Neck and back pain

Lower back pain is very common. There are many different ways to treat it -- part of which is due to the fact that none of them are the perfect treatment for all patients.

When someone presents with back pain or neck pain, there are several important issues that need to be considered. First, has there been any trauma which would lead to a fracture. Second, is there any sign of infection or cancer. Third, are there any symptoms such as bladder or bowel problems or weakness or is there only pain. The possibility of cancer, infection, or fracture can be set aside and ruled out with a set of regular x-rays and a history and physical examination.

Assuming that pain is a major problem and that there is no evidence of fracture, infection, or cancer, then the next issue is how to help the patient. This is divided into three phases.

In the first phase, we have to relieve the pain. For mild pain, I use Tylenol (acetaminophen). The Tylenol dose is one to two 325 mg Tylenol every six hours or one extra strength (500 mg) Tylenol every six hours such as a 12am, 6am, 12noon, 6 pm schedule. If necessary (if the pain is not relieved by Tylenol alone), I add a non-steroidal anti-inflammatory agent such as Naprosyn (naproxen) 250 to 500 mg every 12 hours. If needed, I will give naproxen in a dose of 250 mg every six hours on a 3 a.m., 9 a.m., 3 p.m., 9 p.m. schedule if a 12 hour schedule does not forstall the pain. In that manner, you can take something every three hours for pain. It should be noted that all nonsteroidal medications can hurt the kidneys, stomach and heart if taken in excess. Also, despite recent bad press, they are probably safe taken as short term (days) treatment. Naproxen appears safest of all the non-steroidals for heart patients.

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What are the key principles to weight loss?

I used to base all of my advice on weight loss on calories. If we take in more calories than we use on a given day, the body tends to store the excess calories as fat. The opposite is also true -- if we use more calories in a given day because of our metabolism and/or exercise, our body will burn fat, and we will tend to lose weight. One pound of fat is 3500 calories, roughly. Portion control is obviously a key issue. However, calorie counting is difficult.

The basic advice regarding weight loss that I now use is based on the “Glycemic (sugar) index” of foods. Basically, what this means is that certain foods turn into sugar more quickly and, if taken in significant amounts (called the “glycemic load”), our bodies turn the excess sugar into fat. Therefore, it matters how quickly the food is turned into sugar and also how much of it we take at a given time that determines how much fat we add or lose.

Simply stated, it is better to take numerous small amounts of low glycemic index foods throughout the day rather than taking only one meal a day or taking higher glycemic index foods.

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What is Upper respiratory infection?

One of the most common problems to bring people to the doctor is an upper respiratory infection. This may include a cough, fever, sore throat, runny nose, headache, sputum (phlegm) production, fatigue, muscle aches, etc. It may include just some of these or any combination.

Many people do not realize that most upper respiratory infections are due to viruses and common cold viruses do not respond to antibiotics (antibiotics are drugs used to treat bacterial-not viral infections). Viruses such as HIV-AIDS,hepatitis and flu may be suppressed by anti-viral drugs but the viruses causing the common cold are not touched by these anti-viral medications. Unfortunately, although we have made many advances in medicine, the common cold is still treated symptomatically - which is to say with medicine designed to make you feel better -- aimed at your symptoms. Most colds are caused by rhinoviruses which do not respond to antibiotics or anti-viral drugs. Rhinoviruses infect and cause inflammation of the airways from the nose through the mouth and into the trachea (the big windpipe) and bronchioles (the smaller pipes) leading to the lungs. It is this irritation, swelling, and pus that leads to the stuffy or runny nose, sore throat and irritated, red and raw windpipe causing cough.

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What is Alzheimer's disease (AD)?

Alzheimer's disease (AD) is the most common form of dementia (a brain disorder that seriously affects a person's ability to carry out daily activities) among older people. It involves the parts of the brain that control thought, memory, and language. Every day scientists learn more, but right now the causes of AD are still unknown, and there is no cure.

AD is named after Dr. Alois Alzheimer, a German doctor. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. He found abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Today, these plaques and tangles in the brain are considered hallmarks of AD.

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