@Vulgano-Brother said in Dr. GO? My back's been bothering me...:
Aleve and beer work for me.
At least I have purchased for you, half of that remedy in the recent past. It would be my honor to come back for a visit to administer a second course of therapy!
@moshe said in Dr. GO? My back's been bothering me...:
@Dr-GO said in Dr. GO? My back's been bothering me...:
@moshe said in Dr. GO? My back's been bothering me...:
If the herniated disk is crushing the spinal cord,
only surgery will solve the problem.moshe
Please see my above post. Unless physical symptoms are present, conservative therapy is the standard of care. Symptoms dictate not anatomy. "Only surgery" does not necessarily solve the problem AND may even complicate it as you have stated in your post surgical experience. The reference I posted is evidence based. Conservative management was as effective as surgery and surgery has additional risks above and beyond the evidence-based outcomes.
Again, 80% of patients with MRI demonstrating spinal cord impingement (the word you use is crushing) had no symptoms and did not have a surgical indication for therapy. That again is today's standard of care.
Please try to understand, if nerve impingement is not symptomatic, there is no "problem" with the nerve. The "problem" is with the picture of nerve. With conservative therapy, further impingement with physical therapy may be avoided AND is just as effective as surgery, but without the risk.
@scottfsmith said in Dr. GO? My back's been bothering me...:
Bringing this back to trumpets .. do trumpet players have relatively more back problems? I was moaning to my trumpet teacher about my back problems and he moaned back about his, and then I got thinking my recent back problems started when I got more serious about the trumpet a few years ago. The PT told me my lower back is too tense, and playing trumpet to get out the high notes also causes that to happen..
Any connection here?
A study out of North Texas State reports the overall complaint of lower back pain in trumpet players is 17.5%. There are many publications of Chronic Lower Back Pain in the general (non-musician population), and the most referenced is at 20%. So by an indirect comparison between two separate studies, there is really no evidence for Chronic Low Back Pain to be significantly prevalent in trumpet players over the general population. Here is the reference Table from that article from North Texas State, published in Medical Problems in the Performing Arts, 17:93-98;2002:
A German study (Clin Rheumatol (2015) 34:965–973) parallels these findings; with a lower risk of back pain among trumpet players than other musicians; however in trumpet players, that study showed a 2.5-fold higher association of pain in the teeth/jaw for brass players.
@Robrtx said in Dr. GO? My back's been bothering me...:
One problem that I have with Nsaid pain relievers is that some, such as ibuprofen, tend to elevate my blood pressure, so any non-narcotic alternatives are always of interest to me.
Very true. The good news about Willow bark is it is a "pro-drug" and your body converts it to an NSAID like compound once it passes through your liver. That effect does avoid some of the stomach upset you can get from Aspirin or ibuprofen. HOWEVER, once inside and converted, it can cause the bleeding complications, kidney and blood pressure problems seen with other NSAIDS.
My advice is if started, do retake twice a day blood pressures a week before starting and a week after starting to see if you would be one of the very rare patients that would have blood pressure elevations.
As with ALL medications, there are good (pain improvement or relief) and bad (side effects). THEN there is the comparison to the alternatives: opioids. Opioids will lead to dependency after just two weeks of constant use. I did not state addiction so please don't read into this. Sometimes pain control is so important that the patient will accept the complication of dependency.
@moshe said in Dr. GO? My back's been bothering me...:
@Dr-GO
For a badly herniated disk, surgery is definitely required.
moshe
Not necessarily. I appreciate that you had this surgery done many years ago, but current recommendations for herniated disc surgery as from my MedScape eMedicine (https://emedicine.medscape.com/article/1999923-overview#a2source) reference states:
Indications
Approximately 90% of acute sciatica attacks improve... with conservative management for nonoperative methods, such as anti-inflammatory medications, physical therapy, and lumbar injection, unless the patient has an acute or progressive neurological deficit.
Indications for lumbar discectomy include altered bladder and bowel function and progressive neurological deficits such as motor weakness or sensory deficit in the lower extremities. Surgery should also be considered in patients with radicular pain that persists after an adequate course of conservative management.
Moshe, my heart goes out to your current pain and functional status; AND I don't know your specific symptomatic details from your past experience leading up to surgery, but "severity" is based on symptoms, not the anatomical classification of "badly" herniated. There was a radiological publication that looked at MRI findings in patients with significant disc herniation, and of these patients, 80% were Asymptomatic. Again, the complications of surgery can be as bad as the disease itself.
As a Primary Care provider, to my patients I strongly recommend avoiding surgery (for reasons and evidence noted above) ONLY if neurological symptoms are progressive (motor and sensory symptoms) AFTER an attempt of conservative therapy (for me that is willow bark and physical therapy) is attempted. HOWEVER, if bowel or bladder incontinence is reported, surgery is urgently necessary and I would refer immediately to a surgeon of the patient's choice.
@Pinstriper said in Dr. GO? My back's been bothering me...:
Since I never heard of it, I presume "willow back extract" is some sort of new code-speak for some sort of cannabanoid. To my knowledge I am the only person I know that has no experience base in this.
Willow bark extract is actually a natural salicylic derivative from the willow tree. It is a highly effective agent in this class of analgesics for back pain. It is typically sold in Natural Food stores.
@Pinstriper said in We're off to a good start:
@Dr-GO said
A little math.
These things don't trend linear. We haven't reached critical mass, and won't until there are more topics of substance. That's fine for now.
Oh, if nobody noticed, jazzspazz has moved the troll show over to TH.
Agreed. I did say a little math. It is truly hard to predict trends, especially at this early date. And with jazzspazz now working his magic on TH, perhaps more TH members will come here to avoid the pain. Maybe, just maybe jazzspazz does not find out about TB either.
