Tag Archives: susan locke

Sugar hidden in your meals

The American Heart Association has set guidelines for the recommended daily amount of added sugar in our diets: women: 6 teaspoons = 25 grams (gm) of sugar and men: 9 teaspoons = 36 gm.

Susan Locke

Susan Locke

If we are not careful, we can easily exceed this number on a daily basis. This puts us at risk for obesity, heart disease or diabetes. Let’s take a look at some common meals and their accompanying sugar amounts.

58-Gram Breakfast
1 packet maple brown sugar oatmeal: 13 gm
Drizzle of honey: 11 gm
1 tbsp French vanilla coffee creamer: 5 gm
1 cup vanilla almond milk: 16 gm ¾ cup
Honey Nut Cheerios: 13 gm

Think granola is healthier? A ½ cup of Quaker Oats Granola, has 13 gm of sugar. Who can stop at a ½ cup?

30-Gram Lunch
1 PBJ sandwich: 18 gm
6 oz. plain low fat yogurt: 12 gm

Beware of yogurt with added fruit on the bottom; they can have up to a whopping 19 gm per cup.

24-Gram Lunch
1 bowl Subway tomato basil soup: 8 gm
6-inch Subway sweet onion chicken teriyaki sandwich: 16 gm

Canned soups sometimes contain added sugar as a preservative to extend their shelf life, and you might find up to 15 grams of sugar per 1½ cup in certain varieties.

24-Gram Dinner
2 tbsp. French dressing on salad: 6 gm
1½ cup cheese tortellini pasta: 2 gm
¾ cup tomato sauce: 16 gm

Some salad dressings contain 4 gm of sugar per tablespoon. Light or fat-free varieties will use sugar to make up for the flavor lost by cutting out fat.

Tomato sauces often contain sugar to cut the acidic taste and to keep jarred sauces fresh for a longer period. You might find up to 12 gm hiding in a ½ cup serving.

25-Gram Dinner
2 tbsp. barbecue sauce/grilled chicken: 16 gm
¼ cup glazed walnuts on salad: 9 gm

Sugar can sneak up on you in bread too, with some varieties containing up to 2 gm of sugar per slice (and that includes some whole wheat breads).

Snacks and Drinks
1 store bought granola bar: 7 gm
½ cup vanilla ice cream: 19 gm
1 blueberry muffin: 38 gm
1 handful dried cranberries: 29 gm
12 oz. serving Coke: 39 gm
1 cup hot cocoa: 24 gm
1 bottle Snapple peach tea: 39 gm
Pumpkin spice latte w/ whole milk: 39 gm

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

Natural sugar vs. added sugar

There are two types of sugars: naturally occurring sugars and added sugars. Naturally occurring sugars are in foods such as fruit (called fructose) and in milk (lactose). Added sugars are those added to food or drinks during preparation or processing.

Susan Locke

Susan Locke

The average American eats more than 60 lbs. of added sugar per year. The major offenders are soft drinks, candy, cake, cookies, pies, ice cream, processed food and many types of store-bought fruit juice. That’s the bad news.

The good news is that sugar does not need to be completely eliminated from your diet. The American Heart Association’s guidelines for added sugars include these recommendations: men: 150 calories per day (37.5 g or 9 teaspoons); women: 100 calories per day (25 g or 6 teaspoons); children: preschool age, 4 teaspoons; age 4-8 years: 3 teaspoons; preteens and teens: 5-8 teaspoons.

You would think that reading a food label to see how many grams of sugar are in the product would be a good way to track how much sugar you’re eating. Here’s the problem: nutrition labels combine both the amount of naturally occurring sugar and added sugar to determine the sugar content. So products that contain milk or unprocessed fruit will have some natural sugars in the measurement. You don’t know how much is natural and how much is added.

In addition to the total grams of sugar listed on the nutrition label, it’s important to read the ingredient label carefully to see if there are added sugars. There are many different names for added sugar in a product, including: corn syrup, corn sweetener, fruit juice concentrates, honey, high-fructose corn syrup, brown sugar, malt sugar, raw sugar, sugar, syrup, and products ending in “ose’ (glucose, dextrose fructose, lactose maltose, sucrose).

