Military Veterans and Patriots

Category: This Week in Health

  • Health: Hotter than Hell?

    Health: Hotter than Hell?

    Heat Exhaustion & Heat Stroke

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    Overview

    Prolonged or intense exposure to hot temperatures can cause heat-related illnesses such as heat exhaustion, heat cramps, and heat stroke (also known as sun stroke). As your body works to cool itself under extreme or prolonged heat, blood rushes to the surface of your skin. As a result, less blood reaches your brain, muscles, and other organs. This can interfere with both your physical strength and your mental capacity, leading, in some cases, to serious danger.

    Heat-related illness can strike anyone. But chronic alcoholics, the elderly, the young, the obese, and individuals whose immune systems may be compromised are at greater risk, as are individuals taking certain drugs, such as antihistamines, antipsychotic medications, and cocaine. High humidity also increases the risk of heat illness because it interferes with the evaporation of sweat, your body’s way of cooling itself. The reasons that people have heat related illnesses can be broken into two main categories: 

    • Exercise-associated heat exhaustion or heat stroke and
    • Non-exertional classic heat stroke

    Heat exhaustion, heat cramps, and heat stroke all occur when your body cannot cool itself adequately. But each is slightly different.

    Heat cramps can strike when the body loses excessive amounts of fluids and salt. This deficiency, accompanied by the loss of other essential nutrients such as potassium and magnesium, typically occurs during heavy exertion.

    Heat exhaustion occurs when the body loses larger amounts of water and salt through excessive sweating, particularly through hard physical labor or exercise. This loss of essential fluids can disturb circulation and interfere with brain function. Individuals who have heart, lung, or kidney problems or are on low-sodium diets may be particularly susceptible to heat exhaustion.

    Heat stroke, the most serious of the heat-related illnesses, occurs when the body suffers from long, intense exposure to heat and loses its ability to cool itself. In prolonged, extreme heat, the part of the brain that normally regulates body temperature malfunctions. There is a decreases in the body’s ability to sweat and, therefore, cool down. Those who have certain medical conditions that decrease the body’s ability to sweat — such as scleroderma or cystic fibrosis — may be at greater risk of developing heat stroke

    Source: WebMD

    Symptoms

    Heat Cramps: 

    • Severe, sometimes disabling, cramps that typically begin suddenly in the hands, calves, or feet
    • Hard, tense muscles

    Heat Exhaustion:

    • Fatigue
    • Nausea
    • Headache
    • Excessive thirst
    • Muscle aches and cramps
    • Drenching sweats, often accompanied by cold, clammy skin or a sensation of prickly skin
    • Confusion or anxiety
    • Weakness
    • Slowed or weakened heartbeat
    • Dizziness
    • Fainting
    • Agitation

    Heat Stroke:

    • Nausea and vomiting
    • Headache
    • Dizziness or vertigo
    • Fatigue
    • Hot, flushed, dry skin
    • Rapid heart rate
    • Dry skin
    • Profound sweating
    • Shortness of breath
    • Decreased urination
    • Blood in urine or stool
    • Increased body temperature (104 degrees to 106 degrees F)
    • Confusion, delirium, or loss of consciousness
    • Convulsions

    Diagnosis & Treatment

    Diagnosis

    Observation or experience of any of the above symptoms

    Initial Treatment

    • Heat stroke: Call 911 if any heat stroke symptoms are present.
    • Heat exhaustion and heat cramps: If symptoms get worse or do not improve in an hour, call 911.

    Advanced Treatment

    Heat stroke

    The best treatment for heat stroke is immediate cooling in an ice bath. It takes ice and water to efficiently cool the body. Do not delay. If heat stroke occurs at a location where an ice bath is not possible, move the individual to a cool area if indoors or a cool, shady area if outdoors. Loosen or remove the person’s clothing. Have the person lie down and slightly elevate the feet. Cool the person as quickly as possible. Wet the person’s skin with cool water, place cool cloths or ice all over the body, spray the person with a garden hose or soak the person’s clothes with cold water. Check the person’s temperature and continue these efforts until his/her temperature is 101°F or lower. Do NOT give the person fluids to drink. Continue your efforts until medical help arrives.

