Tag Archives: bay area

Back Pain – the Bane of Being Human

by on July 7, 2015

back pain pjcc

Back pain can be devastating. Just ask my wife. Prior to our upcoming wedding my wife decided she wanted to get in shape. She joined a gym and, in her zeal, she repeated the weight routine three days in a row. The next day she suffered severe lower back pain which subsequently has besieged her for the past 38 years. (I know this because we just celebrated our 38th anniversary.) Guess who has been destined to be the luggage shlepper and primary grocery shopper in our marriage?

My wife has not been alone in experiencing low back pain. 80% of adults suffer low back pain sometime during their lifetime. In younger people, pain is mostly due to mechanical factors – the interplay of spine, muscles, ligaments, discs, and nerves in the way of they fit together. Low back pain can be triggered by repeated straining such as at a gym, or by a fall or accident, or by a sudden action involving lifting a heavy weight or twisting abruptly. Oddly, a herniated disc can happen spontaneously without a specific injury. In older adults, the most common cause of low back pain is spinal stenosis which means narrowing of the spaces of the spine. With aging, some people develop spurs in their vertebrae, and ligaments around the spine may thicken which together may cause narrowing (stenosis) where the nerves exit the spine. This typically results in pain while standing and walking, and relief by sitting.

Red Flags
While most causes of back pain are not life threatening, there are some warning symptoms that indicate immediate attention is required. These “red flags” include history of trauma, fever, incontinence, history of cancer, unexplained weight loss, long term steroid use, and intense localized pain with inability to find a comfortable position. Coincidently, the reason there why there was a position available when I was hired at Kaiser was because my predecessor had died of back pain due to an epidural abscess, an infection near the spinal cord. While I don’t know the details of his illness, he likely had fever with his back pain, and unfortunately did not appreciate the implication. Life threatening cases of back pain with fever I have treated include pyelonephritis (kidney infection) and endocarditis (heart infection.) Back pain with fever can be a lethal combination.

The inability to find a position of comfort typifies a patient who present with an abdominal aortic aneurysm. For this reason alone, I routinely examine any older patient with back pain for the presence of a pulsating mass in the abdomen. During the course of my career, I have detected two patients with aortic aneurysms. They both were ex-smokers and were overtly grateful since delayed diagnosis is almost always fatal.

A patient with a history of cancer always raises a red flag to me even if the cancer occurred decades prior. The most common types of cancer that spread to bone are breast, prostate, lung, kidney and thyroid. While most doctors have been well educated about not doing unnecessary imaging studies, a patient who has a past history of cancer especially with any history of recent weight loss deserves x-ray evaluation.

When back pain is not spine pain
During the fifteen years I spent working part time in spine clinic at Kaiser, I was amazed the number of times a patient was referred for back pain actually had something other than a spine condition. Two of the most common conditions that can be confused with a spinal disorder especially in older adults include osteoarthritis of the hip and peripheral artery disease (PAD). Hip osteoarthritis can usually be distinguished by performing a hip examination during the visit and by getting hip x-rays. A person with good range of motion of hips does not likely have significant hip arthritis. PAD can usually be determined by checking all the pulses in the legs and feet. The other feature differentiating PAD from spinal stenosis is that patients with PAD do not have pain while standing, while spinal stenosis patients generally do. Sometimes, though, a patient might have more than one condition causing back and/or leg pain in which case more sensitive testing is indicated to evaluate circulation competency and neurological function.

Other causes of low back pain outside the spine include kidney stones, acute pancreatitis, herpes zoster (shingles), endometriosis, and fibromyalgia.

What is the scoop about MRI’s?
A common question from many people with back pain is whether they should get an MRI to pinpoint the cause of their problem. The problem is that most people even without back pain will have an abnormality on an MRI exam. Falsely alarming MRI results in patients who have back pain explain why back surgery in the U.S. is more than twice as high as in other countries. Yes, surgery corrects the problem seen on the MRI but this may be unrelated to the cause of the pain.

Treatment of low back pain can vary depending if it is acute or chronic (more than 3 months). There are no hard and fast rules, but generally ice packs are advised for pain within 2-3 days of injury. Heat can help ease subacute or chronic pain. Bed rest after acute injury tends to delay recovery, and it is important to resume normal activity as soon as possible. Physical therapy can help strengthen core muscles that support the spine, but an interesting study from UCLA a few years ago showed that walking three hours a week was more effective than three hours of physical therapy a week. Epidural steroid injections can be given for low back pain associated with sciatica, but a recent NIH study showed that in patients with spinal stenosis who received epidural injections had worse long term outcomes than those who did not receive them. Surgery may be considered in serious injury situations or if there is progressive neurological deterioration. While there appears to be short term benefit in patients who have undergone surgery, long term benefits going out four years and ten years appear to show no clear advantage compared to those who have not had surgery. Although I am not fond of many of the medications advertised for low back pain, sometimes they serve a purpose in helping someone to become more active and exercise once again.