Here are some hints to help you decipher the language of sugar content on food labels: sugar free (contains <0.5 g of added sugars), reduced sugar (contains at least 25% fewer sugars per serving when compared to the standard product), no added sugar, without added sugar (no sugars or sugar-containing ingredients have been added).

When you look at the label and see 12 grams of total sugar, how do you determine how many calories in a serving are from sugar? There are four calories per gram of sugar. Multiply the number of grams by four and you will get the number of calories of total sugar per serving. For example: 12 g x 4 = 48 calories. However, you still don’t know exactly how many calories are coming from added sugar. Even so, this can be valuable information when trying to limit the amount of sugar in your diet.

We should care about added sugar in our diet because too much can contribute to obesity, diabetes and heart disease. Many things are toxic when consumed in large amounts, including water. This doesn’t mean we need to stop drinking water or cut out sugar entirely. Moderation is key. Watch for more on sugar in next month’s column.

SUSAN LOCKE is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

The skinny on diets

There are endless diet regimens that are touted to be “the best.” While many diets include similar food plans with only subtle differences, there are many diets that seem more extreme or restrictive.

Susan Locke

Susan Locke

The best diets are the ones that help you lose weight in the short run, maintain the weight loss, and are heart healthy. Long-term success requires changes in your “relationship” with food and changes in your lifestyle, making exercise an important part of your weekly routine.

Last year, experts at US News and World Report rated 35 diets on seven measures: short-term weight loss, long-term weight loss, easy to follow, nutrition, safety, diabetes and heart health. Each category was scored from 1-5 and an overall score was computed for each diet. Here are some of the basic principles of the top 10 (diets with the same numbers had equal scores).

1. DASH (Dietary Approaches to Stop Hypertension). This diet plan is rich in fruits, vegetables, fat-free or low-fat dairy, whole grains, fish, poultry, beans and nuts. This diet limits intake of salt, red meat, sweets, and added sugar. DASH was developed to fight high blood pressure, not as an allpurpose diet.

2. TLC (Therapeutic Lifestyle Changes) was created by the National Institutes of Health to improve cholesterol. Using similar food groups to the DASH diet, it specifies the number of servings of each food group.

3. Mediterranean Diet emphasizes fruits, vegetables, whole grains, nuts, legumes, olive oil and fish with moderate intake of poultry, eggs, cheese and yogurt.

3. Mayo Clinic Diet emphasizes healthy eating as a lifelong (not short-term) habit. There are two phases: “Lose It,” which includes choosing fruits, vegetables, whole grains and healthy fats, combined with 30 minutes of exercise per day; and “Live It,” which focuses on number and size of servings of the different food groups.

healthnet3. Weight Watchers emphasizes group support and uses a “point” system where values are available for 40,000 foods. A “points plus” target goal is determined by gender, weight, height and age. You can eat whatever you want, but you must stay within your point goal.

3. Flexitarian emphasizes “flexible” and “vegetarian” (most of the time); add tofu, beans, lentils, peas, nuts, seeds and eggs for protein; limit alcohol, exercise, and limit daily intake to 1,500 calories.

7. Volumetrics divides foods into four categories: very low density (non-starchy fruits and vegetables, nonfat milk), low density (starchy fruits and vegetables, grains), medium density (meats, cheese, pretzels, ice cream, cake), high density (crackers, chips, candy, cookies, nuts, butter). Substituting low-density foods for highdensity foods will make you feel fuller.

8. Jenny Craig’s pre-packed meals restrict calories and fats. The plan emphasizes healthy eating, active lifestyle, and behavioral modification via a personal consultant.

9. Biggest Loser Diet allows regular meals with filling calories with fruits, vegetables, lean protein and whole grains. Diet encourages portion control, food journaling, and regular exercise.

9. Ornish Diet: Foods are divided into five groups from the most healthful to least healthful. It also emphasizes the importance of exercise, stress management and emotional support. While the diet is heart healthy, it severely limits the amount of fat, which makes it difficult for some people to follow.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

HEALTHNETWORK FOUNDATION is a non-profit whose mission is to improve medicine for all by connecting CEOs with leading hospitals and their doctors to provide the best access to world-class care and increase philanthropic funding for medical research.

