What an interesting saying huh? But when it happens to you, it is neither interesting nor funny...
What is back pain? It is exactly that. A pain that happens somewhere along your back. It can be very sharp, sudden, and incapacitating. Or it can be dull, slow developing, and irritating. To make things even more confusing--the characteristics can run the whole range in between. It can also be acute and short-lived, or chronic and unending.
Back ailments are an increasingly more common condition these days and are often very debilitating to the person who suffers from them. In fact, according to the National Institutes of Health, it is so common that in any given 3 month period, over one-fourth of adults suffer from at least 1 day of back pain during that time frame. Wow...Imagine that!
Are there actually risk factors for back pain? Yes!
Back pain becomes more common as we age--most common age at first episode is in the 30's to 40's
People who are not physically fit are more likely to suffer back pain--weak core muscles cannot support the spine adequately to prevent injury
People who suddenly try to do physical activities when they are normally sedentary are more likely to sustain a back injury
Genetics is sometimes a factor for certain inherited joint conditions--these will also affect the spine
Obesity increases the risk of back injury--more weight the spine has to support increases the chance of injury
Ethnicity can sometimes be a factor that predisposes certain groups of people to specific back conditions
Certain systemic diseases can increase the chances of back pain--arthritis, auto-immune diseases, cancer (can spread to the spine to cause pain)
Occupation--jobs with heavy labor involved increase the chance of back injury
Recreational activities--sports or hobbies with high amounts of physical contact can also increase the chances of a back injury
Smoking--via multiple possible avenues. Many of the above can apply. Usually overweight and physically unfit. Also, smoking increases chances of osteoporosis (weakened bones) and subsequent back bone fractures
What are the common causes of back pain?
Mechanical or structural--where issues like discs wearing out or scoliosis would become factors. Even how the spine moves mechanically would be factors in injury or pain
Infections--referred pain from kidney infections, meningitis, osteomyelitis of the spine (bone infection)
Tumors--less common cause of back pain. Sometimes cancer in other parts of the body can spread to the spine and cause pain. Less commonly, a tumor can actually begin in the spine.
Injury--actual injury to the spine due to mechanical forces from lifting improperly or twisting motions
The chances of back injury and pain can be reduced by several general measures. Increasing the strength of the core muscles (abdominal and back musculature) that supports the spine will help to decrease chances of injury. Eating a healthy diet and maintaining proper weight and bone health also helps. Regular exercise and general physical fitness is also very important. Activities that improve your balance and coordination will help you to prevent falls that can injury your back. And finally, good posture and good lifting habits of using your legs instead of your back are crucial in protecting your spine.
Most people have some kind of back pain at one time or another. Here are some warning signs that signal the need for further evaluation by your doctor:
Severe pain--especially after a fall or traumatic injury
Numbness or tingling in the arms or legs
Weakness in the arms or legs
Unexpected loss of weight in addition to the back pain
Urinary or bowel problems--burning when you urinate, having problems controlling your bladder or bowels, fever, chills
Pain that does not get better
Back pain is treated by several different methods. This is best left to the discretion of your doctor as he/she knows your history the best. There are many modalities available to treat back pain today. These include: rest, physical therapy, medication, surgery, spinal manipulation (as from a chiropractor), acupuncture, and massage.
In many instances, the best treatment for a particular patient is a combination of these modalities. For this exact reason, in my own practice, it is not uncommon for us to be working side by side with an orthopedic specialist, as well as a chiropractor at the same time. Each professional bringing their own area of expertise to help the person who is suffering with back pain to heal.
So until next time...be kind to your back...and Stay Healthy Hawaii!
"Doc, I'm kind of confused. I like my job, my wife is great, and my kids make me laugh. I just don't understand why I just feel so blue doc...you know...I'm somehow just not truly happy inside." "Ok Mr. W, let's have you take a seat in my office and let me ask you a few questions to see what is going on with you--ok?"
Feeling depressed, "blue", or sad is a normal reaction to life's unexpected challenges, personal losses, or bashes to our own self esteem. However, having feelings of worthlessness, intense sadness, hopelessness, or helplessness that continues for days, or weeks, or months is not normal.
These bouts of strong emotions usually compromise our ability to function normally. These are often signs and symptoms of clinical depression. There are several types of depression and many other associated physical, mental, and emotional aspects related to it. However, today we will focus on general topics dealing with depression.
