Sunday, November 11, 2012

Pause in Blog

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Well, this experiment has been less than successful.  I have made 29 posts over the last six months and only managed to attract about 1100 page views by maybe 100 viewers.  Maybe 10% of those were from Eastern Europe, including Russia, from web sites that were apparently trying to co-opt the blog for other reasons, i.e. hack into it for some nefarious purpose.  Who would think that was something people would waste their time on?

The book has been a slow seller; maybe it will catch on, eventually.  I like it, but I wrote it.  It makes what patients' doctors tell them easier to understand.  The price was right, if you had a Kindle or a Nook, or Kindle or Nook app for a computer or electronic device.  The illustrations are informative and it is entertaining.  The printed version by Lulu is too expensive. **** Cheaper printed versions are now available from CreateSpace on Amazon and Barnes&Noble; see web sites listed below:****

http://www.amazon.com/What-Your-Doctor-About-Lower/dp/1497342910/ref=tmm_pap_title_0

and

http://www.barnesandnoble.com/w/what-your-doctor-wont-tell-you-about-your-lower-back-bill-yancey-md/1119123480?ean=9781497342910

Anyway, thanks to those of you who read the blog.  I hope you learned something, but I can no longer justify the amount of time spent blogging.  The information will be here (and in the book) and available for you to review if you want, but I will no longer be making regular posts.  If something comes up that is newsworthy, I'll make a post.  I will continue to answer questions from readers.

I guess to bow out at the 11th minute of the 11th hour of the 11th day of the 11th month isn't a bad way to go for a veteran.  To those of you who were entertained and informed, thanks for dropping by.

Tuesday, November 6, 2012

Medical Tragedy

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Sorry.  This is a day late.  Had a water pipe break under the slab of my home last week.  Have spent a week getting it fixed, repainting the room and replacing the floor.  And I still have stuff to do.  It's always something!

The recent spate of meningitis caused by contaminated steroid injections was, unfortunately, avoidable for a great number of the people infected.  Steroid injections into the facet joints are statistically no better than placebos for decreasing pain.  Most should never have occurred.

The driving force behind this tragedy may be the design and function of the American medical system.  It is true that we live in a capitalistic society and that capitalism is probably the most efficient and productive way of running an economy ever devised.  Unfortunately, some portions of the economy can be abused by people who are more concerned with profit than the best interests of themselves or their customers.  This is especially true if there are no consequences for actions which lead to deaths, or the crash of the economy itself.  Regulation is not as important as honesty, I think.  We may not be able to legislate honesty, but we can certainly punish those who are overtly dishonest, especially when it leads to serious consequences for their customers.

That said, patients need to be patient.  No one likes to be in pain.  But, in spite of what the AMA, television, the pharmaceutical companies, or even your family has told you, there are no miracle cures.  There is no single procedure, injection, pill, or balm that will miraculously relieve your pain.  Your body has the power to heal itself, most of the time.  People who pay, or get their insurance companies to pay, exorbitant prices for 'cures' that have not been shown to do anything more than a placebo (see my blog post from September 4, 2012) are wasting their money.  They are spending their time undergoing procedures, etc. while their body heals, but they are not helping themselves much.  And they may be taking a big risk.  In the case of the steroid facet joints, they can be hurt by the procedure.

Every pill, every procedure, every injection, every treatment not only has its expected effects, it has side effects and sometimes the side effects are worse than the original problem.  At this point there are about 30+ dead and 400+ affected from the contaminated steroid injections into the facets, numbers that will surely rise.

Be patient.  Do the stuff that statistically works.  Avoid the placebos and hang in there.  You will get better.

12/18/2014: Final toll 64 deaths and an indictment yesterday. Fourteen owners or employees of the New England Compounding Center were charged Wednesday in connection with the outbreak that killed 64 people nationwide and was traced to tainted drug injections.

Monday, October 29, 2012

Newer Surgery

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Arthroscopic (endoscopic) minimally invasive surgery is a newer take on minimally invasive lower back surgery.  For years orthopedic surgeons have been using arthroscopic techniques on knees and shoulders.  Also, for years they have been doing minimally invasive procedures through small tubes in the lower spine and neck.  It was inevitable that the two techniques would eventually merge.

Arthroscopic surgery is done through several small incisions.  Through one incision, a camera is placed.  Through other small incisions, instruments (grinders, cutters, suction, probes, etc.) are used to remodel the joint in question.

