What is an Anesthesiologist?

What is an anesthesiologist? What training is involved?
An anesthesiologist is a doctor (MD or DO) who practices anesthesia. Anesthesiologists are physicians specializing in perioperative care, development of an anesthetic plan, and the administration of anesthetics. He or she has finished college, then medical school (four years), then an internship (one year) followed by a residency in anesthesia (three years). Some anesthesiologists pursue additional years of training (a fellowship).

Who are the HSS anesthesiologists?
Please see our staff listing.
Most of the HSS anesthesiologists have completed fellowship in fields such as regional anesthesia, pediatric anesthesia, critical care medicine, cardiothoracic anesthesia, chronic pain, and anesthesia research.

What do anesthesiologists do?
This may involve general anesthesia (“putting the patient to sleep”), sedation (intravenous medications to make the patient calm and/or unaware) or regional anesthesia (injections of local anesthetic near nerves to “numb up” the part of the body being operated on (i.e. nerve blocks or spinal/epidural injections)).
Many types of orthopedic operations are well suited to regional anesthesia, most often with sedation as well. HSS specializes in regional anesthesia.
Administration of anesthesia involves first talking with the patient to establish a plan for the anesthesia, as well as making sure that the patient is ready for the operation. The first priority is getting the patient safely through the procedure. If the patient is sick and could be made healthier, then the operation may be postponed or canceled (to allow “optimization” of the patient’s medical condition). This reduces the potential risk to which a patient may be exposed.
In addition to getting through the operation safely, the anesthesiologist tries to reduce pain after the operation. This may involve intravenous pain medications, but in many cases at HSS pain relief will involve placing local anesthetic near nerves.
At HSS, the anesthesiologists also run the recovery room (providing care for patients immediately after the surgery), see patients on the Acute Pain Service (so as to help manage the postoperative pain) and we also manage very ill patients who require critical care. Some anesthesiologists at HSS practice chronic pain management. Some HSS anesthesiologists also act as administrators for the Hospital and/or the Anesthesiology Department.

Why should you, as a patient, care about anesthesia?
Your anesthesiologist allows you to undergo surgery safely and comfortably. Anesthesiologists use specialized techniques during surgery to accomplish this. For example, the method of controlled lowering of the blood pressure during hip surgery reduces bleeding and the need for transfusions.
Good pain management is obviously desirable from the patients’ perspective. Good pain management also helps patients perform physical therapy and leads to better surgical outcomes after many orthopedic procedures. Good pain management may reduce the rate of heart attacks and other postoperative complications.

Can’t the anesthesiologist just do the injection (or put the patient to sleep) and then leave?
No. That would be unsafe. The anesthesiologist, or someone working with him or her (a resident, a fellow, or a nurse anesthetist) must remain with the patient. This is needed so that the patient status can be monitored (heart rate, blood pressure, breathing, level of awareness during sedation), and changes made as needed (so as to prevent or manage major problems that could arise during the surgery).

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Sciatica Nerve Pain Symptoms - Part2

Symptoms of a Herniated Disc/Pinched Nerve:
Usually, a person’s main complaint is back pain. In some cases, there is also a previous history of episodes of localized lower back pain, that is present within the back and continues down the leg that's served by the affected nerve. This pain is typically described as a deep and sharp pain, that gets worse because it moves down the affected leg. The onset of pain with a herniated disc might occur out of the blue or it should be proclaimed by a tearing or snapping sensation within the spine that's thought to be the results of a unexpected tear of a part of the annulus fibrosis.

A person with a herniated disc can usually complain of lower back pain that will or might not radiate into totally different components of the body. they're going to typically have restricted vary of motion once asked to bend forward or lean backward, and that they might lean to at least one side as they try to bend forward. Sometimes, they walk with a painful gait, flexing the affected leg thus as to not place too much weight on the facet of the body that hurts.

Diagnosis of Herniated Disc/Pinched Nerve:
A neurologic history and examination performed by a trained physician can provide the foremost objective proof of a rupture and pinched nerve. There are not any laboratory tests which will sight the presence or absence of a rupture, however they'll be useful in diagnosis uncommon causes of nerve root pain and irritation. EMG (electromyographic test) could facilitate to work out that nerve root specifically is being pinched or isn't operating ordinarily within the scenario wherever many nerve roots is also concerned. MRI is that the take a look at of alternative for diagnosis a herniated disc.

Treatment for Herniated Disc/Pinched Nerve:

The treatment for the vast majority of individuals with a herniated disc doesn't commonly embody surgery. several patients can respond to non-surgical treatments. the first component of non-surgical treatment is controlled physical activity. Usually, treatment can begin with avoidance of intensifying activities followed by a gradual come to traditional activities. Sitting is dangerous for this condition as a result of the sitting posture puts a large quantity of stress and pressure on the lumbar spine, which can increase the pressure on the affected nerve root. the suitable use of medicines is a very important a part of non-surgical treatment. this will embody anti-inflammatory drug medicine, analgesics, muscle relaxants, or tranquilizers. in addition, the proper doses of acetylsalicylic acid are tried to assist herniated discs. physiotherapy is additionally necessary.

Surgical treatment and chronic pain therapies are reserved for people that haven't had success with non-surgical treatment choices and a enough amount of your time has passed to point that they'll ought to have surgery so as to assist them to induce higher.