    Heat exhaustion

    While waiting for medical help, move the individual to a cool area if indoors or to a cool, shady area if outdoors. Give the person cool water to drink in small sips. Cool head, face, and neck with cold ice packs, cold cloths or cold water. When symptoms improve, take the individual to a clinic or emergency room to be seen by a nurse or doctor.

    Heat cramps

    Heat cramps usually can be treated by rest and fluids. The person should stop the activity and rest in a cool place. Have him/her drink apple or grape juice or a sports drink in small sips every 15 to 20 minutes. He or she should rest for several hours before going back to work or exercise.

    Prevention

    Everyone should take these steps to prevent heat-related illnesses, injuries, and death during hot weather:

    • Stay in an air-conditioned indoor location as much as you can.
    • Drink plenty of fluids even if you don’t feel thirsty.
    • Schedule outdoor activities carefully.
      • Wear loose, lightweight, light-colored clothing and sunscreen.
      • Pace yourself.
    • Take cool showers or baths to cool down.
    • Check on a friend or neighbor and have someone do the same for you.
    • Never leave children or pets in cars.
    • Check the local news for health and safety updates.

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • This Week in Health: Vitamin D deficiency

    This Week in Health: Vitamin D deficiency

    Vitamin D Deficiency

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    Overview

    Vitamin D isn’t a single chemical – in fact, technically it’s not actually a vitamin at all – but rather a group of fat-soluble hormones responsible for enhancing intestinal absorption of calcium, iron, magnesium, phosphate, and zinc.

    Your body makes vitamin D when direct sunlight (specifically UV rays) converts a chemical in your skin into an active form of the vitamin. Calcium, the primary component of bone, can only be absorbed by your body when vitamin D is present. 

    You can also get Vitamin D through dietary intake. Though not found in many foods, it can be obtained through ingestion of fortified milk, fortified cereal, and fatty fish such as salmon, mackerel and sardines.

    In addition to bone health, getting enough vitamin D may also play a role in  protecting against the following conditions (and increasing vitamin D levels may help to treat them). These conditions can include:

    • Heart disease and high blood pressure.
    • Diabetes.
    • Infections and immune system disorders.
    • Falls in older people.
    • Some types of cancer, such as colon, prostate and breast cancers.
    • Multiple sclerosis.

    Persons commonly at risk for vitamin D deficiency include those with inadequate sun exposure, limited oral intake via diet, or impaired intestinal absorption (as seen with Crohn’s disease, Celiac disease, or in those who have had weight loss surgery).

    Other factors that contribute to vitamin D deficiency:

    • Age: The skin’s ability to make vitamin D lessens with age.
    • Mobility: People who are homebound or are rarely outside (for example, people in nursing homes and other facilities) are not able to use sun exposure as a source of vitamin D.
    • Skin color: high-melanin (dark) skin is less able to make vitamin D than low-melanin (fair) skin.
    • Medications:
      • Laxatives.
      • Steroids (such as prednisone).
      • Cholesterol-lowering drugs (such as cholestyramine and colestipol).
      • Seizure-control drugs (such as phenobarbital and phenytoin).
      • A tuberculosis drug (rifampin).
      • A weight-loss drug (orlistat).

    Symptoms

    Severe lack of vitamin D in children causes rickets, showing up as incorrect growth patterns, weakness in muscles, pain in bones and deformities in joints. This is rare in developed countries due to fortification of milk and other foods with Vitamin D

    Lack of vitamin D is not quite as obvious in adults. Signs and symptoms might include:

    • Fatigue.
    • Bone pain.
    • Muscle weakness, muscle aches, or muscle cramps.
    • Mood changes, like depression.

