Day 1

 

Annnnd we’re off! The 2013 Uganda Spine Surgery Mission officially began on Thursday, August 8 at London Heathrow Airport. This year’s team of six– the smallest team yet– gathered from a smattering of departure cities, including Dallas, Toronto and Tel Aviv. Flying in from Dallas were team lead Dr. Izzy Lieberman, his daughter (and chef extraordinaire) Danielle, and two veteran spine surgery missioners, scrub nurse Sherri LaCivita and medical equipment sales rep Rob Davis. Dr. Zvi Gorlick, a family physician in Toronto, joined the team for the first time, as did I (Jennifer Teichman), a medical student from the University of Toronto.

After a quick caffeine boost at the airport, we dumped our luggage at airport storage and scurried into London for the day. When a two-hour line thwarted our attempt to visit the Sherlock Holmes Museum, we hopped into a cab and found ourselves at Trafalgar Square after a quick drive-by of Buckingham Palace. All six of us clambered up the gigantic lion statues for our first team photo.

Trafalgar Square

 

 

 

Phone Booth

We met Ros Eisen, secretary of the Putti Village Assistance Organization for delectably crispy fish and chips at The Seashell, where Zvi insisted on ordering every dish on the menu that happened to be unavailable that day. Re-energized, we made our way to Big Ben, which several of us were surprised to learn referred to the bells rather than the clock tower itself. Dr. Lieberman surprised us with tickets for the London Eye, which proved to be the highlight of the day. We sipped champagne 40-something stories atop London and congratulated ourselves for a day well-spent. Then, it was back to Heathrow for our 9:00pm flight to Entebbe.

London Eye

 

 

 

 

 

 

 

The 2013 team on the London Eye

Quote of the day: “No time for dresses.”- Dr. Lieberman, after Danielle expressed a desire to change out of her yoga pants and into a dress for our day in London. We mean business!

 

Day 2

 

We touched down in a rainy Entebbe around 7:30am, sleepy-eyed yet itching to get started on the mission! Our collective enthusiasm met its first challenge when my laptop was stolen from the airplane. As a newcomer to the mission, I learned my first lesson of the trip: keep your valuables on you at all times, no exceptions. Our first driver, Eric, then appeared not with the 40-seat bus we thought was to be provided by the Mbrara University of Science and Technology (MUST), but with a small pickup truck and a 6-person van. This was my first hint that things don’t always go as planned in Uganda. We loaded the truck with our bags, piled ourselves into the van and started the bumpy 60 minute drive into Kampala, the capital and largest city in Uganda. Our first stop was Case Medical Centre, a private hospital that served as a base for the mission in previous years. This year, however, we were only there to pick up the medical equipment they had stored for us from last year.  Danielle and I held down the fort by the luggage-laden truck while the rest of the team retrieved the equipment. Rumor has it that while hoisting a big bag of surgical equipment, Zvi lamented Izzy’s choice of profession, and graciously provided us with our first quote of the day: “Why couldn’t you have been an ophthalmologist!?”

Uganda 01

 

After a true feat of space-maximization, the equipment was loaded into the truck and sent off to Mbarara to await our arrival the next day. Meanwhile, we headed to our Kampala accommodations, the Speke Hotel, for a much needed shower and change of clothes. With the whole afternoon still ahead of us, we paid a visit to the Galilee Community General Hospital, a Jewish Hospital in Kampala interested in future collaboration with the Uganda Spine Surgery Mission. We toured the facilities, including the new hospital building currently under construction. It was particularly interesting to learn about some of the considerations given to building and maintaining a small hospital on philanthropic support; the constraints of space, funds, resources and expertise were evident throughout our tour of the main hospital and construction site. Nevertheless, the team agreed that the new hospital promised to be a valuable addition to the community.

The team returned to the hotel to rest before dinner, a good idea since dinner turned out to be a marathon for the stomach and palate. We feasted on delicious Indian cuisine at Khyber Pass, one of two kitchens at the hotel and a favourite of previous incarnations of the Spine Surgery Mission. By the end of the night, several pants buttons were unbuttoned (mine included), and our droopy-eyed procession made its way to bed.

