Perhaps many would be surprised at my latest change of career path. I guess I have always been one of those righteous doctors, who look like the type who would serve their livelihood for the patient's welfare. Well perhaps I was, few months ago. But I guess going through the midlife crisis that I am forced to go through, many would not blame me.
So let's talk about beauty. In the medicine world, there is a study of human beautification or so-called aesthetics. Despite accepted as being a stream of medicine, it is regarded by many as the dark side of medicine as it reaps profits beyond comparison, and the sole purpose of treatment is mainly for vanity. Funny, I should associate myself with such a field - when I continuously spare my time towards medical charity. But the more I study about it, the more intriguing it becomes. In fact, I have come to the point that I believe that I am giving a service to people by providing the proper expertise to help with on-going problems like obesity or a scarred face, to give renewed hope and increased confidence, and to provide safety to patient's rather than they go to some beautician.
So perhaps its not that bad after all? Medicine after all, for all it is, is more of an art than a science.
Wednesday, September 17, 2008
Monday, September 8, 2008
Back Pain
I woke up this morning with the most excruciating pain over my upper lumbar region. I could barely move my right side. I thought, "Oh shit, I have to get to work soon." Trying my best to sit up, I examined my back with my fingers and found what I was looking for - muscle spasm. Okay, at least its not a more drastic problem like a prolapse disc. And I did not have sciatica pain, which is a good sign.
But still I had to keep my back straight while walking and going on to my chores. I couldn't turn my body as it would worsen the pain, so I just prayed silently that it would go off quick, since I have a million and one things to do. Luckily I had some voren gel so I applied a nice amount at the area of spasm. Went to work and survived half the day without causing more trauma to it. In fact by noon the muscle knot was softer and I regained much more of my motor function.
Back pain is so common. So common that I guess if sit in any clinic in a week you must meet a patient who complains of back pain. The most common cause of back pain is muscle spasm, usually the paraspinous muscles of the back. The severity varies from very severe to mild back pain. Some very severe back pain leaves the patient unable to get up from bed or extreme pain on movement. The best treatment would still be back rest or keeping the back in straight position most of the time. Normally I would advise my patients to just sleep on a thin mattress on the floor to ensure proper posture. A soft mattress is always bad for a sore back because it does not support good posture while sleeping. Symptomatic relief would be to give some topical plus oral medications. LMS or methyl salicylate ointment 25% is a good topical pain killer, as it also gives a heaty feeling, and to most people its soothing. Another alternative would be Voren gel (volteran gel) or other NSAID gels which are usually cool instead of warm but they actually give a much longer effect than LMS.
For oral medications it will depend on the severity. My personal favourite is to give patients myonal or Eperisone 50mg which is an anti-spasmodic agent which has vasodilatational qualities together with Mobic (Meloxicam) 7.5mg bd (max 15 mg) which normally gives a fair good response to the pain in a few days. Sometimes I give Celebrex or Arcoxia - cox-2 inhibitors for pain relief which is good for acute pain. A more cheaper alternative is voltaren tablets or ibuprofen. For very severe pain, sometimes IM voltaren is given. Well it depends on which clinician you see. Despite all the hi-fi medications that we can prescribe, it will not be complete without proper advice.
First of all, posture is important. Keeping a good posture is the key to relieving pain fast and not causing any more trauma to the area. This would include sleeping on a hard surface, standing or sitting straight and for ladies, to come off the heels for a while. Secondly, we should advise not to life heavy objects, or move so suddenly as this may cause more trauma to the spasmodic muscle or perhaps cause new problems. Try to be careful when walking as not to fall and to be aware of uneven surfaces. Normally, doctors would prescribe MC for complete back rest for a few days - which means please rest. Some people get leave, but refuse to rest. Give time for nature to set its course.
Even though back pain is usually due to muscle spasms and improper posture, but you should err on the side of caution if you have persistent back pain that is worsening, accompanied by any change in sensation, any shooting pain down your leg, any abnormal bowel habits, if your pain was preceeded by any form of trauma that may have affected your back, back pain that gives you difficulty to walk for more than 3 days, if it is accompanied by muscle weakness and other abnormalities such as fever, rash etc etc. The safest bet is to make a quick stop to your nearest doctor for a proper evaluation and treatment.
But still I had to keep my back straight while walking and going on to my chores. I couldn't turn my body as it would worsen the pain, so I just prayed silently that it would go off quick, since I have a million and one things to do. Luckily I had some voren gel so I applied a nice amount at the area of spasm. Went to work and survived half the day without causing more trauma to it. In fact by noon the muscle knot was softer and I regained much more of my motor function.
Back pain is so common. So common that I guess if sit in any clinic in a week you must meet a patient who complains of back pain. The most common cause of back pain is muscle spasm, usually the paraspinous muscles of the back. The severity varies from very severe to mild back pain. Some very severe back pain leaves the patient unable to get up from bed or extreme pain on movement. The best treatment would still be back rest or keeping the back in straight position most of the time. Normally I would advise my patients to just sleep on a thin mattress on the floor to ensure proper posture. A soft mattress is always bad for a sore back because it does not support good posture while sleeping. Symptomatic relief would be to give some topical plus oral medications. LMS or methyl salicylate ointment 25% is a good topical pain killer, as it also gives a heaty feeling, and to most people its soothing. Another alternative would be Voren gel (volteran gel) or other NSAID gels which are usually cool instead of warm but they actually give a much longer effect than LMS.
For oral medications it will depend on the severity. My personal favourite is to give patients myonal or Eperisone 50mg which is an anti-spasmodic agent which has vasodilatational qualities together with Mobic (Meloxicam) 7.5mg bd (max 15 mg) which normally gives a fair good response to the pain in a few days. Sometimes I give Celebrex or Arcoxia - cox-2 inhibitors for pain relief which is good for acute pain. A more cheaper alternative is voltaren tablets or ibuprofen. For very severe pain, sometimes IM voltaren is given. Well it depends on which clinician you see. Despite all the hi-fi medications that we can prescribe, it will not be complete without proper advice.
First of all, posture is important. Keeping a good posture is the key to relieving pain fast and not causing any more trauma to the area. This would include sleeping on a hard surface, standing or sitting straight and for ladies, to come off the heels for a while. Secondly, we should advise not to life heavy objects, or move so suddenly as this may cause more trauma to the spasmodic muscle or perhaps cause new problems. Try to be careful when walking as not to fall and to be aware of uneven surfaces. Normally, doctors would prescribe MC for complete back rest for a few days - which means please rest. Some people get leave, but refuse to rest. Give time for nature to set its course.
Even though back pain is usually due to muscle spasms and improper posture, but you should err on the side of caution if you have persistent back pain that is worsening, accompanied by any change in sensation, any shooting pain down your leg, any abnormal bowel habits, if your pain was preceeded by any form of trauma that may have affected your back, back pain that gives you difficulty to walk for more than 3 days, if it is accompanied by muscle weakness and other abnormalities such as fever, rash etc etc. The safest bet is to make a quick stop to your nearest doctor for a proper evaluation and treatment.
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