How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Arun Phophalia Your Own Question

Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
5625079
Type Your Health Question Here...
Dr. Arun Phophalia is online now
A new question is answered every 9 seconds

Looking at finding an expert who has a competent knowledge

Customer Question

Looking at finding an expert who has a competent knowledge in costochrondritis and/or rib arthritis
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD :

Hello !

Anthony Bray MD :

Costochondritis may be recurrent of chronic in certain cases... Is this the case with you??

Anthony Bray MD :

It is an aggravating problem. It may beneift from treatment with anti-inflammatory meds but these may be limited in their use due to side effects.

Anthony Bray MD :

At your age I would think that Celebrex or Mobic may be decent options. Arthrotec aslo would be a good option that you might have considered for treatment.

Anthony Bray MD :

A mild pain reliever such as Ultram also may be helpful if you have this condition in a chronic state....

Anthony Bray MD :

I hope that this information helps!

Anthony Bray MD :

Let me kno if you have further questions and I will be happy to get back with you!

Anthony Bray MD :

If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. That would be much appreciated! Thank You and Best Regards,

Anthony Bray MD :

Anthony Bray MD

Customer:

I am looking not for a general MD but someone like a orth surgeon or sports medicine. Simply stating NSAIDS or narcotics - no.


My senior mother (86) incurred her first fall 15 years ago while walking on a wet deck. She fell on her left ribs and had 3 broken ribs. They healed and no chronic pain therafter. Three years ago, she fell on the left ribs again because of avoiding a sleeping dog in a dark house because of an ignorant sister.


Chest and rib xrays showed nothing then and even in the last couple of months.


She periodicaly has flare ups with a bit of pain. In the last couple of days, she had an acute flair up, when she stood up - strong pain when touching the ribs and when walking. A former physician diagnosed it as costochrondritis. She also has spinal arthritis which is the more chronic condition. She has had positive facet joint injections and is awaiting facet radioablation. Has elevated alt enzymes (120 value) because of taking tylenol. She no longer can take this


The value has dropped from 125 to 120 over a week between blood samples.


She took an advil with varying results.


It has been very humid the last week


I need a good thorough answer than just use an anti-inflammatory!

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello,
I am Dr. Arun and will be helping you today.

The comprehensive treatment of costochondritis and rib arthritis are following;

 

1) chest expansion exercises after application of sprayed vapocoolant.

2) deep electrotherapy; iontophoresis, phonophoresis, short wave diathermy, electrical stimulation, high voltage galvanic stimulation, biofeedback.

3) local analgesic patch / ointment / spray

4) anti-inflammatory analgesics may be considered; Ibuprofen (Motrin / Advil), Diclofenac.

6) ischemic compression therapy; pressure on the points

7) mild massage

8) steroid shots

9) acupuncture

10) autologous blood injection (own blood is injected in resistant cases).



Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

 

We have recently implemented a new rating and feedback system. Please be aware that you are rating my courtesy and service as a professional. If you have any questions whatsoever, or there is anything I can clarify for you, please temporarily bypass the rating system by clicking “Continue the Conversation” or "Reply."

Clicking either of the lowest two options reflects poorly on me so please reply to me if there is anything else I can do to help before choosing those options. I appreciate your patience while we work out the kinks. It's important to me that you are 100% satisfied with the service I have provided you. Thank you.
Customer: replied 1 year ago.


Dr Arun


U have assisted before but thanks again


QUESTIONS


 


1. Can any diagnostic (ultrasound etc) confirm this condition


2. Is humidity a significant factor or myth


3. Is a corset good or bad


4. What topical is the best


5. capsaicin - your thoughts on this topical


6. How can a cortisone shot be accurately placed, no puncture hazard


(ie. ribs, lungs etc) - is that the last resort


 


My mother has had good results from the facet lumbar injections and is awaiting rf ablation

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are very welcome.

Following are the answers of your questions;

1. Can any diagnostic (ultrasound etc) confirm this condition

 

Ultrasound can help in diagnosis as about 70% of cases may show soft tissue edema around the joint.


