“Oh Bother!” Treating Those Nagging Little Pains

Those little nuisances that we all suffer from — headaches, runny nose, sore joints — may be nothing, or they could be the signals of bigger troubles. Learn about some common pains and how they affect you.

Many years ago, the cartoon character Ziggy was captioned as saying, “It’s not the big failures you mind so much. It’s the constant pitter-patter of little defeats.”
Everyone has them, those daily nuisances that we just put up with – headaches, runny nose, sore joints. They’re nothing major, nothing to go to the doctor over.
However, it’s the smaller, bothersome health conditions that can erode people’s pleasure in life, adversely affect their work, even influence the lives of those close to them. Diseases such as sinusitis, acid reflux, sleep apnea and foot pain can rob people daily of the joy of living. Fortunately, these conditions can be prevented, treated or controlled, and promote a fuller sense of well-being and good health.

Sinusitus: “By Dozes Stubbed Ub.”

One of the little “pains” that affects nearly 37 million Americans of all ages is sinusitis. Dr. Fazlur R. Zahurullah, an ear, nose and throat (ENT) specialist for Rockford Health System, says sinusitis can be either acute or chronic. He believes that chronic sinusitis can impact a patient’s quality of life more commonly than chronic back pain or congestive heart failure.
“Sinuses are pockets within the bones of the face,” Zahurullah says. “They have wet linings like the nose and mouth, and can become blocked and infected, resulting in sinusitis. We define acute sinusitis as an infection lasting between four and eight weeks. It’s considered chronic when it lasts 12 weeks or longer and doesn’t respond to antibiotics.”

Dr. Zahurullah performs sinus surgery at Rockford Memorial Hospital.

Symptoms can include facial pain; pressure and headache; nasal congestion; difficulty breathing; tooth pain; loss of the senses of smell and taste; fatigue; sore throat; and bad breath. Previously, the standard treatment involved surgery, cutting away tissue and bone in the nasal cavity to open sinuses for better drainage. The downside of this procedure is that patients had their sinuses packed with sterile sponges or gauze, and could experience bleeding and significant pain. Plus, recovery time was longer.
The biggest concern was that, over time, scar tissue could build up, eventually making the nasal passage even smaller, and the sinusitis would return, to the same degree or even worse. For child patients, this was particularly worrisome because of growth as well as the smaller areas in which ENTs had to operate. “We used to be very afraid because of scarring and how close the sinuses are to the eyes and brain,” Zahurullah says.
Fortunately, Rockford Health System and Zahurullah have been using a relatively new procedure called balloon sinuplasty, done most often on an outpatient basis. Over the past five years, he’s performed this procedure on more than 200 adults and more than a dozen children, with an 80-percent success rate without compromising the patient’s safety.
“We start by putting patients on antibiotics, and sometimes prednisone, days before the procedure,” Zahurullah explains. “Anything we can do to reduce swelling prior to the procedure helps.”
At Rockford Memorial Hospital, balloon sinuplasty takes place in a surgical suite with the patient under general anesthesia. Zahurullah begins by guiding a catheter into the nasal cavity with a powerful light attached. He can actually see the light through the patient’s skin and thus tell when the catheter is in place.
“The sinus balloon catheter is guided in over the first catheter,” he says. “When the balloon is in place, it’s inflated at high pressure, about the equivalent of 12 atmospheres. This breaks the small bones that line the outside of the nasal passage and opens it up. There’s no bleeding, less pain and no need to pack the passages. If necessary, I insert a stent, to help keep the passages open until they heal.”
Once the catheters and deflated balloon are removed, the sinus cavities drain. Zahurullah says patients are able to go to work one to two days after undergoing balloon sinuplasty, as opposed to the week needed for traditional sinus surgery.

Acid Reflux: Even When You Didn’t Eat the Whole Thing

Nearly half the population of the United States experiences heartburn at least once a month. Those who suffer from symptoms two or more times a week – approximately 10 to 15 percent – are considered to have gastroesophageal reflux disease (GERD).
“Traditional acid reflux is accompanied by frequent heartburn, but this, by no means, encompasses all who suffer from GERD,” says Dr. John Johanson, a gastroenterologist on staff at Beloit Health System in Beloit, Wis. “Approximately one-third of people suffering from GERD don’t experience traditional heartburn. Instead, their symptoms of acid reflux are felt higher in the throat, resulting in symptoms that would not normally be associated with acid reflux.”

Dr. John Johanson uses an upper endoscope to view a patient’s throat.

