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Bursitis Difficult To Treat

January 12, 2009 By Dr. Gott

DEAR DR. GOTT:
I am a 63-year-old female. I have been about 20 pounds overweight for the last 10 years. I had two back surgeries, one at L4 and the other at L5, nearly 30 years ago.

My current problem is inflammation of the bursa sacs in both of my hips. I have seen two physicians, three orthopedists and a physical therapist. I have had two cortisone shots, three different prescription anti-inflammatories and work out in a heated pool. So far nothing seems to be helping.

Ten years ago I took an office job and sit for eight hours a day. About that same time I started Lipitor. Two years ago I stopped for six weeks (with doctor approval) but the hip pain did not go away. My doctors keep telling me that it is hard to heal this type of problem but I am tired of hurting. I cannot lie on either side and am unable to walk even a single city block. Please help! [Read more...]

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Daily Column

August 5, 2008 By Dr. Gott

DEAR DR. GOTT:
My sister has been suffering with back pain for a very long time and her doctors haven’t been able to find out what the problem is. She’s had all kinds of testing and they’ve tried her on many different pain medications that haven’t done her any good. Now they are giving her morphine. Would a vibrating, reclining chair be the answer? Should I be concerned?

DEAR READER:
It might help if I knew how old your sister is and what other medical conditions, if any, she might have. Without that information, I have to start from square one. And yes, you should be concerned.

If your sister suffered any trauma, such as an automobile accident or major fall, she could have discogenic disease. A slipped or compressed disc can be extremely painful. Confirmation is made by an X-ray known as an MRI. There are numerous methods including balloon kyphoplasty for pain relief. [Read more...]

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Daily Column

July 27, 2008 By Dr. Gott

DEAR DR. GOTT:
What do you know about a procedure called “non-surgical decompression”? I have pain in my thigh and lower leg because of disc problems. Physical therapy and traction work well but the pain returns in a few months without it. I followed the therapist’s instructions explicitly about at home exercises and do them religiously four times a week. However, the pain is still noticeable, especially when I sit or lie down. I don’t want to have surgery.

[Read more...]

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Daily Column

June 10, 2008 By Dr. Gott

DEAR DR. GOTT:
I am a 48-year-old female and am enclosing a CD with an MRI on it provided by my insurance carrier, Kaiser Permanente. I’ve had back problems for years and the only relief I get from the pain is the epidural injections I can occasionally get. Between times, I take morphine and many other pain medications without relief. The pain on one side radiates down one leg to my foot, and on the other it radiates to my knee. Sometimes I fall when my knee doesn’t seem to want to hold me up.

My doctor said surgery is not an option. I can’t determine if his decision is because of the cost involved, or for other reasons. I’m on disability and have a very limited income. If I had surgery, I would have to depend on Social Services to help with the expenses. It may be that they have already refused my doctor’s request, and I don’t know how to find this out. Would it be a good idea to get another opinion? Do you have any advice for me?

DEAR READER:
I must begin by indicating I am a primary care physician, not a radiologist. To the untrained eye, the CD you sent only covers the lumbar/sacral spine and, in my opinion, is abnormal.

Without knowing all the circumstances, I cannot determine why your doctor stated surgery is not an option. Do you have other medical conditions that would have a bearing on the outcome of the procedure? As I have said repeatedly, the benefits must outweigh the risks. If your doctor feels you could end up in worse shape than you now are, then he is justified in his decision.

Could insurance be the issue? Whether your coverage is through disability or you have the best plan money can buy, you are entitled to proper medical care. The surgeon will be paid according to regulated state standards and will make up any perceived lost funds on other carriers that might pay higher rates. It has been my position to advise insurance companies of recommended procedures and state my reasons based on the patient’s physical condition. If quality of life is an issue, it must be addressed and managed appropriately — regardless of cost. I can confirm that I have had to make repeated requests to carriers when I have been rejected. They don’t want exorbitant bills (despite the fact it’s cheaper to provide necessary surgery than to provide several types of narcotics every month for years), but a doctor doesn’t want to see his patient in constant pain either.

Begin by making an appointment with your primary care physician. Write down all unanswered questions, beginning with why surgery isn’t an option. Take a friend with you who can maintain an objective view. If you are still dissatisfied after the visit, get a second opinion. Request pertinent information be made available to the new doctor. If he or she agrees with your primary care physician and is justified in view of the details provided, then you should probably back off. If not, put yourself in the hands of the new doctor and make a permanent change. Good luck.