    Diagnosis & Treatment

    Diagnosis

    A simple serum (blood) level can be drawn – most commonly the  25-hydroxyvitamin D, known as 25(OH)D for short.

    A “normal” level varies depending on the lab’s reference values, but is generally considered to be 32 to 100 ng/ml.

    Treatment

    Adequate intake:  

    Vitamin D consists of 2 bioequivalent forms. 

    Vitamin D2, also known as ergocalciferol, is obtained from dietary vegetable sources and oral supplements. 

    Vitamin D3, also known as cholecalciferol, is obtained primarily from skin exposure to ultraviolet B (UVB) radiation in sunlight, but can also be obtained via ingestion of food sources such as oily fish and variably fortified foods (milk, juices, margarines, yogurts, cereals, and soy), and oral supplements. 

    Supplements:

    D2 – Can be had via prescription from your health provider

    D3 – better absorbed than D2, this is typically an over the counter supplement

    How much you would require depends on your serum level.

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • Health: What’s that Pain in my Butt?

    Health: What’s that Pain in my Butt?

    Wallet Neuropathy

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    Not what you were thinking, was it?

    Overview

    Men’s wallets are causing men a lot of pain- and it’s not because they’re empty!

    Sitting with a full wallet in your back pocket for extended periods can twist the spine and compress the nerves in the buttocks and legs. This unnatural posture leads to inflammation, tingling, and lower-back pain. Wallet Neuropathy or “Hip Wallet Syndrome” is a form of sciatic neuropathy. The sciatic nerve runs underneath (and sometimes through) the piriformis muscle of the buttock; right where that big fat wallet sits in your pocket. The sciatic nerve runs from the pelvis to the thigh. When it is compressed, it becomes inflamed, and the muscles in the buttock and around the hip suffer, and pain can shoot into the back of your leg.

    Diagnosis & Treatment

    Initial Diagnosis

    Observation of that giant wallet in your back pocket!

    History & clinical exam

    Advanced Diagnosis

    Ruling out lumbar sources for the pain, such as S1 nerve root compression – Usually with an MRI and an EMG/NCV

    Initial Treatment

    • Walletectomy
    • Stretching of the piriformis muscle

    Advanced Treatment

    • Physical therapy
    • Muscle re-eduaction
    • Neural Mobilization

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • Health: What’s Bugging You?

    Health: What’s Bugging You?

    What’s Bugging You?

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    Since it is summer, and many of us are spending time outdoors, it is time we turn our attention to the things that can “getcha” and cause illness, that aren’t the Covid-19 virus

    Overview

    Insect-borne diseases are viral and bacterial illnesses that pass to humans either from insect (bug) bites or by the deposition of their feces/larvae on the skin. The most common insects that pass on disease are mosquitoes, ticks, sand flies, house flies, fleas and bedbugs. For example, mosquitoes are known for spreading the Zika virus, Yellow Fever, and Malaria. Ticks are known to spread Lyme disease and Rocky Mountain spotted fever.

    Risk Factors

    You increase your risk of being infected by an insect when you are in areas where they gather. This would include tall grass, bushes, spots near still water (ponds), and places around the globe with heavy outbreaks. It can also include your home and living spaces if you fail to clean and maintain them, especially in the case of fleas and bedbugs.

    Many Known Culprits

    Mosquitoes

    In North America, the most common mosquito-born diseases are:

    • West Nile Virus
    • Zika
    • Dengue fever
    • Malaria (rare in the US)

    Their flight can be more or less noisy; their bite is not always painful. Half of all mosquito bites occur through clothing. Only the females bite – they draw blood from their victims in order to nourish their eggs. Male mosquitoes generally do not buzz and are completely harmless.

