Initial Post and Blog Information


     This blog is being started to help promote, market, and sell a book.  The book is unique in that it helps people with back pain figure out why their lower backs hurt, and what to do about it.  I am a physician and I know a lot about the lower back, more than most patients, although I will admit some have surprised me with what they know.  I have also been surprised by the willingness of some patients to believe anything they were told or read.
     What Your Doctor Won't Tell You About Your Lower Back walks the patient step by step through the possible causes and diagnoses, whether sciatica, stenosis, arthritis, strain, or herniated disc (or disk; your choice).  Along the way the patient learns some interesting facts, like most back pain goes away without intervention (treatment: injections, surgery), and that most back pain returns without intervention (change in life style mostly).  Also, there are scam artists who will sell you a "cure."  The book is not meant to replace your doctor, but to assist him in helping you.  Most doctors don't have the time to explain everything you need to know in order to make an informed decision about your back.  Insurance companies, lawyers, and entrepreneurs have ruined the American health system.  We have the best medical care in the world and the worst delivery system ever devised.  (That's another book, I think.)  These people demand more and more paperwork from physicians, decreasing the amount of time they can spend with patients.  The book will give you the information your doctor hasn't the time to deliver.
     What Your Doctor Won't Tell You About Your Lower Back is available from Lulu as a publish-upon-demand book.  It costs $19.99 from Lulu and $14.95 from Amazon's CreateSpace if you want to hold a printed copy in your hand.  I think that is pretty expensive, myself.  It is also available from either Barnes&Noble or Amazon as an ebook for the Nook or Kindle for only $5.99, a much more affordable price.  If you have a computer, a touch pad, or a smart telephone, you can download a Nook or Kindle app for free and then download the book. You can also review parts of the book for free using these apps.  Chapter 1 and Appendix 1 are shown below if you would like to read them.  On a large reading surface, the electronic book is as easy to read as the paper version.  Your choice.  You may browse even more of the book in electronic format at the web sites noted above.
     In the future, I hope to make more posts and to figure out how to respond to questions by readers.  This blogging stuff is new to me.  In the meantime, if you have any questions, please post a comment to any of my posts.  I will post your questions and my answers myself, again until I can figure out  another way of doing so.

Book Covers 

Front




Back

 


ALSO BY BILL YANCEY
Elvis Saves
Invictus
No One Lives Forever
Multidimension Man
A Dog Named Fridge
The Last Day


What Your Doctor Won't Tell
You About Your Lower Back
Avoid the Pitfalls, Scams, Shysters,
Con Men, Charlatans, and Quacks

_________________________________


Bill Yancey


Copyright © 2009,2012 by Bill Yancey

All rights reserved.  No part of this book may be reproduced in any form or by any
electronic or mechanical means including information storage and retrieval systems
without permission in writing from the publisher, except by a reviewer, who may quote
brief passages in a review.


This book is not to be substituted for consultation with a physician.  Neither the author
or publisher are responsible for injury resulting from ignoring that statement.   

