DEAR READER: Polymyalgia rheumatica (PMR) is an inflammatory disorder that results in widespread muscle aches, pains and stiffness of the hips, shoulders, thighs, upper arms and neck, fatigue, anemia, malaise and unintentional weight loss. Symptoms experienced are the result of mild inflammation of the joints and surrounding tissue. Stiffness can worsen following periods of inactivity, such as after a night’s sleep or sitting for too long.

The condition is thought to be related to an immune-system arthritic disorder that customarily goes away on its own in a year or two. Initially, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) might control the side effects. Long-term use of NSAIDs can include intestinal bleeding, hypertension, renal insufficiency, fluid retention and more. Beyond that, medication such as corticosteroids and self-help measures can go a long way toward dealing with the discomfort. The downside to long-term steroid use is possible hypertension, osteoporosis, diabetes, weight gain and cataracts.

Self-help includes a nutritious diet rich in fresh fruits and vegetables, lean meats, whole grains, calcium and vitamin D. The latter two recommendations can be satisfied through supplements. The daily recommendation for calcium in people over 50 is 1,200 milligrams per day with 600 to 800 international units (IU) of vitamin D. Exercise, primarily low-impact movement such as swimming, riding a stationary bicycle or walking, will go a long way toward reducing the pain.

Risk factors include age, race, gender and those diagnosed with giant cell arteritis. Older adults, primarily those 70 and older, are affected, and women are twice as likely as men to develop the disorder. No one is immune; however, Caucasians, Scandinavians and people from Northern Europe are most at risk. Finally, giant cell arteritis is a condition in which the temporal arteries and other areas of the body become swollen and inflamed. Almost 50 percent of all people diagnosed with giant cell arteritis are found to have polymyalgia, and up to 20 percent of those with polymyalgia develop giant cell arteritis.

Diagnosis can be made through laboratory testing that may include a rheumatoid factor, sedimentation rate, C-reactive protein, platelet and red-blood-cell counts. The only way to rule out giant cell arteritis is through biopsy from the scalp artery at the temple.

To provide related information, I am sending you copies of my Health Reports “Fibromyalgia” (a related topic) and “Managing Chronic Pain.” Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a $2 check or money order for each report made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title(s) or print an order form off my website at www.AskDrGottMD.com.

The first thing to know is that there are two basic types of injury — acute and chronic. An acute injury is defined as one that has rapid or sudden onset. The pain is typically short-lived. A chronic injury is one that develops over time and is long-lasting.

When treating an acute injury, you use cold; when treating a chronic injury, you use heat.

Acute injuries are often accompanied by swelling and inflammation; the application of ice will help reduce those symptoms and the pain. You can usually ice an injury as often as you like but here is the key: only apply the ice for 15 minutes at a time; then allow the skin to warm up in between applications. And do not place the ice directly on your skin; the best thing to do is wrap it in a towel.

If you apply ice for longer than 15 minutes, your body’s natural defenses will kick in and try to warm the area by bringing more blood there. At that point, the ice pack will do the opposite of what you want it to do. It will cause more swelling.

Chronic injuries are often accompanied by sore, still muscles or joint pain. This type of pain can be relieved by warming the injury to increase elasticity of the joint connective tissues and to stimulate blood flow. Heat can be applied for 15 to 20 minutes at a time.

And, of course, sports injuries and the pain that accompanies them can also be treated by a chiropractor.

Monica S. Nowak, D.C.
Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860 824-0748

Reprinted with permission from the writer.

DEAR READER: Burning, stinging, pain, pins and needles, and other abnormal sensations of the buttocks and thighs are often the result of a spinal problem, most commonly sciatica. This condition is caused by impingement of the sciatic nerve in the lower back, usually caused by a slipped, ripped, torn or otherwise displaced disc. Other symptoms include low back pain, abnormal sensations in the low back, calves or feet, and urinary or fecal incontinence. I suggest you speak with your physician about this possibility and get an X-ray or MRI of the thoracic (middle) and lumbar (lower) areas of your spine.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and sent to P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

The backpack might seem like the least important thing for a parent to worry about in the hectic days before school starts, but keep in mind that even very young children wear their packs every day, nine months a year.

