19 reasons why you have back pain.

Fairmont Banff Springs Hotel and Resort (Dr. Noorali Bharwani)
Fairmont Banff Springs Hotel and Resort (Dr. Noorali Bharwani)

If you look at the spine you wonder how it was created.

Spine is a column of bones (vertebrae) held together by muscles, tendons and ligaments and cushioned by shock-absorbing disks. If you have a backache then the problem can be in any one or more of the elements forming your spine.

Low back pain is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70 to 80 per cent of adults at some time in their lives.

Your symptoms can vary from simply being an annoyance or it can be excruciating and disabling pain.

Good news is most back pain goes away on its own or with some medical treatment within four weeks. Surgery usually isn’t needed and generally is considered only if other treatments are not effective.

Most common reasons for strains and sprains are improper lifting, poor posture and lack of regular exercise. In one article, I saw a list of 19 causes of back pain. Some common problems are herniated disk, obesity, osteoarthritis, osteoporosis, poor posture, sciatica, spinal fractures, spinal stenosis and sprains.

When do you need tests like X-ray, CT scan, or MRI?

According to the guidelines in Choosing Wisely, most people with low back pain do not need these tests because these tests do not help.

There are three reasons why you should not rush into getting these tests. First, most people with lower-back pain feel better in about a month. Second, people who get these tests do not get better faster compared to people who took over-the-counter pain medicine and followed simple steps, like walking, to help their pain. Lastly, these tests lead to surgery and other treatments that you do not need.

That does not mean imaging test for back pain is a bad idea. In some cases, you may need an imaging test right away.

For example, if your back pain is associated with weight loss that you cannot explain, fever over 39 degrees C, loss of control of your bowel or bladder, loss of feeling or strength in your legs, problems with reflexes, and if you have a history of cancer.

These symptoms may suggest nerve damage or a serious problem such as cancer or an infection in the spine. If you do not have any of these symptoms, Choosing Wisely recommends waiting a few weeks for x-rays.

How much bed rest is too much?

For many years, getting bed rest was the normal advice. However, newer data have shown that there is little to no role for bed rest in the treatment of low back pain.

Research suggests if you find comfortable positions and move around sometimes, you may not need bed rest at all. Research also shows more than 48 hours of bed rest may actually increase pain, by increasing the stiffness of the spine and the muscle.

The sooner you start physical therapy or return to activities such as walking, the faster you are likely to recover.

A study published in 2015 by Furlan AD et al (Massage for low back pain) found massage therapy has the potential to minimize pain in the short term and speed return to normal function. More study is required to see if massage has long-term benefits.

According to Harvard Men’s Health Watch, yoga is a gentle practice that is ideal for maintaining back strength and flexibility. It’s also one of the more effective tools for helping reduce low back pain. It should be done gently and carefully.

The benefits of yoga go beyond muscles. The slow movements and the continuous focus on proper breathing can improve the emotional aspect of back pain by helping to lower stress and alleviate anxiety and depression.

It is important to keep moving to maintain muscle strength and flexibility. With bed rest, you lose about one per cent of your muscle strength each day. And you can lose 20 to 30 per cent in a week. Then it is harder to return to regular activity.

Most people with lower-back pain should apply heat or ice. Some people can get pain relief from an over-the-counter anti-inflammatory medication.

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Stop flirting with your enemies by eating smarter and healthier.

Cruise ship in St. Martin. (Dr. Noorali Bharwani)
Cruise ship in St. Martin. (Dr. Noorali Bharwani)

Let us start with a question – What is the best way to lose weight? Is it intense exercise or less eating? Or both?

You cannot lose weight just by exercising. Regular exercise will make your heart and muscles strong. To lose weight you have to eat less and eat healthy. This has to be a lifelong strategy. Scientific evidence shows most people (who lose weight) will regain their weight over a period of time as they revert to their old eating habits.

There are many challenges faced by people who try to lose weight and maintain the loss. The challenges are to avoid foods containing sugar, salt and fat.

When you start cooking or sit down to eat, ask yourself – am I flirting with my enemies? How grave are the consequences? Let us look at the answers in more detail.

Your enemy number one – sugar.

Today, our diet is packed with huge amounts of added sugars.

Sugar is used as an ingredient in many packaged foods. Statistics from the National Health and Nutrition Examination Survey shows Americans eat about 17 teaspoons of added sugars per day. That’s significantly more than the American Heart Association’s recommendation of not to consume more than nine teaspoons a day. We are consuming twice the amount of sugar than recommended.