    Ticks

    In North America, the most common tick-borne diseases are:

    •  Lyme disease
    • Meningoencephalitis 
    • Spotted Fevers

    Tick bites result from contact with grassland. This risk is generally restricted to certain well-defined regions. Once the ticks are on the skin, they migrate towards the major skin folds (groin, armpits) where they implant themselves. They do not begin to feed until 12 to 24 hours have passed and so the risk of infection is low if they are quickly removed. It is best to use tweezers or some other precision implement to remove them rather than fingers – if the tick has begun to feed, avoid puncturing its body during removal.

    Flies, Midges

    In North America most fly-borne illnesses are from the common house fly, and are transmitted by some form of fecal contamination of food or water, either directly or indirectly, These include:

    • Typhoid Fever
    • Cholera
    • Shigella
    • E. coli
    Bedbugs

    A common bedbug-borne illness is also transmitted by the bug’s feces, not the bite. Bedbugs feed at night on their sleeping victims. A bedbug infestation can be incredibly difficult to remove: if you discover them in your home, prepare to discard your bed and bedding at a minimum, and you will likely need to fumigate your entire house.

    • American Trypanosomiasis (Chagas’ Disease)
    Fleas, Lice

    Lice transmit different bacterial infections: 

    • bartonellosis (Trench fever),
    • borrelliosis (relapsing fever)
    • certain types of rickettsiosis 

    Rat fleas are a vector for:

    • Plague

    Symptoms of insect-borne diseases

    Symptoms will vary depending upon the type of insect that has bitten you. Common symptoms of insect borne diseases can include:

    • fever
    • chills
    • headache
    • sore muscles
    • skin rash
    • nausea
    • stomach pain

    More serious symptoms can include:

    • difficulty breathing
    • the feeling that your throat is closing
    • swelling of your lips, tongue, or face
    • chest pain
    • a racing heartbeat that lasts more than a few minutes
    • dizziness
    • vomiting

    Diagnosis & Treatment

    Initial Diagnosis

    Your doctor can typically diagnose an insect-borne disease with a physical exam, a review of your symptoms, and a look at your recent travel destinations.

    Advanced Diagnosis

    Lab tests (blood and urine) can diagnose certain insect-borne diseases.

    Initial Treatment = PREVENTION

    There are many actions you can take to reduce the threat of being infected by an insect. You should:

    • Stay out of tall grass and bushes.
    • Dress in long pants, long sleeves, and a hat if you must be in tall grass and bushes. Tuck your pants into long, white socks.
    • Wear light-colored clothing. This makes it easier to spot insects.
    • Use bug spray that contains the ingredient DEET.
    • Examine your skin and scalp when you get back in to check for bugs or bites. Always shower with plenty of soap after being in the outdoors. Ideally don’t go into areas known to be insect hotspots alone; you and your companion(s) can check each other for attached insects.
    • Pay attention to outbreaks through the travel health notices posted by the Centers for Disease Control and Prevention (CDC). If you can, avoid travel to those places during outbreaks.

    Advanced Treatment

    Various treatments exist for these diseases

    1. Medications (usually antibiotics, or in the case of malaria, antibiotics and quinine).  These can be used for both treatment of active disease as well as prophylaxis when going into an endemic area

      • Lyme Disease
      • Spotted fevers
      • Malaria 

    2. Symptomatic support – treating the fevers, rashes, and aches

      • Meningoencephalitis
      • Dengue fever
      • West Nile virus
      • Yellow Fever

    3. Preventive Vaccines

      • Meningoencephalitis
      • Yellow fever
      • Studies underway for Dengue fever and West Nile disease

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • This Week in Health: Insomnia

    This Week in Health: Insomnia

    Insomnia – or why the hell can’t I sleep?

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    Overview

    Insomnia is a common sleep disorder in which sufferers find it hard to fall asleep, or stay asleep long enough.

    Exactly how much sleep is enough is subjective, but most adults need seven to eight hours a night.

    Many adults will experience short-term (acute) insomnia, which lasts for days or weeks, at some point in their lives; usually the result of acute stress or trauma. But some people have long-term (chronic) insomnia that lasts for a month or more. 