Quote of the day (#2): “I’m so full, I don’t even have room for a tic tac”

Day 3

 

Move in day! We awoke to a beautiful morning in Kampala, and hit the road after a hearty breakfast at the hotel. First stop: The Nakumatt Oasis, the Zeus of all department stores. There, amongst the impeccably clean and organized isles, one can find everything from toothpaste and vodka to washing machines and power tools. It puts Walmart to shame. After stocking up on what is reportedly the world’s best coffee beans, we piled back into the van and continued the five hour trek to Mbarara. Newly paved, the road to Mbarara traverses a landscape of rolling green hills, flat valleys of cultivated land and dirt paths dotted with shacks selling local fruit, meat, fish and potatoes. There was a collective cringe as we passed trailer after trailer of live bulls packed tighter than sardines, their ferocious horns piercing the air above them. Every half hour or so, the serene landscape was broken by the bustle and dirt of a small village with decrepit store fronts ironically painted in advertisements for Coca Cola and Nokia. Within an hour of the ride, our clothes were covered in a thin film of copper-red dirt kicked up by fellow drivers and boda-boda cyclists.

 

equator

We made a pit stop at the Ugandan equator, where we stretched our legs and shopped for local artisan crafts. Like school kids watching their first science experiment, Zvi, Rob and I oo-ed and aw-ed at a demonstration of water spinning in opposite directions in funnels placed on either side of the equator. Cooler still, water placed in a funnel centered on the equator didn’t spin at all as it drained! Call me a nerd….

We arrived at our hotel in Mbarara, the Lakeview, and were pleased to find large, comfortable rooms. Anxious to start our work, we gathered our medical equipment and drove to the Mbarara Regional Referral Hospital, our base for this year’s mission. We were met there by a spectacular surprise: last year, the hospital had opened an entirely new wing including an Intensive Care Unit, Emergency Department and operating theatres. We set to work right away, unloading the equipment from the truck and transporting it to a temporary storage room in the Emergency Department.

 

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Unloaded and eager to explore, we began a tour of the new building. The Emergency Department is a bustling continuum of corridors and open spaces filled with beds and curtains, each bed occupied by a patient and surrounded by family members. The spill-over of family members sit quietly on benches lining the hallways, many of whom carry infants. It seemed many of these families had not been home for days. Passed the Emergency Department, we found the ICU, a stark contrast to the crowded hallways of the ER. The ICU is a quiet space with each bed contained in a separate glass room. Computer monitors displaying patients’ vital signs hang over the beds, much like one would find in any hospital in North America. Already impressed, we then proceeded to the surgical wing. Dr. Lieberman’s expression was that of a kid in a candy shop when he first laid eyes on the operating rooms. Big, bright, clean, well-equipped and windowed… we hadn’t expected anything close to this! The team’s excitement was palpable.

We left the hospital elated and even more motivated to kick off a great week at Mbarare. After an “edible” dinner at the hotel, we headed to bed for a good sleep before our first big day at the hospital.

Quote of the day:

“It’s ok, you can take your skirt off here.. we’re all medical professionals”

“The food is…. edible….”

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Dr. Lieberman’s first glimpse of the OR

It’s a Boy!

July 31, 2013

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On the evening of July 22, 2013, the fountains of Trafalger Square in London were gloriously illuminated by blue lights, signifying the heir to the British throne, Prince William, and his wife, Kate Middleton, had given birth to a prince. His Royal Highness, Prince George Alexander Louis of Cambridge, came into the world at a healthy weight of 8 pounds, 6 ounces and it seems the entire world took a collective breath.

In a time of 24-hour news cycles and second-by-second social network updates, the birth of the royal baby was the stuff of water-cooler discussions around the world. In fact, British bookmaker, Coral, noted that this birth was the biggest, non-sporting betting event in history. Everyone, it seems, is talking about babies and moms, royal and otherwise those of us at Texas Back Institute are no exceptions.

The spine specialists at Texas Back Institute treat many new mothers and mothers-to-be who are experiencing back pain associated with childbirth. While the world is fascinated with little Prince George, we chatted with Dr. Nayan Patel whose expertise in physical medicine and rehabilitation makes him an excellent source for analyzing the causes of back pain among pregnant and post-partum women. His insights shine some medical light on the back pain millions of mothers experience. However, before getting his thoughts, let’s take a look at the impact the newest prince has had already.

It’s a Boy!

With this much interest in the birth of Britain’s latest heir, one could predict some ripples running through the media and even the economy as a whole. However, very few could anticipate the tsunami of media coverage and economic impact transpiring immediately before and after the July 22nd birthdate.

On the economic front, the British birth has been very good for business – worldwide – resulting in a feel good bump in sales in a wide range of categories. The UK-based Centre for Retail Research estimates England will get a $373 million (US) boost, with $133 million in festivities, $123 million in souvenirs and toys and $117 million in books and DVDs. Because Americans and Australians can’t seem to get enough of the royal child, it expects exports to these two countries to exceed $57 million in sales.

Because of the popularity of the royal couple and their new baby, whatever choices they make in the way of “baby accoutrements” will likely drive big sales worldwide. Experts say the sales of prams and baby pushchairs should increase dramatically. They expect whatever baby clothes, cribs and toys the royals buy for little George will get the Baby Cambridge bounce.

