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Osteoporosis – Risks and Diagnosing |
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Osteoporosis often does not become clinically evident until a complication occurs such as a bone fracture that can lead to severe pain, disability and a poor quality of life. Risk factors for the development of osteoporosis include advanced age, alcohol use, androgen or estrogen deficiency, amenorrhea, body weight less than 127 pounds, Caucasian or Asian ethnicity, calcium deficiency, early menopause, family history of osteoporosis, female gender, fragility fracture, late menarche, physical inactivity and tobacco use. The most common method of diagnosing osteoporosis is via a DEXA scan. I’ll discuss complications in Osteoporosis next issue. |
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December 30, 2008
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I’m diagnosed with Osteoporosis. Tell me about this condition. |
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Osteoporosis is the most common metabolic bone disease in the U.S. About 10 million people have osteoporosis; 1 in every 3 women and 1 in every 8 men worldwide. It’s a chronic progressive disease that can affect almost the entire skeleton, characterized by low bone mass and bone weakening that increases the risk for bone fractures. Osteoporosis is divided into two disorders. “Primary” occurs as juvenile, postmenopausal, age-related, or senile. “Secondary” occurs from genetic, endocrine, hypogonadal states, deficiency states, drug-induced, inflammatory states, hematologic, neoplastic, and miscellaneous. I’ll discuss risks and diagnosing next issue. |
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December 16, 2008
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My brother experiences pain from his thyroid cancer. What would help? |
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While pain is a common symptom caused by thyroid cancer, there are several ways to reduce the ache. It is important to have the actual source identified for the most effective pain management. Different levels of pain (acute, chronic, neuropathic, and somatic) can occur from the tumor pressing against a bone, nerve, tissue, or organ. By identifying the type and source of pain, his pain physician can find an effective remedy. Treatment may be a combination of chemotherapy, radiation, medications, injections or hot/cold compresses. Additional alternative methods include massage and nerve stimulation. |
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December 2, 2008
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When I wake in the mornings, my fingers are now stiff? Why? |
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Stiffness, swelling, and pain in your fingers or joints can be a sign of rheumatoid arthritis, a common rheumatic disease affecting approximately 1.3 million people in the U.S. This condition is more common with middle-aged women and, unfortunately, the cause and cure are unknowns. Additional symptoms may also include fatigue, lack of appetite, and a low-grade fever. Early intervention is crucial to improving outcomes, so consult with your physician for a diagnosis. Treatment may involve a combination of medications, rest, joint-strengthening exercises, joint protection, and patient education. |
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November 18, 2008
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I have leg pain from a pinched sciatic nerve. What alleviates the throbbing? |
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The sciatic nerve is your largest nerve, running from the base of your spine to your feet. It can become pinched if a vertebral disk bulges out and presses on it. Aspirin or ibuprofen may relieve your discomfort and help in preventing pain reoccurrences. Maintain a diet high in fiber, fruits, and vegetables to prevent constipation. Avoid lifting, bending, and sitting on soft surfaces. Seek assistance when attempting to stand. Sleep on a firm mattress with at least one pillow under your knees. |
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November 4, 2008
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Any tips to condition for skiing? |
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Start 2-3 months minimally prior to ski season with flexibility, strengthening, balance, and cardio (aerobic) exercises that build the muscles around your knee, hip, and ankle joints which will impact your skiing mobility and ability. Cardio workouts also improve your stamina to ski full days or back-to-back days. Stager conditioning to perhaps cardio on Mondays, Wednesdays, Fridays, and flexibility, strength, and balance on Tuesdays, Thursdays, Saturdays. Suggested cardio includes swimming, walking, jogging, rowing, cycling, and skating. Stretch before/after exercises and skiing to keep your muscles flexible and prevent injuries. Consult with your physician before starting. |
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October 21, 2008
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Why does my back hurt when I bike? |
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Low back pain can occur from cycling due to several reasons. One is from stress and fatigue placed on your back from bending over and pushing down on your pedals. Your core musculature (back, abs, legs) supports and stabilizes you during this motion and, if your core is weak, back pain can result. Strengthening your core through exercises can improve or even prevent your pain. Pain can also stem from the support in your cycling shoes to the actual bike fit to your body, such as the positioning of your handlebars. Consult your physician if your pain persists. |
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October 7, 2008
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Why are epidurals used outside of childbirth? |
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While epidurals are commonly performed in pregnant women for labor pain, the injections are also used for pain management, especially with the treatment of “pinched nerve” pain, known as radiculopathy or sciatica. A numbing medicine like Novocaine, with or without a steroid, is injected into the epidural space to block the pain from spinal nerves that innervate the arms and legs. A lumbar epidural is performed in the back for radicular leg pain and a cervical epidural is performed in the neck for radicular arm pain. |
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September 9, 2008
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What is a Facet Joint Nerve Block? |