    Insomnia symptoms may include:

    • Difficulty falling asleep at night
    • Repeatedly waking up during the night
    • Waking up too early
    • Not feeling well-rested after a night’s sleep
    • Daytime tiredness or sleepiness
    • Irritability, depression or anxiety
    • Fatigue related issues such as the inability to focus
    • Ongoing worries about sleep

    Complications of insomnia may include:

    • Lower performance on the job or at school
    • Slowed reaction time while driving and a higher risk of accidents
    • Mental health disorders, such as depression, an anxiety disorder, or substance abuse
    • Increased risk and severity of long-term diseases or conditions, such as high blood pressure and heart disease

    Many Possible Reasons for Insomnia

    Insomnia may be the primary problem, but it may also be the result of other conditions.

    Common causes of chronic insomnia include:

    • Stress. 
    • Travel or work schedule. 
    • Poor sleep habits. 
    • Eating too much late in the evening. 

    Chronic insomnia is usually a result of stress, life events, or habits that disrupt sleep. Treating the underlying cause can resolve the insomnia, but sometimes it can last for years.

    Additional common causes of insomnia include:

    • Mental health disorders. Anxiety disorders, such as post-traumatic stress disorder, may disrupt your sleep. Awakening too early can be a sign of depression. Insomnia often occurs with other mental health disorders as well.
    • Medications. 
      • certain antidepressants 
      • medications for asthma or blood pressure. 
      • Many over-the-counter medications — such as some pain medications, allergy and cold medications, and weight-loss products 
    • Medical conditions.
      • chronic pain, cancer, diabetes, heart disease, asthma, gastroesophageal reflux disease (GERD), overactive thyroid, Parkinson’s disease and Alzheimer’s disease.
    • Sleep-related disorders.
      • Sleep apnea 
      • Restless legs syndrome 
    • Caffeine, nicotine and alcohol. 

    Insomnia and aging

    Insomnia becomes more common with age. As you get older, you may experience:

    • Changes in sleep patterns. 
    • Changes in activity. 
    • Changes in health. 
    • More medications

    Diagnosis & Treatment

    Diagnosis

    • Physical exam. 
    • Sleep habits review. 
    • Sleep study. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

    Initial Treatment

    Prevention

    Good sleep habits can help prevent insomnia and promote sound sleep:

    • Keep your bedtime and wake time consistent from day to day, including weekends.
    • Stay active — regular activity helps promote a good night’s sleep.
    • Check your medications to see if they may contribute to insomnia.
    • Avoid or limit naps.
    • Avoid or limit caffeine and alcohol, and don’t use nicotine.
    • Avoid large meals and beverages before bedtime.
    • Make your bedroom comfortable for sleep and only use it for sex or sleep.
    • Create a relaxing bedtime ritual, such as taking a warm bath, reading or listening to soft music.

    Advanced Treatment

    Cognitive behavioral therapy for insomnia

    • Stimulus control therapy.  Remove factors that condition your mind to resist sleep. 
    • Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises 
    • Sleep restriction. Avoid naps
    • Remaining passively awake.  Getting in bed and trying to stay awake rather than expecting to fall asleep.
    • Light therapy. To adjust your internal clock

    Prescription medications

    Examples include:

    • Eszopiclone (Lunesta)
    • Ramelteon (Rozerem)
    • Zaleplon (Sonata)
    • Zolpidem (Ambien, Edluar, Intermezzo, Zolpimist)

    Prescription sleeping pills can have side effects, such as causing daytime grogginess and increasing the risk of falling, or they can be habit-forming.

    Over-the-counter sleep aids

    • Antihistamines
    • Melatonin supplements

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

  • HEALTH: Let’s Talk About our Aching Joints

    HEALTH: Let’s Talk About our Aching Joints

    Joint Pain

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    With Many Potential Sources

    The most common of these is Osteoarthritis.

