Take good care of your back!
Nearly everyone experiences back pain at some stage. While there are
other potential causes, MOST back pain is musculo-skeletal in origin. It
can be quite severe, although in most cases it is short-lived and can be
managed with simple measures including heat packs, pain relieving
medications and gentle exercises. Bed rest should be limited
as movement is needed for recovery.
The back is a complex structure incorporating the bony spinal column of
vertebrae, fibrous discs between each vertebra (intervertebral discs),
ligaments that hold the spine together, joints between vertebrae and many
layers of muscles that support it all. The spinal cord and all the nerves
supplying the body travel within the space behind the vertebrae and the
intervertebral discs. Pain can arise from any of these structures.
The back is subject to many stresses and strains in the process of daily
living. Muscles and ligaments can be strained by poor posture, improper or
heavy lifting or by sudden awkward movements. Sometimes just a small
movement will be the ‘straw that breaks the camel’s back’. Being
overweight also puts extra strain on the back. Discs may become worn and
can bulge or rupture. Sometimes this causes inflammation leading to pain
or pressure on spinal nerves, although many people have bulging discs with
no pain. Some specific causes of back pain include:
Arthritis in the joints of the spine can cause pain and sometimes
narrowing of the space around the spinal cord, which can put pressure on
the spinal nerves.
Sciatica is pain that shoots through the buttock and down the back of
the leg. This is caused by irritation of the sciatic nerve, either from a
bulging disc or narrowing of the surrounding bony area.
Scoliosis is a condition of abnormal spinal curvature that can lead to
poor muscle function and back pain.
Osteoporosis (brittle bones) can weaken the vertebrae, ultimately
causing a collapse within the bone known as a ‘compression fracture’.
Other causes of back pain include infections, cancer and diseases
affecting the blood vessels, kidneys, gall bladder and other abdominal
organs.
Physical therapies involving massage, heat/ice, ultrasound and
muscle-release techniques may be helpful in reducing pain. As pain
improves, exercises to improve flexibility and strengthen core back and
abdominal muscles will help to prevent further episodes. Sitting causes
the greatest pressure on the intervertebral discs. Back pain sufferers in
particular need to limit this activity and take regular ‘movement
breaks’.
If back pain does not improve with less invasive treatments,
occasionally injections of cortisone around the spinal cord or spinal
joints may be used. Surgery, for example to fuse (join) vertebrae or
remove bone that is pressing on nerves, is used only if other treatments
fail.
Preventing back pain requires regular exercise to strengthen core
muscles that support the back. Good posture for sitting, standing and
lifting is vital – always avoid twisting and lifting simultaneously.
The many benefits of fruit
Fruit is the edible, fleshy part of a plant, which has developed from
flowers. Nuts and some vegetables such as tomatoes, cucumbers and beans
are biologically fruits. But in practice we restrict the term fruit to
sweet tasting plant products.
Fruit makes an important nutritional contribution to our daily diet by
providing vitamins (especially vitamin C), minerals and fibre. The fibre
in fruit is rich in pectin and gums, which slow down the absorption of
nutrients into the bloodstream and also help lower blood cholesterol.
Fibre also creates bulk, which makes fruit a satisfying part of any meal
or a fulfilling snack.
Yellow and red fruits like mangoes, apricots and watermelon are rich
sources of beta-carotene (the building block for vitamin A). Fruits are
also a valuable source of antioxidants, which are beneficial to health.
Whole fruit is preferable to juice because it is higher in fibre and
nutrients. However it is better to have some pure fruit juice than no
fruit. Fruit cordials are only a sugary drink.
Fruits perish easily. The vitamin content of fresh fruit diminishes once
the fruit is bruised, damaged or peeled. Canned fruit packed with no added
sugar has a similar nutritional value to fresh fruit, although some of the
vitamin C is destroyed by heat in the canning process. Eaten in moderation,
dried fruits make healthy snacks. Dried figs contain useful amounts of
calcium and dried apricots contain iron. Dried fruit contains a high
concentration of natural sugars and it is easy to eat too much.
Everyone should try to eat at least two pieces of a variety of fruit
each day. With virtually no fat and refreshing flavours, fruit is an ideal
way to finish a meal.
Good Health on the Menu
Baked apples are a simple, old fashioned and tasty dessert.
Baked Apples (serves 4)
4 cooking apples
4 dried apricots, cut into strips
4 dates, cut into strips
2 tabs blanched almonds, roughly chopped
1 tsp honey
A pinch each of cinnamon and ground cloves
The zest and juice of an orange
A little brown sugar
Using an apple corer remove the cores of the apples. Cut a shallow slit
around the middle of the apples. Mix the remaining ingredients, except the
sugar and orange juice. Fill the apple centres with this mixture and
sprinkle a little sugar over each. Place them in an ovenproof dish. Add
orange juice. Bake at 180°C for 1 hour, or until soft.
Did you know?
Swimmers who hyperventilate (over breathe) before holding their breath
underwater may be putting themselves at risk of brain injury and potential
drowning.
Some believe that this practice can store up extra oxygen for the swim.
In fact, hyperventilation temporarily lowers the blood levels of carbon
dioxide – the waste product we breathe out. This sends a signal to the
brain that we do not need to breathe, causing the brain to actually become
low in oxygen to the point of not functioning properly.