Here are some common signs and symptoms of depression:
Decreased energy or fatigue
Difficulty making decisions, focusing, or concentrating
Feelings of helplessness or hopelessness
Feelings of guilt or worthlessness
Too little sleeping or too much sleeping
Early morning waking and restlessness
Insomnia
The perception of no joy left in life
Vague "illness" type of feelings to include stomach complaints, headaches, aches and pains
Loss of appetite or overeating
Weight gain or weight loss
Sad or emptiness type of feelings
Thinking about suicide or even attempting suicide
These symptoms can be experienced in a combination of components and in varying intensities. If you or someone you know is experiencing these feelings, professional help is needed. A good place to start is to talk to your doctor and let him/her know what you are going through. Your doctor knows you best and can assist you in getting the type of help you need.
The treatment of depression makes use of several different modes of care. Most commonly, psychotherapy and/or anti-depressant medications are used. However, for very severe cases that are unresponsive to the usual modes of therapy, ECT or electroconvulsive therapy (shock therapy) is sometimes considered. The treatment that is best suited to any person's particular situation is best managed by their mental health professional and their physician.
One final word of caution. Unfortunately, clinical depression also carries with it a very high risk of suicide. Therefore, anyone who exhibits suicidal thoughts or behavior that makes attempts at suicide must be assisted into getting help from the local suicide help line or the emergency medical system immediately. Anyone who has suicidal thoughts needs to be taken with the utmost of seriousness. Also, people who have had previous suicide attempts are at an even higher risk for future attempts or even actual success at suicide. A very serious situation that needs immediate intervention.
In a nutshell--persistent and lingering "blues" should always be investigated and not ignored.
So until next time...take care of each other...and Stay Healthy Hawaii!
"Doc...my eyes are very irritated and red. They feel dry like I have sand in them. But what really scares me is that there is some kind of baby slug looking thing growing on my eye!! What is that??" "Relax Mr. W...let me get a good look at this thing. I bet you get lots of sun and don't use sunglasses right?"
Here in Hawaii where we get more than our share of sun and outdoor activities, we often find a common ailment that goes along with our lifestyle...a pterygium on our eyes. This is something that grows from (usually) our nose side of the white part of the eye towards the clear part of the eye or cornea. It is usually fleshy and often has a lot of small blood vessels on it that help it to turn a red, irritated color when it is disturbed or bothering us. The most common symptoms include: dry itchy eyes, persistently red eyes, and the sensation of a foreign body in the eyes. In the worst cases, it can affect vision as the growth invades more of the clear portions of the cornea.
How do we get these interesting looking fleshy accessories? The true cause is not very clear. However, it is highly suspected to be due to our exposure to a lot of ultraviolet radiation in addition to wind, dust, and low humidity. It is most often found on people who have a lot of exposure to these conditions and do not always have proper eye protection. Surfers and other water sport enthusiasts have a fairly high incidence of pterygiums--as it is often difficult to wear proper sunglasses during these types of activities. They are also more likely to occur in areas near the equator. Additionally, they also occur in high numbers in areas that are constantly windy. Interestingly, women tend to suffer from this condition less often vs men.
Prevention is aimed at protection from the sun and wind. Wear sunglasses with side coverage that protects from 100% of UV radiation at all times when in the outdoor environment. Lubricating eye drops also helps to reduce irritation and discomfort. These measures if applied consistently, can help to prevent the formation of or decrease the worsening of a pterygium that is already present.
The first step in treatment is to have your eyes evaluated by your doctor. From there he/she can decide if your condition needs the attention of an ophthalmologist (medical doctor who cares for eyes) or if it is mild enough to be monitored in the primary care setting. More serious cases can be treated by several methods that require the skills of an ophthalmologist. These methods include (most commonly) surgical removal. However, other methods range from beta particle irradiation to membrane grafting.
Here's the bottom line. Most of us who enjoy the outdoors use pretty good sun sense and always slather on lots of good sun block. However, not all of us take the time to protect our eyes--also very important. When in Hawaii, enjoy the outdoors...but give your eyes a break...keep em behind a good pair of shades.
"Wow doc...my throat is so super sore...I can't even eat or drink water. When I look in the mirror it is very red. And what is that white stuff?" "Mr. W, I think you better let me take a look in your mouth and see what is going on with you".
