Themadag NVTH Werkgroep Hemostase Diagnostiek 24 Maart 2011 De jaarlijkse Themadag vond dit jaar plaats in het AMC te Amsterdam en had als thema‘Trombocyten’. Er waren 33 deelnemers afkomstig van 15 instellingen. Als gastsprekers waren aanwezig Prof. Dr. Flip de Groot (UMCU), Dr. Thomas Bergmeijer (St. Antonius Ziekenhuis Nieuwegein) en Dr. Bert Verbruggen (ECAT). Als inleiding op het onde
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EsiIf you are taking Aspirin (or like products, see last page) you should stop it 7 days prior to this procedure. Please talk to your Physician.
or two. This is due to the mechanical process of HOW LONG DOES THE INJECTION
needle insertion as well as initial irritation from the steroid itself. The cortisone starts working in The actual injection takes only a few minutes, but about 1 to 5 days and its effect can last for several
plan to spend 1-1.5 hours at the facility. EPIDURAL STEROID
WHAT IS ACTUALLY INJECTED?
WHAT SHOULD I DO AFTER THE
The injection consists of a mixture of local PROCEDURE?
anesthetic (lidocaine) and the steroid medication Make sure to make an appointment to see us in follow up 2-3 weeks after each injection to decide the future course of treatment options. You WILL THE INJECTION HURT?
should have a ride home. Please DO NOT plan to
WHAT IS AN EPIDURAL STEROID
The procedure involves inserting a needle through drive or perform activities needing coordination INJECTION?
skin and deeper tissues (like a "tetanus shot"). So, right after the procedure. You do not need to stay Epidural Steroid Injection is an injection of long there is some discomfort involved. However, we in bed, walk and do activities as tolerated, but do lasting steroid ("cortisone") in the Epidural space numb the skin and deeper tissues with a local not resume strenuous physical work even if you (the area which surrounds the spinal cord and the anesthetic using a very thin needle prior to nerves coming out of it) done under a fluoroscope inserting the Epidural needle. IV sedation is used (X-ray camera) with the latest and advanced in most cases to provide relaxation, but you will CAN I GO BACK TO WORK THE NEXT
not be completely “put out”. With IV sedation you will have food and water restrictions (see last You should be able to return to non-physical WHAT IS THE PURPOSE OF IT?
The steroid injection is directed to the source of the pain. (“It can be compared to trying to put the HOW IS THE INJECTION PERFORMED?
HOW MANY INJECTIONS DO I NEED TO
fire out from where it starts”) The steroid reduces It is done with the patient lying face down. We HAVE? If the first injection does not relieve most
inflammation and swelling of targeted nerves in use a fluoroscope, which gives x-ray image of the of the symptoms in about three to four weeks, you the Epidural space to relief pain, tingling, spine for proper placement of the needle. The may need to have the 2nd or 3rd injection. numbness and other symptoms. The fluoroscope patients are monitored with blood pressure cuff allows pinpointing the pain source safely and CAN I HAVE MORE THAN THREE
effectively. This also allows less use of steroid INJECTIONS?
dose and number of procedures done per patient. WHAT SHOULD I EXPECT AFTER THE
In a 12 month period, we generally do not By getting to the source of the pain and INJECTION?
perform more than three Epidural injections. If controlling it, the body is given chance to recover Immediately after the injection, you may feel your three injections have not helped you much, it is from the pain, avoid drug dependence, disability legs slightly heavy and/or numb. Also, you may very unlikely that you will get any further benefit and improve quality of life. In most cases patients notice that your pain may be gone or quite less. from more such injections. Often the injections can live with the condition they have and avoid This is due to the local anesthetic injected. This may help the pain in the leg (sciatica) but not the will last only for a few hours. Your pain will center back pain. Other procedures such as Facet return and you may have a "sore back" for a day If you are taking Aspirin (or like products, see last page) you should stop it 7 days prior to this procedure. Please talk to your Physician.