We know added sugars are bad for us. It is associated with an increased risk of overweight and obesity. That is directly linked to the development of type 2 diabetes. Studies have shown odds of being overweight or obese were 54 percent greater among individuals with the highest intake of sugars compared with those with the lowest intake.

Those who like to eat sweet stuff also increase the risk of heart disease. Several studies have shown a higher sugar intake also meant higher levels of total cholesterol, LDL (bad) cholesterol, and triglycerides irrespective of your weight.

Your enemy number two – salt.

We know too much sodium (salt) is bad for your heart. And yet, most North Americans consume about 50 per cent more than the maximum of 2,300 mg per day of salt. Reducing salt intake reduces the risk of heart disease.

Sodium is present in all types of food as a preservative or to improve the taste. It is lurking in some foods you wouldn’t necessarily suspect.

According to the Centers for Disease Control and Prevention, 10 categories of food (breads, pizza, sandwiches, cold cuts and cured meats, soups, burritos and tacos, savory snacks, chicken, cheese, eggs and omelets) account for 44 per cent of our overall sodium intake.

Best thing is to cook at home. Restaurant foods are heavily loaded with salt. Eating at home is always healthier and safer.

Your enemy number three – fat.

If you eat the right kind of fat then fat is good for you. Studies show different types of fats -monounsaturated, polyunsaturated, and saturated – had varied effects on health.

Saturated fat is the bad one. Instead of consuming saturated fat, eat unsaturated fats (fish, nuts, olive oil) or healthy carbs (grains, legumes). This way you can protect your heart. You want your heart to pump forever!

Avoid trans fats. American Heart Association says, “Doughnuts, cookies, crackers, muffins, pies and cakes are examples of foods that may contain trans fat. Limit how frequently you eat them. Limit commercially fried foods and baked goods made with shortening or partially hydrogenated vegetable oils.” Trans fat is really bad fat.

Eat more foods that contain unsaturated fat. Avocados, nuts, olive oil, and fatty fish should all appear regularly on your plate. Keep an eye on the calorie intake. Otherwise these foods are good.

My favourite diet: heart-healthy Mediterranean diet with a four-point plan.

According to Mayo Clinic website, if you’re looking for a heart-healthy eating plan, the Mediterranean diet might be right for you.

The main components of Mediterranean diet include:

  1. Daily consumption of vegetables, fruits, whole grains and healthy fats
  2. Weekly intake of fish, poultry, beans and eggs
  3. Moderate portions of dairy products
  4. Limited intake of red meat

Sounds pretty simple! Enjoy!

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Painful experience of acute renal colic is hard to define.

Columbia Icefield, Rocky Mountains (Dr. Noorali Bharwani)
Columbia Icefield, Rocky Mountains (Dr. Noorali Bharwani)

Renal colic is painful. The pain comes when urinary stones block part of the urinary tract. Kidneys are part of the urinary system. So are the ureters, urinary bladder and urethra.

Kidneys are very important organs in our body. We are blessed with two kidneys. If one kidney fails we have a spare one. Compared to other organs like brain, heart, liver and spleen. It is important we take good care of our kidneys. Two functioning kidneys are better than one.

Why kidneys are important? Because they remove waste and extra water from the blood in the form of urine. Without the kidneys, the waste would keep building up and, over time, you would die. Or go on a long-term dialysis until you find a matching kidney for a transplant.

There are many illnesses that can destroy the kidneys. Today, we will discuss the effect of kidney stones. Kidney stones have many causes and can affect any part of the urinary tract – from the kidneys to the bladder.

Some individuals are prone to forming stones in the kidneys or urinary bladder. Kidney stones are hard deposits made of minerals and salts. These include calcium phosphate, calcium oxalate and uric acid. Minerals crystallize and stick together. Supersaturation of the urine constitutes a driving force favouring stone formation.

Kidney stones are rarely, if ever, fatal. The main impact of kidney stones is felt by young, otherwise healthy adults in the form of acute renal colic, causing symptoms of pain, nausea, vomiting and blood in the urine.

The lifetime risk of passing a kidney stone is about eight to 10 per cent among North American males. The peak age of incidence is 30-years. The rate of kidney stone formation in women is about half that in men, with two peaks, the first among women aged 35-years and the second among those aged 55-years.

Among patients who have passed one stone, the lifetime recurrence rate is 60 to 80 per cent.

