April 2003

Contributed by readers • Edited by Donald B. Middleton, MD
 

HAVE A BALL

To relieve back or neck pain, Dr. Basil Rodansky in Lincoln Park, Michigan, tells his patients to lie on a hard floor in a supine position with a football or a basketball underneath the area that hurts the most. The patient then rolls two to three inches at a time in alternating right-left, up-down movements. Gravity causes the musculature to relax. Generally, I have found that sports balls are less than optimal in size, shape, or both for this purpose and that a towel rolled into a cylinder and taped is more useful. Some physical therapists recommend Swiss balls, which are large, soft, plastic balls of various sizes that give more support to the spinal column.
 

WHISPER SWEET NOTHINGS

Involving a child in his or her physical examination helps to ease anxiety. In Los Altos, California, Dr. Gus Garmel always asks which ear the child would like him to look in first. For a really anxious patient or a child with otalgia, he advises examining the ears last. I usually like to keep up a steady stream of encouragement in a calm, soft voice, telling the child how well he or she is doing, to further allay fears.
 

HANDY RULER

Don't have a ruler? Dr. John Wipfler in Peoria, Illinois, always keeps his handy, so to speak. Every doctor should make a mental note of three measurements from his or her index finger: metacarpal-phalangeal (MP) joint to tip (usually 8 cm), MP joint to proximal interphalangeal (IP) joint (usually 2.5 to 3 cm), and MP to distal IP (usually 6 cm). This "ruler" stays with you wherever you go to facilitate physical assessments involving measurement, such as the extent of a rash or laceration. Knowing the distance from your thumb tip to your fifth digit tip with fingers abducted is also useful for larger measurements.
 

TOOTHPICK TEST

Dr. Darryl Gebien of Grand Rapids, Michigan, is always prepared for the patient who requires sensory testing for sharp pain or two-point discrimination. He keeps individually wrapped toothpicks, like the ones some restaurants provide, in his pocket as tools of choice to accomplish this task. A toothpick can be snapped in half to use for two-point discrimination, is likely to be more sanitary than a paper clip or calipers, and will not puncture the skin.
 

TREATING MEATAL PAIN

To treat distal urethral meatus pain, Dr. Dean Varian in Canton, Ohio, applies a little lidocaine jelly to the meatus if it is raw and inflamed. The immediate pain relief usually facilitates voiding quickly. A small tube of lidocaine jelly given to the patient or the parents equips them for recurrences. If the appearance of the meatus suggests infection, Dr. Varian recommends applications of a broad-spectrum ophthalmic (hence nonburning) antibiotic such as tobramycin. The thin nipple on the typical tube is easily slid a few millimeters into the urethra so that a small bead of antibiotic can be squeezed out as the tube is withdrawn. Treatment four times daily for three days usually provides relief. Dr. Varian uses these medications primarily for children who often get diaper or chemical meatal irritations, but they should work for adults as well.
 

DERM DOUBLE DUTY

From Yuma, Arizona, Dr. Rodolfo Gonzales reports success with unorthodox use of nasal steroid spray samples to treat common skin problems, such as an eczematoid patch or inflamed seborrheic dermatitis, especially for indigent patients who cannot afford to buy any medication. In the absence of studies proving its safety or overall effectiveness, this is a trick that should not become standard procedure, but it is worth considering in a pinch. Others who have related experience may choose to comment.
 

BIT OF RADIOLOGY

To obtain an unobstructed view of the odontoid in a cervical spine series, Dr. Patrick Aguilera of San Juan Capistrano, California, makes use of a 30- or 60-cc syringe. He removes the plunger and places the empty syringe barrel across the patient's open mouth between the teeth to hold open the mandible and move it out of the way. This preparation, he notes, helps x-ray technicians avoid moving the patient's neck.