Ouch! My Back Hurts: Understanding and Dealing with Low Back Pain

Working in Occupational Medicine one of the most common injuries and complaints that I encounter are back pain/injuries. The National Institute of Neurological Disorders and Stroke states that nearly everyone at some point in their life will have back pain which will interfere with work, everyday activities as well as any leisure activities. It is also stated that back pain is the second most common neurological ailment in the United States whereas headaches is listed as the first common.

If anyone has ever suffered the agonizing experience of having low back pain, then they know the impact of having their quality of life affected. It us one of the most annoying and agonizing discomforts that just seems to present at the most unfortunate times. Rushing and stressful events may trigger this type of injury secondary to neglect and carelessness. I think we have all been there.

Often there is no one event that may be the cause of the low back, it may arise from many different sources such as lifting especially if done improperly, sitting, standing, or walking for a long period. Other precipitating factors may also contribute to low back pain such as a fall or a trip. Read More For Tips and Prevention of Back Pain

Measles Outbreak in the United States!

Everyone Be Aware:

There is a measles outbreak!!
It is affecting different parts of the United States.

A measles outbreak has been reported in the United States. This has been linked to an introduction from someone in Switzerland visiting Arizona. The first case was reported on February 12, 2008 when an adult visitor from Switzerland was hospitalized with the measles and pneumonia. Still ongoing there has been nine confirmed cases through March 31, 2008 in Arizona. And two other suspected cases in which one is a resident from Colorado. These nine cases that have been confirmed range from the ages of 10 months to 50 years old. All of these were infected in the healthcare setting except for one. And all these cases were individuals that were unvaccinated during the time of exposure. Read More About Measles Outbreak...

Child Abuse and Munchausen by Proxy Syndrome (MBPS)

Please read this it may save a child:
During my career as a Physician Assistant and having worked in several Emergency Rooms I have encountered unfortunate situations with child abuse. These have to be the hardest cases and scenarios to deal with because there is seldom a true or definite sign of physical abuse. Only when the cases are very clear where the child has been battered severely can this be definitely called a case of child abuse.

We all know that child abuse can be done in many forms and not only through physical abuse. There are many forms of psychological and emotional abuse as well. And again these are very unfortunate cases because these children are often missed and go on to having more abuse inflicted on them for several years. However, there is also another form of abuse which is not so quickly recognized and for that matter not many are even aware that it exists, and this is called Munchausen by Proxy Syndrome also known as MBPS.

Examples of MBPS cases are usually presented as a young child that is hospitalized more than 30 times in his or her 6 years of living. They are diagnosed with asthma, pneumonia, unexplained fevers and mysterious illnesses. Physicians are unable to determine a cause of illnesses. Another example could be that of a child at the age of 10 has been admitted to the hospital more than 200 times. He or she has gone through numerous surgeries for unexplained abdominal pains and diarrhea. The child at times has vomited for no apparent reason and has also developed unexplained fevers and malaise.

These unfortunate children were the result of MBPS. Please read more on this...

Understanding a Blood Pressure Reading: Systolic and Diastolic

As a health care provider I am always asked about blood pressures and the significance of "the numbers" used in obtaining a blood pressure. I have found a vast variety in how individuals correlate and interpret "these numbers." An understanding of what and how a blood pressure is obtained may help to clarify that.

Accurate measurement of blood pressure is crucial to classify individuals with certain health risks and to also guide in correct management of other disease processes. There are several types of devices used in measuring blood pressure. The auscultatory (listening) technique with a trained professional and a mercury sphygmomanometer (an instrument used to measure blood pressure in an artery that consists of a pressure gauge, an inflatable cuff placed around the upper arm, and an inflator bulb or pressure pump) is still considered to be the method of choice in assessing a blood pressure according to the American Heart Association Journals. However, we know that there are a variety of different devices found today such as electronic ones.

Regardless, of which method is used the way a blood pressure is measured is done the same. A cuff is wrapped around the upper arm which occludes the brachial artery it is then inflated to above systolic pressure (the contraction of the heart, during which blood is pumped into the arteries), then it is gradually deflated as the blood flow is re-established giving a tapping noise. Please read more on obtaining and understanding a B/P.

Why Do We Seek Medical Advice?