Neurotomy (heat waves to burn pain nerve CERTAIN MEDICATIONS MAY INCREASE • Stop taking Asprin or like products 7 days
endings) may be indicated, check with the doctor. THE RISK OF COMPLICATIONS.
prior to the scheduled procedure.
• Bring any requested MRI, CT, X-ray images
WILL THE EPIDURAL STEROID
If you are on Coumadin (warfarin), heparin, on the day of the procedure.
INJECTION HELP ME?
• If you are pregnant or possibility that you
In most cases it may not stop all back, leg, neck or (ticlopidine), Plavix (clopidogrel), Aspirin or may be pregnant, let the physician know
arm pain with one injection. Mostly, it will Aspirin like products * you will need to get a immediately, as the X-ray camera cannot be
reduce pain by 50% or more than before. Some medical clearance allowing you to stop your patients may feel more relief from an injection medication from your physician, prior to your • When you check in you will need to sign
than others, while some patients may need more scheduled procedure. DO NOT STOP TAKING
consent forms, advise the medical staff of any
than one injection to get relief. Generally YOUR MEDICATIONS UNTIL WE CALL
allergies, especially to shellfish, iodine or
speaking, the patients who have "radicular AND NOTIFY YOU THAT YOU HAVE A
symptoms" (spine pain traveling in legs or arms) MEDICAL CLEARANCE. You can continue to • IV sedation; No FOOD for 8 HOURS before
respond better to the injections than the patients use Celebrex and your pain medicines before the the procedure. Clear fluids (Water, Apple
who have only back or neck pain. Similarly, the procedure. You should continue to TAKE YOUR
Juice) are OK 4 hours before the procedure.
patients with a recent onset of pain may respond ROUTINE MEDICATIONS (high blood
If you are Diabetic please omit morning dose
better than the ones with a long standing pain. pressure and diabetes medications) before the of diabetic control medicine the day of the
procedure. If you are on antibiotics please notify appointment. If you have taken your
WHAT ARE THE RISKS AND SIDE
diabetic medicine, please make sure you
drink Apple Juice 4 hours before your
Generally speaking, this procedure is safe. * List of Asprin like products:
procedure to avoid low sugar related
However, with any procedure there are risks, side Asprin, Advil, Aleve, Motrin, Ibuprofen,
effects, and possibility of complications. The most Naprosyn, Naproxen, Voltaren, Relafen,
common side effect is temporary increase in pain, Clinirol Cataflam, Feldene, Lodine, Mobic,
ALL PROCEDURES DONE AT THIS
soreness or trouble sleeping. The other rare risks Arthrotec, Vicoprofen and similar products.
involve spinal puncture with headaches, infection You can resume taking these the next day after New York Spine & Sport Rehabilitation
or bleeding, nerve injury etc. In many years of Medicine/New York Advanced Surgical
practice, Dr. Gopal has performed over 15,000 REMEMBER :
2008 Eastchester Road 2nd level, Bronx, NY spinal procedures on thousands of patients with • Please DO NOT stop taking your blood
no reported serious complications. pressure, diabetic, insulin, or cardiac
WHO SHOULD NOT HAVE THIS
• Have adult drive or take personalized taxi
SIREEN GOPAL, M.D.
service to return to your home.
Clinical Assistant Professor Albert Einstein College If you are allergic to any of the medications to be • Wear loose, comfortable 2 piece clothing
Board Certified in:
injected, or if you have an active infection or • If you are diabetic, steroids may temporarily
Physical Medicine & Rehabilitation (PM&R), illness going on or have bleeding disorder you affect your blood sugar, please contact your
Pain Management/ Electrodiagnostic Med physician.
No conviene tomar el poder. Si uno quiere hacer un mundo mejor, no hay quetomar el poder. Un grupo de personas accede al sillón de Rivadavia y al juego de sillas quecompletan el lote y se sientan con la esperanza de darle a ese poder unrumbo nuevo. Enseguida se advierte que, como en los mejores cuentos deterror, no son ellos los que mandan. El que manda es el sillón. ¿Qué pasa?Es que en ese si