And, when those backpacks fit incorrectly, it can add pressure to a child’s neck, shoulders and back.

Here are some tips to prevent neck and back pain/strain.

* Choose a lightweight material. You might have to replace it sooner but it won’t add to your child’s already heavy load.

* Wide padded shoulder straps help distribute the weight of the pack more evenly.

* Children should carry no more than 10 to 20 percent of their body weight. Their bodies are still developing muscles, bones and their attachments are only equipped to support a small amount of weight without taxing them. Would you be comfortable carrying an 80 pound briefcase to work? For many children, this means working with a parent to figure out which one can remain on campus, in a desk or locket.

* Show them how to pack their bags ergonomically. Heavy items should be closest to their back. Use multiple compartments so that the load doesn’t sway from side to side.

* Make sure your children are wearing their backpacks correctly. They should be worn over both shoulders, high on the back (2 inches above the waistline) and have them buckle the waist strap if their pack has one.

No one is saying that backpacks are going to cause major illnesses or dysfunction in a child. But, packs can contribute to future neck and back problems.

So, check in with your children, ask them if they have any pain and/or numbness in their neck, shoulders, arms, back and/or legs. Children should not have any pain at any age, it’s just not normal.

If they are experiencing pain, try a natural alternative: chiropractic. It can help them adjust their spine and skeleton before any problems become permanent.

Monica S. Nowak, DC
The Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860 824-0748

Reprinted with permission

First, hydrate. Your body is 70% water and your nervous system is 90% water. Water feeds your body, discs, ligaments and joints.

Position yourself properly. Being bent over, kneeling for long periods of time or lifting and hauling heavy objects can put a strain on your back, shoulders and neck. Bend your knees when lifting; use a kneeling board or stool; and get help with the big stuff.

Rest. Take breaks. Stretch before any strenuous activity and in-between doing them. Warming up your muscles can significantly reduce your chance of injuring yourself. The job may take you a little longer, but your back will thank you in the lung run.

And, finally — get adjusted. Visit your local chiropractor to realign your spine and get that much-needed muscle work done to balance out all that summer “fun”.

People too often put more care and attention into their cars and homes than their own bodies. We only have one and if you take care of yours, it will take care of you.

Monica S. Nowak, DC
Chiropractic Center of Canaan
176 Ashley Falls Road
Canaan, CT 06018
860 824-0748
www.PeterMarkowiczDC.com

Above article reprinted with permission from Monica S. Nowak, DC

I’ve since had chiropractic treatments and massage therapy but am unable to continue due to financial difficulties. I saw an orthopedic surgeon but to my dismay, he didn’t refer me for any treatment. Instead, he administered a cortisone shot and asked that I return for a follow-up visit in three months. Follow-up visits were disappointing as he did not even try to refer me for therapy or anything beneficial to my injury.

I took it upon myself to work my knee muscles and provided self-therapy. I’m finally walking a little better, but I still cannot fully bend it. Without having to undergo surgery, is there a sports kinesiologist similar to those who care for professional athletes you can refer me to? Would that be outside my insurance benefits?

DEAR READER: I recommend that you see your primary-care physician and orthopedic specialist to obtain some answers. In a sense of the word, you must know the rules of the game before you can start to play. Perhaps they will both indicate that you have improved as much as you can, that you have arthritis, disc degeneration or other condition(s) that affect many people as they age. If that is the case, there are self-help steps you can take. If not, consider physical therapy, hydrotherapy, yoga, weight loss, pain medication and/or ice/heat for relief. You don’t indicate if you have taken any medication other than the cortisone injections that were somewhat ineffective. Is a trial medication an appropriate first step? Once you receive answers and know your limitations, ask for an appropriate referral, perhaps to a sports-medicine specialist who would be covered under your insurance.

On the home front, your local hospital or health center should have a physical-therapy department with qualified individuals to work with you. A local community center might have yoga instruction and a swimming pool with trained personnel in hydrotherapy. Even if the services are not covered by Medicare or other insurance, these programs should be affordable for seniors.

