Diplomate, Board Certification of Emergency Medicine
Wire service articles about medical issues can be
problematic. These articles generally look at one trial, and
ask one or two various experts to comment. Invariably the
response is positive and a miracle drug or procedure is
unfolding. It just doesn't work that way, my friends.
One article I saw concerns a new technique for knee
replacement that has a rapid recovery time. Perhaps this is a
good procedure and an improvement over the previous ones, but
it is done by only a few practitioners and it has not been
studied for safety or effectiveness in controlled trials.
A second article speaks about the benefits of low cholesterol
-- I do agree with this, but the studies involved were all
biased by makers of the cholesterol- lowering drugs and this
taints their conclusions. The people who were asked for
comment were also from the drug companies. We need better
research before we jump on the bandwagon.
Let's speak about another subject -- anal fissure -- a common
cause of pain when defecating, especially after childbirth.
This is caused by a fissure, that is a laceration of the
sphincter, which causes spasm when using the bathroom and
intense pain. Surgery is very effective, but can cause
incontinence -- a worrisome side effect. Many creams exist,
but their effectiveness is much lower; although still better
than placebo, and they often cause severe headaches. These
are the same creams recommended for hemorrhoids. There also
the effectiveness level is low. Most probably, an
antispasmodic that does not cause headache would be
effective, and they are working on this.
As in hemorrhoids, the best bet is always prevention, that is
avoiding straining and eating plenty of fiber, fruits and
vegetables. People eating institutional diets -- such as
those in yeshivas, old age homes or other dorms -- have a
predominance of this problem. Warm baths seem to help,
especially if used with magnesium (Epsom salts). Hemorrhoids
and fissures can both bleed, but this is usually self-
limited. Write me in care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Do not forget Lamactil, one the most effective
anti-seizure medications. Its failure rate is low, and it can
restore a patient to a normal life.