Laryngopharyngeal reflux, sometimes called silent reflux, doesn’t usually cause heartburn but presents with other symptoms, such as post-nasal drip, hoarseness and coughing. Patients often attribute their chronic cough to a cold, allergies or chronic sinusitis. They may experience globus esophagus, the feeling that something is stuck in their throats. Their voices may change; they may have a chronic sore throat. Frequently, people start coughing shortly after going to bed at night. Since these symptoms persist without the pain of heartburn, most people simply don’t put them together.
When patients come to Johanson with upper gastrointestinal complaints, the first step is to ask about their specific symptoms.
“We use an upper endoscope to look into the patients’ throats, to see the condition of the esophagus,” he says. “If the patient has erosions or other damage, we may also take biopsies, to check for Barrett’s syndrome [or Barrett’s esophagus], a pre-cancerous condition that, if left untreated, can lead to the development of esophageal cancer. Although uncommon, if we find a cancer, it needs to be treated immediately.”
Treatment for all types of acid reflux is fairly straightforward. Initial treatment is suggesting lifestyle changes, including avoiding the kinds of foods that produce excess stomach acid. These include many things people love, such as chocolate and caffeine. Spicy dishes, acidic items like tomatoes or citric fruits and juices, and greasy foods may worsen reflux symptoms. “Alcohol is another irritant, as is smoking,” says Johanson. “These options don’t work for everyone. But such adjustments are easy and free, so it doesn’t hurt to try them.”
Over-the-counter medications that neutralize acid offer temporary relief, but Johanson explains that it may be necessary to prescribe proton pump inhibitors – known under brands like Prevacid or Nexium – to better control the production of stomach acid.
“We also recommend that patients raise the heads of their beds on 6-inch blocks,” he says. “The goal is to have the patient lying at a straight slant with his or her head higher than the feet. Piling pillows on the bed doesn’t help. This causes the patient to bend in the middle and can actually make the acid reflux worse.”
The course of treatment for acid reflux varies depending on severity. Short-term therapy may be required to control mild symptoms, although long-term treatment may be necessary, particularly among those with severe symptoms or acid-related damage.
“In patients who have damage to their esophagus, we take another look in their throats after eight weeks, to see if the condition has healed,” Johanson says. “Even if the erosions have healed, however, these patients require long-term treatment, because without it, the odds of their symptoms recurring within a year are close to 100 percent.”

When Snoring is a Health Concern

Snoring can also be a chronic nuisance, not only for the snorers who sometimes wake themselves but also for those trying to sleep nearby. While snoring in itself is not particularly harmful, an underlying condition called sleep apnea is.
A specialist in pulmonary disease, sleep disorders and critical care medicine, Dr. Rajeev Varma is the medical director at Mercy Harvard Sleep Disorders Center. He also oversees the Mercy Harvard Hospital Respiratory Therapy program. Varma says there’s a lot of overlap with pulmonary disorders and sleep apnea.
“Sleep apnea, or obstructive sleep apnea syndrome, is diagnosed when a patient stops breathing more than five times in an hour, for 10 seconds or longer, while sleeping,” he explains. “Five to 15 times an hour is considered mild apnea, while 16 to 30 times is moderate, and 30 times or more is severe. Occasionally, we have patients who stop breathing for up to a full minute.”

Snoring may be a sign of sleep apnea.

Because the apnea interrupts sleep cycles, sufferers never get the rejuvenating effects of a night’s sleep. Among symptoms of apnea: excessive snoring; gasping or choking during sleep; periods of breathing cessation during sleep; morning headaches; morning fatigue; memory loss or limited attention; lethargy; moodiness or personality changes; weight gain; GERD.
Of the three types of apnea, obstructive sleep apnea (OSA) is the most common. This occurs when the muscles in the back of the throat relax, narrowing or closing the airway. Smokers are three times more likely to have OSA, and about 70 percent of those with the condition are overweight. The most common cause of OSA in children is oversized tonsils or adenoids. Causes among adults include persistent nasal congestion, postnasal drip, seasonal allergies, chronic sinusitis and even broken noses.
“A subset of patients present with excessive tissue in the back of their throats, such as enlarged uvula or redundant palate,” Varma says. “These can be the source of sleep apnea as well.”
In fact, anything that restricts the flow of air may cause apnea. In less severe cases, the symptoms may be alleviated with weight loss or use of nasal decongestants. Abstaining from alcohol several hours before bedtime can also help. In other cases, surgery is necessary, either to remove inflamed tonsils and adenoids, or to reduce tissue in the back of the throat, in a procedure called uvulopalatopharyngoplasty.
Whatever the cause, the condition must be addressed. “It’s vital to treat sleep apnea, because anything which restricts the constant flow of air impedes the supply of oxygen to the heart and brain,” Varma explains. “When oxygen levels drop, the heart has to pump harder. This can lead to development of cardiovascular disease and/or cardiac arrhythmias, such as atrial fibrillation or an irregular heartbeat. Reduced oxygen to the brain from sleep apnea is associated with cerebrovascular disease and the higher incidence of strokes. High blood pressure is another strong association with sleep apnea. It can start as a temporary condition, but without treatment, it can become chronic.”
Aside from a body mass index of 25 or higher, another sign that a patient might be prone to sleep apnea is the circumference of his or her neck.
“A circumference of 17 inches in male necks and 16 inches in female necks is one measure of potential sleep apnea,” Varma says.
Sleep apnea is diagnosed by conducting a polysomnogram, or sleep study. The patient comes into the Sleep Disorders Center for an overnight stay.
“Electrode leads are placed beneath and above the eyes, and an airflow meter is attached to the nose and mouth,” Varma explains. “Another lead to measure muscle tone is attached to the chin, because when a patient enters the deepest part of sleep, REM, the chin muscles relax. Chest leads are put in place and belts secured around the patient’s chest, to measure breathing effort. More leads are attached to the chest, and others are placed on the patient’s shins, to test for restless leg syndrome, another type of sleep disorder. Finally, a finger lead is attached to measure oxygenation.”
When a patient is diagnosed with OSA, Varma prescribes a constant positive air pressure device, commonly known as a CPAP. The tabletop device provides a constant, even flow of air through a tube connected to a face mask.
“CPAP delivers air pressure that opens airways and prevents collapses,” says Varma. “For most patients, CPAP will be a lifelong treatment. If the patient loses a significant amount of weight, however, and reduces the number of times he or she stops breathing down to two or three times an hour, CPAP may be suspended.”
For the milder form of sleep apnea, an oral appliance, similar to mouth guards worn by football players, may be prescribed instead of CPAP. Most of these work by repositioning the jaw slightly forward of its usual rest position, which, for many people, is enough to keep the airway open.