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Sciatica Nerve Pain Symptoms - Part1

About Sciatica:
Sciatica is a symptom not so much condition. It refers to pain that begins within the hip and buttocks and continues all the manner down the leg. This symptom is usually among low back pain, which might be a lot of or less severe than the leg pain. The term sciatica indicates that the sciatic nerve, that travels from the lower back through the buttocks and into the leg, is believed to be the explanation for the pain during this condition.
True sciatica happens when a herniated disc or osteoarthritic bone spurs compress and pinch one amongst the conducive roots of the sciatic nerve. this can be referred to as a pinched nerve. this kind of lower back pain is less common than different causes and conditions that produce back pain. for example, sporting activities, recreational activities, and significant labor will cause back and leg pain, that is usually misdiagnosed as sciatica. The challenge for a physician is to differentiate between radicular pain (also referred to as radiculopathy), that is caused by an inflamed nerve root, and referred pain, that may be a results of a musculoskeletal sprain or strain.

About Radiculopathy:
Doctors use the term radiculopathy to specifically describe pain, and other symptoms like symptom, tingling, and weakness in your arms or legs that are caused by a tangle together with your nerve roots. The nerve roots are branches of the spinal cord that carry signals to the remainder of the body at every level on the spine. This term comes from a mix of the Latin words radix, which suggests "roots of a tree", and pathos, which suggests "disease."

This malady is usually caused by direct pressure from a herniated disc or chronic changes within the lumbar spine that cause irritation and inflammation of the nerve roots. Radiculopathy typically creates a pattern of pain and symptom that's felt in your arms or your legs within the area of skin supplied the by sensory fibers of the nerve root, and weakness within the muscles that are supplied by an equivalent nerve root. the number of roots that are concerned will vary, from one to many, and it may also have an effect on each side of the body at an equivalent time.

About Herniated Disc:
Herniation describes an abnormality of the intervertebral disc that's additionally called a "bulging," "ruptured," or "torn" disc. This process occurs once the inner core (nucleus pulposus) of the intervertebral disc bulges out through the outer layer of ligaments that surround the disc (annulus fibrosis). This tear within the annulus pathology causes pain within the back at the purpose of rupture. If the projected disc presses on a spinal nerve, the pain might unfold to the area of the body that's served by that nerve. Between every vertebra within the spine could be a pair of spinal nerves, that branch faraway from the spinal cord to a specific area within the body. Any a part of the skin that may expertise hot and cold, pain or bit, refers that sensation to the brain through one among these nerves. In turn, pressure on a nerve from a rupture can cause pain within the a part of the body that's served by that nerve. Most disc ruptures occur once an individual is in their 30s or 40s once the nucleus pulposus continues to be a gelatin-like substance.

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Some other therapy for sciatica

Physical therapy is commonly prescribed for neuralgia.

• Someone might receive special directions from a doctor on dealing with back pain. Some recommend complete bed rest (getting up solely to go to the bathroom). Others recommend sleeping on the ground or putting a board below the mattress for support. Some can advocate using heat, others cold. 

• One may additionally get info with pictures of back exercises and stretches one is anticipated to start out once the pain improves. (These patient education sheets come back from totally different sources and will have conflicting info.)

• Current analysis recommends staying active, within limits imposed by one's pain. try and occupy work if doable. If the pain forces somebody to rest, do so, however avoid staying in bed simply because of the back pain.

• If somebody isn't up once every week or ten days, speak with a doctor concerning alternative therapies. several people get some relief by visiting physical therapists, osteopaths, and chiropractors. Others realize that relaxation techniques and acupuncture work for them.

• Epidural injections, that are injections of a steroid (commonly referred to as corticosteroid or prednisone) into the spine, are typically performed for persistent sciatica.

• Studies have shown that exercise therapy is useful to treat back pain that persists for more than a number of weeks. sensible exercises for sciatica include walking, yoga, Pilates, and alternative specialized exercise programs.

• Recent studies in Europe and specialised show that injection of botulinum toxin (Botox) offers relief to several people stricken by long sciatica. There are, thus far, not enough cases or completed studies to form this over an experimental procedure.

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Sciatica Home Remedies for Pain Relief

Pain from sciatica typically limits one's activities. Here are some home treatments for sciatica:

• Do not bend, lift, or sit in a soft, low chair; the pain can get worse.

• Unless somebody is allergic or mustn't take them for different reasons (if somebody takes a blood thinner like coumadin, for example), over-the-counter pain medicines like analgesic (Tylenol), aspirin (Bufferin or bayer Aspirin), or other (Advil, Motrin IB) can most likely facilitate ease the pain.

• Try a cold pack to see if it helps the pain. If somebody does not have a cold pack, use a large bag of frozen vegetables; it makes a good first aid cold pack. Or have somebody massage the sore areas in a exceedingly|in a very} triangular pattern with an ice cube. The person ought to move the ice cube if the skin gets too cold (this could melt many ice cubes).

• After the cold massages, try alternating with heat from an electrical heating pad to envision if it helps the pain. (Do stay awake with a heating pad on the back. It may cause a nasty burn.)

• If somebody does not have an electrical heating pad, place a face towel underneath hot water, wring it out, and place it on the back. Some physiotherapy consultants believe that moist heat penetrates a lot of deeply and provides higher relief of pain. (Do not use wet packs with an electrical heating pad as a result of electrical shock could result.)

• The affected individual could feel higher lying on his or her back on a firm surface with a pillow underneath his or her knees. another choice is lying on one's aspect with a pillow between the knees to stay the back straight. Also, one may notice that a recliner chair is useful.

• Take it easy, however don't consist bed for extended than two days as a result of this has been shown to really worsen the condition. Do activities one is in a position to tolerate, and don't expect to feel higher long. If somebody is stricken by neuralgy, the doctor can virtually actually dictate or provide medication for the pain. If the pain is severe, the affected individual might have robust medication like a narcotic (Codeine, Vicodin, morphine) for relief.

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