Wednesday August 3, 2011

Are you a victim of chronic headaches? Or perhaps you wake in the morning feeling as if you haven’t slept at all and sleepwalk through your day. maybe you have consulted with a chiropractor, neurologist or sleep specialist, with varying results. There is another avenue that should be considered, according to one local doctor: your problems may be the result of jaw issues.

If that is the case, Dr. Frederic Hyman, general dentist and owner of Berkshire Center for Craniofacial Pain and Dental Sleep Medicine on Church Street in Great Barrington, may have answers for you.

Hyman, who has had a general dental practice for 27 years, started seeing patients about 10 years into his practice who were experiencing jaw pain and headaches.

“I was seeking ways of helping the patients. Tufts University was offering a year-long residency,” he said. “I really began to learn and develop skills to go out and help patients much more than I had in dental school.”

Hyman continued on with his studies at Tufts, earning his diplomate in oral facial pain and then staying with the university on a part-time basis as an instructor “to stay on top of the field,” he said.

His patients started coming via word of mouth, “but then a year ago, we had a name change to let the public know we’re doing this as a special interest.”

And who are the people who make use of Hyman’s specialized skills? the first group is made up of people who are experiencing temporomandibular joint pain (commonly known as TMJ), clicking sounds when opening or closing the jaw or even problems with opening or closing it. they may be also suffering from chronic headaches and may have tried other solutions, unsure of what the actual problem is. “It’s really by its nature a problem that can mimic other things. they may seek treatment from other practitioners and may get some relief.”

A headache sufferer, for example, may try drugs to treat the headaches or may see a chiropractor.

“But the headaches continue,” he said, “because it may be a problem with their jaw or muscles surrounding the jaw.”

In fact, it is these other providers the patient may have already consulted with who are today providing Hyman with many referrals.

“I get many referrals from physician providers, chiropractors, physical therapists and others,” he said.

Hyman works in concert with these other providers to provide the patient with the best care possible.

“My whole sort of mission is to provide an integrative pain management approach Š to provide the patient with options,” he said.

Types of treatment for these jaw issues may include splint therapy, better known perhaps as a night guard or bite guard. in addition, Hyman may use a low-level laser to help muscles and joints where there is pain to help the body heal itself, he said, or an “alpha stim,” a low-level current. the pain is usually reduced by one or more of these methods, he said, although it can take several visits.

Hyman said, however, that the focus is on pain management, rather than a cure, and that he tries to give patients things to do at home if the pain recurs — ice or heat, for example.

“But by working with the other providers, we can really help the patient to feel better, to function better,” he said.

Jaw issues may not only manifest, however, in the symptoms described above. they may in fact cause a patient to be very sleepy during the day from disrupted sleep the night before. “They may also experience a morning headache,” Hyman added. they may snore so loudly that the snoring affects others. these are all symptoms of obstructive sleep apnea.

That patient is usually referred by a sleep physician or a sleep center, Hyman said, and has had a sleep study done overnight at a sleep center with a diagnosis of sleep apnea. the first step, he said, is to try the patient with a CPAP (continuous positive airway pressure) machine, which pushes air into the airway to prevent it from collapsing overnight.

“An alternative is to use an oral appliance. It is very useful for mild to moderate sleep apnea,” Hyman said. “The nice thing about an oral appliance is it’s a reversible procedure.”

Hyman stressed that untreated sleep apnea can lead to serious medical issues, including cardiovascular problems, stroke, heart attack, diabetes and even depression.

“There are probably 18 million people in the country undiagnosed with sleep apnea, and probably 12 million to 15 million with craniofacial pain like TMJ pain,” he said.

With his approach to treatment, “80 percent to 90 percent can be made to feel better. But it’s not like a broken arm, where you can say ‘we can stabilize it and it will be healed in six to eight weeks,’” he explained. “Sleep apnea tends to be a progressive problem. as they (patients) get into their 50s, 60s, 70s, it gets much worse.”

Obstructive sleep apnea occurs, Hyman said, when a person lays back and his or her jaw drops open. the tongue falls into the back of the throat, and now the person has a very narrow passageway to breathe. as the flow of oxygen to the brain lessens, the brain eventually wakes from sleep far enough to cause the person to take a breath or even gasp.

“This cycle could be repeated 100 times an hour if it’s severe enough,” Hyman said. Thus, the person’s sleep is disrupted over and over throughout the night.

When using an appliance, it advances the jaw forward. “The tongue follows the jaw. as that occurs, the airway is wider. the net effect is the person has less apneas during the night. It may not eliminate it the way CPAP can,” he said, but some people are not successful with CPAP and this offers another option.

Dental sleep medicine is an emerging area, Hyman said, and he is very excited by that, but even more so that he can bring relief to those suffering from TMJ pain or related sleep issues.

“To me, it’s very satisfying to be able to help people who have maybe tried several different things and are really quite desperate,” he said. “The goal of the whole treatment is to feel, function and sleep better.”

Dr. Frederic Hyman’s Berkshire Center for Craniofacial Pain and Dental Sleep Medicine practice, a general dental practice as well as an integrative pain management center dedicated to helping patients who suffer from TMJ, headaches and sleep apnea, is located at 29 Church St., Great Barrington. for more information, call 413-528-4680 or visit berkshiretmjcenter.com.