Even US – based retailer, Target is celebrating the arrival of the royal baby. This company has been featuring Princess Kate’s maternity clothing throughout her pregnancy and is selling a special line of baby clothes in honor of the newest prince. Target’s campaign theme – “We may not know anything about being third in line to Britain’s throne, but we know about babies (and their first-time moms and dads)”- suggests a reason for our fascination with this event. More on that later.

A Royal Pain in the Back

When all the media noise dies down (if only for a few hours) and Princess Kate is left alone to enjoy some quiet time with her baby, there is a very good possibility she will be left to deal with the problem that new moms everywhere have to deal with – chronic back pain. This pain often accompanies pregnancy and continues in many post-partum women.

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Dr. Nayan Patel of Texas Back Institute notes, “Back pain occurs in approximately 50 percent of pregnant women on some level. It can start as early at the first trimester and continue for as long as 18-months after delivery. It can be very painful and adds to the stress of being a new mom.”

What causes this pain? Dr. Patel says, “Many people feel the added weight of the baby strains the back muscles and causes pain. However, in most cases, the real culprit for the pain is the perfectly natural process of a hormone being released in a pregnant women’s system to allow for the muscle ligaments to expand and allow for the passage of the baby through the birth canal.”

Dr. Patel continued, “This can lead to a condition known as ligamentous laxity – basically loose ligaments – which can lead to sacroiliac joint dysfunction and pain. The sacroiliac joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis which are joined by strong ligaments. The sacrum supports the spine and is supported by an ilium on each side.”

How does Dr. Patel treat this condition? “With women who are pregnant, we are very careful to avoid anti-inflammatory medicines because the baby is receiving everything the mother is ingesting. So, for pregnant women, we often prescribe a visit to the chiropractor for adjustment therapy and physical therapy, especially aquatic therapy. As for post-partum back pain, we typically prescribe the anti-inflammatory medicines and if the pain continues, physical therapy,” he notes.

“Women who are pregnant are typically younger and this is case with Princess Kate. This youth allows the muscles and ligaments to rehabilitate quicker and if Prince George’s mom is experiencing any back pain, she will likely recover quickly.”

Why We are Fascinated by the Royal Baby

Whether Princess Kate has a royal pain in the back or not, she is without doubt the most high profile mom of the decade and perhaps in history.  What is it about this event that fascinates people around the world?  Child birth is the most common occurrence on the planet, and yet we can’t seem to get enough details about the royal birth.

Some of the more philosophical pundits and pop culture observers have suggested a reason for this fascination. The marriage of the British heir to the throne, Price William, to Kate Middleton a commoner was similar to a fairy tale to many people. The couple is charming and attractive and they are a real-life prince and princess. Their having a beautiful baby just enhances the fairy tale. And after all, most of us love happy endings in our fairy tales!

All Star Back Care

July 15, 2013

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When Dr. Rey Bosita of The Texas Back Institute talks about back health and baseball, his voice reveals his passion for both subjects. He clearly loves the game and his medical profession. This makes Dr. Bosita the ideal source to share information and opinions about the 2013 Major League Baseball All-Star game and how these athletes deal with back injuries.

Since Texas Back Institute is the Official Spine Specialist for the Frisco RoughRiders, the AA affiliate of the Texas Rangers baseball club, Bosita knows all about baseball-oriented back injuries. Before getting his thoughts on back injuries and ball players, let’s take a brief look at the 2013 MLB All-Star game.

The Fan Favorites

This year’s All-Star game will be played at Citi Field in New York City, the home field for the National Leagues New York Mets, on Tuesday evening, July 16, 2013. As always, the game will be nationally televised on Fox and the festivities begin at 7 p.m. (Central).

The MLB All-Star game owes much of its popularity to the fact that professional baseball fans can vote on the players who will take the field. Of course, this “popularity contest” format has gotten negative comments in the past – particularly from traditional baseball fans who feel that a player’s on-field abilities and performance in the first half of the season, rather than his name identification – more often than not, the popular vote reflects what type of season the starting lineup players are having. A great example of this is Baltimore Oriole’s first baseman, Chris Davis.

After being traded from the Texas Rangers to the O’s, Davis is having a remarkable year at the plate – 85 RBIs and 33 homeruns. In the All-Star voting, he finished with 8,272,243 fan votes to edge out last year’s triple-crown winner, Miguel Cabrera of the Detroit Tigers, who amassed 8,013,874 votes. Since neither plays for teams in large metropolitan markets, where vote totals can be manipulated by in-stadium promotions and both are having great years, it appears the fans made the correct, non-partisan, decision.

