. Among the migraine symptoms, this is one of the most classic complaints of patients. They will say that the headache is accompanied by nausea and most patients say that they feel some degree of relief after they vomit.

• Increased sensitivity to light, odors or noise.  The patient gets more easily irritated by these stimuli. That is why a person who suffers from migraine will prefer to rest on a dark and quiet place.

• Other less common associated migraine symptoms such as pain near the eye, loss of appetite, blurred vision and dizziness

Remember, migraine is different from the other types of headache. These migraine symptoms described above are not commonly experienced by patients experiencing the other types of headache. Thus, you will be able to identify the difference. Now you would know, if it’s truly a migraine.

Delayed Onset Muscle Soreness or DOMS is described as muscle pain that occurs 12-48 hours after the muscles were subjected to vigorous exercise. It can be more frequently experienced when you exercise at a particular intensity that the body is not yet used to, like when you initiate a new exercise regimen or when you progress your usual exercise to a heightened intensity or duration.

The reason why you experience DOMS is because of microscopic tearing of the smaller components of your muscles called muscle fibers. Aside from the tearing, swelling can also occur at the muscle fibers, causing you to experience muscle pain. Studies say that the greater the intensity of exercise, the greater will the microscopic tearing be, and so it also follows that the soreness of the muscles will be of a greater extent. There are studies that further say that eccentric or lengthening contractions of muscles are more likely to cause DOMS. Examples of activities that require eccentric muscle contractions are slowly lowering of weights after you have lifted it and the downward motion that you perform during squats and push-ups.

Although DOMS can largely cause discomfort, rest assured that it is a normal phenomenon. It is actually expected that when you subject the muscles to strenuous exercise, DOMS will eventually occur in a few days. However, there are measures that you can do to prevent the occurrence of DOMS. To avoid the discomfort of having that dull, aching type of pain days after you exercise, follow these three important measures:

• Include a warm-up exercise for at least 10-15 minutes before your actual exercise regimen.

Gentle stretching of your muscles prior to your high intensity exercise can lower the tendency for you to experience DOMS. When you stretch prior to exercise, the muscles get more prepared for the actual exercise regimen.

• Perform a cool-down exercise for at least 10-15 minutes after the actual exercise regimen.

Having a cool-down exercise after vigorous exercise, rather than suddenly stopping, can help in preventing the occurrence of DOMS. Cool-down can be in a form of gentle stretching or low-intensity activities such as walking or marching in place.

• Progress your exercise gradually, not drastically.

With regards to progression of exercise, follow the ten percent rule. Progress the duration or intensity of your exercise only by ten percent a week. Also, be aware not to make sudden changes to your exercise regimen.

Most lifestyles today are full of deadlines, hectic schedules or quotas. That is why stress is a common experience for most of us today. The fact that some people consider stress as a natural thing is not a good idea. This is because, people might not be aware of how much stress is creeping into their systems and affecting their health. When stress becomes chronic without you doing anything about it, it may greatly affect your mental, physical and social health. This is why; stress relievers must be learned by you before stress takes its toll on your body.

Studies say that a large percentage of primary care consultation to physicians is due to stress-related issues. Come to think of it, these medical consultations could have been minimized if people know how to deal with stress on their own. If you think you are stressed now, you should learn some techniques that are known to be effective stress relievers. Do not let stress damage your health and well-being. You should do something about it now!

Find time to exit from the pressures of your daily routine. Try these different stress relievers and save yourself from the long-term adverse effects of stress.

• Studies reveal that quiet reflection is one of the most effective stress relievers. This is done by stopping for a while, despite how fast paced the day is, and just think of thoughts that will be relaxing to you. It may be in a form of imagination of a serene place or reminiscing on a favorite memory. Studies further say that doing this for 10-20 minutes is the most effective duration that will help you relieve your stress.

• Make a to-do list in chronological order based on the weight of priority of the tasks. To-do lists are also very effective stress relievers. Not only will they help you organize the things that you have to do, they will also decrease your tendency to mind-race. After you have listed the things that you should do in a day, cut your list into half. This means that you need only to do the “top priority tasks” in a span of one day.

• Have a regular exercise regimen. Exercise helps your body to release the happy hormones called endorphins. These hormones are proven by many studies to reduce stress. In addition to this, endorphins cause a positive or euphoric feeling in the body that can help you have a renewed feeling of energy that will help you cope with the daily hassles that you will encounter.