    Others include (but are not limited to): Rheumatoid Arthritis, Sprains, Tendinitis, Bursitis, Dislocation, Gout, Lyme Disease, Fibromyalgia, Avascular Necrosis, and Metastatic Cancer.

    For the purposes of this post, we will be focusing on Osteoarthritis 

    Overview

    Osteoarthritis (OA) is the most common form of arthritis. It affects over 32.5 million US adults.

    Some people call it degenerative joint disease, or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees.

    With the onset of OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly, and get worse over time. OA can cause pain, stiffness, and swelling, and – in more severe cases – it can reduce joint function to the point of disability: some chronic sufferers are no longer able to do daily tasks or work.

    Symptoms generally include:

    • Persistent joint pain.
    • Stiffness.
    • Decreased range of motion (or flexibility).
    • Swelling.

    Risk factors for OA include:

    • Injury 
    • Overuse—defined as heavy or repetitive stress on a particular joint.
    • Age
    • Gender—Women are more likely to develop OA than men, especially after age 50.
    • Obesity—extra weight puts more stress on joints, particularly weight-bearing joints like the hips and knees. Obesity may also have metabolic effects that increase the risk of OA.
    • Genetics—OA is hereditary; further, having OA in one joint increases the risk factors for other joints.
    • Race— Some Asian populations have lower risk for OA.

    See Also: This Week in Health: Low Back Pain

    Diagnosis & Treatment

    Initial Diagnosis

    Basic history and physical exam is the starting point.

    X-rays are invaluable in identifying changes in the internal bone structure and/or joint space narrowing consistent with OA.

    Serum lab studies can rule out any systemic inflammatory conditions (such as rheumatoid arthritis, etc).

    Advanced Diagnosis

    MRI imaging can identify any muscle, cartilage, ligament, or tendon injuries that might contribute to the condition.

    Initial Treatment

    • Increasing physical activity.
    • Physical therapy with muscle strengthening exercises.
    • Weight loss.
    • Medications, including over-the-counter pain relievers and prescription drugs.
      •  Non-steroidal anti-inflammatory drugs (NSAIDS) – both oral and topical
      • EDIT to add: Supplements! (see comments below)
    • Supportive devices such as crutches or canes

    Advanced Treatment

    • Bracing
    • Corticosteroid injections
    • For knees, viscosupplementation injections
    • Nerve Blocks and radiofrequency ablation (RFA) (for spine joints, knees, and sacroiliac joints)
    • Experimental stem cell injections
    • Opioids (to be considered carefully, with risk stratification and close monitoring)
    • CBD products, both oral and topical, have some anecdotal evidence of benefit, but should only be used with full disclosure to one’s MD, and in accordance with State laws.
    • Surgery
      • Arthroscopic “clean-up”
      • Total or partial joint replacements

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.

    Edited by: WhiteKnightLeo

  • Let me tell you a story….

    Let me tell you a story….

    Let Me Tell You a Story About an Epic Night-time Battle

    Once upon a time there was this great warrior named Gastrocnemius (Gastroc).  He was a force to be reckoned with, and when he was made angry, he would draw up and create much havoc.  Most of the time he was left alone, and only occasionally was he made so angry. It was often a matter of a moment to calm him down with a good stretch.

    As with any great warrior, there were others that wished to usurp him. One of these wannabes was Extensor Hallicus Longus (EHL). He decided it was time for himself to rise up and challenge the mighty Gastroc.  So with all of his might he drew himself as tight as he could. As you would expect, this did make Gastroc a bit angry, and the battle was on. 

    Gastroc pulled with all his might, as did EHL.  At first it was a lopsided battle, with Gastroc claiming the initial victory.  However EHL had a secret weapon. He had established an alliance with Anterior Tibialis (AT). The two of them joined forces, and the battle soon came to a draw.

    Meanwhile, it was the people’s home over which these warriors were fighting to control (known as the land of Foot, of which there were two distinct tribes: the Dorsums, and the Plantars), that ultimately suffered the most.