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Facet joint nerve blocks, or facet joint injections, are performed for the diagnosis and treatment of neck and/or low back pain from injured or arthritic facet joints. Facet joints are found throughout the spine to assist with motion and weight bearing. Patients with this condition may complain of pain and stiffness, difficulty standing, or must turn their entire body to look left or right. During this procedure, a needle is placed in the facet joint, or along the facet joins nerve and a local anesthetic agent and/or corticosteroid is injected to relieve pain. |
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August 26, 2008
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I am scheduled for an IDET procedure. Can you explain this procedure? |
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Intradiscal Electrothermal Therapy (IDET) is a minimally invasive procedure for the treatment of localized back pain caused by a certain disc problem. A catheter is passed into the damaged disc through a need that is placed inside the same disc. Thermal energy is then applied to the injured area resulting in repair of disc tears, reduction of disc bulges, and decreasing pain by destroying painful nerve endings within the damaged disc area. There are no incisions or surgical scars associated with this outpatient procedure. |
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August 12, 2008
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Sacroiliac Joint Pain (Part 2) |
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Last issue I discussed injections for treating sacroiliac joint pain. An additional treatment is radiofrequency, a procedure that uses high frequency radiowaves to generate heat for the destruction of nerves that transmit pain from the sacroiliac joint. This procedure is used to provide pain relief for longer periods of time. The procedure is performed after the joint injections have confirmed that the pain is coming from the sacroiliac joint. Pain relief can last up to two years after the procedure. |
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July 29, 2008
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My doctor has prescribed sacroiliac joint injections for treatment of my back pain. Are they safe? |
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Sacroiliac joint injections are performed for the diagnosis and treatment of low back and buttock pain originating from the sacroiliac joint. The sacroiliac joint is a joint of the pelvis located underneath each buttock. This joint can be a source of back and buttock pain (sacroiliac joint syndrome) when injured, such as a sprain or during lifting. The injections are safe and are often times combined with physical therapy or chiropractic care to maximize recovery. Next issue I will discuss another type of treatment. |
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July 15, 2008
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My elderly father has flank pain. Can it be cured? |
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Flank pain is a sensation of discomfort, distress, or agony in one side of the body between the upper abdomen and the back. Many of the common causes of flank pain are relatively benign, but if the pain is accompanied by fever, chills, blood in the urine, or frequent/urgent urination, then a kidney problem might be the reason. Treatment will depend on the cause. Contact your physician and immediately so if blood appears in the urine or if the pain is accompanied by high fever, chills, nausea, or vomiting. |
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July 1, 2008
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Every so often, I pull a muscle in the exact same spot in my lower back – 2 inches to the right of my spine, just above my butt on my hip bone. What's the best way to prevent it from reoccurring? |
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There is a possibility that you may have a herniated disc or other problems involving the lower region of the spine. Without knowing the specifics of your pain, I would highly urge you to see your physician who may order an MRI or refer you to specialist to diagnose the cause of your pain and provide treatment. |
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June 17, 2008
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I have adenomyosis and I am in absolute agony. The pain starts in my back, works down my hip, into my pelvic region, and then down my thigh, knee, lower leg and even my foot. What can help? |
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Adenomyosis is the thickening of the uterus within tissue that normally lines the uterus which instead infiltrates outer muscular walls. It typically affects women over the age 30 who bore children. Pain associated with adenomyosis is uncommon. For treatment, pain medicine may be prescribed or a hysterectomy may be necessary in younger women with severe symptoms. Consult with your physician. |
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June 3, 2008
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Urodynamic Testing (Part 2) |
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Last issue a reader asked about urinary incontinence, which can be evaluated by urodynamic testing. Urodynamics is the electronic evaluation of bladder function and involves computerized measurement of the bladder's ability to store and empty urine. It helps explain symptoms, including incontinence, frequent/painful urination, problems starting to urine, problems emptying the bladder, recurrent urinary tract infections, and sudden urges to urinate. Undergoing this test determines how well your bladder and muscles work, and identifies whether there is a bladder, nerve, or spinal cord problem. Once the cause is better understood, a treatment plan can be determined. |
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May 20, 2008
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Every time when I sneeze, I release a small amount of urine. How can I stop this? |
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Whether you have urine leakage when you sneeze, cough, or laugh, or the sudden urge to urinate frequently, urinary incontinence can be disruptive to daily life. Urinary incontinence is a common problem that affects one out of every 25 Americans. Most people believe it is inevitable, untreatable, and irreversible as a normal part of aging. Actually most urinary incontinence is treatable. A first step for treatment may be urodynamic testing, which I will discuss in the next Healthy Advice Q&A. |
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May 6, 2008
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Spinal Fusion Surgery |
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My last question inquired about vertebroplasty and kyphoplasty as surgical treatments for osteoporosis. Another option is spinal fusion surgery which is often a last resort treatment if previous surgeries haven't been successful or the patient is still experiencing chronic pain. During this procedure, two or more vertebrae connected by metal plates/rods are bolted in the back of the spine, holding the vertebrae in place, and a metallic implant is placed in between the vertebrae. While this inhibits mobility, it allows the vertebrae to fuse and heal. Recovery typically requires a hospital stay, a brace, and rehabilitation. |