The world you live in has continuous demands from you. Whether you are working or you are still in school, the stressors come in different ways. Although stress may be good, too much of it can also be a bad sign. Thus, it is recommended that you at least minimize them. The best way to reduce the stress in your life is to be aware of their common sources.

Interpersonal Relationships

Maintaining a good interpersonal relationship with the significant people around you entails effort and time. The key in keeping the harmony with your family and friends is an open line of communication. Generally, simple misunderstandings can lead to big arguments if you do not communicate well.

Life Adjustment

If your body is accustomed to your daily routine, changing your regular schedule can cause significant stress in your life. If you have been used in working, enjoying financial abundance, and physical wellness, a sudden change in these situations can put pressure to you. Loss of employment, economic crisis and illness require life adjustment. If you are not ready for these and you lose support from your family, you might end up feeling depressed.

Because changes are constant in life, you need to be ready for them. The best way to prepare for the adverse situations is by keeping an intact interpersonal relationship with others

Exercises for pregnant women have been proven to be beneficial to in preparing a woman’s body for child birth and childcare. For those women who have been physically active prior to being pregnant, you might be wondering if there are still exercises that you can do even during this time that you are pregnant.

However, there might be a lot of hesitations with regards to the safety of performing exercises for pregnant women. There might be a lot of questions that will run on a pregnant woman’s mind. Is this exercise not harmful for my baby? How do I know the intensity and frequency of exercise? What would be the benefits of this exercise?

First of all, it is important to consider if your pregnancy is an uncomplicated one. Your willingness to participate in exercises for pregnant women may be consulted to your obstetrician-gynecologist during your regular prenatal check-ups. Some women, especially those who are experiencing a threatened abortion are contraindicated for exercise. Thus, a clearance from your doctor should be acquired first.

The benefits that you can obtain from exercises for pregnant women are:

1.      Increased strength of the pelvic floor muscles

- This is good for you because the pelvic floor muscles support the contents of the abdominal cavity

-When these muscles are strong, there would be better support for the growing baby on your womb.

-Studies say that when pelvic floor muscles are toned, it also increases sexual pleasure for both the woman and her partner.

2.      Awareness of contraction and relaxation of the pelvic floor muscles

-          This would be beneficial, especially for first time moms, because they might not yet be aware of the feeling of contraction and relaxation of the pelvic floor muscles.

-          Being able to control contraction and relaxation of the pelvic floor muscles can help you have ease during delivery.

3.      Increased strength of the abdominal muscles

-          Abdominal muscles are overstretched during pregnancy, and thus, they have the tendency to weaken.

-          Strengthening your abdominal muscles reduces strain on your back and helps you to avoid back pain, which is a common complaint during pregnancy.

4.      Increased strength and flexibility of upper extremity muscles

-          This is good for you because it prepares you for the increased physical demands that you have to meet during child care.

For you to determine the procedures, intensity and duration of the exercises for pregnant women, it is advised to seek for the expertise of a physical therapist. These professionals may give you advice on the right parameters of exercises for you.

As you now know that there would be a great deal of benefits that you will get by performing exercises for pregnant women, also keep in mind two things: compliance & safety. First, compliance is important for an exercise to be effective. Second, do not overdo whatever among the exercises for pregnant women that you perform, because two much stress on your body might increase uterine contractions and that might be harmful for you and your baby.

ADHD
Image Credit: Tiyok

It is important for parents and teachers to learn about ways in coping with ADHD. It is a fact that ADHD can hinder the maximum learning potential of a child in school. This is of great concern to those parties who are interested in the child’s education, which would be mostly the child’s parents and teachers.

It would be a great deal of waste if the child is by nature intelligent, and could have achieved much, but because of his inability to focus and impulsivity (brought about by having ADHD), he would not be able to develop his maximum potential.

Thus, these tips on coping with ADHD would be really valuable to be able to improve the ability of the child to grasp his lessons in school even amidst ADHD.

Behavior modification is one of the most effective strategies in coping with ADHD. The following techniques of coping with ADHD are all behavior modification strategies:

1.      Use of reward & consequence

-          Educators can swear for the effectiveness of the use of positive or negative consequences  either to reinforce positive behavior or to correct negative behavior.

-          For example, a child can be given verbal praises when he was able to accomplish a given task.  On the other hand, he can be given reprimands or simple punishments for not remaining on his seat during classroom discussion.