How to talk to your parents about aging

As our parents are getting older, it’s often difficult to speak with them about issues they will confront because of the aging process. The most important piece of advice is to start the conversation early!

Susan Locke

Susan Locke

• Enlist other family members to participate in the discussions. First, find out what their opinions are before you start the conversation with your parents. It’s best to present a united front, so try to reach a consensus before you include your parents in the discussion.

• Use good communication skills. Do not offer advice, but present your parents with options. Listen to their needs. Ask open-ended questions to better assess their views and enhance the discussion

• Understand your parents’ need to control their own lives. A sense of losing control is frightening. Parents have a right to make decisions, but often you need to balance their need for independence with safety issues

• If you and your parents disagree, allow their wishes to prevail until their health or safety is an issue.

• Address competency to drive before it becomes too late. This is a huge issue for the elderly because it affects their independence and their sense of control. If you have concerns that your parents’ driving is not safe, it’s often better for the family physician to address this issue to avoid your parents blaming you if they’re not allowed to drive anymore. There are ways to assess driving ability using simulators which provide objective data that the physician can use. Be warned that even with objective data, your parents will struggle with giving up their car.

healthnet• Ask your parents details about their finances. While this may be a difficult topic to open up for discussion, it’s important to know about insurance policies, trust documents, tax returns, bank records, investments, etc. Find out where they keep their paperwork and organize the papers if necessary.

• Ask about living wills and health care proxies. Understand your parents’ wishes concerning their medical care. It’s important to have this in place before there is a medical crisis.

• Gather information for your parents about their Medicare benefits. Medicare does not usually cover long-term care, so it’s helpful to explore whether long-term care insurance is appropriate.

• Identify community resources. Find out what services are available for your parents should they decide to stay in their home as they age.

• Re-evaluate the situation on a regular basis. Your parents’ needs can change rapidly.

If you’re having trouble with these conversations, consider involving a third party such a family physician, financial planner, attorney or geriatric care manager. Most importantly, always treat your parents with love and respect and let them know you will be there for them as they age and confront difficulties.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

How to find a primary care physician

With increased demand for doctors and fewer medical students choosing primary care as a specialty, there is a growing shortage of primary care physicians (PCP). Here are some suggestions on finding a PCP.

Susan Locke

Susan Locke

• Ask a friend or co-worker. Personal experience with a particular physician is invaluable.

• If you see a specialist of any kind, ask the doctor for a referral to a trusted PCP.

• Choose from your insurance company’s list of PCPs.

• Any university hospital in your area will have an “internal medicine” or “family medicine” department. Call these departments and see whom they recommend.

• Local hospitals often have affiliated physicians. Check with your local hospital for recommendations.

• The Castle Connolly website lists “Top Doctors” in your area: CastleConnolly.com/doctors. For a PCP, enter “internal medicine” or “family medicine” under “specialty.”

• Consider going to a “concierge” medical practice. These practices charge an annual fee, but access to the doctor is much better than with a traditional practice.

• If all of the above fails, you can look at healthgrades.com. This website lists many of the physicians in your area and you can search by specialty. The site does not evaluate the quality of the doctor.

Making contact

Once you’ve narrowed down your list to a handful of PCP candidates, it’s time to contact their offices. Make a list of the questions that are important to you. Here are some questions you may want to ask the office staff:

• Is the physician a provider on your insurance plan? (In cases where you did not find the PCP through your insurance company.)

• Is the physician taking new patients?

• What is the wait time for an appointment for a new patient and an established patient?

• To what hospital(s) does the physician admit patients?

• When hospitalized, would the physician manage my care?

• Who covers the physician when he/she is unavailable?

• Does the practice have a nurse practitioner (NP) or physician’s assistant (PA)? If so, when would I expect to see the NP or PA instead of the doctor?

• What are the office’s hours? What happens after hours?

• Does the physician respond to email?

• Will the office give medical advice over the phone for an established patient or are face-to-face appointments required.

