Sciatica Treatment Johns Hopkins

Common Causes of Back Pain

My name is Stephen Levin. I'm a Johns Hopkins Pain Medicine specialistpracticing at Howard County General . There are multiple different origins of backpain. They can range from the very minor to thevery severe. Muscle strains or sprains can cause spasmand the most common cause of back pain.fortunately, they can be very selflimited and go awayby themselves. Patients can suffer inflammation or arthritis,which can affect the joints in the back including the sacroiliac joints and the facet jointswhich can cause pain with movement.

There can also be pain that is referred fromthe hip. Patients can also experience degenerativedisc disease which can cause what we call axial back pain, which is pain in the middleof the back and in some cases those discs can herniate and create what we call sciaticaor radiculopathy and this is a result of pressure from the disc on the nerves in the back. Posture or scoliosis, which is a curvatureof the back, can lead to biomechanical back pain, which is pain caused by abnormal movement. Some individuals can experience infectionswhich can lead to back pain.

Some of those are very unusual infectionsthat include tuberculosis or lyme disease or can be a more common from bacterial infectionsand that can infect the bone or the epidural space. Patients or individuals as they age can experiencethinning of their bone or experience osteoporosis and that can be so severe that the bones fractureand cause back pain. And in some cases patients with kidney, breast,lung, thyroid and prostate cancers can have their disease spread to the back and thatcan also cause back pain. The diagnosis of low back pain starts witha careful medical history along with a complete

physical examination. If those examinations suggest concerns, thenblood tests, xrays, CT scans, and MRIs are sometimes needed in aiding the diagnosis. In some cases, we use diagnostic injectionsthat are xray guided to help facilitate the diagnosis. Most people experience back pain in theirlives. The peak incidence of back pain can occurat two different times in life. One time that it occurs most often is in themid30s when people's discs start to dry out

and they can be susceptible to injuries fromlifting which can cause disc herniation. Later in life the incidence will go up againand will be associated with degenerative processes associated with aging so patients will experiencemore arthritic problems in the back or the thinning of their bones or osteoporosis. In general, it's good to avoid lifting injuries,poor body mechanics, and it's also good to maintain a good body weight and have a balancedexercise program. Doing these things can lessen the likelihoodthat you'll experience back pain in your life. Determining the best treatment for back paincan involve the thoughtful application of

interventional techniques, medication management,as well as rehabilitative and wellness programs. Our program offers a full spectrum of themost sophisticated medication management, highly specialized interventional pain managementtechniques, as well as rehabilitative and wellness programs. The mainstay of conservative treatment forpatients with back pain is the use of physical therapy. It can be also very helpful for individualsto use short courses of nonsteroidal antiinflammatory medications, muscle relaxants, oral steroids,or even in some cases a short course of opioid

Umbilical Hernia Symptoms and Treatment

Hi. I'm James Harris. I'm a general surgeonpracticing at Johns Hopkins, Howard County General . An umbilical hernia is a defect through theumbilicus, or the belly button, and it's basically a protrusion of abdominalcontents either a fat or intestine into the area whereyour belly button is. Often people will notice a bulge at the areaof their umbilicus or belly button. They can have some pain and discomfort. At extremes, if it becomes large enough andenough intestine

gets stuck into this hernia, it can actuallycause. it can cause an obstruction. An umbilical hernia should be repaired ifit's causing symptoms Um, people are at risk of developing incarceration, which means the bowel could get stuck in thisdefect. And if that happens you could actually developan obstruction or it could even cause strangulation of thebowel, meaning it could cut off the blood supply

and it could cause emergency surgery. Most of the time these defects are small. They may just contain fat and they can periodicallycause pain and people will notice with heavy liftingand coughing, they'll notice that the pain could get worse and if it's causing symptoms it should be fixed. The surgery for umbilical hernia is oftenstraightforward. It entails a very small incision over thearea

of the belly button where the contents ofthe hernia are reduced back into the abdomenand if it's very small it can just be closed primarilywithout the use of any type of mesh. If it's a larger defect, to decrease the likelihoodof recurrence mesh is used to be able to reinforce the repair. The recovery after surgery is fairly mild. Most of these small umbilical hernias are just same day surgery.You come in as an outpatient and you're sent home the same day with pain medication.It's fairly well tolerated. People will usually

be off of pain medication within a week. After surgery, the patient can expect to beon pain medication for the first two or three days.Most people are able to wean off of pain medication because it's a very small incision and itdoesn't really lead to that much pain after surgery.There are restrictions as far as lifting. I don't wantpatients to do any significant lifting for about 6 full weeks.They can lift anything up to about the size of a milk jugimmediately after surgery, but anything heavier

than thatputs the repair at risk. Umbilical hernias can recur. People who areoverweight, who smoke, have lung disease, haveconnective tissue disorders or are on steroids, etc, pregnancy, all these things that increaseintraabdominal pressure can actually lead to a recurrence.Um, if the repair is used with, if mesh is used for the repair,the likelihood of recurrence is smaller, but when they are very small umbilical herniasmesh is usually not warranted and the likelihood of recurrence is fairly small.

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