It looks like we are right in the middle of the season for sore throats--also known as acute pharyngitis. A sore throat can be caused by several things. The most common being bacterial or viral. However environmental factors may play a role here also. A sore throat can often feel scratchy and dry and swallowing can be very painful.
Here are some common causes of sore throat:
Viruses--like the flu or common cold virus
Bacterial--several types. However, the most notorious is "strep throat" caused by Group A streptococcus. This is one that should not be ignored
Environmental factors--Dry air, pollution, allergies, exposure to smoke
It is a very good idea to visit your doctor when these symptoms are present:
Temperature over 100.4 'F
Sore throat that is lasting longer than 1 week
A rash on your body along with the sore throat
Having a hard time swallowing or breathing
Pus on the tissues in the back of your throat--white and slimy appearing
Finding blood in your phlegm or saliva
In children, lots of drooling
If you have a voice hoarseness lasting over 2 weeks
Recurring sore throats
Having a sore throat after any contact with people who have known strep throat
In general, if you are not sure, call your doctor and get checked
A viral cause of sore throat will not be cured by antibiotics. However, if it is caused by bacteria, the most dangerous situation would be strep throat. You will need a throat swab and a lab test to determine if you have strep throat. For this you will need to be evaluated by your doctor.
Why should we be so concerned about strep throat? Because the bacteria that is responsible for strep throat, Group A streptococcus, if left untreated, can also cause rheumatic fever. Many organ systems can be damaged by rheumatic fever. It can occur after you have been infected by the streptococcus bacteria. The most common problems caused by this inflammatory disease are damage to heart valves, skin, joints, and if really unlucky--the brain. It is VERY important not to leave strep throat undiagnosed and untreated.
How do we help to prevent getting a sore throat? The most important thing is good hand washing. The next most important thing is to try to avoid contact with people who are sick with sore throats, colds, or the flu.
Unfortunately, it looks like sore throats are here to stay, and they are definitely one of life's inconveniences. However, if you have symptoms of what may be a more serious illness like strep throat, your best bet is to see your doctor as he/she knows your medical history the best. Don't just ignore it.
Sometimes an intense, nasty itch is not only a simple everyday "itch". Maybe it is scabies...
What is scabies? It is when human skin becomes infested with a colony of very tiny mites more commonly known as the human itch mite. The nasty little critter is also known officially as Sarcoptes scabiei var. hominis. The female mite makes tiny burrows in the superficial layer of the skin and lays its eggs and reproduces. Characteristically, it causes a pimple-like rash that is often found between the fingers and in the creases of the wrists and is usually very intensely (sometimes unbearably) itchy. Infestations can also be found in other parts of the body like: armpits, elbow area, waist/belt-line area, between shoulder blades, genital area, and buttocks. Sometimes, a raised crooked line that is skin colored or grayish can be seen on the skin where infestation is occurring--these are the mite burrows.
Scabies is usually spread by prolonged, direct skin to skin contact with an infested person. It is often fairly easily spread within the members of a family or household. The most common way for adults to spread scabies is by sexual contact. Scabies can sometimes be spread to others by sharing of clothing articles, towels, and bedding of an infested person. Scabies outbreaks can spread the fastest when there are crowded conditions like prisons, nursing homes, and child care facilities.
If it is the first time a person is infested with scabies, symptoms may not become obvious until after 4 to 6 weeks later--although they can still spread the bugs to others. If a person has been infested before, symptoms can become obvious in a much shorter time period of 1 to 4 days or so. Once a person is infested, the mite can often live for up to 2 months. However, the mite alone with no host can only live about 3 days.
How is scabies treated?
Visit your personal physician to get checked
The people who need treatment are the infested person, their close contacts, household members, and their sexual contacts
All bedding, towels, clothing used by the infested person need to be washed in hot water and dried in the hot dryer setting. Alternately, they can be dry cleaned.
Everything that may be infested that cannot be washed can be sealed in a airtight plastic bag for at least 3 days minimum
Medications that are used to kill scabies are called scabicides and are by prescription from your doctor
You may need re-treatment if you find new rashes or burrows on the skin. Or if you continue to have problems after 2 to 4 weeks from the original treatment.
So it seems that a persistent itch may sometimes be something more... If you are not sure, have your doctor take a look at your itch to be certain.
Staying healthy and fit is a life-long endeavor. Dr. Gerald H. Watanabe hopes his blog offers you some helpful insights, practical tips and good information that can raise your health IQ.