As a medical provider it always amazes me that when an individual seeks help, they never really seem to want the reality of what may be the cure. I find more often than not that when I see a patient they are more than willing to share what they may be feeling, however when I seem to offer what I think may be the answer it does not seem to be what they want to hear.

How many of us know someone or even for that matter ourselves, that may have an issue such as obesity, addiction, stress or just general aches and pains? Well, I see it daily and even feel it for that matter. But, why is it when seeking medical consultation there is always, well almost always resistance met with the prescription that may be of help. I constantly hear the same stories over and over, which some may consist of:

- I don't have time
- I'm not getting on medications
- It won't help me
- I can't quit
- It makes me sick

The excuses are endless, and are very frustrating from a provider's point of view. I can honestly say that for myself and other health-care providers something goes off in our brain sort of like this, "Well then what do you want from me?" But fortunately I hope I am speaking for others as well, we are compassionate and caring individuals that would truly like to make a difference and the hopes would be to make the patient ultimately feel and be better. Please read more to find out what can be done to get appropiate medical advice.

Symptoms, Treatment and Prevention of Tennis Elbow

What is lateral epicondylitis (tennis elbow)? Lateral epicondylitis is just a fancy term for tennis elbow. It is the name for a condition in which the bony bump on the outer surface of the elbow becomes painful and is very tender to touch. The technical term for this bump is called the lateral epicondyle so when it becomes inflamed it is referred to as a lateral epicondylitis.

How does tennis elbow develop? Tennis elbow develops from overusing the muscles in your forearm when used to straighten to raise your hand and wrist. When these muscles are overused, the tendons that are attached to the lateral epicondyle become inflamed. And when this motion is repeated tiny tears can develop causing pain.

Who develops tennis elbow? Any activity that requires repetitive motion can cause tennis elbow, however it is most common with tennis players (such as the name), carpenters, machinists, and typists. However this type of injury can be seen in many other activities or jobs depending on the type of maneuvers and how often it is done. Click here for more information on tennis elbow

Omega Fatty Acids Inhibit Pain and Other Health Risks

What are the omega fatty acids?

Omega-3 fatty acids are called essential fatty acids, which mean that it cannot be synthesized by the body and must result from the diet. The best source for this fatty acid is found in fish especially sardines, salmon and herring. It may also be found in vegetarian sources such as flaxseed, flaxseed oil, canola oil, soybeans, soybean oil and walnuts.

Omega-6 fatty acids are also considered essential fatty acids, but most individuals are not deficient in these. Good food sources to obtain these fatty acids include cereals, whole grain breads, eggs, and poultry.

Omega-9 fatty acids are not considered essential fatty acids. These can be synthesized from unsaturated fat by the human body. Good food sources of these fatty acids include olive oil, rapeseed and mustard seed.

How do these fatty acids inhibit pain and reduce other health risks?
Click here to find out...

Frequent Hand Washing Increases Contact Dermatitis in Health Care Workers

Do you or do you know of someone that is working in an environment where hand washing is a must? Did you know that in doing so the risk of developing contact dermatitis is likely? I found this to be interesting especially with health care workers since one would think that hand washing is the best for prevention of germs, however the potential of developing dermatitis is still there.

Are health care workers at an increased risk of developing contact dermatitis due to frequent hand washing? According to Wikipedia.org, contact dermatitis is a term for a skin reaction resulting from exposure to allergens (allergic contact dermatitis) or irritants (irritant contact dermatitis). It is a common skin condition causing redness, itching, and a burning sensation due to exposure of a substance on the skin. And according to a study from the University Hospital Case Medical Center in Cleveland, Ohio frequent hand washing by health care workers may actually be counterproductive, causing contact dermatitis.

The study was based on 111 health care workers in which 58% developed contact dermatitis with hand soap, but when using an alcohol based solution there was no association with contact dermatitis. All the health care workers were asked to fill out a questionnaire about personal medical and family histories including any previous history of allergies. Read More About Contact Dermatitis

Aging Baby Boomers May Increase Work-Related Injuries

So, how old are you? Do you fall into this category of soon being an elderly boomer? If you are then this may be very pertinent information to know.