For more, please visit my “Prescription for a Better Life” at healthnetworkfoundation.org.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

What a pain in the neck!

Approximately 10% of adults have neck pain at any one time. There are many possible causes, but it’s often difficult to determine with certainty what’s causing the pain.

healthnet

The most common causes include:

Cervical strain is caused by injury, which is realized as spasms of the muscles of the cervical spine and upper back.

Cervical spondylosis is caused by degenerative changes of the cervical spine. Wear and tear causes narrowing in the disc space, a loss of the normal shape of the bone and growth of bone spurs.

Cervical discogenic pain is very common and caused by changes in the structure of the cervical intervertebral disc(s). Symptoms commonly occur when turning or tilting the head.

Cervical facet syndrome affects the facet joint, located on the left and right side of the vertebra. Injuries in this area present as whiplashrelated neck pain, headaches, and in cases where a person has a job that includes repetitive extension of the neck.

Whiplash injury

Cervical myofacial pain is a result of tightness or tenderness of muscle.

Cervical radiculopathy occurs when a nerve root is irritated by a protruding disc, arthritis of the spine or a mass that compresses the nerve. Herniation of a disc is the most common cause.

A majority of patients respond to nonsurgical treatment of neck pain. For more information we talked to Todd Albert, M.D., of Hospital for Special Surgery (HSS).

What type of cases do you recommend surgery, rather than non-surgical alternatives, as a first line treatment?

Todd Albert, MD

Todd Albert, MD

If there is a suspicion of a tumor or infection (red flags include fever or weight loss), an early MRI should be done to confirm the diagnosis, and then surgery should be performed.

If there is evidence of spinal cord compression, “cervical myelopathy” surgery should be considered as a first line approach. Symptoms of the myelopathy can include numbness, tingling, significant weakness, balance issues or bowel or bladder dysfunction.

If a patient has been undergoing treatment with a physiatrist without improvement, at what point do you recommend surgical treatment?

Most causes of cervical pain will resolve within six weeks to three months without surgical intervention. There are several situations when surgery may be considered earlier. If the pinched nerves have caused a C5 palsy, which affects the muscles of the shoulder, this can be a very disabling condition. Similarly, a C8 palsy affecting hand muscles can also be disabling if it occurs in the dominant hand. Small muscles of the hand do not recover as well as larger muscles.

What are the risks of these procedures?

Anterior cervical decompression and fusion is a very safe procedure with a greater than 90% success rate. The most common risk is that of short-term swallowing dysfunction, which resolves in the majority of patients. There is about a 1-2% non-healing rate with a one-level fusion.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

Skin cancer treatment: Mohs Surgery

Skin cancers are on the rise in the United States. To get answers on a microsurgical treatment called “Mohs surgery,” we spoke to Timothy Wang, MD, director of the Mohs Surgery Program at Johns Hopkins Hospital.

In Mohs surgery, a dermatologist performs the dual role of skin cancer surgeon and pathologist. The Mohs procedure involves the surgical removal of the visible portion of the skin cancer, along with a layer of the surrounding skin. Mohs surgery allows surgeons to verify that all cancer cells have been removed at the time of surgery.

Mohs surgery has primarily been used for treatment of basal cell and squamous cell carcinomas. What are the indications/criteria for use in patients diagnosed with melanoma?

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Timothy Wang, MD, performs surgery at Johns Hopkins Hospital (Johns Hopkins Photo)

Mohs surgery is typically used to treat basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and its use in the treatment of melanoma is multifaceted. In 2012, the American Academy of Dermatology, American College of Mohs Surgery, American Society of Dermatologic Surgery and American Society for Mohs Surgery released “Appropriate Use Criteria for Mohs.”

This paper specifically stated that due to the complexity of the issue, invasive melanoma was not included in the article. Generally, their published indications for Mohs for melanoma include untreated (primary) and previously treated (recurrent) melanoma-in-situ (MIS) on the head and neck.

What is the cure rate and risks of Mohs surgery?

The cure rate for any type of therapy varies based on many factors. Cure rates of higher than 95% have been reported for many BCCs and SCCs treated by Mohs.