    You must understand that this was a risky move by AT to join forces with EHL.  The last time AT was drawn into a battle, he pissed off his finance minister (Peroneus Nervus), losing all of his funding and rendering himself useless on the battlefield.  His particular tribe, the Dorsums were left unemployed, and unemployable. This depression of the economy lasted for several weeks, rendering the whole of the Foot flopping about.

    In any event, AT did choose to join forces with EHL in this most recent battle.  The ultimate outcome was that there were no winners, and the biggest loser was their global overlord, Cerebrum, and most especially his top minister Somnum.

    The moral of the story is…
    Well there is no moral, just a tired and cranky Unicorn.

    But there was one lesson to be learned…..
    We all must drink lots of water in 90+ degree heat in order to avoid nocturnal leg cramps!

    Stay tuned for our next This Week in Health feature: Let’s Talk About our Aching Joints. To be published tomorrow…

  • This Week in Health: Low Back Pain

    This Week in Health: Low Back Pain

    Low Back Pain

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    With Multiple Potential Pain Generators

    The most common of these are muscle strain, disc degeneration/herniation, facet joint arthritis, and sacroiliac joint inflammation.

    Overview

    Low back pain is very common. More than 80% of people have at least one episode of low back pain during their lifetime. Although back pain usually does not represent a serious medical problem and most often resolves on its own, it can be frustrating when pain interferes with daily life.

    Certain factors seem to increase a person’s risk of developing low back pain. These include smoking, obesity, older age, female sex, physically strenuous or sedentary work, job-related stress, job dissatisfaction, and mental health issues such as anxiety or depression.

    Low back pain is often categorized as “acute” (lasting four weeks or less), “subacute” (lasting 4 to 12 weeks), or “chronic” (lasting more than 12 weeks). While most episodes of acute pain resolve quickly, some people do go on to have longer-term pain.

    Diagnosis & Treatment

    Initial Diagnosis

    Diagnosing the source of pain can often be challenging, as the different pain generators can mimic each other.

    Often it is a clinical diagnosis, made via history and physical exam.

    X-rays are easy to obtain and can add to the picture.

    Advanced Diagnosis

    An MRI is the definitive diagnostic tool, but before that costly test is done, some basic conservative treatment should be employed, as the majority of cases will resolve with some simple methods as outlined below.

    An EMG/NCV is another useful test when one is presenting with “sciatica”, pain radiating down one or both legs.  It is used to determine if lumbar nerve roots are injured. In the hands of a skilled practitioner, this should NOT be a painful test.

    Initial Treatment

    Initial treatment for any episode of low back pain starts with the use of NSAID’s, muscle relaxers, and physical therapy.

    Physical therapy is the KEY component here…but with a caveat.

    You MUST be treated by a McKenzie Method certified physical therapist if you want to get the outcome desired

    Otherwise you are throwing away good time and money.

    About 80% of sufferers will respond to these basic treatments.

    Learn about the McKenzie Method. It is also a treatment that can be self directed by a motivated person, with resources available at this link: The McKenzie Institute

    Advanced Treatment

    Muscle Strain

    • Myofascial Release (in PT)
    • ESTIM device (like a TENS)
    • Trigger point injections

    Discogenic pain

    • Epidural steroid injections
    • Interdiscal injections
    • Surgical decompression
    • Spinal Cord Stimulation

    Facet Joint pain

    • Facet Joint injections
    • Diagnostic Medial Branch Blocks
    • Radiofrequency Ablation to the medial branches

    Sacroiliac Joint pain

    • Mobilization and stabilization (in PT)
    • SI Joint injections
    • Sacral Lateral Branch Blocks
    • Radiofrequency Ablation to the sacral lateral branches
    • Surgical Fusion (minimally invasive)

    So tell us YOUR story!

    Ask questions!

    Disclaimer: This is an informational post designed to foster discussion. It should not substitute for the advice of your doctor.