Surviving Lumbago: The Low-Down On Back Pain

iStock_000014522484Small85%. That’s the percentage of you who will, at some point, be plagued by low back pain. Sure, there are more exciting topics out there, but maybe none more pertinent to the majority of us.

One word of advice: don’t help your friend move his refrigerator down the stairs. There. That is all.

Have a nice day.

I see people come in in droves with low back pain, often with a history of helping a buddy move this piece of furniture or that appliance. Tell your friend to stay put. Moving is overrated.

For me, my bout with low back pain was less sexy than that. It was also less noble. No, I was on a boat and bent over to lift the cushion that covered the built-in cooler. It’s ok. You can laugh. That cushion was as light as you’d expect. I never claimed to be a manly man. My take-home message from that was that almost anything can exacerbate an episode of mechanical low back pain. You move the wrong way, with or without weight involved, and bam – “threw” your back out.

My episode was mild, lasted a few days, and never came back. But, when you do have lumbar pain, you’ll have to make a decision about whether you need to see a doctor. That’s when you’ll want to reference this post. Maybe bookmark this. You know your time is coming.

Since I’m an emergency physician, I have to point out the things that I look for that make me think this is NOT just strain of the muscles of the low back. In other words, if you have low back pain and these confounding factors, you should go see a doctor.

• trauma – if you fell off a ladder onto your back, or your crazy cousin hit you with his car, you need to be seen. There could be a broken bone causing your pain. Get an x-ray.

• weakness – if you have legitimate weakness, not just pain with movement, but the “I can’t pick my foot up off the floor” weakness, you need to be seen.

• loss of bowel/bladder control – inability to urinate, or peeing and pooping on yourself should be cause of concern. Sounds obvious, right? Seriously, go to the hospital.

• risk for infection – fevers are a red flag for me. If you are chronically on medications, like steroids, that put you at risk for infections, or if you have a nasty habit of shooting up illicit drugs, especially if you’re running a fever with your back pain, go see a doctor.

• risk for cancer – if you have cancer, or had cancer, you’re more likely to need x-rays, especially if your pain is lasting a while, or you didn’t do anything to cause it.

Assuming you simply tweaked your back and are suffering, you might be able to get by without seeing a doctor. The first thing you need to understand is that most mechanical low back pain gets better in 2-4 weeks. That’s not a typo. I didn’t say 2-4 days. So, part of figuring out if you need to be seen is setting reasonable expectations for your recovery.

Most of the time the pain in the low back is from straining muscles and ligaments. Sometimes it’s from a bulging disc. If you notice the pain radiates from your low back down your leg, it might be a disc that is bulging (also called herniated). Even most of these get better without surgery.

So, what to do. Try taking ibuprofen and Tylenol for your back pain. You can try a heating pad (low to medium setting, and don’t fall asleep on it), or you can try an ice pack (for 10-15 minutes out of each hour while you’re awake). If you can get that area numb, it doesn’t hurt so much. Don’t sleep on anything really hard or really soft. A nice, firm mattress is the best. If you lie on your back and put a pillow behind your knees, this can relieve some of the pressure on your back. Gentle stretching and strengthening exercises can be helpful.

If the pain is too much, you may need to see a doctor for some prescription pain relief. Use this only as a last resort. Narcotic pain medications tend to delay how long it takes you to get better from your back pain. In addition, they are addictive.

Some people benefit from seeing their MD, or going to physical therapy, or by seeing a chiropractor. The studies show that they all get you better at about the same rate, just each using different modalities.

So, when you do hurt your back, try some home meds and ice. And time. That’s the main one. Come see me if you have one of the worrisome features we discussed, or if your pain is just not manageable. Or, if you need a work note. We specialize in those, too.

What experiences have you had with low back pain? How long did it take to improve?