To give you related information, I am sending you a copy of my Health Report “Choosing a Physician”. 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.

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Daily Column

June 9, 2008 By Dr. Gott

DEAR DR. GOTT:
There are so many articles written on lower back pain, but I have yet to read anything on upper back pain. This has been a problem for me for the last couple of years. I’ve tried a chiropractor, acupuncture and physical therapy.

The pain can be excruciating at times, especially after I’ve been standing at the kitchen sink, ironing, or wrapping gifts. The pain generates across my upper back between my shoulder blades. I’m constantly using a heating pad which helps for a short while.

Do you have any answers?

DEAR READER:
You are correct in that upper back pain is not as common as pain in the lower back. There are numerous causes for the condition, to include poor posture, over-use of muscles, osteoporosis, a ruptured disc, and heart disease.

To begin with, review your situation. Are you using good posture while standing at the kitchen sink or while ironing, or do you slouch? Could the problem be caused by weakened muscles and joint strain? If this is the case, standing straight and doing some upper body exercise might alleviate the problem. One minute of self-massage each morning will work toward relieving muscle pain. For example, stretch your right hand over your left shoulder, reaching as far as possible. Massage the area with your fingers. Then, repeat the process with your left hand over your right shoulder. Over-the-counter ibuprofen might be added for relief of symptoms.

Do you have a job sitting at a desk all day? Answer a telephone that you cradle against your shoulder? Work on a computer? These can cause muscle tightness and pain. Again, sit straight and hold the phone with your hand, rather than exhibiting poor posture that can lead to difficulties.

If you sustained an injury through a motor vehicle accident, fall, or other trauma, this might explain your problem. Whiplash can severely strain muscles in the upper back and can injure your neck as well. Speak with your doctor about the correct steps for initiating outside help, such as with a physical therapist at your local hospital or nursing center.

If you have a family history of cardiovascular disease, you certainly need to involve your primary care physician. Heart disease and other serious illnesses can present in the form of upper back pain and should be both identified and addressed.

Osteoporosis can cause compression fractures. While a ruptured disc is not as common in the upper back as in the lower, it can indeed occur and cause extreme pain. When was your last bone density test? Is one in order?

In summary, attempt to identify the cause of your upper back pain. If self-help doesn’t fill the bill, make an appointment with your doctor. A full medical history will help him or her put the pieces together and head you in the right direction.

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.

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Surgery last, best hope for pain relief

January 23, 2008 By Dr. Gott

DEAR DR. GOTT: I am a 68 year-old female with back problems (spinal stenosis) for the past 10 years. Over this period, I have had eight cortisone shots and several physical therapy sessions — anything to avoid surgery.

Now I suffer muscular pain in one leg and even limp when I try to walk any distance. I also have difficulty in climbing stairs. I’m wondering if I can put off the surgery any longer and what the success rate is with the procedure.

DEAR READER: You appear to be the victim of a progressive neurological disorder: pressure on the nerves as they pass through or around the spinal discs, with resulting compression of the nerves leading to chronic pain.

I believe that you have put off repair as best you can but it is surgery alone that will “fix” your back and nerves. My conclusion is based on the limited information in your letter. Your best bet is to be examined and tested by an orthopedic surgeon specializing in discogenic disease. Speak with your primary care physician for his referral.

On the negative side, no surgery can be guaranteed free from side effects. Every person who undergoes surgery responds in a different manner. Some fare extremely well, while others having the identical procedure have a more difficult recuperation period. Age, physical condition, related or unrelated medical problems and a host of other issues all come into play. I cannot begin to guess which category you might fall into. Therefore, I’ll have to pass on projecting the success rate. Quality of life is an important issue and the risks of surgery must be weighed against the pain you are suffering. I recommend selecting a specialist you have confidence and who is highly recommended by your own doctor. This is often the foundation on which to build success.

While you are awaiting your appointment, you might try acupuncture, massage, physical therapy, chiropractic manipulation, and other modalities. Then, should you not be a candidate for a procedure, the specialist can advise which alternative therapy is appropriate.

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 4 ¼” X 9 ½” letter-sized stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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