The generation known as the "baby boomers" is soon to be known as the "elderly boomers" and in turn will create the healthcare workers to have to work harder and longer. According to the National Council on Compensation Insurance, long-term care industry will be impacted substantially by the aging of the population. This as well is expected to raise workers' compensation as aging employees also need accommodations to stay in the health field.

As injury rates are dropping overall in the work industry it appears that for the health care worker this is not so. As a medical practitioner in occupational medicine most of the work related injuries that I treat are those that work in the health care fields such as hospitals, nursing homes and home health aides. These injuries are usually musculoskeletal related. So it is concerning that with the aging population and the aging work force of how many more injuries will arise. NCCI states that the frequency of workers' compensation claims in nursing homes alone are double than the national average for private industry. Read More

10 Simple Tips to Prevent Bad Breath

Halitosis means foul or offensive-smelling breath. It comes from inside your mouth and is usually caused by not having proper dental hygiene such as brushing your teeth and flossing on a daily basis. The food that you consume sticks between your teeth, on your gums and tongue. So without proper dental care this will cause the food that sits in your mouth to rot and decay and in turn causes a foul smelling odor in your mouth. The food that sits in your mouth and in between your teeth causes bacteria to grow which can then lead to more serious complications such as gingivitis or gum disease. Gingivitis is also a cause of bad breath.
Do you or someone you know have a problem with bad breath? Bad breath is common and this is something that probably be easily controlled however it does take a lot of discipline along with good dental/mouth hygiene. It is also one of those things that is a little embarrassing so at times may not be so easy to approach an individual with it. I always advise people including myself to carry an extra pack of gum or mints for those moments that are unpleasant to the nose. Good Luck!

Non-Emergent ER Visits: Why You'll Have a Long Wait

Have you or do you know someone that has used the Emergency Room for a visit that could have waited until the were evaluated in a doctor's office? I see this all the time, having worked in the ER as well as hearing many stories from friends and families i have been faced with both sides.
Recently, my friend went to the emergency room for a sore throat about 1 a.m., and she stated to me that she had to wait three hours to be told that she had a virus. Her prescription was to go home, drink fluids and rest. She was really upset not because of her instructions, but because of her lengthy time in the ER. I asked her if she had called her physician that day and her response was that she did not want to have to wait for an appointment so she thought she would get seen quicker in the ER especially if she went in the middle of the night.
My personal advice and professional opinion is unless you don't mind waiting sometimes countless hours for a non-emergent visit to the ER just wait until you are able to speak to your physician.

A Neti Pot is Better & Cheaper than Drug Therapies for Nasal Irrigation

Inflammation of the sinuses is simply known as sinusitis and there may be many reasons for this including seasonal allergies or the common cold. Whatever the reason, the symptoms are annoying and aggravating. We have all been there trying to obtain immediate relief with over the counter nasal sprays, and medications. However, I have been told by friends, family and patients that the use of a Neti-Pot has alleviated their symptoms.
I personally have never used one but I have irrigated the sinuses of patients in the office in a similar fashion with a syringe. They too have stated that this has given them significant relief and from my understanding the long term cost of using a Neti-Pot is much less than pharmaceutical agents so I highly recommend looking into the Net-Pot for anyone with chronic nasal irritation.

Quick First Aid and Safety for Bites, Burns, Stings and Bruises

As a clinician who has worked in a family practice setting along with the emergency room, I have had the experience of treating many injuries related to insect bites, sunburns, cuts and bruises. I also have the personal experience being the mother of four children, which is more difficult than the clinical setting.
The first goal as a practitioner is to educate the caregivers on safety. Preventative medicine is always the best, however we all know that when it comes to children that is not always possible, if there is a will I am sure they will find the way. The good and most important thing to remember is that most of these injuries can be handled at home safely with simple quick first aid however I encourage anyone that has any doubt in handling a situation to follow up with a health care provider immediately. In medicine there is no such thing as an absolute, however some simple tasks may help alleviate a worsened outcome.