A recent case reported in the Medical Journal of Australia highlights
the risk of this practice. Two fit medical students hyperventilated before
competing to see who could swim the furthest underwater. Both became
unconscious and required resuscitation. Similar cases overseas have
resulted in brain injury and drowning.
Those who dive or swim need to be aware of the risks before
experimenting with such techniques.
Diabetic ketoacidosis is a serious illness
Diabetic ketoacidosis (DKA) is the term used when a diabetic does not
have enough insulin (the hormone needed to transport glucose into cells)
leading to increased blood glucose levels, biochemical imbalance
(acidosis) and dehydration. This can be fatal if not treated.
Symptoms include frequent urination (polyuria) or soaked nappies in
infants, thirst and frequent drinking (polydipsia), needing to urinate at
night (nocturia) or bedwetting (enuresis), weight loss, tiredness, nausea
and vomiting, abdominal pain and confusion. The breath may smell sweet and
chemical-like due to the presence of ketones, which are produced when body
tissues break down. DKA can progress rapidly, causing death if it is not
promptly diagnosed and treated. Treatment involves replacing fluids and
correcting insulin levels, usually in a specialised hospital setting.
DKA may affect up to a quarter of all newly diagnosed type 1 diabetics -
in type 1 diabetes, the cells that produce insulin are destroyed causing
insulin deficiency. It can also be caused by changes in insulin
requirements with illness or trauma, inadvertent missed doses or insulin
pump failure. Some diabetics may reduce their insulin in order to lose
weight, a potentially disastrous strategy.
While newly diagnosed diabetics and their families need education about
insulin and prevention of DKA, it is wise for everyone to be aware of the
symptoms. The number of cases of type 1 diabetes in young people is
increasing worldwide. Children and infants in particular should be checked
immediately if thirst and urination increase, even if there is no family
history of diabetes.
Myth and Fact
Myth
Taking aspirin before a long flight will help prevent blood clots in the
legs (deep vein thrombosis – DVT).
Fact
Awareness of the increased risk of DVTs on long flights has risen
greatly in recent years. Perhaps because aspirin is used to prevent
strokes in those at risk, some believe that they can take aspirin prior to
and during a long flight to prevent a clot forming in the legs.
In fact, research does not support this and aspirin has no role in
preventing DVTs. It should be remembered that aspirin has side effects,
including bleeding and stomach irritation, and should not be taken without
good reason.
The recommended measures include doing regular leg muscle exercises to
avoid blood pooling in the legs and keeping well hydrated during the
flight. Ankle-knee graduated compression stockings are recommended for
those who may be at increased risk including the obese, those with
mobility problems and those with cancer, varicose veins or a history of
blood clots. In those at significant risk, a heparin injection prior to
flying may occasionally be recommended.
Painless swelling of feet and ankles is common after air travel and is
not likely to be a DVT. However, pain or swelling in the calf or trouble
breathing shortly after a long journey requires prompt medical
attention.
Health reminder!
Next time you visit the doctor, ask for a blood pressure check. If it’s
normal, that’s good news. If it’s up, you may need further checks but
could avoid a stroke.
Dr Norman Swan
A Matter of Health
“Extra virgin” for your heart?
“Extra virgin” olive oil may not just be a marketing slogan.
One of the big differences between ‘refined’ olive oil and
‘extra-virgin’ olive oil is the level of polyphenolic molecules. These
molecules not only add to the taste but also are powerful
antioxidants.
A small study recruited people with recent heart attacks directly from
the hospital ward. Over two week periods, people recovering from heart
attacks were given 50ml each day of either extra-virgin olive oil or
refined olive oil. In just these two weeks, the differences were
significant. Two blood markers of inflammation (a sign that may indicate
your arteries are being damaged by the immune system) were reduced when
the people had the extra-virgin olive oil. It has been suggested that
these inflammatory factors help activate immune cells that bind
cholesterol. These may become the ‘foam’ cells that accumulate to form
atherosclerosis.
Extra virgin olive oil contains a rich mixture of complicated
anti-oxidant molecules. Known as polyphenolics, these molecules typically
add a bitter taste to many foods, including leafy green vegetables. In
people at risk of heart disease, extra virgin olive oil may be the good
oil – perhaps helping to quench the body’s inflammation and heart disease
risk. Virgin olive oil is certainly a core part of the Mediterranean diet,
which is known to extend life by several years in people who closely adhere
to it.
In people who have had a heart attack, extra virgin olive oil is not a
substitute for aspirin, cholesterol and blood pressure medications – all
proven to reduce your chances of a repeat heart attack. It’s an add-on –
but watch the calories!
Plan for end of life care
We make plans for many of life’s major events. However, the situation at
the end of life is often that family members have to make decisions about
medical care without being clear about the wishes of their loved one.
In some parts if the world, ‘advance care directives’ have been
developed as a plan for a variety of medical contingencies. This plan is
usually discussed with the person involved, their relatives and carers and
the medical team. Having such a plan means that, when decisions have to be
made, there is confidence in knowing the wishes of those who may no longer
be able to speak for themselves.
American research indicates that those who have plans are highly likely
to receive the type of care they requested – whether it be “all care
possible” or “comfort care”.
If you are caring for an elderly or ill relative, it is a good idea to
discuss openly with both them and the doctor what decisions they want made
on their behalf, should the need arise.