To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: The pain of fibromyalgia is widespread and can be felt throughout the body. Symptoms vary from person to person and can include joint stiffness, sleep disorders, fatigue, widespread pain and a great deal more. Herein lies the problem, because every symptom can be tied in to other disorders, making it difficult to diagnose.

There is no X-ray testing or laboratory work to confirm or rule out fibromyalgia. Rather, the history a patient presents to his or her physician, coupled with a hands-on examination, will likely tell the story.

Treatment commonly begins with over-the-counter remedies such as ibuprofen, aspirin or naproxen sodium, advancing to prescription medications such as gabapentin, tricyclic antidepressants, SSRIs (selective serotonin reuptake inhibitors) and narcotics. The downside to narcotics is their addictive qualities, which appear to control one condition while replacing it with another damaging one. Physical therapy and an exercise program might be an appropriate addition to more conservative methods. Water aerobics, deep breathing exercises, massage, chiropractic manipulation, acupuncture, yoga and even counseling might teach a patient methods of successfully dealing with the constant pain. There are options. Therefore, it is important that you enlist the services of a physician well versed in the treatment of fibromyalgia. Don’t give up. The condition is an unpleasant, exhausting one but there is help.

To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

A “normal” spine when viewed from the front or from behind should appear straight up and down. When viewed from the side there should be three apparent curves. There should be a curve towards the front of the body in the neck or cervical region, this is a lordotic curve; a curve towards the back of the body in the middle back or thoracic region, a kyphotic curve; and a curve towards the front in the lower back or lumbar region, again a lordotic curve. It is the alteration of the straight up and down posture of the spine that constitutes a scoliosis; that is when the resultant curve is greater than ten degrees.

Most curvatures, greater than 80% of the time, are of unknown causes or idiopathic. Sometimes trauma, tumors, neurologic disorders or birth anomalies affecting the shape of the bones of the spine may be the underlying cause. In a lot of cases the cause may be as simple as having one leg congenitally shorter than the other, which can also happen post-leg fracture or by having inequalities of the feet. Most people who have scoliosis have curves less than twenty degrees which are not usually of any great clinical significance other than they can contribute to back pain. These are not of any great concern as long as they are stable and not progressing. These curves do have the ability to progress rapidly, especially in children and adolescents, and particularly in young girls who have not yet had their first menses. They therefore need to be monitored closely early on in those situations.

Scolioses are generally found on spinal screenings which are commonly done in the school systems. Parents may notice that their child has one shoulder or hip higher than the other or that one pants leg needs to be hemmed a bit higher. Also, there may be a noticeable “hump” on one side of the spine while a child is bent over at the waist. Sometimes the curves may be very subtle and may be missed during a mass screening as is done in the schools so I always encourage my patients to bring their children in so that I can screen them also. If a curvature is found x-rays are generally performed to assess the degree and extent of the curve and to see if the cause of it can be determined. Occasionally a MRI of the spine may be necessary to rule out any pathology that may be instigating the problem.

Scoliosis can affect the patient’s quality of life by restricting movements, causing pain and restricting lung and heart function. In some cases there can even be psychological scarring as the curves can be disfiguring affecting the patient’s self-esteem.

Treatment for scoliosis primarily depends on the degree of the curvature. When a curve is mild, generally less than 25 degrees, the patient is monitored with periodic screenings and x-rays to insure that the curve is not progressing. As long as the curve does not appear to be progressing no treatment is needed unless the patient is experiencing pain. If the curve does progress to between 25 to 45 degrees then the patient may be a candidate for bracing. Bracing can help stop the progression of a curve but won’t reverse it. If the curve progresses to beyond 45 degrees then surgery is generally performed which usually entails the implantation of a metal rod to stabilize the curvature.

As a chiropractor, my role in the treatment of scoliosis, involves the early detection and treatment of the subsequent pain that my be present as a result of the condition. Spinal manipulation has not been shown to be effective for stopping or reducing scoliosis but it can help restore some of the mobility that is lost due to the abnormal positions that are assumed by the vertebrae and thus help in relieving some of the pain that the patient may have. Another role that I can play is in determining if the scoliosis is present due to a leg length deficiency or inequalities in the feet. I have seen this many times over the years in my practice. These conditions can usually be addressed with orthotics or by simply adding height inside the shoe of the short leg. Another recommendation I make is to do stretching and mobility exercises which is best addressed by joining a yoga class.