On the National League side, St. Louis catcher Yadier Molina was the leading vote-getter and he joins 4 other Cardinal teammates to make the Midseason Classic lineup. The NL player who has gotten lots of attention for his amazing season after being called up from the Los Angeles Dodgers minor league team, Yasiel Puig, failed to make the All-Star team this year.

2013 Major League Baseball All-Star Starting Lineups

The American League Starters include:

Joe Mauer (C – Twins)

Chris Davis (1-B – Orioles)

Robinson Cano (2-B – Yankees)

J.J. Hardy (SS – Orioles)

Miguel Cabrera (3-B – Tigers)

Mike Trout (OF – Angles)

Adam Jones (OF – Orioles)

Jose Bautista (OF – Blue Jays)

David Ortiz (DH – Red Sox)

For the National League:

Yadier Molina (Catcher – Cardinals)

Joey Votta (1B – Reds)

Brandon Phillips (2B – Reds)

Troy Tulowitzki (SS – Rockies)

David Wright (3B – Mets)

Carlos Beltran (OF – Cardinals)

Carlos Gonzales (OF – Rockies)

Bryce Harper (OF – Nationals)

Over the course of their careers, most if not all of these All-Stars have had to deal with injuries and some have been serious. Unlike football, baseball is considered a non-contact sport. However, there are more than a few collisions between runners trying to make it home and catcher trying to guard the plate and the constant swinging and throwing can take its toll on these athletes. Injuries to the spine and back are very common in this sport and we talked with Texas Back Institute surgeon, Dr. Rey Bosita to shed some light on how playing baseball can be dangerous to your back health.

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Now Batting – Dr. Rey Bosita

Dr. Bosita was between appointments when we caught up with him and asked him about the most common back ailments for professional baseball players. He said, “Lumbar sprains and other muscular strains are the most common back problems for baseball players. However, the most serious injury is a disc herniation. This involves the damage to the disc, which cushions the vertebra in the spinal column. When a player has a herniated disc, there is intense pain and any movement – whether it’s swinging a bat or throwing a baseball – almost impossible.”

So, what causes a herniated disc?

Dr. Bosita noted, “It can occur as a result of repetitive stress, for example if a player is swinging a bat for hundreds of times each week. A disc can be herniated when a player takes a powerful swing and misses or it can be the result of a collision on the base paths.”

Texas Back Institute is the Official Spine Specialist for the Frisco RoughRiders team and because they are just starting their careers in professional baseball, these players tend to be younger than those in the “big show” in Major League Baseball. Does the age of a player have any effect on the likelihood of back injuries?

“Definitely,” notes Dr. Bosita. “Older players have much more wear and tear on their back muscles, discs and vertebra and the constant repetitive stress from playing more than 160 games a year can gradually wear down these back muscles and cartilage. Plus, younger players tend to be in better condition and their muscles can withstand the quick starts and stops of baseball.”

Bosita was quick to note that some older players such as retired Baltimore infielder Cal Ripkin showed remarkable conditioning and ability to play with pain. “During his famous and historic complete games run, Ripkin played with a lumbar compression. This would have incapacitated most players, but Ripkin continued to play every day with this condition.”

What type of conditioning exercises do professional baseball players use to avoid the back sprains and other, more serious injuries?

Dr. Bosita said, “Cross training exercises which are designed to improve flexibility and strength and proper pre-workout stretching and post-workout cool downs are the most important elements of a conditioning regimen. Since baseball players are required to go from a complete stop to full-speed at the crack of a bat, it’s important that they remain loose even when they are in the dugout. Stretching will help with this.”

The All-Star Team at Texas Back Institute

The All-Stars who take to the field on July 16th are at the very top of their profession. Their conditioning is impeccable and their knowledge of potential injuries is extensive. And yet, the odds are very good that at some time, in the course of a season, they will experience a back injury that can potentially end their season or career.

If these athletes, with all of their physical conditioning and knowledge can be sidelined by back injury, it goes without saying that non-athletes can also experience the pain and physical limitation of back injury or pain. When this happens, it’s a good idea to go to the specialists – the All Stars – who deal with these issues every day: Texas Back Institute.

Balance and Back Pain

June 28, 2013

nik-wallenda-s-successful-tightrope-walk-over-grand-canyon-covered-by-discovery-channel

After Sunday’s spectacular walk on a 2-inch steel cable across the Grand Canyon, aerialist Nik Wallenda earned a new title: daredevil. His exploits also suggest how important one’s balance is to daily activities – not just survival on the high-wire.  The physicians at Texas Back Institute have first-hand experience helping regular people correct the back pain which can cause a loss of balance, leading to potential injuries from a fall. More on that later, but first let’s briefly review one of the most dramatic walks in history!