In recent years these arthroscopic techniques have been applied to the spine.  The spine consists of many very complicated joints.  Access to them is difficult, whether open, micro, minimally invasive, or arthroscopic techniques are used.  The hope is that when arthroscopic (endoscopic) techniques are used, there will be less collateral damage to muscles, joints, ligaments, tendons, and nerves, and therefore shorter recovery times.

With micro and minimally invasive techniques visualization of the surgical fields can be difficult, increasing time under anesthesia for the patient.  With the newer arthroscopic techniques, that may change.  Shorter, more accurate, less invasive surgeries will benefit the patient and speed his recovery.

Keep this technique in mind if you face the prospect of surgery.  Understand that it is relatively new; not many surgeons are trained in it or have a lot of experience with it, yet.  Also remember, there are very few indications for surgery.  See my posts from July 12, 2012 on back surgery and August 6, 2012 on minimally invasive surgery to understand the pros, cons and reasons for having surgery in the first place.

Thursday, October 25, 2012

Good Review of Imaging for Back Pain Patients

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

Go to this web site for a neuroradiologist's take on imaging for lower back pain.
http://news.georgiahealth.edu/archives/6656/comment-page-1#comment-2125

When you finish that article, you might compare it to my post here from May 22, 2012.

Sunday, October 21, 2012

The Plank and the Push-up

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

The Plank

Core strength diminishes lower back pain.  Two more exercises that require core strength are the Plank and the Push-up.  Start with the Plank.

Again, as with other core exercises we have discussed, start on all fours, on knees and hands.  Drop to elbows and knees and let your abdomen sag to the floor.  Your elbows should be directly below your shoulders.

For beginners, stay on your knees and straighten your body; your butt should be off the floor, but not elevated any higher than a straight line between your shoulders and knees.  That is the Plank position.  Hold that position for 5-10 seconds then relax.  Repeat until you are able to hold the position for 20-30 seconds with 5-10 repetitions.

Intermediate exercise is the same, but off your knees and on your toes.  Hold the position for 10-20 seconds.  Repeat up to ten times, increasing the hold time to 45-60 seconds.

Advanced exercise includes lifting an arm or leg off the floor and holding the proper position, like the Bird-dog we discussed earlier.

You can check out your technique by watching these videos:
http://www.youtube.com/watch?v=MHQmRINu4jU
http://www.youtube.com/watch?v=kiA9j-dR0oM

Or reading this Fox News post:
http://www.foxnews.com/health/2012/11/06/are-doing-push-ups-wrong/

The Push-up

Once you are doing the advanced Plank with ease, it is a relatively easy transition to, or add, push-ups.

Beginner push-ups start on your knees and hands, hands directly below shoulders, trunk straight as when doing the Plank.  Bend your elbows and drop your chest within 2”-4” of the floor, maintaining a straight back.  Once you can do beginner push-ups with ease, get up on your toes for intermediate push-ups.  Keep your trunk straight.  These are harder.

There are numerous versions of push-ups, some very advanced, others extreme.  Many can be seen at this web site:
http://artofmanliness.com/2009/07/21/push-ups-exercises/

Pick the one you like.  The best exercise is one that you will do.  If an exercise is too hard or it causes you pain, it the wrong exercise to be doing.

As with most core exercises I have recommended, there is very little compression of discs or facet joints with these exercises, cutting down on irritation of those structures.  If these exercises cause you pain, then you should not be doing them.  Start slowly.  There is no rush.  If you can only add one push-up a month, you will still be doing 12 by the end of the year and 24 by the end of two years.
 

Monday, October 15, 2012

One More Exercise


The Sidebridge

Reminder: If you have not done so, please read the Initial Post and  Blog Information.  At the upper left of this page above my picture click on the button, Initial Post and  Blog Information.

The sidebridge also strengthens abdominal, lateral side, and back muscles, without compressing the disc spaces or the facet joints.  If it is painful, stop.  You may have to start with just one cycle and gradually increase the number, or you may not be able to do this exercise. 

Beginners start on the floor or mat lying on one side or the other and leaning on that elbow.  They have their knees bent.  By tightening the muscles on the side away from the mat they straighten their body and lift their hip from the mat until it is in a straight line between knees and shoulders.  Hold that position for a count of 3-5, and repeat 10 times as you get better.  Do both sides.

The intermediate exercise is done on the toes, rather than knees.

Advanced exercise is rolling from one elbow to the other while on the toes, and dipping to the mat.

You can see the beginner and intermediate versions at this website: http://www.youtube.com/watch?v=Yh2U0XSPIv8

Monday, October 8, 2012

No Post This Week

We are visiting the grandchildren in Virginia this week.  Have limited internet access. Should resume posting next week.