Mohs is typically performed as an outpatient procedure using local anesthesia only. It is generally considered a safe and effective treatment. As with any surgical procedure, risks and complications include pain, bleeding, infection, poor healing, recurrence and others.

How long is the healing process?

After Mohs has been used to remove the skin cancer, the resulting defect is often repaired using sutures. The time it takes to heal is affected by factors such as the size and location of the defect and the type of repair used. Recovery time typically ranges from one to a few weeks. The surgeon performing Mohs often repairs the Mohs defect or sometimes works in conjunction with colleagues in reconstructive surgery.

Mohs can be performed on multiple lesions on the same day but much depends on the size and location of the lesions, the predicted repairs, as well as patient factors such as medications and underlying health.

How many Mohs procedures should a dermatologist have done to be considered an expert?

Training programs for Mohs surgery vary. The Accreditation Council for Graduate Medical Education (ACGME) currently offers accreditation to fellowship programs in Procedural Dermatology (soon to be re-named Micrographic Surgery and Dermatologic Oncology), and a major part of this training includes education in both Mohs and complex surgical repairs. These programs must provide at least 1,000 surgical procedures of which at least 600 must be Mohs cases.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

Healthnetwork Foundation is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

Nurse practitioners vs. physician assistants

healthnetMost U.S. consumers want to see a doctor. But when presented with the chance to see a physician assistant (PA) or nurse practitioner (NP) sooner than a physician, most choose that option.

Primary care treatments are increasingly moving to a team-based approach. According to a study in the May-June 2013 issue of the Journal of the American Board of Family Medicine, 60% of family doctors “routinely” work in collaboration with nurse practitioners, physician assistants, and certified nurse midwives.

So what are the roles of these professionals? Both NPs and PAs perform the following tasks:

• Reviewing and updating patients’ medical histories

• Examining patients

• Diagnosing and treating medical problems

• Ordering and interpreting diagnostic tests

• Educating patients and their families in matters of health

• Researching the latest treatments and technologies impacting their fields

Both NPs and PAs serve as primary and specialty care providers, often specializing in a particular area of medicine. Both professionals also tend to work fairly independently, though they may at times report to or collaborate with doctors, surgeons and other medical professionals. Every U.S. state allows PAs to prescribe medications; not all states allow NPs to prescribe medication and they require NPs to maintain collaborative relationships with physicians and other providers.

PAs tend to have a bit more independence universally.

The most significant differences between NPs and PAs have less to do with their day-to-day work than their career training and licensing requirements.

NPs are certified by the American Nurses Credentialing Center and the American Academy of Nurse Practitioners. They have a Bachelor’s degree in nursing followed by a graduate level degree (Master’s or Doctorate) in Nursing Practice. Advance practice nurses with doctoral degrees teach them in the Nursing Model.

The National Commission on Certification of Physician Assistants certifies PAs. They have a Bachelor’s degree followed by a Master’s degree in Physician Assistant studies, health or medical science. Physician assistants with doctoral degrees teach them in the Medical Model.

If going to see a PA or NP, see one that works in close conjunction with a physician. Some physicians use a PA or NP to do patients’ initial screenings.

When is it reasonable to have an appointment with a PA or NP?

• For simple problems such as colds, sore throat, bronchitis, minor injuries, etc.

• For follow-up appointments after surgery if all is going well

Please visit Prescription for a Better Life by Susan Locke at healthnetworkfoundation.org.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

What happens as we age?

DR. SUSAN LOCKE gives excellent advice on slowing the body’s aging process . . .

Susan Locke

Susan Locke

by Susan Locke

As we age, the body goes through many changes. Outlined below are just some of the changes we can expect, along with suggestions to promote a healthier future.

Cardiovascular health. As we grow older, our blood vessels stiffen, so the heart needs to work harder to pump blood. This may lead to hypertension and other cardiovascular problems. To promote better cardiovascular health: Maintain normal cholesterol levels; eat a diet high in fiber, whole grains, lean protein, fruits, vegetables, and avoid salt and fatty food; stop smoking; exercise more; and lower your stress.