Representing the next generation of the famous “Flying Wallendas” family, known for its daring and sometimes deadly stunts on the high wire, Nik Wallenda completed a tightrope walk that took him a quarter mile over the Little Colorado River Gorge in northeastern Arizona. He walked 1,500 feet above the river on the Navajo Nation near the Grand Canyon with no net or safety vest.

This feat was broadcast live on the Discovery Channel and had viewers around the world griping the arms of their chairs for more than 22-minutes. The life-or-death drama was further enhanced by the fact that viewers could hear Wallenda speaking to himself from the mobile microphone attached to the aerialist and see what he was seeing from a camera placed on the aerialist. Throughout the spectacle, he was heard praying and attempting to calm himself as the 40-miles per hour winds above the Grand Canyon buffeted his taunt cable.

After the stunt was completed, Wallenda was asked by the media to recount the things that were going on in his mind during his walk. He noted at one point during the walk he “knelt down and I thought of my great-grandfather and that everything I do is to honor him,” Wallenda said. “It took my mind off all this movement underneath me … and I was able to focus on him and regain composure.” Nik’s great-grandfather, Karl slipped and fell to his death from a high wire in Puerto Rico in 1978 when he was 73 years old.

Here’s is a brief video clip, courtesy of the Discovery Channel of Wallenda’s amazing walk across the Grand Canyon.

http://dsc.discovery.com/tv-shows/skywire-live-with-nik-wallenda/videos/final-moments-of-nik-wallendas-historic-walk.htm

Lack of Balance is a Big Healthcare Problem

Tightrope walkers such as Nik Wallenda have an uncanny sense of balance. How else could he and the rest of the Flying Wallendas successfully walk more than 1,400 feet on a steel cable no thicker than 2-inches?

Clearly, most people don’t have this superhuman sense of balance. In fact, many people struggle to keep their balance when walking on a perfectly flat surface. Why? Sometimes this is due to an inner-ear injury, but often this has to do with the effects of back pain.

The Center for Disease Control and Prevention (CDC) notes that “in 2000, falls among older adults cost the U.S. health care system over $19 billion dollars or $30 billion in 2010 dollars. With the population aging, both the number of falls and the costs to treat fall injuries are likely to increase.”

The federal agency also notes:

  • One in three adults age 65 and older falls each year.
  • Of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard for them to get around or live independently, and increase their risk of early death.
  • Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.
  • In 2009, emergency departments treated 2.4 million nonfatal fall injuries among older adults; more than 662,000 of these patients had to be hospitalized.

How Does Back Pain Affect Balance?

As these healthcare costs suggest, this lack of balance is a problem which is both painful and expensive. We talked about balance and how it is affected by back pain with Texas Back Institute spine surgeon, Dr. Jessica Shellock.

shellockCan back pain cause a loss of balance?

Absolutely.  When someone suffers from back pain, there is usually some amount of muscular spasm or imbalance that can lead to an alteration in their overall spinal alignment. That’s going to present many times as a change in posture, such as the patient leaning to one side or even stooping forward. Sometimes on a radiograph we can see a subtle curvature of the spine that’s not scoliosis but actually a musculature imbalance because of pain. When we are unable to walk effectively then our balance will be hampered as well.

Does this lack of balance due to chronic back pain affect only older people, or do younger people have this problem as well?

Anybody in pain because of their low back, whether young or old, can be affected.  However, one issue that preferentially affects the older population is degenerative changes in the neck that can result in compression on the spinal cord.  This can also cause balance problems.

Here’s a quick video synopsis of Dr. Shellock’s thoughts on back pain and its effect on balance.

What are the back injuries or diseases that can cause a loss in balance?

Anything that can cause back pain, such as a herniated disc, pinched nerve, muscular strain or ligamentous sprain in the back can result in a loss of balance.  Degenerative changes in the neck or mid-back that create spinal stenosis, or pressure on the spinal cord, can result in a loss of balance.

How can these back problems, and the concurrent loss of balance, be corrected by surgery or therapy?

Understanding the source of the pain is key.  For example, if the cause of the limp is due to muscular pain or a ligamentous injury, physical therapy to address the problem and restore balance may be very successful. Alternatively, if compression of the spinal cord is causing the problem, we can take surgical actions to relieve this compression. In most cases, physical therapy can correct the root causes for muscular pain and misalignment of spine and also help many patients with pain from a herniated disc. Surgery is always the last resort in patients who’ve failed to respond to these more conservative measures.