Chapter 1
Introduction

          So, why wouldn’t your doctor tell you what’s in this book?  For most physicians, it’s not because they don’t want you to know.  It’s because they don’t have the time or they don’t think you will understand.  I have all the time it takes – yours.  And if I have done a good job explaining, I think you will understand.   If I haven’t, contact my publisher or me (make a comment to any post) and I’ll try to answer your question and make corrections in the next printing.  I promise.
          There also exists a subset of medical practitioners who are not so much interested in you or your pain, as in your money.  Some have deluded themselves into thinking their special method is the only way to stop back pain.  Many others have realized that no matter what they do, your pain will likely improve.  They can then claim success for their procedure and entice others to pay for it.  The bigger, shiner, and more exotic the equipment, the more outlandish the claims, the more notoriety these snake oil salesmen have, the more back pain sufferers they attract.  The more patients they see, the more capital they collect, and the richer they get.  A little knowledge can help you avoid these shysters.
          My publisher has made me acutely aware that she wants to sell many, many copies of this book.  Risking her displeasure, by condensing this information to one page, I’m going to tell you how to get rid of your back pain.  Please don’t take that page home without buying the book. 
          Before proceeding, you need to ask yourself a question, “What type of information do I need?”  If you want unscientific, rumor-based, biased, or wishful thinking, you won’t find it here.  You can find that on the internet, from a friend of a friend who has had back pain or surgery, or from the charlatans who sell expensive “cures.”  I have tried to present only scientific evidence based on thirty years of medical practice and scientific studies done by others.
          By the way, I am a doctor and according to Dave Barry (former columnist with the Miami Herald who wrote about me and my dog, Refrigerator, on May 4, 1997) can legally park anywhere, give shots, tell people to get naked, and make scientific observations, like this one: 79% of statistics are made up on the fly, but the following are pretty accurate.
          1.  In a mythical population of 1000 people who are suffering with low back pain, about 850 have injured muscles, ligaments, or tendons.  That’s 85%.  Most of these heal very quickly.  50 people will have a herniated disc (defined later in the book, hang in there), most of which heal on their own.  Another 50 will have stenosis (also defined later), some of which will need surgery.  Compression fractures will be the source of pain for about 40 people, those who suffer with osteoporosis.  And a small number, 10 people or 1%, will have rare problems like infection, autoimmune diseases, cancer, etc.
          2.  If this is your first episode of back pain, there is a 95% chance it will go away, on its own, by itself, EVEN IF YOU DO NOTHING ANYONE TELLS YOU TO DO, even if you DON’T ALLOW ANYONE TO DO ANYTHING TO YOU or FOR YOU, and even if you DO NOT READ THIS BOOK.  I’m already a hero; I just cured 95% of the new back pain in the world.
          3.  If this is one of several episodes of back pain you have had, there is an 85% chance it will get better – without intervention from doctors, chiropractors, physical therapists, etc.  And there is only a 3% chance you would benefit from surgery. There is a 50% chance it will recur.
          4.  There is a 1-3% percent chance you have something serious going on in your back.  Appendix 1 at the end of this book (also below) is entitled Red Flags.  Quickly, skim that.  If you have any of those symptoms, put this book back on the shelf (or shut down the computer).  GO SEE YOUR DOCTOR, NOW!!
          5.  This is the good stuff.  This makes you better (abbreviated version). 

THIS IS THE PAGE MY PUBLISHER DOESN’T WANT YOU RIP OUT OR COPY:
          First, your back needs a period of rest. A short period of bed rest is in order.
          Second, get some pain relief with an over-the-counter medication.
          Third, place some ice on the areas that hurt.
          Fourth, after the bed rest and pain medicine have begun to give you some pain relief, and as soon as you notice any improvement, get moving.
          Fifth, address muscle spasm with rest, massage, and/or heat. 
          Sixth, give your body a chance to heal.  Takes 2-12 weeks.
          Seventh, gradually resume normal activities.
          Eighth, gradually strengthen your back.  Some exercises will make it better; some will make it worse.  Find out which are which.  Don't start them, yet.  You have a couple weeks to figure out the difference.
          Ninth, eventually increase flexibility once the pain has resolved.  Don’t overdo it.