What promotes crystallization of chemicals in the urine? There are many factors involved in this process, including urine pH, stasis and dehydration. The whole process is complex, involving many factors.

A kidney stone may not cause symptoms until it moves around within the kidney or passes into ureter – the tube connecting the kidney and bladder. Passing kidney stones can be quite painful, but the stones usually cause no permanent damage if they are recognized in a timely manner.

Depending on the situation, you may need nothing more than to take pain medication and drink lots of water. In other instances – for example, if stones become lodged in the urinary tract, are associated with a urinary infection or cause complications, then surgery may be needed.

Some controversy exists about the extent of investigation required after the passage of a single stone. Because the rate of recurrence is high, some experts favour an exhaustive evaluation for anyone who has passed a stone.

Patients with kidney stones are advised to increase fluid intake to produce a urine volume of 2-3 L/day. Good advice is to reduce the intake of animal protein, calcium and sodium, because reduction in the renal excretion of sodium will also reduce renal calcium excretion and thus render the urine less prone to making stones.

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Anal fissure can be a pain in the butt!

The Goddess in Catalonia Square, Barcelona, Spain. (Dr. Noorali Bharwani)
The Goddess in Catalonia Square, Barcelona, Spain. (Dr. Noorali Bharwani)

Anal fissure is a painful and annoying problem. I have written about this twice in the last few years (2004 and 2014). These columns are posted on my website. I thought it is about time to review the subject again.

An anal fissure is a tear in the lining of the anus (anal mucosa). Most often it is caused by injury sustained during passage of a large hard bowel movement. Pain in the butt may be mild to severe. It may be acute or chronic (recurrent). Sometimes pain is associated with bleeding.

Other causes of anal fissure are: chronic diarrhea, anal intercourse and childbirth. There are other less common causes of anal fissures. These are: Crohn’s disease or another inflammatory bowel disease, anal cancer, HIV, tuberculosis and syphilis.

Fissures of less than six to eight weeks’ duration are acute, and those persisting longer are chronic. Chronic fissures are associated with skin tags at the edge of anal margin.

Anal fissures are very common in young infants but can affect people of any age. Most anal fissures get better with simple treatments, such as increased fiber intake or sitz baths. Some people with anal fissures may need medication or, occasionally, surgery.

Ninety per cent of fissures are located in the upper or lower anal midline. Fissures that are not in the midline (atypical locations) may be associated with cancer, Crohn’s disease, HIV, syphilis or tuberculosis.

Good news is most fissures will resolve with medical management.

Studies have shown up to 87 per cent of acute fissures treated with a high-fibre diet or stool-bulking agents (psyllium) and sitz baths twice daily will resolve the problem. Patients with chronic fissures require the addition of topical smooth muscle relaxants (two per cent diltiazem). Medical management will heal chronic fissures in 65 to 95 per cent of patients.

There is strong evidence that topical calcium channel blockers (diltiazem) have fewer adverse effects and similar fissure healing rates when compared with topical nitrates (0.2 per cent nitroglycerin ointment). More patients complain about headache with nitrates than diltiazem.

Diltiazem works by relaxing the muscle around the anus (the anal sphincter). This reduces pressure and increases blood flow to the area to allow healing to occur. About 30 per cent of patients will have recurrence of fissure after medical therapy.

Certain fissures may heal quite quickly, whereas others can take several months to heal. Patients whose fissures do not resolve after six to eight weeks of medical management should be considered for botulinum toxin injection or surgical management.

Even with classic symptoms and a midline fissure, patients with new rectal bleeding who are older than 50-years or have any suspicious symptoms (weight loss, change in bowel habits, unexplained anemia or family history of colon cancer) require colonoscopy to rule out a more proximal cause of bleeding.

Some individuals will need surgery. Most effective surgical procedure is called partial lateral internal sphincterotomy (division of anal sphincter). Most people will notice that the pain from an anal fissure goes away within a few days after the surgery. In my experience most people find immediate relief after surgery. Rarely a small number of people have problems controlling stools when they pass gas. This usually gets better with time.

Surgical treatment is offered to those who do not respond to medical treatment or who have frequent recurrences. Rate of recurrence of fissure after surgery is small, about three per cent in one study.

How can I prevent getting a fissure in the future?

The quality and quantity of stool passing through the anal sphincter is important. It should be soft, bulky and dry. Chew your food well. Eat lots of fruits and vegetables. Use psyllium daily. And relax when you have a bowel movement.

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