Don’t Try This at Home

Walking across the Grand Canyon on a 2-inch steel cable is not something anyone – except maybe another Flying Wallenda – will do. The amazing sense of balance  Nik Wallenda showed was no doubt learned at an early age and could even be genetically determined. Most of us just want to be able to walk down a flight of stairs without taking a tumble.

If back pain is keeping you from maintaining your balance, it could be as simple as working on muscular strength with the specialists at Texas Back Institute’s physical therapy department. If  your condition is more serious, state-of-the-art diagnosis and appropriate therapy from our spine  specialists can have you back on the tight-wire of life sooner than you think!

Summer’s Back!

June 21, 2013

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Since the official beginning of summer is June 21st, the spine specialists at Texas Back Institute are preparing for the annual spike in the number of back injuries. “The primary culprits in this rash of acute back injuries are the accidents which occur when people get outdoors to enjoy some summer recreation,” notes Dr. Daniel Bradley, a spine surgeon at Texas Back Institute.

Activities such as mountain biking, water skiing and wake-boarding have an unusually high incidence of back injuries associated with them. Overdoing it on the golf course, tennis or basketball court can also lead to a visit to Dr. Bradley’s examination room. Even lifting those heavy suitcases into the car for summer vacation has the potential of causing painful back injuries.

So, how can you avoid the backache blues this summer? We asked Dr. Bradley for his advice.

Tips on Avoiding Summer Back Injuries

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“The best strategy for avoiding back injuries from summer recreation is to build core strength through proper conditioning before undertaking the activities, Dr. Bradley said. “Of course, this is easier said than done because in the summer, the weather is warm and we want to get out and play 36 holes of golf, rather than the 18 holes we are used to playing. Plus, we all believe we are in better shape than we really are.”

What is it about biking, equestrian sports, water skiing and wake-boarding that is makes them so dangerous to back health?

“The sudden pull on the ski line from the boat can cause trauma to unconditioned back muscles. However, this pales in comparison to the impact from falls that occur from a bike, horse, skiing and wake-boarding. A fall from this high speed can lead to strains and sometimes fractures to the vertebra of the back.”

What about swimming? Are there any potential back problems associated with taking a refreshing dip in the pool?

“So long as you’re careful on the depth of the water in which you’re diving, swimming is actually the best type of exercise anyone can do – in the summer or any other time of the year. In fact, we recommend regular swimming for those who are rehabbing from other back injuries. It’s extremely low impact and offers an excellent aerobic workout, while exercising all of the muscle groups.

Some summer sports such as fishing, tennis, golf and jogging seem to be pretty mild recreation. What are the possible problems with these activities?

“These activities are highly repetitive and sometimes involve twisting motions. While they are not high impact, they can exacerbate existing back pain if some form of stretching and muscle warm-up is not completed before the activity. By loosening up the muscles, they are more flexible and less likely to be strained by the motions of these sports.”  

How can someone determine when their back pain is related to soreness resulting from inactivity or a severe injury requiring medical attention?

“Any pain that does not subside after icing and over-the-counter pain medication over 2 or 3 days might require medical attention. Also, a physician should be consulted for any back pain which runs down the legs or arms and weakens these muscles.”

Summer is hot. Does heat have any effect on back pain or injuries?  

“Heat-related illnesses such as a heat stroke affect the central nervous system not the spinal muscles. I am not aware of any back injuries that are caused by the body overheating. However, the heat and fatigue can cause a person to be more careless in their physical activity and this can cause accidents. Plus, insufficient hydration can result in muscle cramps which can lead to injuries in the back and other areas of the body.”

Celebrating the Summer Solstice

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June 21st is the longest day of the year in the northern hemisphere and is known as the Summer Solstice. This is when the tilt of the earth’s semi-axis, in either the northern or the southern hemisphere, is most inclined toward sun around which it orbits.

While there are many myths and legends associated with the Summer Solstice, the most interesting place to celebrate the longest day of the year is at Stonehenge, located near Wiltshire, England. Many scholars believe this pre-historic monument was built to serve as a celestial observatory which helped predict events such as solstices, equinoxes and eclipses of the sun.

Online references note that during Summer Solstice, Stonehenge provides visitors with a visually stunning view of the rising sun. It can be seen rising above the ‘Heel’ Stone when one stands within Stonehenge facing north-east through the entrance towards the stone. The ‘Heel’ Stone stands just outside the main entrance of Stonehenge.

Whether you celebrate the beginning of summer at Stonehenge, in your backyard pool or favorite golf course, Texas Back Institute reminds you to exercise good judgment about the activities that can affect your back. Chronic back pain can take the fun out of this wonderful time of year. It can limit your ability to participate in the activities that are fun and can help you stay fit and healthy.