2. Is humidity a significant factor or myth

 

Humidity do play a role in aggravation as tissue inflammation may increase due to it.


3. Is a corset good or bad

 

Corset in day time only may be recommended in people who have severe and significant pain. This would not harm in these cases.


4. What topical is the best

 

Diclofenac (prescription product) is best.


5. capsaicin - your thoughts on this topical

 

This is used only in those case, which do not respond to the usual measures and pain is severe and excruciating and there is a significant night time pain.


6. How can a cortisone shot be accurately placed, no puncture hazard

 

Ultrasound guided injection can be used. Usually physicians are experienced enough to not go in the deeper tissue. Consistency of the tissue experienced during the needle placement also help in determining the depth. This is used when other measures are not giving adequate resolution.


It is privilege assisting you.
Customer: replied 1 year ago.

So a corset is not recommended for mild to moderate


She has acute pain when erecting and walking the first few strides.


Is mild swimming an irritant


 


capsaicin - you infer this is some strong topical for extreme cases


is that correct?

Expert:  Dr. Arun Phophalia replied 1 year ago.
Yes, capsaicin is used for severe cases. Mild swimming can help most of the times, but if one feels aggravation than may not be done. So an individual assessment has to be made for its use. Corset is not recommended for the mild to moderate cases.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.


What does that mean, she feels the primary pain along the lower left rib but feels pain radiate into upper left thigh.


She has taken 1 aleve today and feels a bit better


Do you favour advil over aleve or other way around


 


Also she had rib pain before facet lumbar injection shot the other day but it appears it got worse the rib pain, any connection?


Her back pain is gone completely


thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are welcome.

Rib pain and radiation to thigh can be due to pinched nerves in the back. Advil is suppose to be slight better in pain relief. The aggravation of the rib pain is not likely connected to the lumbar injection.
Customer: replied 1 year ago.


Dr Arun


Now I am the patient


I visit my senior mother weekly or biweekly 200 miles.


Its aXXXXX


At first I developed buttock pain.


I have stretched and the pain last week was very acute in the hamstring.


I tossed and turned in bed all night. I attempted to stretch enduring pain. Lie flat on bed, put my leg straight up to ceiling and with towel around calf - stretch it out.


I used three aleve over 1 1/2 days.


By that time, pain had mostly disappeared from hamstring - none in buttock either


 


However, for the last week - my foot feels half asleep and my calf muscle is weak. I cant lift off with my calf and limp. I have no pain


 


1. WHat is this


2. What can I do


 


thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.

This is most likely due to the pinched nerves in the back. This can be due to;

1) Herniated/degenerated disc in back

2) Lumbar spondylosis; bone spurs in the back vertebrae pressing on the nerves.

Following investigations would be required;

1) X-ray of the lower back

2) MRI of the spine

3) Nerve conduction velocity (NCV) study

4) Electromyography (EMG)

Following measures would be helpful;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze.

 

2) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

 

3) If obese or over weight, reduce weight for long term benefit.

 

4) You can start the following exercises;

a) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

b) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

http://www.mayoclinic.com/health/back-pain/LB00001_D

You can consult following specialists (apart from your GP);

a) Orthopedist

b) Neurologist

c) MD in Physical medicine and rehabilitation

 

Please feel free for your follow up questions.

Dr. Arun

Customer: replied 1 year ago.

I went to a physiotherapist today.
He did a battery of physical range tests - arching my back, bending legs, balance tests etc to see if he could trigger a pain or radiating pain. Other than muscle tension in certain lower muscles, he found nothing exceptional. He did heat, acupuncture, electostimulation and cold.


He stated he didn't think it was any form of sciatica.


Conjured that some very tight hamstring muscle compressing a nerve affecting the weak calf and numb foot. Also, aleve has a side effect as numb arms and limbs


I spent today on the inversion table, I am getting some of my function back but I don't wish to go through this sh.t again


Guess many others have it worse and I have learned very quickly when one loses control of a major muscle group, it isn't dandy

Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello,

A tight hamstring occasionally can be responsible for your symptoms and just stretching exercises and electrotherapy, which you had undergone are most of the time able to resolve the issue. A daily mild stretching program, brisk walking are usually sufficient to prevent the recurrence. I understand this is annoying and discomforting, but is not significant. Thus do not worry much about it.

