pain


Voice Troubles – Episode 117

A cartoon depiction of a white male with black hair with a tear coming form his eye. You're getting an inside look of his mouth and throat, where there are two 10-spiked, googly-eyed representations of a virus causing sore throat and hoarseness. In front of him are four treatment options. Starting at the top, a while megaphone icon with three curved sound waves with a red X over it, indicating no talking. Below that are two pink pills that say "aspirin" on them. Below that is a bowl with a yellowish liquid and what's possibly a chicken leg to represent warm broth. And at the bottom is a glass with a straw and a little left as a garish filled with brown liquid to represent tea. This is a representation of the top treatment advice given for hoarseness.

Laryngitis

Laryngitis, known as inflammation of the larynx, is the most common cause of hoarseness and voice loss.  It is very common in viral infections, such as a cold, flu, or adenovirus.  Acute laryngitis is caused by an illness, while chronic laryngitis may be a secondary symptom of another problem like acid reflux, smoking, or severe thrush.

There is a lot of advice that goes around about what can “cure” laryngitis or get rid of hoarseness.  Hydration is always key.  Some of the other advice is more anecdotal.  But above all, whatever you do for a hoarse voice, DO NOT WHISPER!

Laryngopharyngeal Reflux Disease (LPRD)

LRPD is a condition where stomach acid refluxes into and burns the vocal cords.  It may or may not accompany GERD.  It causes intermittent to chronic hoarseness, swallowing troubles, throat pain, or a constant sensation that something is stuck in your throat.

Misuse and Overuse

Misuse of your voice is defined as the inefficient use of your voice.  It may stem from poor posture, poor breath support, or poor hydration.  Overuse of your voice is defined as excessively loud or prolonged use of your voice.

Lesions

Vocal cord lesions are benign growths on the vocal cords that interfere with normal vibration. These can result from repeatedly prolonged periods of misuse or overuse.  They will cause chronic hoarseness or sporadic voice-silencing.  They come in three varieties and are all treatable:  nodules, polyps, and cysts.

Nodules require vocal rest and voice therapy and training to help make sure they don’t happen again.  Polyps and cysts require micro-surgery where the growth is removed, and then rest and therapy and training will follow.

Hemorrhage

If you have a sudden loss of voice after yelling, then it is possible a hemorrhage occurred.  A hemorrhage is when blood vessels in the surface of the vocal cord burst and fill it with blood.  COMPLETE REST is required until the blood is reabsorbed by the body.

Paresis and Paralysis

Paresis is the fancy word for weakness.  Vocal weakness can occur during a viral infection or after neck or throat surgery.  It can be temporary and strength will return on its own after a recovery period, or it can be permanent.  Prolonged or permanent vocal weakness can be improved somewhat through therapy and training.

Paralysis, on the other hand, is neurologically based, whether damage happened in the area of the brain that controls the voice and supporting structures, or the nerves in and around the larynx are damaged.  This can also be temporary or permanent and is generally one-sided.

Symptoms of a weakened or paralyzed vocal cord include noisy breathing – like something is hanging in the way of the air flow.  And breathy talking – like when someone is trying to use their “sexy” voice and there’s more air making noise than vocal vibrations.  There is a surgical repair process that involves taking the working vocal fold and stretching it over so when it activates, it will still come in contact with the unmoving vocal fold.

Callbacks

Voice
Thrush – Mouth Issues

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Music Credits: Up In My Jam (All Of A Sudden) by – Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b…Music provided by Audio Library https://youtu.be/tDexBj46oNI


See it in my head [Show Notes]

Parietal Lobe

It sits in the top of your head

  • Responsible for translating: touch, temperature, and pain.
    • So does it tickle? Or hurt?  How does it hurt – throbbing, stabbing, sharp, dull?
      The way your body translates temperature is based on the relative temperature to the body part that is being touched.
  • Proprioception – ability to know where you are in space relative to the other things around you
  • That awkward moment  when you think the toilet is higher or closer that it really is and you almost fall.
  • Hand-eye coordination – being able to see something that is moving and make your body to interact with it.
  • Two-point discrimination – the body’s ability to tell if it’s being touched by one thing or two separate things.  Different parts of your body have different levels of sensitivity.  Large body parts have a larger distance than small body parts (fingers and tongue have the closest discrimination distance due to the number of sensors).
  • Graphesthesia = writing feelings = being able to correctly translate letters or shapes drawn on your body without you looking.