I Can’t Stand The Pressure: Essentials of Hypertension

Doctor checking blood pressureIn my occupation, I see a lot of people who obsess over their blood pressure. Sometimes they show me pages and pages of scribbles of what their readings were on this day, at a certain time, after they ate a certain meal, and whether it was pre- or post- The Bachelor, or Dancing With The Stars, or whatever other program is currently captivating the masses.

For the most part, as an emergency physician: I. Don’t. Care.

Gasp! Shock! Horror! The heresy!

Crickets…

Let me clarify. I do care. But as the doctor taking care of your emergency that day, it’s usually not overly relevant. While your elevated blood pressure may be a risk factor for certain diseases, it is often not the one culprit I have to fix in the ED to make everything better. Usually that’s something that is best addressed by your primary care physician.

Now, low blood pressure. That springs an emergency physician into action. That’s what happens to really sick patients. That what we see with sepsis, trauma, and bad heart attacks. We put in central lines, we give fluids and medications to try to do the impossible: prevent death.

Before we get back to high blood pressure, let’s just spend another minute on low blood pressure. People ask, what blood pressure is too low? The blood pressure that’s low and making you feel lousy. If you’re a young, thin female, and your blood pressure is 92/58, you might feel fine. For me, I’d be nearly unconscious. If the readings are low, and you feel lightheaded or like you might pass out, then you need to be seen by a doctor.

What is blood pressure? There are two numbers. The first, or higher number, is the systolic blood pressure. The second, lower, number is the diastolic blood pressure. The way it is measured is a cuff is placed on the arm. That cuff squeezes hard enough to stop the blood from flowing through the artery. As the pressure in the cuff is released, it will get to the point that it allows just a little bit of blood to flow through. That is the top number. As it continues to release pressure, the cuff gets to a point that it is not blocking any flow of blood into the artery. That is the bottom number. Your blood pressure is basically how much pressure your artery walls see at any given moment.

High blood pressure (hypertension) is defined as a blood pressure greater than 140/90. It is not a disease to be taken lightly. It is a risk factor for heart disease, strokes, and kidney disease to name a few areas. But, it is a risk factor over the long haul, not in short intervals.

Chronic blood pressure elevation does not need emergency treatment until the number is above… wait for it… wait for it… wait… Nope. There isn’t an absolute number. In fact, treatment of high blood pressure is not an emergency until it is causing what we emergency physicians refer to as end-organ damage.

End-organ damage means that your extremely elevated blood pressure is causing damage to your organs right in front of my eyes. An example would be if you’ve had a rapid increase in your blood pressure so that your heart cannot pump against that pressure and you’re having heart failure, where fluid is building up on your lungs. Another example would be a sudden decline in your kidney function. Or, if your blood pressure is so high that you’re not thinking clearly. We call that hypertensive encephalopathy.

As a patient now, since my, um, “heart” episode, I am paying closer attention to my blood pressure. I’m checking my blood pressure, noting when it’s running high, and keeping a log. But, I don’t worry about what it’s running from day to day. For me, it’s more of a battle that I don’t like losing. My blood pressure record is my scorekeeper. My doctor and I are watching what it’s doing over weeks. When I have a reading that’s a little high, I don’t sweat it. I know I don’t want it there for a decade, but a week or so here or there, a month or two to get it where I want it, is not a big deal.

Aside from medications, which you can discuss with your doctor, there are some lifestyle modifications you make if you find yourself with hypertension. First, exercise, regardless of your weight. If you’re overweight, lose some weight. Another change is to decrease your consumption of salt and alcohol. Stress, too, is considered to contribute to hypertension in some people. If you snore, or have sleep apnea, you should have a sleep study and get treatment for that.

So, if you’re feeling fine, and you notice you blood pressure is running high, schedule an appointment with your doctor. Save some dough and don’t pay me a healthy wage to tell you to keep a log of your readings and to see your doctor. You got that from me here for free. Spend your money elsewhere.

What worries have you had when your blood pressure is running on the high side?