Search for tag: "neurologic"

Interviewer: What's it mean if you have ringing in your ears? We're going to explore that next on The Scope.

Announcer: This is "From the Frontlines," with emergency room physician Dr. Troy Madsen on The Scope. On The Scope.

Interviewer: Dr. Troy Madsen's an emergency room physician at University of Utah Health. And from your perspective as emergency room physician, if somebody comes in and they've got ringing in the ears, what are your concerns?

Dr. Madsen: So ringing in the ears, it's kind of a tough thing because quite honestly, the large majority of the time people have ringing in the ears, we really don't have a great answer. Some people, for whatever reason, just for ears have had this, you know. Most cases I've seen of this is because of work they do, where they've been exposed to a lot of noise, and that's then led to this sort of chronic ringing in their ears just from this noise exposure they've had. And if you do a hearing test on them, and you have them try and hear high-pitched sounds, they absolutely cannot hear these things, just because that ringing is always there. They've just sort of gotten used to it over time.

Interviewer: Gotcha.

Dr. Madsen: If it's the sort of thing where, let's say, just all of a sudden, you start to develop some ringing in your ears, especially if it's just in one ear, you know, you always think about weird stuff like a little tumor, something like that that can sometimes cause some weird things like that. Don't want to scare you and make you, you know, immediately run to get an MRI because you're having some ringing in the ears. But it is the one thing I think about as a physician and if someone's having issues with that, sometimes we'll recommend they get an MRI to look for some sort of tumor there.

But beyond that, oftentimes, like I said, it's something work-related, where they've had a lot of noise exposure. Obviously, concerts, if you've been to that, you've experienced that ringing in your ear afterwards. And that's something that usually goes away within a day or two. But if you're continuing to have issues with it, if you have questions, typically, what I'll do in the ER is, you know, try and get them in to see an ear, nose, and throat doctor. And they can then do further assessment, look for any sorts of abnormalities in the ear, possibly do additional testing like an MRI if they think that's necessary, and then talk to them about where to go from there, what the prognosis is, what to expect.

Interviewer: So it sounds like that some ringing might be common for some people, not necessarily a concern. If it's just in one ear, it could be something weird. Is that a reason to go to the ER, or do you have time to probably go and see an ENT instead?

Dr. Madsen: I can't think of a whole lot of reasons where you would need to go to the ER for that. Maybe if it's associated with a lot of ear pain, certainly if there is drainage, then we could think, "Well, maybe there's an infection there, and you've got some ringing, just some issues associated with that." Something you could go to an urgent care for and they could get you on some antibiotics. But beyond that, I think it's the sort of thing where you could set up an appointment with an ear, nose, and throat doctor, get in there, they could do their assessment, and then take things from there.

Interviewer: So at least generally, in your world, what you're looking for is there an immediate threat to this person's life? Ringing in the ears is not one of those symptoms that you generally get too concerned about.

Dr. Madsen: It's really not. If I see someone that comes in the ER and that's all they have, honestly, there's just not a whole lot we can do in the ER. I'm going to look personally for other neurologic symptoms, if they're having weakness anywhere, difficulty speaking, difficulty with their vision, that changes things. But if it's just ringing in the ears, again, probably . . .

Interviewer: Go to an ENT.

Dr. Madsen: Yeah. You could see an ENT for or see your primary care doctor. They could do some testing, get you a referral if it's necessary.

Announcer: Want The Scope delivered straight to your inbox? Enter your email address at www.thescoperadio.com, and click "Sign me up" for updates of our latest episodes. The Scope radio is a production of University of Utah Health Sciences.

Announcer: Is it bad enough to go to the emergency room, or isn't it? You're listening to "ER or Not" on The Scope.

Interviewer: Time for another episode of "ER or Not." That's where we give you a situation and then our emergency room physician, Dr. Troy Madsen from University of Utah Health, tells us whether or not we should go to the ER or not. So play along at home.

Dr. Madsen, today's "ER or Not" is if a pencil punctures the skin. So however it happens, you accidentally sit on a pencil, somebody pokes you with a pencil, that pencil gets in and punctures your skin. ER or not?

Dr. Madsen: Well, this is one of those . . . I have to answer by kind of referencing probably something all of us have seen as children, and that is a pencil stuck in other kids. And I remember distinctly as a kid, growing up in elementary school, and I don't know how this happened, but some kid threw a sharp pencil across the room and flung it, and it stuck in another kid's forehead, just stuck there.

Interviewer: Oh, man!

Dr. Madsen: Yeah, that's one of those images that just does not leave your mind.

Interviewer: No, I don't suppose. No.

Dr. Madsen: And I remember that kid had, basically, a mark on his forehead for quite a while after that and actually had some of the lead in his forehead as well. And you could see that lead there for quite a long time.

Interviewer: Yeah, I did the same thing with my leg. I have lead that you can still kind of see the dark discoloration in my leg, but it's not really . . . And I think that's what freaks people out. They think, "Oh, lead, lead poisoning," but it's not really lead, is it? It's graphite, isn't it?

Dr. Madsen: It's graphite, exactly. And it's not lead that's going to cause lead poisoning.

Interviewer: Okay.

Dr. Madsen: So that's probably the biggest concern and that's probably why this question comes up because you could take, say, a pen or you could take something else and cut yourself, and you have a little cut there and you think to yourself, "Okay, that's fine. I'm going to put a little bit of antibiotic ointment on here. It's going to get better." But then, you throw in the whole lead thing and people think, "I'm going to get lead poisoning from this."