Regular exercise is the best way to keep one’s back healthy. My wife has found walking at least 60 minutes a day helps to lessen recurrences of low back pain. She also stretches regularly, and does not wear high heeled shoes. When she is sitting in the car or a chair, she uses a lumbar support called a Sacro-Ease or an inflatable travel pillow. She avoids any significant lifting, but if she does lift something she lifts with bent knees, carries the object close to her, and does not twist. For me, running, biking, and doing yoga at the PJCC keeps my back in shape, but everyone has to find a regimen that works best for them.

While back pain can be disabling, it can also be managed with regular activity and awareness to prevent further damage. Three months ago my wife injured her back again when she missed a step getting out of an elevator while holding one of our granddaughters who impeded her vision. To avoid trauma to our granddaughter, she sacrificed herself by intentionally twisting her spine as she fell. I am happy to say that granddaughter and “Nana” are back in each other’s arms once again.

For further information about low back pain, visit the NIH site.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider



Is Pilates The Secret To Youth?

by on June 29, 2015

Audrey / Pilates


I usually don’t ask people their age, especially if it is a woman. When I met Audrey Guerin I was surprised when her age came up; she is 81. She has such a youthful appearance. I told her I needed to know her secret–and we’re sharing it here with you!

Q:  Audrey, I was surprised to learn your age after seeing your picture and then meeting you in person. What is the secret for how you stay so young?

A:  Age just seems like a number and that number does not define me. I listen to my body to Continue reading

The Case for Camp — Why Kids Need It Now More Than Ever

by on February 19, 2015

pjcc summer camp

By Peg L. Smith

Change is a part of life. It is often directly related to survival and can enrich one’s life in ways unexpected. Childhood is in essence a time of profound change and development. It is exciting and disquieting at the same time. When it comes to our children, we need to be sure that change is made for the better.

We’ve been so concentrated on the brain, we forget about the rest of our bodies. This change in focus has lead to an obesity rate that is unacceptable. Our kids are not as healthy as the Continue reading

Half My Size: A Weight Loss Journey

by on January 28, 2015


By Randi  Reed, PJCC Assistant Camp Director

Everyone asks me what happened. How did I do it?

As a teenager at age 16 I weighed 350 lbs. If that sounds like it would be hard to overcome, it was.

I had PCOS (Polycystic ovary syndrome) and I knew if I kept going and growing the way I was, I would have died. With help from my doctor to get the PCOS and hormones under control I Continue reading

Happy Trails: Hiking in the Bay Area

by on April 9, 2014


by Rhonda Press
Guest Author, Rhonda Press, is an Adult Program Coordinator at the PJCC and an avid Hiker.

I happen to love hiking.  Being out in nature restores my soul.  Living in San Mateo County, we are lucky to have many miles of hiking trails.  There are hikes that are more like city hikes and others that will take you deep into the redwood forests.  I’ll share 3 of my favorite hikes plus one that is brand new.

Edgewood County Park and Natural Preserve is located in Redwood City and is right off Edgewood Road between Alameda and Highway 280.  There is a formal park entrance with a parking lot but you can also park just immediately west of the 280 overpass at Edgewood

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by on April 1, 2014


“Ahh choo, bless you, ahh choo, gesundheit “ are the expressions one hears this time of year from allergy sufferers and their companions.   People who have migrated to California from other parts of the country are surprised to experience allergy symptoms they never had previously.  Allergy victims march into doctor offices and pharmacies every spring because of the combination of the long growing season here, habitat for many species of plants in California, and windy days. The “bless- yous” and “gesundheits” exclaimed by empathetic bystanders are exclamations based on an ancient superstition to forestall evil spirits from entering the body after one sneezes, but now it seems impolite not to offer consolation.   Sneezing usually heralds the onset of a cold, but can also be triggered by exposure to sunlight or strong odors.  This time of year, sneezing portends hay fever or seasonal allergic rhinitis. You may be one of the estimated 20% of Americans who have this condition and if so, keep reading.

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Interview with Rabbi David Saperstein – Part 2

by on January 22, 2014

Rabbi David Saperstein

Interview with Rabbi David Saperstein - Part 2

In our second installment of Q&A with Rabbi David Saperstein, Rabbi Lavey Derby asks about his roll and influences.

Q: You’re held in high esteem by colleagues and peers: who do you admire and why?

“Too many to do justice to. I have been blessed to meet and work with so many of the greats over the years. My parents rank alone in their influence on my life: My father, as a beloved rabbi for nearly 50 years in one synagogue and he and my mother as passionate social justice activists. In the Jewish social justice arena, my two most influential Jewish social justice mentors were Al Vorspan, the longtime social justice VP of the Reform Jewish Movement, and at 90, in my Continue reading