Hello again, dear readers! It's been a busy month for letters, so we'll get right to it.
-- Regarding a column about post-operative cognitive dysfunction (POCD), in which elderly patients experience mental disruptions following surgery, we heard from an anesthesiologist in Florida. In our column, we explored the link the condition has to general anesthesia. However, he points out that the stress of surgery in and of itself can lead to POCD, and that a more accurate definition is an "impairment to the mental functions of an individual following surgery."
His concern is that isolating general anesthesia as the cause "will create unnecessary fear for elderly patients scheduled for general anesthesia, as there are no definitive studies showing that one form of anesthesia is better than another in preventing POCD. Patients may request a less-than-optimal form of anesthesia in the misguided belief that it would prevent POCD."
-- We recently wrote about a fascinating study in which researchers found that a wound sustained during the day heals twice as fast as one sustained at night. A reader from Louisville, Ohio, wondered whether this applies to the operating room as well.
"What about surgery, since that is a type of wound, and since many doctors like to do surgery early in the morning, is there any evidence about faster healing for surgery done at any special time of day?"
The answer is yes, the time at which surgical cuts are made affects their healing rate as well. The study tied the speed of wound healing to the body's circadian clock, the rhythms of which are keyed to daylight and darkness. The incisions from an emergency surgery performed at night healed more slowly than similar daytime incisions. Although the study didn't go into differences in healing rates between early-morning wounds and afternoon or early-evening wounds, we'd love to see that data.
-- Regarding nighttime leg cramps, many of you offered home remedies.
A reader in Pennsylvania wrote that "when attacked by leg cramps in the middle of the night, I manage to make it into the kitchen and put a rice bag in the microwave for a minute or so. The heat from that, or even a hand towel run under very hot water and wrung out, is very effective when applied to the cramp."
A reader from Simi Valley, California, says that standing tall and then slowly bending forward, aiming for the floor ("if your knees hurt, as mine now do at 74, I bend them a bit") delivers a thigh and calf stretch that helps banish cramps.
One more, from a reader who drinks "1/2 to 1 teaspoon of baking soda in a glass of water (and no, it is not the water by itself that does it, I've tried). The cramp will be gone within a minute or two. Gone are even the agonizing cramps in my groin that drove me crazy. I keep baking soda by my sink in my bathroom so it's handy whenever I need relief."
Thank you, as always, for your thoughts, corrections, thanks and encouragement. It's a pleasure to hear from you.
(Send your questions to firstname.lastname@example.org, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)