Long version of the same information (good reason to buy this book; it’s tough to hide the whole chapter in your back pocket):
          First, your back needs a period of rest.  Sometimes that period can be as short as overnight.  In the case of overworked discs or muscles, they just cry out for some relief.  If you do strenuous work all day and compress your disks, they will talk to you, “Enough!  Stop this nonsense or you will damage us permanently!”  Go lie down.  Stop compressing the disks and stop using the muscles.  Don’t sit; don’t stand; do lie down.  Get up to go to the bathroom and to eat.  That’s it.  But, do not stay in bed continuously or for more than 48 hours.   After 48 hours, you will begin to lose muscle mass and strength.  You will also start to lose stamina.  Those losses will make it more likely you will suffer another injury.  It is also possible that lying down for too long will allow the nucleus pulposus (central portion of disc) to absorb too much fluid, swell too much, and put pressure on the endplates of the disk, causing pain!  One common complaint of astronauts in zero gravity is back pain resulting from the expansion of their discs in zero gravity. 
          When you lie down, find a comfortable position.  To avoid pressure soreness from lying in the same position for too long, find two or three comfortable positions you can change into when your body tires of one or the other.
          Second, some pain relief from over-the-counter medication is in order.  An injury causes a cascade of hormonal (chemical substance released within a body) responses within your body.  (Medical terms are defined within the following chapters and in the glossary, more good reasons to buy the book.)  This inflammatory cascade is sometimes too effective and can add insult to your injury.  The drug companies are trying to figure out where they can block this cascade of natural chemicals to make healing less uncomfortable.
          In the meantime, acetaminophen (Tylenol™) will give some relief.  Do not take massive doses (take no more than six 500 mg tablets in one day) unless you hate your liver and are looking for a transplant.  Non-steroidal anti-inflammatory drugs (NSAIDs) will also give pain relief, or an ulcer, and shut down your kidneys if you abuse them.  NSAIDs, like aspirin, ibuprofen, and naprosyn are potent pain medications.  Follow directions carefully.  Take only after meals.  Just because these are over-the-counter medications doesn’t make them candy.  If worse comes to worst, take an anti-inflammatory plus the acetaminophen.  If you need more pain medication than that combination, you are in red flag territory.  Go see your physician.
          Third, place some ice over the areas that hurt.  Ice is a potent vasoconstrictor.  At times, inflammation is an over-reaction to injury and it causes vasodilation (swelling of the blood vessels, hence the rubor – redness, calor – heat, dolor – pain, and tumor – swelling, the cardinal symptoms of inflammation).  Ice slows the process of swelling, taking pressure off pain receptors.  For long term treatments, say 30-45 minutes, put the ice in a plastic bag and wrap a towel around it.  You want a cooling effect, not to add frost-bite to your list of problems.  For shorter treatments, take an ice cube and rub it in circles directly over the area that hurts until the area is numb, or for 15 minutes, whichever is shorter.  If you can’t reach the area, have someone else do this for you.  Use ice 4-6 times per day as needed for up to a week. 
          Fourth, after the bed rest and pain medicine have begun to give you some pain relief, as soon as you notice any improvement, get moving.  The sooner you move, the sooner you will heal, and the better you will move later on.  Do not overdo it. Standing, by itself, is work against gravity and requires the use of all your back muscles and joints, and compresses discs.  Being upright increases disc nucleus pulposus and cartilage exchange of nutrients and waste products and keeps them healthy.  Inactivity leads to suboptimal nutritional states for both.   Just stand for a while.  If it hurts, lie down again, but get up again, soon!  When you can tolerate standing, walk a short distance, maybe 10 feet.  Try to double that each time you get up.  Working against gravity is important; it stops muscle loss and squeezes fluid out of the tissue that causes swelling and pain.
          Maintain your mobility.  Joints, ligaments, tendons, and muscles all heal better and more quickly when used.  Do not overuse them or increase your pain.  Joints which are not used tend to lose flexibility, increasing your chance of future injury. 
          Fifth, address muscle spasm.  Muscles do go into spasm on occasion.  Basically, they are trying to keep you from moving the damaged parts of your body.  One of the reasons you laid down was to stop using the injured parts.  There are four ways to address muscle spasm: rest, gentle massage, application of warm compresses, and muscle relaxant medication.  The first three are best.  Heat and massage increase collagen production and advance healing.  Don’t overdo the heat; you might increase the swelling, which is causing some of the pain.  You can also induce skin pigment (color) changes and otherwise damage your skin if you use too much heat.  You want warmth, not cooking.  But, 20-30 minutes of warmth between cold packs won’t make things worse, and can help quite a bit.  In spite of what the pharmaceutical companies want you to believe, there really is no such medication as an anti-spasmotic or muscle relaxant.  These medications are all sedatives, i.e. they make you sleepy.  Some are addictive.  Once you are asleep, you have no reason to move damaged body parts and the muscles relax.  Avoid muscle relaxants if you can.
          Some people find that splinting the area that hurts helps control the pain.  Like muscle spasm, a splint decreases motion.  Wearing a corset or lumbar brace can give some relief, but don’t use it for more than 3-7 days, or the muscles in your back and abdomen will begin to atrophy (shrink from lack of use).
          Sixth, give your body a chance to heal.  Modify your activities to lessen the chance of injury.  In the case of mild overuse, you might be able to return to your normal job (not lifting furniture) the next day.  It will take a minimum of two and possibly as long as twelve weeks for pulled muscles, ligaments, tendons, joints, and discs to heal.  Some physicians think it takes three to six months for the body to synthesize enough collagen for a complete repair.  There are some researchers who think neurogenic and muscular response to an injury can last 5-10 years without treatment (exercise and stretching, as mentioned later).  Unfortunately, scar tissue is not as strong as the original muscle, tendon, ligament, joint, or disc tissue.
          Seventh, gradually resume normal activities, provided they don’t make you worse.
          Eighth, gradually strengthen your back.  Exercise increases collagen production and healing.  There is no exercise you can do that won’t use your back muscles, tendons, ligaments, joints, and discs.  You can’t stand up without using every joint and muscle in your back.  Since the scar tissue isn’t as strong as the original tissue, the tissues surrounding the scar have to be made stronger to take up the slack.  Without recovering strength, you are a set up for a repeat injury.  We’ll address exercises and stretching further in Chapter 17.  For years doctors have been giving patients back exercises to do.  SOME EXERCISES MAKE BACK PAIN WORSE!  Avoid the following: flexing your spine, extending your spine, sit-ups, crunches, pull-ups, or anything that causes significant pain.
          Ninth, increase flexibility once the pain has resolved.  There are people who need a stronger, stiffer spine to avoid injury.  Being flexible can help prevent injuries, but it can also lead to worse injuries if the flexibility is actually instability.  There is no stretching exercise that won’t increase your back’s flexibility, but if the stretching causes pain, then it is the wrong thing to do.
          If you want to know how to prevent your back pain from returning in the future, you need to read Chapter 17, Prevention.  If you want to know why the above regimen works 85-97% of the time and why prevention is a good idea, you need to read the rest of the book.  But, what the heck, you’re going to be in bed for a day or two, and resting your back for a while.  Reading an entertaining book might fill the boring gaps in your day.