Don’t overdo it. Stay hydrated. And make this the best summer ever! 

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For Father’s Day 2013, forget about neckties and golf balls as gifts!  Rather, remind yourself of this…

What are the most important things your father ever gave you?  Most likely it wasn’t a set of golf clubs, your first car or anything tangible.  Perhaps you can thank Dad for your witty sense of humor, problem-solving ability or knowing right from wrong.  These are the most valuable things we carry with us for the rest of our lives.  Show Dad your gratitude by giving him something just as important.

At Texas Back Institute, we’re focused on overall spine health.  As anyone who has ever experienced back and neck pain knows, a healthy spine is crucial to one’s quality of life.  “Use Father’s Day as a spring board for a new way of living,” suggests Dr. Rey Bosita, a Texas Back Institute spine surgeon, who himself is a father of four  young boys.  From that perspective, we recommend healthy activities and actions that will be a meaningful investment in your relationship with Dad.

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Dr. Bosita and his family are sure to have an active Father’s Day!

Go on walks together.  This will not only enhance your general well-being but will boost your neck and back health as well. “Ask your dad about his health and fitness habits.  If your dad has been sedentary, start off easy and build yourself up to longer and faster walks.  Most importantly, make a commitment to your dad to walk with him regularly.  Consistency over time is what will improve his and your health.”

Taking walks together also fosters conversation.  Dr. Bosita notes that “walking and talking can help reduce stress and emotional pain which is usually carried in people’s neck and back.”

Commit to Annual Exams.  And follow through!   Serious health issues can usually be prevented if discovered early.  We all know dear old Dad sometimes avoids going to the doctor.  Make it a family affair and follow with a lunch date!

Or better yet, do what Dr. Bosita did with his dad.  He made it a Guys Day Out!  The day started with morning golf followed by lunch.  The tour of check-up appointments followed, from 1-5pm that afternoon, including “the dentist, eye doctor, primary care physician and a specialist,” says Dr. Bosita.  And naturally one works up an appetite after all of that, so he and his dad finished the day at their favorite steak house for dinner.  Father/son time and investment in your quality of life all in one day – pretty good by any measure!

“You have to create the same efficiencies in your health care as you do in your job everyday.  It’s all about commitment.  Time and money are the same thing.  Put them where your heart is,” advises Dr. Bosita.

Summon the child within.  What are the activities you enjoyed as a child with your father?  What are the activities he enjoyed with his father as child?  Consider bringing out the fishing poles and dusting off the tent.  Or perhaps your dad likes strolling art galleries or working on a project.  Whatever it is, do it together.

Dr. Bosita brought along the grandparents with his family to Disney World!  He laughed saying, “my father-in-law sure got his exercise walking all around the Magic Kingdom and Epcot Center- while pushing strollers and carrying kids. It was tough but it was great to spend time together as a family.”

In fact, older adults make up many of Texas Back Institute’s patients.    They often seek out preventive measures for the sole purpose of being active with their adult children and grandchildren.  Physical therapy at Texas Back Institute is integral to this approach.   Physical therapy helps prepare you or your older parents for carrying luggage or children, handling squirmy toddlers or playing in the pool. The benefits include “improvements in core strength and endurance, cardiovascular fitness and proper lifting mechanics,” says Dr. Bosita.  So, by planning ahead for such a trip, you will enjoy your experience more fully by being physically prepared.

Dr. Bosita observes that “there are many common neck and back conditions, which surface as we age, like chronic back pain, herniated discs, degenerative disc disease and others.”  However, he continues, “It is never too late.”  Start this weekend with Dad.  He may wear a tie you give him once a year.  But sharing a life full of wholesome activities and meaningful relationships will certainly be his life’s treasure.

 

 

 

 

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The fact that June 5th was National Running Day was lost on many people. Why? The joints and muscles of most individuals are not flexible or strong enough to take the pounding that running requires. However, almost anyone can walk and this exercise seems to be as effective as running. There’s even recent research that proves this.

In April 2013, Paul Williams of Lawrence Berkeley National Laboratory in California and Paul Thompson of Hartford Hospital in Connecticut compared 33,060 runners to 15,045 walkers and found that it’s how much a person exercises, in terms of energy spent, not how long he or she spends exercising. While it takes longer to walk a mile than to run one, when these two exercises compared in terms of energy expended, they are comparable yielding the same benefit.

The researchers measured blood pressure, blood sugar and cholesterol at the beginning, and then watched for six years to see who got diagnosed with high blood pressure, unhealthy cholesterol or diabetes. Those who exercised equally (in terms of energy output) got the same benefit whether they ran or walked. This study was published in the American Heart Association journal, “Arteriosclerosis, Thrombosis and Vascular Biology.”