Musculoskeletal health. With age, bones are more susceptible to breaking due to decreased density. Muscles also tend to get weaker and become less flexible. Joints become stiffer and are more prone to inflammation. To promote bone, muscle and joint health:

• Recommended daily amount of calcium: 1000 mg/day for adults ages 19-50 and men 51-70 (1200mg/day for women age of 51+ and men 71+)
• Recommended daily amount of Vitamin D3: 600 IU/day if you’re under 70 (800 IU for adults 71+). Sunlight is an excellent source of Vitamin D, but your sunscreen may block absorption. Oily fish and egg yolks are good sources.
• Exercise promotes strong bones and slows bone loss.
• Avoid smoking, and drink in moderation.

healthnetUrinary tract health. Issues associated with aging include loss of bladder control (incontinence) and difficulty urinating due to an enlarged prostate. To promote urinary tract health, empty your bladder regularly, strengthen your pelvic floor with Kegel exercises, and schedule prostate exams on a regular basis.

Brain health. Some memory issues are a normal part of aging. It may even take longer to learn new things or to recall names or remember familiar words.

To promote brain health: Challenge yourself by reading, learning a new language or musical instrument, doing crossword puzzles; be social to ward off depression and reduce stress; eat healthy; and exercise regularly.

Digestive health. As we age, constipation becomes more of an issue. To promote digestive health, increase fiber in your diet, increase physical activity, and avoid weight gain.

In summary, the best tips for healthy aging are: Schedule regular checkups and screenings with your primary care physician; manage chronic health conditions; maintain a well-balanced, low fat diet and moderate alcohol intake; challenge yourself mentally; get out and be social; exercise regularly, including aerobic and strength training; and quit smoking.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

When is back pain an emergency?

SUSAN LOCKE helps readers understand when low back pain is and isn’t an emergency . . .

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Most cases of low back pain don’t require urgent care, but patients should seek a doctor immediately if they experience low back pain as a result of severe trauma, or if low back pain is accompanied by any of the following four situations.

1. Progressive leg weakness and/or loss of bladder or bowel control. These symptoms may be “cauda equina” syndrome where there is severe compression of the nerves in the lower spine. Left untreated, cauda equina syndrome can result in permanent paralysis, loss of sensation in the areas below the lumbar spine and loss of bladder/bowel control.

2. Unexplained weight loss, loss of appetite, pain and neurological problems. These symptoms may be indicative of a spinal tumor.

3. Severe, continuous abdominal and lower back pain. This could be symptoms of an abdominal aortic aneurysm.

4. Sustained fever and increased pain. These symptoms are consistent with spinal infection (osteomyelitis).

A diagnosis will typically classify the patient’s condition as one of three types of pain. Patients can experience one type, and based on the progression of their condition, may experience another.

• Low back pain, the most common type of back pain, is confined to the lower back only and does not travel into the buttocks or legs. The pain may be sharp or dull and may be severe enough to limit everyday activities. Pain may worsen with certain activities (such as sports) or physical positions (such as sitting for long periods) and is relieved by rest. Most low back pain is acute (short-lived and heals within six to 12 weeks).

• Sciatica is the second most common type of pain caused by a lower back problem. Caused by conditions that compress the nerve roots of the sciatic nerve, the pain is more severe in the leg than in the back. Symptoms are pain, numbness and/or weakness in the lower back and on only on one side of the lower body, affecting the buttock, leg, foot, or the entire length of the leg.

• Low back pain with referred pain that radiates to the groin, buttock and upper thigh, but rarely below the knee. Patients describe the pain as dull and achy with varying intensities. Low back pain with referred pain is similar to axial pain and is managed with similar treatments.

Treatment for lower back pain depends upon the patient’s history and the type and severity of pain. The vast majority of lower back pain cases get better within six weeks without surgery, and lower back pain exercises are almost always part of a treatment plan.

If pain persists or worsens, more involved diagnostic and surgical procedures may be recommended. Rest for a few days to allow injured tissue and nerve roots to begin to heal. Heat and ice packs help relieve most types of low back pain by reducing inflammation. Over-the-counter medications and prescription medications are available to help reduce symptoms of lower back pain.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

HEALTHNETWORK is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org