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2.      Repetition when giving instructions

-          This strategy on coping with ADHD is especially effective for children that get low scores on exams not because of not knowing the answer, but because of not following exam instructions. Even with difficulty in focusing on something, a child can find it easier to follow instructions when it is repeated by the teacher for several times.

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3.      Providing frequent verbal feedback

-          Attention span is frequently shorter on a child with ADHD, that is why when given a task, it is helpful to prompt the child with frequent verbal feedback to make sure that the child is able to follow through the instruction of the task. Verbal feedback can also be used in motivating the child to finish a task when the teacher observes that the child seems to be losing his interest or attention towards the task.

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4.      Use of routines

-          This is another strategy of coping with ADHD that addresses a child’s carelessness with regards to details of everyday activities. Forgetfulness about simple details is one common problem of children with ADHD. If a routine is practiced daily, the child has a lesser tendency to forget small details regarding everyday tasks.

5.      Teach the child to organize his things

-          Children with ADHD have the tendency to lose things such as school supplies or even toys. Organizing his things into how they are placed in his room decreases the tendency for the child to forget where his things are.

6.      Use planners, lists, written reminders or posted notes

-          Planners can help in organizing the schedule of upcoming activities like assignments or tests. This can improve the child’s anticipation and preparation for such activities. Lists, written reminders and posted notes can help the child to be always “on track” of the tasks that he has to accomplish.

7.      Breaking down long, complicated tasks into a series or short, simple tasks

-          A child with ADHD will usually get easily exhausted with longer tasks. If the task is broken down into a series of small tasks, each small task accomplished can give a sense of achievement to the child and thus, will increase the child’s eagerness to accomplish the task.

It is a rule of thumb in special education that “no two children are alike”. These strategies in coping with ADHD may be effective for one but may not work for the other. However, the above mentioned techniques in coping with ADHD may be tried by parents because these techniques has been tried and proven to increase the ability of a child to focus on school lessons and activities.

What is Polycystic Ovary Syndrome?

Many women are now familiar with polycystic ovary syndrome because it is a common diagnosis in women, especially for those who are already in the reproductive age. The diagnosis of polycystic ovary syndrome is of great concern to females who are married and planning to have a child. This is because the condition is almost always connected to infertility. What is polycystic ovary syndrome? How do you know that you have it?

Polycystic ovary syndrome, more commonly known by its acronym PCOS, is a condition wherein there is a development of multiple ovarian cysts in females. These ovarian cysts are connected to the hormonal changes that occur to a woman’s reproductive system on the different phases of the menstrual cycle. Normally, the ovarian cysts may resolve by themselves and go away. But for the case of PCOS, the ovarian cysts remain.

This condition is very much about the hormonal system of the body. When we talk about polycystic ovary syndrome, the most commonly mentioned hormones are: insulin and male hormones such as testosterone. It is said that the cause of PCOS is the body’s resistance to insulin, which is a hormone that controls blood sugar levels. Because of insulin resistance, the body secretes comparably high amounts of insulin, and when the body secretes high amounts of insulin, the ovaries also secrete high amounts of testosterone. Normally, the male hormone testosterone is also present in the female’s body but only in small amounts. In polycystic ovary syndrome, testosterone is present in higher amounts.

The manifestations of polycystic ovary syndrome are very much explained by the presence of higher amounts of male hormones:

1.      Irregularities in menstruation

-may be in the form of amenorrhea (absence of menstruation), oligomenorrhea (fewer menstrual flow) or very irregular menstrual cycles

- This poses the greatest threat to a woman’s fertility, because women with PCOS have irregular menstruation owing to the fact that they do not ovulate every month

2.    Acne

3.    Excessive hair growth

4.    Obesity

Polycystic ovary syndrome can be treated by addressing the problem of insulin resistance. Pharmacological management includes prescribing medicines such as metformin, which can address the body’s problem with insulin. In addition to this,  anti-androgen medications are also prescribed to address the irregularities in menstruation. These anti-androgen medications also can decrease skin problems caused by PCOs such as acne. However, non-pharmacological intervention can also help such as regular exercise and diet modification.

Parents of children with autism might be wondering what the experts say regarding the reasons why their children act in a particular, exceptional way. What is behind the typical head banging or the hand flapping? Why do they appear to be socially withdrawn? What are the explanations behind their other manifestations?