"I'm Not Depressed I Have Lyme Disease"

One would think that being in the medical field things should not slip by, however as a medical provider I have noticed that as patients we tend to either ask too many questions or not enough. I have seen this type of behavior being on both ends of the spectrum. An example of that was when my daughter was having vague symptoms and it took three years to have her diagnosed with Lyme disease.
She was having vague symptoms of headaches, dizziness, and feeling tired all the time she was twelve at the time. I had taken her to the pediatrician whom in turn did some lab work, then told me all was normal. The pediatrician stated that sometimes with puberty these vague symptoms may occur, understandably I accepted this diagnosis. Then I was told that she may have the beginning of depression. So I went in a circle for several years until finally someone listened to her say "I'm not depressed, listen to me please."
Unknown to me that some of these symptoms could have been resolved if only the proper testing was done in a timely fashion.
My advice is to ask questions, many questions and if they are not answered ask more questions!

Breast Cancer: Testing and Detecting

There are still too many women today that do not get screened for breast cancer for reasons that I just cannot comprehend. There are certain cancers that if detected early can have a great prognosis and this is one of those types of cancers. So maybe understanding a little about testing and screening it will help educate the public on why they should have early screening.
According to the American Cancer Society breast cancer is the most common cancer in women. It can occur at any age, but it is more commonly found over the age of forty.
There have been certain risk factors associated with breast cancer, these factors may increase the likelihood of developing breast cancer.
Usually they include:
- family history of breast cancer (male or female)
- personal history of breast cancer
- genetic changes
- previous radiation therapy to the chest wall
Other factors may also have a chance in increasing your risk such as:
- menstruating at an early age
- going through menopause at a late age
- not having children
- first pregnancy over the age of thirty
- weight gain
- excessive use of alcohol
So please be proactive in your own health!

What is Occupational Medicine?

There are many different areas of medicine, however some just aren't easily recognized by the title of that area of expertise. Occupational Medicine is one of those sub-specialties that most are not familiar with. The misconception is that it is related to a form of occupational therapy which in itself is an entirely different specialty. As a Physician Assistant working in an occupational health setting my specialty is often confused with another area of medicine.
It is unique in that we deal most of the time with well individuals seeking employment or individuals seeking to return to work as soon as possible so the interest of recovery is higher. It can also be challenging as some may not be fit for certain positions, however as a health care provider accommodations should be done to get them employed. It is in the best interest of both employee and employer. I think the better educate we are about the specialties in medicine will also allow for better resources.

Oral Cancer: Is it Being Overlooked?

When people hear the word cancer I think that only the most common cancers come to mind such as breast, lung, prostate, skin etc. However not too often does one hear about oral cancer, including myself.
That thought changed for me when I had a recent visit to my dentist he suggested that I have a screening for oral cancer. Not thinking that I was at any risk since I thought it was linked mostly with smokers I declined. He didn't seem to push the screening, which basically only consisted of using a special light to look at cells in your mouth, cheek and throat. So when he walked away I picked up the brochure that he left behind and started reading some interesting facts about oral cancer and then realized that maybe I needed to get screened.
I believe when a screening is offered and if it will make a dramatic difference in the outcome, then it should strongly be considered. It can save your life.

Are you Overweight? Do you know how to calculate your BMI?

The Body Mass Index is used to measure body fat based on height and weight. It applies the same value for both adult men and women. Body Mass Index assesses whether an individual is underweight, normal, overweight or obese. It is inexpensive and easily calculated by using a chart method which can be readily found on the internet or in a physician's office. The caveat to this is that there usually is not an explanation attached to it.
I personally am not a great fan to calculating your body mass index because it does not take into account the difference between women and men. Neither can it distinguish muscle mass in athletes or body builders. However, literature states that it is a good way to assess the health of an individual so for the average person it may be a marker to determine a baseline of their health. I do agree that everyone should have an idea of their BMI (Body Mass Index) it can help in setting some goals in lifestyle changes.

How you feel can impact your day!

I don't care what anyone says about controlling your emotions. I know that depending on how you feel physically will definitely impact your feelings emotionally.
Do you ever wake up with that nagging headache? How does this impact the remainder of your day? Does it seem like everyone is annoying you, although the day before these same situations had no emphasis on you either way. If you get up feeling good then the chances of having a better day is higher.
Well today I woke up with terrible cramps and boy did it affect both my mental state as well as my productivity. Nothing I did seemed to help my emotional state, even though I took something for the pain. This is when I realized that I cannot let my pains control how I feel, funny thing is that I often give out that same advice to others.
Feel well and be well.