Customer: replied 1 year ago.

Dr Arun


My mothers rib pain got gradually better.


It has been very humid and hot lately


When she woke up this morning she had a skin rash in the area of the rib pain.


What could this be?


SHe does have a fungus rash in her groin and she got a topical for this


Will be visiting the Local ER but could you provide any insight, thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello,

A fungal rash is a possibility here again.

But if the rash has burning or pain; Shingles would be considered.
Customer: replied 1 year ago.

I haven't seen the rash.
I live 200 miles away and just left last night.


She is in the ER now and the nurse stated they are doing an xray and bloodwork


I don't imagine its shingles as my mother stated its not painful or burning.


This whole area is with inexperienced doctors.


There is no connection with costochrondritis that cause can a skin flare up, is there?


 


I hope she isn't prescribed something unnecessary


Isnt shingles with skin scrapings and no real blood test exists either - correct?


 


thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.
Shingles is a clinical diagnosis, but occasionally it may occur without any symptoms.

The rash is not related to costochondritis.

Allergy is one of the possibility.
Customer: replied 1 year ago.

Dr Arun


Doctor stated she has a fungal infection.


Anyhow, the more pending issue relates to that she sometimes feels (as she did last night) she cant breathe.


 


She does have atrial fibrillation controlled by meds and currently wear a holter monitor. Nothing went off last night and she had no heart pain but had a bit difficulty breathing


This could be related to costochondritis - correct?


 


She never gets an ultrasound but countless chest/rib xrays. Today, the doctor stated her breathing problems might be related to asbestos....??


My mother has never had exposure to asbestos fibres in her life


 


So, answers that are provided are sometimes completely wacky

Expert:  Dr. Arun Phophalia replied 1 year ago.
Without an exposure to the asbestos; Asbestosis cannot occur. So that is ruled out/

Breathing problem can be due to costochondritis. Ideally pulmonary function tests, heart ultrasound (echocardiography) and EKG, if not done yesterday should be performed.
Customer: replied 1 year ago.


Dr Arun - WHY ARENT YOU ANSWERING THIS??

As a recap, my mother had a facet diagnostic shot back in April 2013 on the lumbar area. The shot consists of an anaesthetic and a bit of steroid combo called methylprednisolone acetate injectable suspension USP. She had a bit of relief which lasted a week or so.

She continued to do her stretches for her back and periodic weekly spinal traction sessions.

Then in June, the same procedure was done on the right lumbar facet joints - I think there were 4 injection points on the left side. She felt more pain durinh the injections but then felt much more pain relief for 3 weeks before the pain came back.

But now, her back pain seems worse than it was originally before the two treatments.

She can no longer take Tylenol as she has some elevated liver enzyme ALT. She takes 1 advil every other day.

Her radiofrequency ablation procedure for both left and right side is scheduled for latter August


Questions

1. She feels very apprehensive as the literature provided for the RF ablation states, the first 4 days after the procedure will be "rocky" because of pain of the nerves being burned. What does that mean?

How can the nerve that supposedly causing the pain which is burned be then causing more pain in that regard?

2. Is the vertebrae etc damaged by the insertion of the needles??

 

 

thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.
The complete nerve destruction by radio frequency ablation takes 3-4 days, so there is nerve cry for around 72 hours after the procedure. But almost 50% people may have instant relief and there is no rocky period.

There is no vertebral damage by the needles.
Customer: replied 1 year ago.

Dr Arun


I truly am hoping she gets some longer term relief from the radioablation procedure. She had significant pain relief for two weeks where she could even stand in the kitchen after the facet diagnostic test shot in the left lumbar. But now the pain seems almost worse than before that diagnostic injection


Is there any reason for this?

Expert:  Dr. Arun Phophalia replied 1 year ago.

