Sunday, September 30, 2012

Low Back Pain

Back pain affects 80% of Americans at some time in their lives. It comes in many forms, from lower back pain, middle back pain, or upper back pain to low back pain with sciatica. Common back pain causes include nerve and muscular problems, degenerative disc disease, and arthritis. Many people find relief from symptoms of back pain with pain medication or pain killers.

Low back pain is one of the most common reasons for outpatient visits to physicians. Medical costs related to low back pain have increased disproportionately to the prevalence of the condition, with no associated improvement in outcomes. Total costs related to back pain, including imaging, are estimated at $100 billion per year in the U.S.

Chronic low back pain is a common problem in primary care. A history and physical examination should place patients into one of several categories:
(1) nonspecific low back pain;
(2) back pain associated with radiculopathy or spinal stenosis;
(3) back pain referred from a nonspinal source;
(4) back pain associated with another specific spinal cause.

For patients who have back pain associated with radiculopathy, spinal stenosis, or another specific spinal cause, magnetic resonance imaging or computed tomography may establish the diagnosis and guide management.

Because evidence of improved outcomes is lacking, lumbar spine radiography should be delayed for at least one to two months in patients with nonspecific pain.

Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line medications for chronic low back pain. Tramadol, opioids, and other adjunctive medications may benefit some patients who do not respond to nonsteroidal anti-inflammatory drugs.

Acupuncture, exercise therapy, multidisciplinary rehabilitation programs, massage, behavior therapy, and spinal manipulation are effective in certain clinical situations. Patients with radicular symptoms may benefit from epidural steroid injections, but studies have produced mixed results. Most patients with chronic low back pain will not benefit from surgery.

A surgical evaluation may be considered for select patients with functional disabilities or refractory pain despite multiple nonsurgical treatments. has great slide show about low back pain. For more information please click here for the slide show

American Family Physicians has great and detailes information for low back pain. please click here

Monday, September 24, 2012

7 Ways to Manage Arthritis Pain

Here are a few self-management tips to help you cope with arthritis pain.
1. Rest from repetitive activities and straining postures.
2. Heat application—hot packs, hot shower/bath; ice therapy for acute flare-ups or with inflammation.
3. Light-to-moderate exercise; start with pain-free range of motion.
4. Controlled and proper exercise. Overtraining and poor form can lead to injuries, and faster degeneration.
5. Weight control, which is important in preventing back, hips and knees arthritis.
6. Posture awareness, such as your sleeping position and sitting posture.
7. Improved diet and/or supplementation—Glucosamine with Chondroitin, fish oils, antioxidants, rich fruits and vegetables. has great article on this issue. For more information please Click Here

Sunday, September 23, 2012

Link Between Sugar-Sweetened Beverages and Expanding U.S. Waistlines

Three studies published Friday September 21, 2012 in the New England Journal of Medicine represent the most rigorous effort yet to see if there is a link between sugar-sweetened beverages and expanding U.S. waistlines.

A report released this week projected that at least 44 percent of U.S. adults could be obese by 2030, compared to 35.7 percent today, bringing an extra $66 billion a year in obesity-related medical costs.

New York City adopted a regulation banning the sale of sugary drinks in containers larger than 16 ounces at restaurants and other outlets regulated by the city health department.

Sugary drinks are in the crosshairs because from 1977 to 2002 the number of calories Americans consumed from them doubled, government data show, making them the largest single source of calories in the diet.

About a quarter of the kids stopped drinking the beverages. Among those who stuck it out for 18 months, the sugar-free kids gained less body fat, 2.2 pounds (1 kilogram) less weight, and 0.36 units less BMI than the sugary-drink kids, the researchers report in the NEJM.

Why? There is good evidence that liquid sugar does not produce a feeling of fullness that other calories do. "When children substituted a sugar-free drink, their bodies did not sense the absence of calories, and they did not replace them with other food or drinks," said Katan.

Hispanic teens benefited the most: Those receiving no-cal deliveries gained 14 fewer pounds after one year and almost 20 fewer pounds after two. That raised the possibility that genetic factors influence the effect of sugary drinks.