Chronic back pain due to aging disc disease leading to localized back pain, spasms and pins and needles traveling down into the buttock or legs is troublesome. Many such patients seek surgery for a solution. How good are the results of surgery?
In a study reported in Surg Neurol Int. 2016; 7: 38; 501 surgical candidates were randomized (245 assigned to surgery, 256 assigned to nonoperative management) with imaging-confirmed lumbar intervertebral disc herniation and persistent signs and symptoms of radiculopathy for at least 6 weeks. Patients were randomized to standard open discectomy or nonoperative care as described in the above study design section. The intention-to-treat analysis showed that both treatment groups improved substantially in all primary and secondary outcomes.
So what can you do medically if you elect not to go through surgery to avoid that extra risk when outcomes show no significant difference? I have had amazing success with this following combination treatment plan:
Willow bark extract at 260 mg per day has been shown in a double blinded, randomized control study in comparison to morphine to be better at pain management, to the results of for every patient responding to willow bark, 3 patients were needed to be treated with morphine to achieve the same pain control. So I recommend Willow bark at 260 mg daily.
I also found great success in patients that have purchased the "Back-2-Life" mechanical rocking device. Unfortunately, this device is becoming harder to find, and now anyone desiring one will likely need to purchase it directly from the company. The company notes it is currently on back order (no pun intended). But this machine acts as an at home chiropractor, and it rocks the lower spine to open up the disc space, helping to remove impingement on spinal nerves.
So I recommend giving the above two options a try before electing surgery... OR meeting under a freeway bridge in Spokane!
OR we could have TB's Medical Moderator give out free lip enhancing anabolic steroids for the first 69,870 NEW members. We will be to 70,000 in a week, just wait and see.
@administrator said in We're off to a good start:
What can we do to build our user base? I believe that TH has something like 70k registered users. We only have 130 to date.
A little math.
We have 130 @ 5 weeks = 26 new member/week.
26 members/wk x 52 wks in a year - 1,352 members/year.
70,000 TH members/1,352 members TB members/year = 51 years.
Hey, perhaps we are on course, as hasn't TH been around for 51 years... or does it just seem that way!
@Vulgano-Brother said in We're off to a good start:
When can we meet under the bridge in Spokane again, Dr. GO? My back's been bothering me...
...SINCE WE ARE ALL IN SUCH GOOD HEALTH... with the exception of that ONE problem patient....
@administrator said in We're off to a good start:
No spam, so far. Please report any that you find. Currently, I have registration pretty liberal. I am trying to attract new members.
This is an amazing site, and your are doing a great job.
However, I believe I have your posted evidence that I would be Moderator of Medical Concerns; however, since no members have yet posted medical concerns (just my reports from medical studies) SINCE WE ARE ALL IN SUCH GOOD HEALTH, I guess there is nothing to moderate. But when that time does come, I hope I am worthy of anointment or Great One!
@Doc-Wannabe said in Copper is cool!:
@Dr-GO That's a great concept. What era and region did you perform? I'd love it if there was a need for a P&W horn band. Interest seems to be spotty in our church.
This band played from 2001 to 2005. We were essentially the House Band at a Cincinnati Club called Simone's. That band was even featured in Delta Airlines flight magazine titled: "Queen City Jazz". We also played frequently at Pachia's in Dayton, and had an every Sunday Gig at the United Methodist Church on Salem Avenue in Dayton where we were scripted to play Hymnal pieces linked to the sermon, but had the freedom to inject a classic jazz tune from the Real Books that had a connection to the sermon content.
I lost the article but this is the photo used for the "Queen City Jazz" article in SkyMagazine:
@BigDub said in Great Idea!:
@administrator said in Great Idea!:
Currently, I'm the only moderator and I don't read enough posts to catch much of anything.
That was my problem trying to edit gmonady's posts on you know, TM. He had over 18,000. Whew. Too much for one person!
BUT that is why I paid you the BIG Dub-Bucks!
Here is the female musician that I would end my medical career and tour for:
@Doc-Wannabe said in Copper is cool!:
@Dr-GO great song and great job with it.
Thanks Doc-Wannabe.
That song was recorded with my prior band, Second Coming. We played more spiritual Jazz Standards (Mercy, Mercy), and took many songs from the Methodist Hymnal and converted them to jazz blends with re-harmonizing and more jazz phrasing styling. That band was a local favorite between Cincinnati and Dayton, and we had entire weekends booked for the several years we kept that band together. This was a regional fresh idea to take gospel and turn it into 60's style jazz.
One of my favorite pianists of all time is Kenny Drew Jr (son of Kenny Drew who was Coltrane's pianist on his first solo album Blue Train). Kenny was our pianist for the Bass Notes the Heartbeat of Jazz cuts I have been using to demonstrate horns that I play. Here is Kenny playing a month after we played or CD Release at Gilly's, now playing with Ronnie Cuber. It's just so amazing not only the hear him but to watch him in action:
@Dr-GO said in Copper is cool!:
A bit of the quite side of the Rose brass Recording. This is a Miles Davis inspired re-harmonized arrangement I did of "Jesus is All the World to Me" to give a different perspective of how this horn, with a Harmon mute, comes close to the Committee sound:
https://soundcloud.com/user-296675506/07-track-7
Here is the above chart with the re-harmonized chords written in:
Post would not be complete without the Rose brass of an Olds Recording. I shall oblige:
HERE IS THE ABOVE HORN playing on: Jacktime
Here is the C-Instrument Part to Jacktime:
This is a rose brass horn that can play with bright spirits when so energized!
@Shepherds_Crook said in Copper is cool!:
My Marcinkiewicz Rembrandt Four-X Rick Braun model with commercial bronze bell
I was waiting for this one. I can feel my lips puckering now with the incitement of putting them up against this horn. Soon my friend, real soon!