The facet joint diagnostic injections are to assess if the radioablation would be effective or not. The effect of these may last for 1-3 weeks in different individuals and pain may come back with same intensity or occasionally more. The recurrence of pain or aggravation usually does not have any specific cause except more physical activity during the pain relief period.

 

It is a great privilege assisting you. Please provide a positive rating as this is the only way we are credited and paid for the time and expertize.

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.


Dr Arun
I authorized another payment, realize its not much.


My mother is getting scared about the RF ablation procedure even the left lumbar diagnostic shot gave her 80 pain reduction in her lower back for 2 weeks.


She heard today there are other procedures?? where they inject some solution/substance to strengthen/solidify the disks - what is that exactly and is it applicable for her? It took her two years to be on a waiting list for the RF ablation.


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
Thanks for the excellent rating.

The other procedures, apart from RF ablation are;

1) Continuous epidural infusion

 

2) Spinal cord stimulator

 

3) Baclofen pump; Intrathecal infusion (Intrathecal bupivacaine infusion or Morphine pump are the other alternatives).

 

4) Fusion of the vertebrae by surgery

 

The disc injections or solidification are experimental and are not applicable in her age group.

 

Customer: replied 1 year ago.


Do you think rf ablation has good merit when the diagnostic shot had good results?

Expert:  Dr. Arun Phophalia replied 1 year ago.
Ablation is only done, if diagnostic test has given adequate pain relief. So patient is the decision maker here. The ablation is likely to give amount of relief which was achieved by the shot. Ablation is done when the other measures had not given relief and pain is severe for significant duration.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.


Dr Arun


 


So the aspect of blood thinners comes up as my mother approaches her radiofrequency ablation in a weeks time now. My mother has atrial fibrillation. She takes 160mg aspirin daily and 1500mg omega 3 historically, in the last month up to 2000mg omega 3


She refuses a true anti-coagulant like coumadin etc but thats not the point of the discussion here.


She was already on the 2000mg omega 3 and 160mg aspirin when she had the 2nd facet diagnostic injection series which were 4 needles.


No excessive bleeding occurred and physician doing the procedure was not overly concerned about her being on aspirin or omega 3


She had been on the increased omega 3 for two weeks at that point.


 


Two weeks after that, she had blood drawn from her arm for routine bloodwork and she bled quite a bit when the needle was pulled out.


They had to apply blood pressure.


 


She gets the radioablation in a weeks time. The RF ablation doctors secretary made a generic statement that she should cease ALL blood thinners 5 days before the procedure


 


Questions


 


1. Is the RF ablation procedure creating a bigger puncture hole than the diagnostic shots prior?


2. Doctor didnt seem concerned about the omega and aspirn combination but should she cease that altogether too? She does


have atrial fib


3. Was it coincidence she bled more with the arm bloodwork but not when she had the diagnostic facet shots


 


thanks

Customer: replied 1 year ago.


Dr Arun


 


So the aspect of blood thinners comes up as my mother approaches her radiofrequency ablation in a weeks time now. My mother has atrial fibrillation. She takes 160mg aspirin daily and 1500mg omega 3 historically, in the last month up to 2000mg omega 3


She refuses a true anti-coagulant like coumadin etc but thats not the point of the discussion here.


She was already on the 2000mg omega 3 and 160mg aspirin when she had the 2nd facet diagnostic injection series which were 4 needles.


No excessive bleeding occurred and physician doing the procedure was not overly concerned about her being on aspirin or omega 3


She had been on the increased omega 3 for two weeks at that point.


 


Two weeks after that, she had blood drawn from her arm for routine bloodwork and she bled quite a bit when the needle was pulled out.


They had to apply pressure.


 


She gets the radioablation in a weeks time. The RF ablation doctors secretary made a generic statement that she should cease ALL blood thinners 5 days before the procedure


 


Questions


 


1. Is the RF ablation procedure creating a bigger puncture hole than the diagnostic shots prior?


2. Doctor didnt seem concerned about the omega and aspirn combination but should she cease that altogether too? She does


have atrial fib


3. Was it coincidence she bled more with the arm bloodwork but not when she had the diagnostic facet shots


 


thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello and welcome,

 

Here are the answers of your questions:

 


1. Is the RF ablation procedure creating a bigger puncture hole than the diagnostic shots prior?

 

Yes, it is slight bigger hole than the diagnostic shots.