My symptoms are: constant sneezing, runny nose, yellow nasal discharge and a headache.

if it was allergies it would be a clear discharge, if it was a sinus infection you would have facial pain, headache, you might feel slight dizziness, and your discharge would be green/yellow
If it was a cold your body might slightly ache and you might run a low grade fever…

If its constant sneezing and nasal discharge it sounds like an allergy! you could be allergic to something ! Do u have pets ? or a dusty house ? Hayfever etc ! Takes some anthistamine like piriton which relieves allergy !! Hope it helps !

It is sinus. both sinus and cold are caused due to excess fluids. so give all liquids a break for 24 hours and see the impact.

Sinusitis might be to blame for congestion, discomfort

Each and every year, when the temperatures hover around or below freezing, scores of men, women and children reach for the tissue box to overcome what’s typically assumed to be the common cold. but that common cold might actually be something much different.

Roughly 37 million Americans suffer from at least one episode of sinusitis each year. an inflammation, or swelling of the tissue lining the sinuses, sinusitis can prove very difficult to live with. Healthy sinuses are normally filled with air, but when a person is suffering from sinusitis, their sinuses become blocked and filled with fluid and germs, potentially leading to infection. To avoid succumbing to sinusitis this year, learn as much about the condition as possible so it can be properly diagnosed early on and limit its potentially painful effects.

It’s easy to overlook sinusitis because many people mistakenly assume sinusitis is purely a chronic condition. However, sinusitis isn’t always chronic.

* Acute sinusitis: Acute sinusitis is characterized by a sudden onset of cold-like symptoms that don’t go away after 7 to 10 days. Symptoms can include runny nose, congestion and facial pain that lasts 4 weeks or less.

* Subacute sinusitis: Symptoms will last 4 to 8 weeks.

* Chronic sinusitis: When sinus inflammation lasts 8 weeks or more, the condition is considered chronic.

Certain people are more likely to suffer from sinusitis than others. Those people include:

* People with structural differences, including a deviated septum, that narrow the drainage ducts.

* People who suffer from allergic rhinitis, which causes the swelling of the lining of the nose.

* People with nasal polyps, or small growths in the lining of the nose.

* People whose nasal mucous membrane swells as from a common cold.

Because it’s common to mistake a bout of acute sinusitis with the common cold, men and women should learn about acute sinusitis to help determine if what they or their children are suffering through is sinusitis or just a common cold. the symptoms of acute sinusitis include:

* Facial pain and pressure

* Cough or congestion

Doctors will typically ask for a full list of symptoms when attempting to diagnose the problem. if the doctor suspects sinusitis, he or she may press the sinuses to feel for tenderness and might also tap the individual’s teeth to determine if the paranasal sinus is inflamed.

There are also tests available to determine if a person is suffering from sinusitis. these can include studying the mucus culture, conducting a CT scan of the sinuses, allergy testing, nasal endoscopy, or even blood work.

When a person is diagnosed with sinusitis, their treatment will depend on whether they were diagnosed with acute or chronic sinusitis.

The best thing to keep in mind when suffering from sinusitis is to be proactive if you suspect you have it. Delaying treatment will only extend the often painful and uncomfortable symptoms.

By Paul G. Donohue M.D. December 02, 2010 12:00 AM

DEAR DR. DONOHUE: I am a 68-year-old female. A little more than a year ago, I developed shingles on my midsection. the blisters and rash healed. I was left, however, with severe pain. my doctor prescribed Neurontin. I also am taking L-lysine and doses of vitamin B-13. I also took hydrocodone. Lidocaine patches worked for a while but became ineffective. I am now taking larger doses of narcotics to obtain relief. would any of the procedures you mentioned in your column previously (I have underlined them) work for me? I will try anything.

You have postherpetic neuralgia, pain that lingers well after the shingles rash has gone. the herpes zoster virus, the cause of shingles, damaged the nerves it traveled down to reach your skin and produce shingles. the item I wrote about (the one where you underlined treatments) involved trigeminal neuralgia, facial pain of an entirely different cause. None of the procedures I mentioned — microvascular decompression, the gamma knife, nerve-killing injections — is useful for postherpetic neuralgia.

Things that you haven’t tried but show some progress for postherpetic neuralgia include antidepressants like amitriptyline and Cymbalta (duloxetine). They are not given for depression. They’re given for their pain-relieving properties. Seizure-control medicines also are prescribed for pain relief. the Neurontin you tried is one. another is Lyrica (pregabalin). Zostrix, capsaicin cream, has been helpful to many.

A new product, the Quentza patch, contains a high dose of capsaicin. it is applied directly to the painful skin. A doctor has to apply it.

Opioids, the narcotics you mentioned, have a place in treating this distressful condition. Opioids bring the possibility of overdosage and addiction. it takes careful use for both patient and prescribing doctor to avoid these complications. if no other medicines bring pain relief and the pain is severe, then turning to these drugs is acceptable. Tramadol and oxycodone are two popular drugs in this class of pain relievers.

Have you thought of visiting a pain clinic? you should. the specialists there are experts in pain control.

DEAR DR. DONOHUE: I am fine, but my liver enzymes are very high. I have undergone an extensive search to find out why, including scans and blood work, but the answer hasn’t been found. my liver enzymes remain high. now doctors want a liver biopsy. I don’t want it. do you have any idea what’s going on?

I don’t. but I have faced the challenge of trying to find an answer for people like you whose liver enzymes are high but who have no symptoms. Your doctors have pursued their search by employing every noninvasive test they could. the best test for you now is the biopsy.

The liver is very close to the skin. A needle can obtain a piece of liver tissue quickly and relatively painlessly. the skin and underlying tissue are numbed. it sounds grim, but it really isn’t. I urge you to reconsider your doctor’s suggestion.

Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando FL 32853-6475.

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