It was found through research that the brains of children with autism are not “wired” the same way as those with the regular kids’ brain. The world is perceived by an individual based on the way his brain interprets the different sensory stimuli. Everything that a person sees, hears, smells, tastes or feels are recognized and interpreted by the brain. However, for children with autism, the brain interprets the world in a different way. For example, sounds that are not too loud for the regular person may be perceived as irritatingly loud for someone with autism. This phenomenon is known as sensory integration disorder.

Sensory integration disorder may explain a lot why children with autism act in very unusual ways. These are some of the most common stereotypical behavior observed in children with autism:

1.      Children with autism have routine preferences. They might have a preference for a specific type of food or clothing.  This is because only this particular type is acceptable by  their sensation. Children with autism may be very particular with textures of food and clothing that is introduced to them. They can easily detect even the slightest difference to their preferred texture.

2.      Children with autism usually manifests hand flapping, head banging or the need to jump in place. It is explained that the child does this because he is “wanting to feel the sensation of movement and position”.

3.      Children with autism often throws tantrums. It may be because what is moderate or modulated by a regular person may be very irritating to these children. There can be a lot of ordinary visual or auditory stimulations in the environment that can already be very annoying to children with autism.

Aside from sensory integration disorder, autism is also characterized by impairments in speech, which can be an additional frustration to the child. The child may have difficulty in expressing what he wants to other people. Some children with autism may have delayed speech development or worse, others may even remain non-verbal. Another thing, these children also have impairments in social skills. Thus, they can also be very socially withdrawn.

Children with autism can actually act in very unusual ways. But knowing that there are reasons behind their atypical behavior, makes a parent or teacher more understanding and patient, even when already frustrated.

Signs to help you draw the line between having a child that is naturally active and having a child who has ADHD. ADHD, also known as attention – deficit hyperactivity disorder, is a disorder that is common in school-aged children, and characterized by the triad of inattention, hyperactivity or impulsivity. A child who has ADHD need not manifest all three symptoms. In fact, ADHD is divided into three subtypes depending on which of the triad predominantly manifests in the child.

The subtypes of ADHD are the following:

1. ADHD Predominantly Inattentive
2. ADHD Predominantly Hyperactive Impulsive
3. ADHD Predominantly Combined

One thing that may be of great concern to a parent is that manifestations of ADHD can affect a child’s social functioning and academic performance. Often, it is the school teacher who first suspects that a child has ADHD.

The school teacher will most likely inform the parent with regards to the observed signs of ADHD. However, a lot of children who has ADHD are within a regular classroom setting, and most teachers in the regular classroom setting do not have special training with regards to detecting signs of children with special needs, in particular, children with ADHD. Thus, it will also be helpful to a parent to know such signs and symptoms to be able to have an idea if the child has ADHD.

Based on the DSM-IV Diagnostic Criteria for ADHD established by psychiatry experts, the following are “red flags” that can make a parent suspect that his or her child has ADHD:

• For the predominantly inattentive type:

1.      Child has poor attention span

(a child with less than 10 minutes focus to a particular task is said to have poor attention span)

2.      Child is very forgetful with details

3.      Child often complains of losing his things (like school supplies, toys, etc.)

4.      Child has problems with following instructions, as observed when answering exams or when child is instructed a particular chore (take note that inability to follow instructions is not because of inability to understand the instructions)

5.      Child often commits mistakes on school exams because of carelessness

6.      Child has difficulty in organizing things

7.      Child is unwilling to participate on tasks that require prolonged mental effort

• For the predominantly hyperactive – impulsive type:

1.      Child is excessively talkative

2.      Child seems never to run out of energy

3.      Child seems to always move about

4.      Child has difficulty to comply when asked to behave

5.      Child has cannot remain on his seat for long periods of time

6.      Child loves to butt into other people’s conversations

7.      Child butts into someone who is talking (answers questions before someone has finished asking)

8.      Child has trouble with taking turns

• A combination of the above signs and symptoms characterizes that a child who has ADHD is categorized in the predominantly combined subtype.

Parents, in collaboration with school teachers, must be watchful of these enumerated “red flags” in identifying if a child has ADHD. Although issues have been raised with regards to the effect of labeling a child with “having ADHD”, special educational needs might be met if we can identify that a child has ADHD. If a parent or concerned school teacher has suspicions that a child has ADHD, the professional that can best help with making a specific diagnosis is a developmental pediatrician.

(For more detailed readings on the DSM-IV criteria for ADHD, the complete criteria may be read on any psychology or psychiatry book)

This video was uploaded by Johnson and Johnson, which is about child ADHD.