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April 22, 2008
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I have osteoporosis. Please explain between vertebroplasty and kyphoplasty treatments. |
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Vertebroplasty and kyphoplasty are surgical procedures used to treat spinal fractures and relieve chronic pain in osteoporosis patients. In both, the pain physician or spine surgeon injects bone cement into the crushed vertebrae. The cement hardens quickly and stabilizes the spine immediately. The difference is in how the cement is injected. During a vertebroplasty, a needle is inserted into the damaged vertebrae. With a kyphoplasty, a thin catheter tube with a balloon is used. Both are minimally invasive and need very little healing time. Patients typically go home the same day. |
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April 8, 2008
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Who qualifies to see a pain specialist for pain management? |
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Anyone with persistent subacute or chronic pain. In addition to the pain, an inability to perform work or normal household tasks, excessive use of prescription drugs, irritability with family/friends, or depression may be signs of a chronic pain condition often brought on by an injury or medical condition. Some of the most common painful conditions include shingles, cancer, herniated disks, back/neck conditions, spinal stenosis, reoccurring headaches, facet syndrome, and major nerve injuries. The sooner a patient can seek treatment, the better chance of a complete recovery and a life without pain. |
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March 25, 2008
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My doctor has recommended a laminectomy for my herniated disc. Is it safe? What can I expect? |
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There are some risks associated with a laminectomy due to the length and extent of the procedure. During a laminectomy, your surgeon will remove the back part of the affected vertebra, the associated ligament, and the herniated portion of the disc. Doing so alleviates the pressure/irritation of the affected nerve ends. Expect up to a 2 day hospital stay and longer if elderly. Typically you can begin physical therapy about 2-3 weeks post surgery. Complete recovery can take 4-6 months or longer. |
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March 11, 2008
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My primary care doctor referred me to a “pain specialist” to treat my pain. Please tell me about this type of doctor. |
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Primary care doctors often refer patients to a pain specialist to assess the cause of their pain and find an appropriate treatment option. Pain specialists, or pain medicine doctors, are physicians specialty-trained in pain management to diagnose and treat pain. Pain physicians utilize medication, therapy, and intervention procedures to reduce the pain and treat the cause of the pain. The majority of painful conditions can be treated conservatively and without surgery. |
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February 26, 2008
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My father was diagnosed with degenerative disc disease? What is it? Is it hereditary? |
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Degenerative disc disease is a condition when the soft central portion of a disc loses some of its water content and dries out. While not hereditary, developing degenerative disc disease is simply part of the aging process that begins at about age 20 in all of us. This can lead to low back pain in people not physically fit but attempt strenuous activities. Degenerative disc disease is best treated simply with proper exercises, good body mechanics, and anti-inflammatory medication. |
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February 12, 2008
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I'm an avid skier. Any tips to staying limber and conditioned to ski? |
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Downhill skiing is physically demanding and highly dependent on strong leg muscles. Unless prepared, your downhill run can invite soreness, exhaustion, and joint-related injuries. The best way to protect yourself is keep conditioned year-round. Strong leg muscles stabilize your joints and enable you to control your skis. A strong core is important for turning. Maintain a workout routine that targets muscles important to skiing, increases your metabolism, and burns calories like skiing. Nautilus exercises, squats, dead-lifts, lunges are good. Hiking and swimming are also great cross-training activities. |
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January 29, 2008
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I have chronic back pain syndrome. What will help? |
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Less than 10% of individuals with back pain develop chronic back pain syndrome. If your back pain has lasted over 3-6 months and it's not improving, you are probably developing this disorder which is caused by muscle tension among other factors, including deconditioning, depression, or a lumbar spine condition. If left untreated, it can remain for years provoking pain. Treatment should be multidisciplinary to remedy all aspects of the condition simultaneously (physical and/or psychological). Exercise, physical therapy, anti-inflammatories, and sometime surgery are common treatment. Consult with your pain physician. |
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January 15, 2008
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What are some tips for exercising? |
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First, get a complete physical exam before starting any exercise program. Once approved, plan ahead and set aside at least 30 minutes a day, 3-5 times/week to exercise. Wear sneakers and loose-fitting clothing. Exercise on a firm but comfortable surface. Warm-up before stretching by walking or riding a stationary bike. Move slowly and smoothly through exercise routines and focus on good breathing patterns – slowly inhale through your nose and exhale through your mouth. Take brief rests between exercises or when needed. When finished, repeat stretches. Increase repetitions and regime at your own pace. |
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January 8, 2008
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