The key to scoliosis is the early detection of such. It is a condition that can be potentially life threatening if it is progressive and left unchecked. Luckily, most scolioses are not of the progressive type and never need any intervention. If you should have any concerns you should discuss them with your chiropractor or primary care physician.

Dr. David D. Godwin
Chiropractic Physician
Salisbury, NC
704-633-9335
www.salisburychiropractic.us

Despite regular yoga, chiropractic care and massage, I wake up stiff and uncomfortable. It lasts all day. The left side of my back from my shoulder to the mid-back is also noticeably more developed or pronounced than the right side. A few years ago, a physician diagnosed me as having notalgia paresthetica.

What are your thoughts on this situation? Where should I go from here?

DEAR READER:
Notalgia paresthetica is defined as a chronic, localized itch that usually affects patches of skin on the upper back. It can occasionally affect the shoulders, upper chest and other portions of the back.

Symptoms include itching, tingling, prickling, and/or numbness, usually on one side of the back. The cause is unknown, but is thought to be the result of nerve damage.

Upon presentation to a physician, the affected areas are often hyper-pigmented (darkened), scratch marks are present and in some cases, scarring is also due to chronic scratching. Little treatment is available but some physicians have had success using topical capsaicin or certain types of botox.

That being said, this condition sounds nothing like what you are experiencing. I recommend you speak to your primary care physician or an orthopedic specialist. You may need imaging studies of your neck, back and hips (to get a full view of your entire spine).

Your back pain may be the result of a herniated disc, degenerative changes in the spine or more. You have taken appropriate steps by seeing a chiropractor, massage therapist and keeping physically fit and limber with stretching exercises. However, with little or no results to show, it is now time to move on to more aggressive testing and diagnosis.

In the meantime, I suggest you try using over-the-counter pain relievers such as acetaminophen or ibuprofen. Hot and cold packs may also be of benefit.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

My son has incurred a large amount of debt from doctor visits, testing and treatment. He has seen neurologists, orthopedic specialists, pain specialists and chiropractors. He has tried acupuncture, exercise, prednisone, Oxycontin, Percocet, injections into his spine, and others. The narcotics helped the most but he does not want to be on them again because they caused severe withdrawal symptoms which he does not want to go through again.

None of his physicians have given him any hope. He has spinal stenosis, calcification of the thoracic region and bulging discs at L4 and L5. He has numbness in parts of the legs and the soles of his feet. He cannot sit for more than 20 minutes without pain. Even the slight bending caused by shaving or brushing his teeth is agony for him. Oddly, however, bending so far as to touch his toes is not painful. He doctors say he is not a candidate for surgery but don’t give him any reason or alternative options.

I have heard about a new procedure that involves injecting pig fat into the areas, but don’t know much about it. It breaks my heart to see my son in so much pain all the time. I hope you can help him or point us in the right direction.

DEAR READER:
Your son appears to have run the gamut on non-surgical treatment for his pain. Based on your note, he obviously has nerve involvement, likely caused by the bulging discs. This is what is causing the numbness of his legs and feet. Slight bending such as that you mentioned is probably causing the discs to move further out of place causing worsened pain. He may be experiencing relief by touching his toes but the vertebrae are being pulled apart allowing the discs to then slip back into their proper place.

You say your son is not a surgical candidate but has been given no reason why. I urge him to speak to his physician about this or to seek out an orthopedic or spinal surgeon who can review his chart and tests. This is your son’s best bet as to a definitive answer about surgical repair. The surgeon may even be able to offer suggests for minimally invasive surgical procedures or non-surgical treatment options that may benefit your son.

As for the pig fat injections, I am unaware of any new procedure but cannot imagine how this would help him.

To give you related information, I am sending you a copy of my Health Report “Managing Chronic Pain”. Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.