2. Doctor didnt seem concerned about the omega and aspirin combination but should she cease that altogether too? She does


have atrial fib

 

Ideally these should be stopped before 5 days, as there is a definite chance of increased bleeding. Though this bleeding is controllable and once we know the history of taking these medicines, we are prepared for it. So stopping these medicines is the ideal way to proceed. These can be restarted 2-3 days after the procedure.


3. Was it coincidence she bled more with the arm bloodwork but not when she had the diagnostic facet shots.

 

The increased bleeding may or may not occur in every instance. It goes by the incidence. There is an increased chance once you are on these medicines, compared to the normal population who are not taking these medicines.

Customer: replied 1 year ago.

Dr Arun


Two months ago, my mother had a small stroke or BPPVertigo.


Thus, as it is, she isnt taking a true blood thinner - pradaxa or coumadin etc.


She is on this aspirin/omega 3 regiment. Doctors dont like to recognize natural supplements typically.


So would it be reasonable that for the 5 days leading into the RF ablation, she cuts the aspirn/omega 3 dosage into half and then 2 days before the procedure no aspirin or omega 3.


I cant get hold of the doctor and the secretary just provides generic statements not tailored to the patient.


If the person isnt bleeding after the procedure, cant you resume the full regiment immediately than 2 to 3 days later.


 


thankyou

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are most welcome.

Yes this can be done; cutting the doses to half and than stopping all before 48 hours. Almost 90% or more would not have any increase in bleeding. Though, doctors would not like to take chance and thus stop it 4-5 days before.

To be cautious; to prevent the secondary bleeding, which can happen in any surgical procedure (including the minor ones); the earliest it should be restarted is in 48 hours after the procedure.
Customer: replied 1 year ago.


Dr Arun


I was wondering this aspect as well.


I imagine you are in a modern surgical room


When my my mother had the first 2 diagnostic facet procedures


She would lie on her stomach. She would then have to prop her arm in a bent position under her head while laying there. After twenty minutes her arm and shoulder was stiff. Obviously you dont want to be squirming around.


 


The second time they gave her a doughnut pillow. Her head was comfortable but she would have to regularly move her head up to catch a breath of air.


 


Is it not optimum for both patient and doctor to have a proper table


The head portion of the table would have a hole insert. The patient could lieface down and be able to breathe comfortably through the bottom of the table


 


Kind of a prehistoric set up.........correct in what she has to contend with.


 


Even chiropractors and physiotherapy clinics have these doughnut tables

Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello,

 

There are some ORs which do have specialized tables where proper positioning for shots in back and radio frequency ablation can be done and patients' discomfort is minimized.

Customer: replied 1 year ago.

Dr Arun

Today was the day of my mothers first RF ablation on the right lumbar area.

She had a diagnostic shot in April (right side) and June (left side).

Even though the left side, she felt the pain relief was for a number days longer than the right side, the doctor stated its more critical the pain relief that resulted a few hours directly after. In the end, he summed it up she had pain relief on both sides as both sides of the facet joint was diseased

Anyhow, she told me later - she had strong pain while the doctor did the RF ablation on the right side and he even asked her while he was working on her where she could feel the pain

She left 45 minutes later and was a bit wobbly on her legs for a couple of hours. Initially she thought she had some back pain relief in the lumbar but stated she had a pressure feeling on the right side. The pressure feeling eventually subsided.

However after walking an hour after for about 20 minutes in a store, she had the typical back pain again

Questions

1. Is it normal to actually feel the pain in the back while the ablation is going on and the doctor is testing you?

2. Is it deemed a failure if she already feels back pain two hours after

the procedure?