So, number one, yeah, it's graphite. It's not really lead in the sense we think of lead poisoning. And when you think of lead poisoning, you're talking typically about houses that have old lead paint so houses built anything prior to 1978. And there, you're talking about young kids who can then be kind of walking around, like toddlers, around near the ground putting stuff in their mouth. And for that, for these kids to really be at risk of lead poisoning, you're talking about exposure over a long period of time and really just kind of eating paint chips or getting stuff, dust in their mouth, things like that.

So even if this were lead that were concerning from a pencil, such a small amount, but again, it's not. This is more graphite. We're not talking about lead poisoning here so the lead itself is not a reason to go to the ER.

Interviewer: All right. So a lead pencil punctures the skin, probably not the ER. Treat it like any other wound unless it is, I suppose, really severe.

Dr. Madsen: Exactly. Treat it like you would anything else that stabs you. If you're having neurologic issues, if it affects a nerve, if it affects tendons, if it's deep where it's going to potentially affect anything internal. Anything beneath the surface, yeah, go to the ER, but otherwise, the lead itself is not something you should be concerned about.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: July 20, 2018
originally published: January 15, 2017

Interviewer: Going to find out what to expect when you go to the University of Utah orthopedic center concussion clinic. That's next on The Scope.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah's Health Sciences Radio.

Interviewer: Let's say something happened to somebody that led to a concussion, whether it's playing football or skiing and took a nasty fall, or maybe even an accident. I've gone to my primary care physician or it's pretty clear that I do have a concussion, and I make an appointment with the concussion clinic. What should I expect after walking in the door?

Dr. Hansen: You'll be evaluated by a specialist in traumatic brain injury. As far as what the evaluation entails it will include a comprehensive look at what types of symptoms you are experiencing, what were the circumstances of the injury, what other medical problems do you have that could contribute in some way to the symptoms you're experiencing. For example, if somebody has a chronic headache disorder already and then they have a head injury, that certainly can affect how they experience their headaches, for example.

We'll want to find out if they've had head injuries before and if so, how did they occur, what was the recovery pattern. Beyond that history gathering, we'll perform a physical examination that looks at a good balance assessment. We know that that is often affected after a head injury. A general neurologic examination which is typically normal. Then, an assessment of how your eyes and vestibular system are working together and maybe provoking or aggravating symptoms.

Those are the main components of our physical exam. Depending on the circumstances there may be other supplementary tests that we do. The ultimate goal is to document what might be aggravating symptoms, what maybe is not back to normal, because in the case of athletes or people who are wishing to return to sports, or otherwise potentially risky activities, it's really important to make sure that you're "100%" before going back out into harms way.

Interviewer: So a lot of basic tests, a lot of questions, some balance tests, but what about some sort of a brain scan?

Dr. Hansen: Brain scans typically aren't very revealing. If you have a severe injury and show acute signs or symptoms that there might be a more serious problem in the brain, people with those sorts of issues usually end up in the emergency room and those appropriate scans are done at that time.

Interviewer: So imaging is not something that you normally would do there at the concussion clinic.

Dr. Hansen: Not typically. Certainly if the story doesn't add up or we're concerned about something else, but I guess I would say that imaging tests don't diagnose a concussion.

Interviewer: What kind of questions should the patient be asking when they're in the clinic? Is there anything in particular they should be actively doing?

Dr. Hansen: If I could put myself in a patient's shoes or in a parent's shoes, and certainly I'm a parent, how do I know when it's safe to go back and play such and such a sport? Or if I'm having symptoms that aren't going away, what can we do about it? It's a tricky process to navigate.

One of the big things that we try to tackle in our clinic is providing adequate education into how to manage this, and adequate support they can then take back to their work environment, their school environment, their coach, or whatever so that they can educate them on what's the right things to do or not to do to help facilitate getting better.

Interviewer: What are some of the treatment options that you might give a patient after they've come in and you've done the diagnosis? You mentioned medications could be one.

Dr. Hansen: Most of medical management of concussion is geared towards symptom management. There's not a pill that cures a concussion. Medications have a role. There are times when the best medicine is just education and helping them understand the right balance between rest and activity, how to scale things back, and how to tailor their daily activities to facilitate recovery. Sometimes we'll get rehabilitative therapies involved, physical therapy if somebody is struggling with a lot of dizziness or vertigo, or even a lot of neck pain sometimes coincides with their concussion.

Interviewer: If I got a concussion it sounds like rest . . . is rest a big part of it? I guess what I'm saying is instead of coming in, why don't I just rest for a few days?

Dr. Hansen: Sometimes that is the trick. We know that about 50% of concussions will spontaneously get better on their own without doing anything particularly special. The important thing in those situations is just making sure that you're not getting back into harms way too soon.

There are however cases research would suggest probably in the ballpark of 20% of patients may still be having problems even a month out from their injury. Continuing to just rest and do nothing there gets to be a point of diminishing returns I guess I would say where that's not helpful and you need to figure out how to balance the right amount of rest with the right amount of activity.

Interviewer: Certainly somebody in that particular category is somebody that you would want to see, if a month has gone by and they've still got symptoms.

Dr. Hansen: Absolutely, yeah. Some guidelines would even argue that anything beyond two weeks may merit a specialist evaluation.

Interviewer: It sounds like if somebody has had no history of having concussions, and has received one, resting for a few days would be fine. They probably don't need to come into the clinic unless those symptoms persist.

Dr. Hansen: Yeah, they probably don't need to come into necessarily our clinic, but it is super important to check in with a healthcare provider.

Announcer: The ScopeRadio.com is the University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.