Appendix 1
Red Flag Symptoms and Bad Things That Also Cause Back Pain
Reasons to Worry or to See Your Doctor

Red Flag: possible cause of back pain

Abdominal pain: pancreatitis, abdominal aortic aneurysm, prostatitis, endometriosis, intestinal disease, ulcer, gall bladder disease, cancer, menstrual pain

Abnormal immunity (including HIV or cancer therapy): infection (diskitis, epidural abscess, spinal osteomyelitis), cancer

Age
Under 18: infection, congenital abnormalities, tumor, spondylolysis, spondylolithesis, apophysitis (growth plate injury at iliac crest)
Over 50: abdominal aortic aneurysm, infection (diskitis, epidural abscess, spinal osteomyelitis), tumor
Over 65: spinal stenosis

Anesthesia (numbness, saddle distribution, i.e. the part of your body that would touch a saddle if you sat on one): spinal cord compression, Conus Medullaris or Cauda Equina Syndromes

Bilateral sciatica: spinal cord compression, Conus Medullaris or Cauda Equina Syndromes

Bowel and bladder dysfunction: spinal cord compression, Conus Medullaris or Cauda Equina Syndromes

Cancer history: recurrence, especially lymphoma, myeloma, sarcoma, neurofibroma; or spread, especially of breast, lung, thyroid, kidney, or prostate cancer

Constipation: spinal cord compression

Early morning pain: cancer, infection (tuberculosis, diskitis, epidural abscess, spinal osteomyelitis)

Fever, chills, night sweats: infection (tuberculosis, prostatitis, diskitis, epidural abscess, spinal osteomyelitis)

Fatigue, excessive: infection (diskitis, epidural abscess, spinal osteomyelitis), cancer, autoimmune disease

Hypertension (abnormally high blood pressure): abdominal aortic aneurysm

Immune deficiency (Congenital, Cancer, HIV, transplant patients: kidney, heart, lung, etc.): infection

Intravenous drug use: infection (diskitis, epidural abscess, spinal osteomyelitis)

Inherited metabolic disorders: Multiple

Muscle weakness, significant or progressive: nerve compression

Neurological deficit, i.e. numbness, weakness, difficulty with balance, erectile dysfunction: nerve compression and damage

Night pain: vertebral osteomyelitis (infection of bone)

No improvement with time or with therapy: Multiple

Numbness (especially in crotch), radicular distribution: spinal cord compression, Conus Medullaris or Cauda Equina Syndromes

Pain at night: cancer, infection (diskitis, epidural abscess, spinal osteomyelitis)

Pain lasts more than 6 weeks: tumor, infection, auto-immune diseases (rheumatoid arthritis, Lupus, Reiters, psoriasis, Crohn’s, ulcerative colitis, ankylosing spondylitis, etc.), herniated disc

Pain radiating below knee: compression and/or damage of nerve

Pain with cough, sneeze, prolonged sitting: compression and/or damage of nerve

Rash or burning pain: Shingles (Varicella Zoster Virus), infection, cellulitis

Recent hospitalization or urinary catheter: infection (diskitis, epidural abscess, spinal osteomyelitis)

Recent surgery: infection (diskitis, epidural abscess, spinal osteomyelitis)

Recent Urinary tract infection (bladder infection): kidney infection, kidney stone

Severe, unremitting, or intermittent excruciating pain: infection (diskitis, epidural abscess, spinal osteomyelitis), cancer, Paget’s Disease, sickle cell, osteoporosis fractures, kidney or gall stones

Stiffness of multiple joints for hours in the morning: arthritis

Steroid use: infection (diskitis, epidural abscess, spinal osteomyelitis), fractures

Trauma: fractures, ligament tears and instability, osteoporosis

Urinary incontinence or urinary retention: spinal cord compression, Conus Medullaris or Cauda Equina Syndromes

Vascular disease (previous heart attack or peripheral vascular disease): abdominal aortic aneurysm

Weight loss: infection, cancer

Worse pain at night, or unrelieved by bed rest, wakes patient from sleep: tumor, infection