3. The pain that incurs after the anaesthetic wears off - is that muscle pain where the instrument gets stuck through or the nerve being irritated

4. Based on what I have described - liklihood she might get some relief

Her left ablation is 1 1/2 weeks from now also - Would they treat the right side again or do the left side

5. When they did the diagnostic shots - she had 4 needle points

Today, she appeared to have only two entry points on her right back

6. Does she ice or apply heat packs

thanks for your insight.

The doctor who did the procedure just took off and didnt even return to answer questions, lunch was more important

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello and welcome,

Here are the answers of your questions;

1. Is it normal to actually feel the pain in the back while the ablation is going on and the doctor is testing you?

 

Yes this may occur. It is due to nerve being stimulated or due to muscle pain.

 

2. Is it deemed a failure if she already feels back pain two hours after

the procedure?

 

No it is not a failure. The actual relief is assessed after 1-2 weeks.

 

3. The pain that incurs after the anaesthetic wears off - is that muscle pain where the instrument gets stuck through or the nerve being irritated

 

Yes, that is likely to be the muscle pain due to instrumentation.

 

4. Based on what I have described - liklihood she might get some relief

Her left ablation is 1 1/2 weeks from now also - Would they treat the right side again or do the left side

 

They are likely to do opposite side. There is high likelihood of pain relief.

 

5. When they did the diagnostic shots - she had 4 needle points

Today, she appeared to have only two entry points on her right back.

 

It is difficult to answer as person performing the procedure is the best to explain it.

 

6. Does she ice or apply heat packs.

 

Ice compresses are best.

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.

Dr Arun


My mother woke up this morning and instead of having the regular back pain. She was pain free and her overall spirit was much better from the right ablation yesterday. She was able to walk around - straighter and perform regular housechores.


However, by days end - she had some historical back pain again.


Not as bad as usual but it re-surfaced


 


Questions


1. Is there a chance that the right facet nerves re-generate themselves


or werent knocked off as one hoped?


2. Or is it the left facet lumbar nerves that are triggering the pain?


3. Imagine in her case if the facet lumbar nerves are the culprit - the joint


is equally diseased - like 50/50 vs 90/10 where one side is the main problem. Unlikely its just one side


4. The anaesthetic used is depo-medrol, is there anything that can be done for next weeks ablation to make her feel more comfortable or she simply has to tolerate the discomfort she had yesterday


 


She stated though the 40 minute experience was painful, and she was wobbly on her legs - she would endure it if her chronic pain would be relieved. She was released from the clinic within 15 minutes of the bandage gauze put on her back. Thats called public health care!

Expert:  Dr. Arun Phophalia replied 1 year ago.

Hello and welcome,

 

1. Is there a chance that the right facet nerves re-generate themselves


or werent knocked off as one hoped?


The pain she experienced is more likely due to muscle fatigue or left facet nerves. The right facet nerves are unlikely to regenerate or the chance of incomplete ablation is quite unlikely.


2. Or is it the left facet lumbar nerves that are triggering the pain?


Chance of left facet nerves being the culprit is there as mentioned.


3. Imagine in her case if the facet lumbar nerves are the culprit - the joint


is equally diseased - like 50/50 vs 90/10 where one side is the main problem. Unlikely its just one side


Unless the other side is done, assessment of the pain relief is difficult to determine.


4. The anaesthetic used is depo-medrol, is there anything that can be done for next weeks ablation to make her feel more comfortable or she simply has to tolerate the discomfort she had yesterday


Unfortunately the procedure is painful and there is no way this can be eliminated.

Customer: replied 1 year ago.

Dr Arun


After a week after the RF ablation, my mother felt her overall back was better.


The next day, she went to see her family physician who has these hard poor shaped plastic chairs.
She sat there for two hours and it aggravated her back.


She does some basic stretching in bed every morning but feels she hasn't negatively affected


the outcome of the RF ablation sitting in the hard plastic chairs


 


Opinion?


 


Also she is hesitant to swim as she feels her back was always aggravate by that - whether that's muscle or the facet joint nerve?


Also she hasn't doesn't done any spinal traction or physio since the RF procedure

Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello and welcome,

Physio is recommended one to two weeks after ablation. The plastic chairs strains the muscles and responsible for the pain. She should initially start the physical therapy and after one month or so may try swimming once a week. These would help in long term and prevent recurrence.
Customer: replied 1 year ago.