In addition to these physical benefits, walking lowers stress levels in most people. A study at the Department of Behavioral Science at the University of Texas M.D. Anderson Cancer Center showed university students who walked had lower stress levels than sedentary people or even those who exercised strenuously. Plus, walking can be done almost anywhere – on the street, in a park or in a shopping center.

Is Back Pain Keeping You From Walking Tall?

With all of these benefits, why isn’t everyone walking every day? Sometimes, back pain precludes this activity. This is where the spine specialists at Texas Back Institute can be of assistance. We spoke with Dr. Stephen Tolhurst, an orthopedic spine surgeon at Texas Back Institute about the benefits and challenges of a regular walking program.

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To watch a video interview of Dr. Tolhurst explaining the benefits of walking for the back, please click here. 

Are there benefits to back health that are derived from a regular regimen of walking? If so, what are these?

Walking improves one’s overall health and this affects the whole body including the back and neck. The back tends to be healthier and less susceptible to injury and/or disease such as arthritis when an individual is active. Additionally, walking can help to keep the core muscles – abdominals, back and legs – stronger and this supports the back and neck.

What are some lower back problems that can keep someone from walking and how does one know when these pains are serious enough to visit the physicians at Texas Back Institute?

There is a condition called spinal stenosis, which is an abnormal narrowing of the spinal canal that can occur in any of the regions of the spine. This narrowing causes a restriction to the spinal canal, resulting in a neurological deficit. The symptoms of spinal stenosis include pain, numbness and loss of motor control. The location of the stenosis determines which area of the body is affected. This can cause a “rubbery” feeling around the leg when walking. This condition is serious and should be treated by a spine specialist.

There are also situations where pain shoots down one’s leg when standing or walking. This could be caused by a herniated disc or pinched nerve and should also be treated by someone on our staff.

However, mild to moderate back pain or stiffness during or after walking is usually not serious. If the pain is not getting worse, it’s probably safe to work through. In fact, the exercise from walking will likely help this pain and stiffness.

What are the most common factors that can cause lower back pain and keep someone from walking?

The number one factor is a sedentary lifestyle and the lack of regular activity. In this situation, core muscles are weak and walking can cause back pain. Obesity also plays a role in back pain and it’s no surprise regular physical activity can help to reduce obesity. Sleeping on awkward surfaces, such as a cot, floor or even a too-soft mattress, can cause back pain.

Some people experience “side stitches” when they walk. Is this a back problem or not?

Side stiches are not a back issue. While there are lots of theories on what causes them, no one is sure. They are not dangerous but they are annoying. When I’ve gotten them, I’ve used deep breathing techniques – after inhaling, breathing out through pursed lips to force the exhale – and this helps me. Stopping and stretching is also a tactic to use to work out this pain. Under any circumstances, this is not a sign of spinal problem.

How You Can Get Started

Just knowing the physical and psychological benefits of walking is not sufficient to motivate most people to “put on their walking shoes.” Texas Back Institute is involved in the specialized care of neck and back pain, spine trauma, scoliosis, artificial disc replacement and related spine surgery – not fitness counseling. However, we recognize physical fitness can have very positive effects on one’s back health.

With this in mind, here are a few fun suggestions to get you and your entire family involved in a daily walking program.

  • Bring along a walking buddy. This can be friends or family and if they’re excited about feeling better…all the better!
  • Walking has to be fun, otherwise it’s boring. Finding visually interesting places to walk such as trails in parks and greenbelts and then combining natural studies such as bird watching or tree/flower identification activities with your walking buddy.
  • Purchase an inexpensive pedometer, clip it to your waist and keep track of the miles you walk each day. Some of these steps will come from your daily activities. The average person’s stride length is approximately 2.5 feet long and this means it takes just over 2,000 steps to walk one mile, and 10,000 steps is close to 5 miles. Set a reasonable and attainable goal and then log your daily steps in a journal and try to add more steps each day.
  • Take the stairs whenever possible. Climbing stairs is a great aerobic exercise and when you take them, you’re not stuck in an elevator with 5 or 10 other people.
  • Get some tunes for your walk with your mobile device and ear buds. Music is a wonderful addition to any walking program because it not only distracts the walker from fatigue, but sports psychologists have noted that a steady beat can elevate a person’s performance by as much as 20%! In order to get you in the mood, why not download some tunes that have “Walking” in the title. Here are some:

Spring and summer is a great time for you to step up to a walking program. With this advice from Dr. Tolhurst you have some of the medical facts you need to get started. Now all you need is your walking buddy, pedometer and walking tunes and you’re good to go. Are you ready? Start walking.

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