Anti-Anxiety and Anti-Depression Medications

I have found in the last several years that there has been a stigma attached to anti-anxiety and anti-depression medications. I mostly found this when patients were filling out their health history and left it blank or put none, yet when I would personally ask them they would reluctantly mention one of the medications for anxiety or depression.
I am here to tell you that there is nothing to be ashamed of. Today’s world is so complicated that I actually commend the individuals that are on these medications especially if they feel good. It is more important to feel well and happy then not to take these medications and be upset, sad, or anxious.
My only reason to suggesting that individuals admit to this is because I do not wish them to add another burden by denying something. I’m not saying to tell everyone, you may be selective but chances are the person whom you are talking to may be taking it as well.
Just be happy and confident in who you are and if it takes a pill to do this then that is perfectly OK.

Is your health care provider listening?

I wasn't too convinced at my last appointment. Had a recent visit to a health care provider, which I must admit I do not go often but I felt like they were not really listening to me. "How terrible" I thought to myself. I know that time is sometimes an issue, scheduling may become an issue but that is not my problem. I would expect to be treated as the very first person that was seen that day.
Now I can truly relate. I like to consider myself compassionate and caring. I try to hear everyone out, but after this visit I will make sure to be more alert to what anyone has to say. I hope this does not occur to anyone, although I am sure it has. I guess understanding and patience is what is needed. And that is what I told myself as I left the office. I recommend you do the same. It's healthier...instead of getting aggravated :)

Working In The North Country

Coming from NYC and now working in the North Country I thought I had pretty much seen it all. But if I tell you having to deal with the snow and weather up North is actually much worse than a lot of things I dealt with down south. Of course with my profession it is difficult not to go to work and in these last two days we have had treacherous driving conditions, snow, ice and sleet.
But when I look around I see so many others out and about and that is when it occurred to me that if you are used to something you deal with it. If this weather had happened in the city they would probably close school for days. Unless of course they were used to it. So I guess I will go with the flow and next year invest in good snow boots.

Toothache, Headache, Backache Hydrocodone Anyone?

I am sure we all know someone who has been on some form of hydrocodone more commonly known as Vicodin. Some may take it for a simple toothache, others for chronic pain, but the reality is that some are just plainly addicted to it. Yes I will admit that it is prescribed sometimes too freely and thus may cause an addictive response but who is accountable. Physician or patient. Some symptoms are subjective meaning as a medical provider the pain cannot be seen so we rely on patients being honest and truthful, however should some providers be more conservative with their treatments at time. I am not sure there is a right answer.
From personal experience I had very bad side effects with hydrocodone. So it is difficult for me to even believe that this is addicting, but anyway this should be used with lots of caution.

My Occupation...

As a full time PA I often find that many question "what is" my profession. So in one of my articles for AC (Associated Content) I have laid it out the best I could. I give a brief description of my role as a PA in hopes to clarify some of these questions. What is a Physician Assistant?
At least this will explain a little about what we do. And yes in our field there are many who have different roles in all specialties and as a growing profession I am sure that you may have encountered one in some way. We can all hope that the experience was a professional and pleasant encounter as it should be with any health care provider.
I would love to say that I hear only pleasant stories about health care providers, but we all know including myself that we have had a few that either lack professionalism and have no "people skills" and some that may or may not, but present with a lack of knowledge as well. Which I say sometimes it is Ok as long as the answer is being sought. And with medicine honesty is the best policy. It builds trust between the provider and patient. Agree?

Why Anything Goes...

Recently I moved into the North Country about one year ago. I have found that one of the most interesting things that I have discovered is listening to people. I am a working full time mother in the medical field and also most recently started writing articles. I constantly hear my share of stories from patients, friends as well as other parents. Stories are many and if really listening, a vivid image can appear and soon enough there is a story. Everyone has them.
I also find that I give out a lot of medical advice away from the office as well as in my workplace so I figured this would be a great place and a great challenge to continue doing so.

I know that I am not the only one with my share of stories so I hope this will give me a way to connect in all areas. It also gives me a way to connect to many that I have unfortunately lost communication with mostly due to distance. So, basically I have created this with the title of anything goes so the lines of communication can include, friendships, health, parenting and just about whatever there is to talk and write about.