When someone says “I can see it in my head” – it’s the area that can recall visual memories.  Remembering the last place you saw your keys or visualizing driving directions based on the landmarks you pass (which is the only way we give directions in the South).  So, when someone closes their eyes to try and remember something, they’re trying to deactivate their eyes and activate the parietal lobe.

Being able to identify a 3D object with your hands by touch only, and without your eyes.  This is also how Braille works, the dot patterns created to represent letters.

Good info here and here about Braille activates the brain.


APAP vs NSAIDs

FAQ

What’s the difference between acetaminophen (Tylenol) and ibuprofen (Advil/Motrin)?

APAP

Acetaminophen (A-SEET-a-men-o-fin, APAP) is in a class all by itself and science isn’t 100% sure how it works. There is a suspicion that there is an enzyme in the inflammation cascade that is only found in the central nervous system, and that enzyme is inhibited by APAP. But because it’s central, this is why APAP works on pain and fever but not swelling. APAP is metabolized by the liver, and that metabolism pathway produces a very toxic by-product if it gets into a traffic jam. This is why APAP dosing limits have been adjusted, and APAP overdoses are so dangerous, even if one does not have liver disease or consume alcohol.
Podcast Episode: Too Much Acetaminophen

NSAIDs

Ibuprofen is in a class many call NSAIDs (non-steroidal anti-inflammatory drugs – because the other medications used to treat inflammation are steroids). NSAIDs, including ibuprofen work on a specific enzyme step in the inflammation process that result in pain, swelling, and fever. That is why joint and muscle injuries respond well to NSAIDs. It is also why the inflammatory response due to viral or bacterial infections are subdued easily by NSAIDs. NSAIDs are metabolized and processed through the kidneys. An overdose can lead to kidney damage, as well as kidney disease can be worsened if these medications are used.  Aspirin is also a NSAID, as well as naproxen.

Bottom Line

In my personal experience, APAP works well on fever and overall body aches (think the flu). Ibuprofen and naproxen work well on injured joints and muscles, as well as sore throat symptoms due to viral infections.  Aspirin doesn’t get recommended for the same things as NSAIDs, mostly because it has such a big reputation as a blood thinner.

Treating Injured Muscles [Show Notes]

How Muscles Work

Muscle contractions depend on the muscle cells trading Potassium (K⁺) and Calcium (Ca⁺⁺).

As your muscle uses up energy to do work, the by-product is Lactic Acid.

Muscle fibers are “woven” together – kinda like fabric.

Contracting and relaxing a muscle causes the fibers to grip together and then spread back out.

Bilateral muscles = symmetrical muscles.  They look the same on each side of your body and worktogether to move your body in both directions from your center (left and right).

How Muscles Get Hurt

Stretching a muscle causes the muscle fibers to extend.

Over-extending a muscle can lead to a strain or pull/torn muscle. 

Inflammation happens in the tiny fibers of your injured muscle.

Treatment Options for Injured Muscle

Anti-inflammatory medications work great for strained muscles.
– Ibuprofen (Advil, Motrin)
– Naproxen (Aleve)

R.I.C.E.
Rest: stop using it, or at least give it a little break with only light use
Ice: yep, that cold, frozen water stuff
Compression: for smaller muscles, they can be wrapped to help limit inflammation and hold muscle fibers in a inoffensive position.
Elevation: smaller muscles that can be affected by gravity pulling blood to it, can benefit from being elevated and allowing gravity to pull blood away from it for a short time.

Here’s a link with a concise explanation of when to use ice vs when to use heat.

Prescription steroids help relieve inflammation.

Prescription muscle relaxers keep the muscle from knotting up.

Holla

@_KevinBuchanan used 800 mg ibuprofen for his injury.  800 mg should be taken every 8-12 hours, no sooner, or GI side effects may occur.

Recap

1. Stop the offending activity.

2. Ice the injured muscle (24-72 hours after injury)

3. Take anti-inflammatory pain relievers.

4. Apply heat to keep muscle relaxed

5. Gentle use or stretches

Behind the Scenes

Wearing a toddler while cleaning the kitchen can cause sore or injured muscles. Wear toddlers and clean kitchens with caution!

Since baby sister was born, Jossalynn gets one-on-one time with me by riding in the “backpack”, which is a woven wrap by Pavo Form.

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