Foot Pain: You Can Beat It

Don’t think those bothersome health conditions are all in the head. Think of how often people complain, “My feet are killing me!” The average American walks about 115,000 steps in a lifetime – that’s more than four times around the world. According to a recent study by the National Institutes of Health, chronic foot pain occurs in about 28 percent of the U.S. population – the criterion being that it interferes with walking and exercising. It’s not surprising that women experience twice as much as men.
Asked how people can avoid foot pain, Dr. Roland Tolliver, DPM, a podiatrist who works with FHN in Freeport, says jokingly, “Don’t do anything!”
He continues: “All kidding aside, some people are blessed with good genetics, but exercise, working on cement floors, trauma, can bring about foot pain in anyone. Unless the patient lives in a plastic bubble, foot pain can occur, just as back pain or any other pain does.”

Dr. Roland Tolliver works with a patient.

The human foot includes 26 bones; together, the foot and ankle have 33 joints. The foot has two crossing arches, four major nerves, supporting sinew called plantar fascia – in all, over 100 muscles, ligaments and tendons. Given its complex structure, it’s easy to understand the number of potential maladies.
During the past five to 10 years, Tolliver has seen an increasing number of heel pain cases. Decreased circulation and lack of muscle tone can lead to heel pain, as can improper shoe fit or style. “People tend to overdo things, too,” he continues. “Whether it’s the weekend warrior or people who wear inexpensive flip-flops all summer with no real arch support, by the end of summer, their feet hurt.”
He also treats stress fractures, tendon problems, and pain to the balls of the feet.
Diabetic patients suffer a variety of foot ailments, as do overweight patients. “When you consider that with every step, you apply one-and-a-half to two times your body force on your feet, it’s not surprising that being overweight is a contributor to the problem,” says Tolliver. “A person who weighs 200 pounds places 300-plus pounds of force on each foot every time he or she walks. Add diabetes, with its loss of sensation and changes in blood flow, and you have a recipe for significant foot disorders, such as calluses, ulcers and fractures.”
A common condition that doesn’t necessarily cause pain but can be problematic is flatfeet, when the arch of the foot is flattened and the entire sole of the foot touches the floor. Tolliver says there are two causes. The first is genetic; the second is adult-onset flatfeet, where the main tendons overstretch and thus fray or tear. The condition can force ankles and knees to turn inward and throw off the body’s alignment.
Surprisingly, as people age, their feet can grow and change shape.
Many other conditions can lead to excruciating foot pain, including ingrown and infected toenails, fungal infections, bunions, bone spurs and hammertoes. “Oddly, ingrown toenail infections tend to happen more with children,” Tolliver says. “They outgrow their shoes, which causes pressure on the foot and nails.”
In cases of fungal nail infections, removing the nail or applying medication is the best remedy. A newly developed laser treatment for fungal infections is available, but most insurance companies don’t cover it yet.
In addition to suffering with such chronic maladies, Tolliver has had many patients tell him they believe nothing can be done about broken toes or dislocations. “How can they walk on these toes and not come in to be treated?” he wonders. “Broken toes can be splinted, just like any other broken bone. Otherwise, patients are taking the chance of the toes healing out of alignment. When you take into consideration that each foot has 26 bones, with both feet having more than a quarter of the body’s bones, it’s not surprising that things can go wrong, and often do.”
Foot pain can be an indication of a condition that may cause other problems and aches in the body. No matter what the complaint, it’s important to remember that foot pain isn’t the norm, and there are many options for treatment.
“Take care of your feet, as you only get one pair per lifetime,” says Tolliver.
Clearly, our daily chronic ailments needn’t be borne in silence. As poet Emily Dickinson pointed out, “If you take care of the small things, the big things take care of themselves.” ❚