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Troubles swallowing food or liquids – what does it mean?

Dysphagia refers to the sensation of food or liquid being delayed or hindered from the mouth to the stomach.  This abnormality is increasingly recognized as an important concern that requires attention and study.  There are many causes of impaired swallowing, which are categorized into two types, mechanical, a structural barrier to food bolus movement, and motility disorders, involving abnormal muscle movement.  There are also two major anatomical sites, oropharyngeal and esophageal. 
 
Oropharyngeal dysphagia is related to problems with the initiation of the swallows and clearing the food bolus from the mouth to the esophagus.  This usually occurs within a second of swallowing and you may feel that you cannot initiate a swallow or food hangs up in the neck region.  A test that is commonly used to evaluate this is a modified barium swallow or videofluoroscopic swallowing study.  This study provides critical information on inability or excessive delay in initiation of swallowing, unintentional inhalation of food, unintentional expulsion of food from the nose or mouth, and/or abnormal retention of food in the back of the throat after swallowing.  Most ...

January 25 essential tremor seminar

If you or someone you care about shakes a lot—it could be essential tremor (ET) or another movement disorder. Essential tremor is a disorder affecting approximately 10 million Americans. This progressive neurological condition can cause the hands, head, voice, legs or trunk of the body to shake and can cause significant disability. It is often confused with Parkinson’s disease or dystonia. Because of stereotypes and lack of awareness, many people with ET never seek medical care, though most would benefit from treatment.
 
In an upcoming event, Dr. Ryder Gwinn will explain the causes, diagnosis,  research and treatment options for essential tremor.
 
Date: Saturday, January 25
Time: Check-in 9:30am/Program 10am-Noon
Location: Bellevue Hilton, 300 112 Ave SE, Bellevue, WA
 
There is no charge for the event but please note, parking in the Bellevue Hilton lot is $5.

Registration is required - call 888-387-3667 or visit www.essentialtremor.org/seminars

 

 
 

How to treat PFS runner's knee

Patellofemoral pain constitutes a quarter of the injuries to the knee.  Kneecap pain can be both debilitating and frustrating; prolonged pain can limit physical activity and cause those suffering from it to abandon their recreational and sporting activities. 

Patellofemoral pain usually manifests as a gradual onset of pain around the edge or underneath the kneecap during physical activities.  Common activities such as descending hills or stairs, squatting, running, or sitting for long periods of time can all aggravate the pain and cause soreness. 

How your knee works

patellofemoral pain image from http://www.moveforwardpt.com/The knee joint is made up of three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap).  The patellofemoral joint refers to the kneecap and the groove (trochlea) in the femur in which the patella sits.  The four muscles of the quadriceps all attach to the patella.  The patella is a sesamoid bone (the bone is embedded within the tendon) and it plays a crucial role in the function of the leg by lengthening the lever arm of the muscles and tendons of the quad to maximize power and function and by acting as a shield to protect the knee from direct trauma.  The cartilage covering the kneecap within the knee joint acts as a shock absorber, protecting the underlying bone from stress.  With running and jumping, the knee (and its overlying cartilage) can experience forces up to 8 times bodyweight.  The cartilage itself does not have a nerve supply, but the bone underneath has an extensive nerve supply and these nerves become painful when the cartilage is not functioning properly to pad and protect the bone.

In patellofemoral syndrome, or PFS (also known as runner’s knee), the cartilage undersurface of the patella become angry, inflamed, irritated, and the kneecap hurts.

How to treat PFS or runner’s knee

  1. Loosen things up.  Use a foam roller to roll out the quad muscle and the illiotibial (IT) band.  These tissues all hook into the kneecap and can contribute to pain when they are tight.
     
  2. Make things stronger.   In the early recovery period (the first several weeks when you are just starting out on your recovery journey) ....

Gluten allergy: myth or fact?

Gluten is a hot topic these days, and is hitting the headlines again. Why? At the American College of Allergy, Asthma, and Immunology annual meeting, Dr. David Stukus (a pediatric allergist) set out to clarify frequent myths that he encounters in his practice.  So, why is he saying that gluten allergies do not exist?

Gluten is a protein found in foods processed from wheat and related grain products.  In celiac sprue (affecting up to 1% of adults), gluten intake leads to damage of the small intestine, impairing its ability to absorb nutrients.  I like to imagine that a healthy small intestine is like a shag carpet, and small intestine affected by active celiac sprue is more like a tile floor.  Celiac sprue is not a gluten allergy, but rather an autoimmune condition where the gluten is triggering an inflammatory response in the body.

Studies find that ...

What are the options when lung cancer is inoperable?

November is Lung Cancer Awareness Month and for those who have been diagnosed with lung cancer, one dreaded word is inoperable. Many feel defeated when they hear they are not candidates for surgery, but promising non-surgical treatments are available. CyberKnife, a form of stereotactic body radiation therapy (SBRT), is one of these options.

Radiation treatment to a moving target adds a level of complexity. However, CyberKnife tracks a tumor and directs targeted radiation via a state of the art robotic arm. Most patients complete their treatment in 3 to 5 days.

Highly focused radiation has become the standard of care for treating medically inoperable early stage non-small cell lung cancer with excellent results.

This video demonstrates the robotic real-time tracking of the CyberKnife.

Testosterone is associated with worse disease severity in men with early relapsing onset multiple sclerosis

MS and many other autoimmune diseases are less common in men than in women. This is especially true during reproductive years. Sex hormones, including testosterone and estrogen, may be responsible for the difference. It is thought that men with multiple sclerosis may have lower testosterone levels than healthy controls.

Dr. Bove and his group assessed the prevalence and clinical associations of hypogonadism in men with recent onset relapsing multiple sclerosis.  Male subjects from the Comprehensive Longitudinal Investigations of MS at the Brigham and Women's Hospital (CLIMB) cohort were included. Hormonal measures included testosterone, the testosterone: estradiol ratio, leutinizing hormone (LH), and free testosterone. Clinical outcomes were collected every 6 months for Expanded Disease Severity Scale (EDSS), and annually for Symbol Digit Modalities test (SDMT).

The analysis included 96 men with a mean age of 40 years, disease duration of 4.6 years; 71% subjects were untreated at baseline. Of these men, 39% were ...

Life-saving technology and getting the word out about radiosurgery

Twice last week I received phone calls from grateful family members thanking us for taking care of their loved ones when treatment options were dwindling. One patient is now 4 years past his CyberKnife treatment for inoperable lung cancer and is going strong and living life to the fullest. The other patient was recently treated and is feeling great and planning a European vacation. Both families are extremely appreciative for the care they received but both voiced frustration that they stumbled upon this treatment option by chance and that we need to do a better job of publicizing the radiosurgery modalities. As the person receiving these calls, I am thrilled to hear how our center has positively impacted so many lives but struggle with how to get the word out to those who may benefit from radiosurgery in the future. So with our patients’ stories fresh in my mind, here is an introduction to radiosurgery.

Stereotactic radiosurgery is targeted radiation therapy delivered to nearly any body part with precision while utilizing real time image guidance. The ....

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