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Daily Column

October 8, 2008 By Dr. Gott

DEAR DR. GOTT:
I am having aches and pains throughout my body. My family doctor did blood tests but says they show no signs of arthritis. He recommended I see an internist but when I saw him he only told me to take Tramadol (which I already take for my restless legs syndrome) and Tylenol. When I said I didn’t want to treat the pain without knowing why I had it, he told me I should see someone else. I am frustrated.

I am an 80-year-old woman but feel ancient because of the pain. How do I go about finding out what is wrong with me?

DEAR READER:
You have already taken the appropriate first steps by seeing your family physician and having blood work done. I believe your doctor appropriately referred you to an internist who specializes in diagnosing. In your case, however, [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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Daily Column

May 2, 2008 By Dr. Gott

DEAR DR. GOTT:
Could you please explain to your readers what fibromyalgia is and how painful it can be?

I am 44 years old and work as a State Tested Nurse Aide (STNA). There are days when my co-workers think I am just looking for ways out of doing my job. In reality all that is going on is that my feet, back, legs and arms hurt all over. Every joint, tendon and muscle aches. No matter how much medication I take, I hurt. During these times even a simple hug hurts enough to bring me to tears. Yet, despite this pain and my co-workers quips, I do my job to the best of my abilities. Then I have good days when there isn’t much pain and I can function reasonably well. The cycle effect is exhausting. All I want is to feel better.

DEAR READER:
Fibromyalgia is a chronic, complex and poorly understood disorder that is often difficult to diagnose. It affects about nine million people in the United States. Of those, nearly 80 percent are female. However, men and women of every ethnicity and age have been diagnosed with the condition. It typically presents with fatigue and widespread pain in muscles, ligaments and tendons. Fibromyalgia differs from arthritis in that it doesn’t cause pain or inflammation IN the joints. Rather, it produces pain in the soft tissues AROUND joints and in skin and organs throughout the body.

The associated fatigue varies from person to person. While some individuals experience mild symptoms, others are completely exhausted with debilitating flu-like symptoms. Stiffness can result upon awakening or after remaining in one position for a prolonged period. Damp, cold weather is particularly difficult because it can exacerbate symptoms. Lightheadedness, headache, memory lapses, difficulty concentrating, and paresthesias (numbness and tingling) of the arms and legs may be present.

Presently, there is no simple test available for diagnosis. Evaluation by a skilled medical professional, usually a rheumatologist, consists of ruling out other medical conditions with similar symptoms, such as rheumatoid arthritis, polymyalgia rheumatica, Lyme disease and lupus. The physician should take an extensive medical history followed by a physical examination that includes the application of pressure to specific anatomical points known to be particularly sensitive in sufferers.

There is no known cure at this time, but the symptoms can be treated. This generally includes medication (anti-inflammatory drugs, narcotics and steroids), physical and relaxation therapy (such as meditation, massage, walking and more) and nutritional counseling. Some individuals have had amazing success with the alternative therapies acupuncture or acupressure.

For further information, contact the National Fibromyalgia Partnership by mail at PO Box 160, Linden, VA 22642-0160 or the Fibromyalgia Resource Center by phone at 1-866-725-4404.

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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Physical therapy may worsen injury

January 26, 2008 By Dr. Gott

DEAR DR. GOTT: Several months ago I sustained a strained groin ligament and a slight hip displacement.

I was sent for a course of physical therapy and placed on ibuprofen. It is much better but I do still have some pain and soreness that persists.

My question is this: How long does it normally take for an injury of this type to heal and what are the best exercises or treatments to maintain? I still do the exercises my physical therapist showed me.

DEAR READER: The length of time for recovery from a strained ligament and hip depends on the extent of the injury. Ordinarily, minor strains respond within days with or without physical therapy that — in some instances — may actually delay recovery.

I suggest that you be examined by an orthopedic specialist. Meanwhile, stop doing the exercises. This simple solution may significantly lessen your pain. If not, the specialist will have other suggestions about treating your pain.

To give you related information, I am sending you copies of my Health Reports “Medical Specialists and Managing Chronic Pain”. Other readers who would like copies should send a long, self-addressed, 4 ¼” X 9 ½” letter-sized stamped envelope and $2 FOR EACH report to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

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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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