Reuter has great article on this issue. For more information please Click Here

Sugar-Sweetened Beverages and Genetic Obesity Risk
September 21, 2012 | Q. Qi and Others
(DOI: 10.1056/NEJMoa1203039)

Sugar-free Drinks in Normal-Weight Children
September 21, 2012 | J.C. de Ruyter
and Others | (DOI: 10.1056/NEJMoa1203034)

Calories from Soft Drinks — Do They Matter?
September 21, 2012 | S. Caprio
(DOI: 10.1056/NEJMe1209884)

Sugar-Sweetened Beverages and Adolescent Weight
September 21, 2012 | C.B. Ebbeling
and Others | (DOI: 10.1056/NEJMoa1203388)

Manage Erectile Dysfunction in Patients with Hearth Disease - High Risk Patients

The Princeton guidelines define High Risk as patients with:
High risk: defer resumption of sexual activity until cardiological assessment and treatment
Unstable or refractory angina
 -> Increased risk of MI
Uncontrolled hypertension
  -> Increased risk of acute cardiac and vascular events (i.e., stroke)
CHF (NYHA class III, IV)
  -> Increased risk of cardiac decompensation
Recent MI (<2 weeks)
  -> Increased risk of reinfarction, cardiac rupture, or arrhythmias, but impact of complete revascularization on risk is unknown
High-risk arrhythmias
  -> Rarely, malignant arrhythmias during sexual activity may cause sudden death
  -> Risk is decreased by an implanted defibrillator or pacemaker
Obstructive hypertrophic cardiomyopathies
  -> Cardiovascular risks of sexual activity are poorly defined
  -> Cardiological evaluation (i.e., exercise stress testing and echocardiography) may guide patient management
Moderate to severe valve disease
  -> Use vasoactive drugs with caution

Manage Erectile Dysfunction in Patients with Hearth Disease - Intermediate Risk Patients

The Princeton guidelines define Intermediate Risk as patients with:
Intermediate or indeterminate risk: evaluate to reclassify as high or low risk
Asymptomatic and ≥3 CAD risk factors (excluding gender)
  -> Increased risk for acute MI and death
  -> ETT may be appropriate, particularly in sedentary patients
Moderate, stable angina pectoris
  -> ETT may clarify risk
MI >2 weeks but <6 weeks
  -> Increased risk of ischemia, reinfarction, and malignant arrhythmias
  -> ETT may clarify risk
LVD/congestive heart failure (CHF) (NYHA class II)
  -> Moderate risk of increased symptoms
Cardiovascular evaluation and rehabilitation may permit reclassification as low risk
Non-cardiac atherosclerotic sequelae (peripheral arterial disease, history of stroke, or transient ischemic attacks)
  -> Increased risk of MI
  -> Cardiological evaluation should be considered

The full article can be find at:  Click Here

Saturday, September 8, 2012

Manage Erectile Dysfunction in Patients with Hearth Disease - Low Risk Patients

Erectile dysfunction and cardiovascular disease share similar risk factors, and erectile dysfunction may precede or be a marker for cardiovascular disease.

The Princeton Consensus Conference guidelines for the management of erectile dysfunction in the cardiovascular patient can be used to determine the need for further cardiac evaluation.

The Princeton guidelines define Low Risk as patients with ability to perform exercise of modest intensity without symptoms. These patients do not have any heart related complaints and less than 3 major risk factors (age, hypertension, diabetes mellitus, cigarette smoking, high cholesterol, sedentary lifestyle, and family history of premature CAD).

In addition, low risk patients have controlled blood pressure (it worth mentioning Beta-blockers and thiazide diuretics may predispose to erectile dysfunction). 

In patients with mild, stable angina pectoris, noninvasive cardiac evaluation is recommended. In addition, the anti-anginal drug regimen may require modification.

In patients with post-revascularization (after CABG or cardiac stents) and without significant residual ischemia, exercise tolerance test may be beneficial to assess risk.

If patient is more than six to eight weeks post-revascularization and has no exercise tolerance test-induced ischemia, intercourse may be resumed 3–4 weeks post-

Other low risk patients include those with mild valvular disease, New York Heart Association class I heart failure and left ventricular dysfunction.

If the patient does not respond to an adequate trial of the phosphodiesterase inhibitor, it would be reasonable to obtain a testosterone level. However, a testosterone level does not need to be obtained at the time of the initial evaluation unless there is decreased libido or physical signs suggestive of small testicles.

The full article can be find at:  Click Here