Use Ibuprofen in caution post hernia surgery
DEAR DR. ROACH: My second inguinal hernia operation resulted in pain and a lot of blood in my groin area. I can understand why I was prescribed acetaminophen, but I am confused about ibuprofen. It’s a blood thinner, and I am not sure if my blood needed thinning, since there was plenty of blood in the groin and surrounding area.
– M.I. ANSWER: There are two systems that clot blood in the body: platelets and clotting factors. Reducing the effectiveness of either of these systems can reduce the likelihood of blood clots. Although medicines that affect either system can be called “blood thinners,” they don’t thin the blood at all.
Aspirin, clopidogrel, ticagrelor and a few others are antiplatelet agents. Aspirin is still used by some people for pain or inflammation and to prevent a heart attack, but it is well-known to increase bleeding risk, sometimes seriously enough that a person can’t take it. Nonsteroidal anti-inflammatory drugs like ibuprofen have much less of an effect on the platelets than aspirin does, but they still need to be used with caution in a person who has something wrong with their platelets or is postoperative.
In someone who is still having some oozing after surgery, or in someone where postoperative bleeding would be disastrous (like after brain surgery), anti-inflammatory medicines like ibuprofen or naproxen (despite their beneficial effects on pain and inflammation) should probably be held off until it is safe to restart them. Another option would be a special kind of anti-inflammatory drug called a COX-2 inhibitor, such as celecoxib, which is anti-pain and anti-inflammatory but doesn’t really affect the platelets at all.
Drugs that affect the clotting factors, like warfarin and apixaban, are also usually held off before and after major surgeries.
DEAR DR. ROACH: I am a 76-year-old male who suffers from severe osteoarthritis in my left knee. I am bone-on-bone and manage the pain with periodic cortisone injections and daily nonsteroidal anti-inflammatory drugs (NSAIDs).
Recently, I read an article that cautioned against cortisone injections, noting that short-term relief (three to four months) can be obtained, but the long-term use of cortisone injections actually speeds up deterioration and the need for a total knee replacement. Can you confirm this and whether alternative injections, such as hyaluronic acid or prolotherapy, have the same effects?
– D.A. ANSWER: I can absolutely confirm that regular steroid injections will damage the cartilage in the joint.
Hyaluronic acid does not damage cartilage, but the studies have only shown marginal improvement over placebo injections. They are also quite expensive, so I seldom recommend them.
Prolotherapy is an injection of irritants, such as dextrose, into the joint. Although some studies have shown benefit, most authorities, including the American College of Rheumatology and the Arthritis Foundation, recommend against its use. Still, there is little risk to this therapy, and it may be considered when there are no other good options.
I must emphasize that an injection in a person expecting benefits puts them at a high risk for a placebo effect, which is why studies are necessary to compare potential treatments against an injection of something inert, like saline.
Readers may email questions to: toyourgoodhealth@med.cornell.edu
BOSTON (AP) — Apparently, it’s pretty easy being green after all.
That was the takeaway from Tuesday’s physical examination of Myrtle, an ancient green sea turtle that has delighted visitors to the New England Aquarium in Boston for more than 50 years.
Veterinarians performed Myrtle’s checkup after the 500-pound reptile was hoisted from the aquarium’s Giant Ocean Tank in an enormous crate on a chain. Watching the humungous turtle elevated from the tank in a way that resembled the way a piano is lifted outside a building provided some of the aquarium patrons with an unexpected thrill.
Myrtle is thought to be up to 95 years old, which would place her just beyond the upper boundaries of the species’ longevity. But the big turtle is “in robust condition” despite her advanced age, said Mike O’Neill, manager of the ocean tank.
There’s every reason to believe Myrtle will stick around for years to come, O’Neill said.
“She is iconic,” O’Neill said. “One of the really special things we see is parents with their kids who say, ‘This is Myrtle, she has been here since when I was a kid.’ She has this multigenerational impact, which is really special.”
Giving the massive sea turtle a physical exam is no small feat, and it happens about twice per year.
First, a team of divers shepherded Myrtle into the underwater crate, which was lifted from the water by a winch. The process took place during open hours at the aquarium, and dozens of onlookers watched as Myrtle was brought to a deck for the exam.
Next, a team of veterinarians, vet techs and aquarists worked together to draw blood from Myrtle, check her flippers for range of motion and make sure her eyes, mouth and nose were in working order. Aquarium staff assured curious children that the turtle was in no danger – and that the veterinarians were trained professionals safe from her powerful jaws.
Myrtle then received an ultrasound, her weight was taken, and she returned to the ocean tank, O’Neill said. The turtle was back in the ocean tank munching on lettuce and cabbage by late morning on Tuesday.
Myrtle has been visited by about 50 million people over the decades and has gotten used to humans in that time. The aquarium’s website boasts that Myrtle, who arrived from another aquarium in 1970, “loves having her shell scratched.”
Green sea turtles are the second-largest species of sea turtle, and they live in tropical and subtropical oceans around the world. The International Union for Conservation of Nature lists them as endangered and decreasing in population.
Myrtle shares space with a pair of loggerhead sea turtles named Carolina and Retread who are about half her age and size.