Dr Arun


My mother put a lot of hope that the RF procedures would give her significant pain reduction. The diagnostic shots were quite good.


She simply hasn't experienced the same with the RF procedures. Its been 2 1/2 weeks.


During the end of the first week, she felt her overall back pain was better. She then sat over a 1 1/2 week ago on hard plastic chairs and then it aggravated everything again.


She does sit a lot during the day.


Can a competent physiotherapist truly guage if certain muscle bands are tight through touch and feel


 


thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are welcome.

I am sorry that pain relief is not complete. This means that there are other component of the spine which are responsible for the pain. The good physiotherapist would be able to gauge the tight muscle bands. Though a better would be consulting a MD in physical medicines and rehabilitation for ascertaining the cause of residual pain and discomfort.
Customer: replied 1 year ago.

Dr Arun

Its been 3 weeks now since the 2 RF procedures.

My mother experienced some pain relief after a week.

Then after sitting on some hard plastic chairs, her back was aggravated. Now whether its muscular strain or the ablation procedures simply didn't work.

 

My mother took a long hot shower yesterday and her back felt immediately better.

Her biggest problem to date is the aspect she cant stand longer than 15 minutes (cooking) and then needs to sit down to relieve the pain.

She was seen by the back clinic a couple of days ago. They think the RF procedures are of no true merit to her and wish to cancel the ones 6 months down the road even though the diagnostic facet joints showed some good relief.

 

They want to try an epi-dural steroid injection for the lumbar area

 

Your opinion on the epi-dural and throwing the RF procedures out the door, thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.
Let me at the outset say, that I am not an advocate of epidurals, which do not have any long term positive effects. There are though some short term relief periods. Since there is 6 months time for the next RF ablation, she may try the various physical modalities like mild physical therapy and deep electrotherapy with the warm compresses and massage. Acupuncture too, may many times be helpful. Wearing a back support during standing may help her. The two things point to muscle fatigue / muscle component being major factor for pain;

1) pain relief on hot shower.
2) pain on standing which gets better on sitting.

So conventional therapies can be tried and later on you may decide if RF ablation can be repeated or not.
Customer: replied 1 year ago.

Dr Arun


You seem to be a doctor with a bit of a "heart"


Thus, I respect your opinion. Why are you not an advocate of an epidural?


They want to cancel the RF ablation as the result didn't appear meaningful unless the muscle pain is overshadowing the facet joint pain relief

Expert:  Dr. Arun Phophalia replied 1 year ago.
Thanks for your kind words.

Epidural in my personal experience and in the medical literature has not shown any significant long term or permanent pain relief. Also in your mother's age group; this has more chance of complications. In her age, epidurals are usually not recommended.
Customer: replied 1 year ago.

I asked the doctor specifically today - is there a problem (age 87) having this


He stated other than bleeding - there aren't any


 


What are the other complications?

Expert:  Dr. Arun Phophalia replied 1 year ago.
Infection is another major complication which can sometimes travel to brain.
Customer: replied 1 year ago.


What is the true risk of that?


Also aren't there some that get long term relief lasting a few months or even more or is that a rarity?



I still don't understand why the diagnostic facet injections yielded good results wheras the RF ablation didn't.


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
True risk of bleeding and infection in her age group is 1 percent. Long term relief is rarity.

The explanation of RF not giving complete relief can be that nerve may have not been completely ablated.
Customer: replied 1 year ago.

Two more questions for the day


1. Its been three weeks now - is it true, it takes up to 6 weeks for the RF results to be seen or it would have already been noticed by now?


 


2. What is the probability that the nerves whether left or right were missed during the procedure or not ablated fully - 10 , 30 , 60 percent?


 


The doctor stated today, it was much less than 30 percent that the nerve was either not burnt fully or not even touched


 


thanks

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are welcome.

I agree with the doctor that there is a 20-30 percent chance that nerves may have not burnt fully.

The RF results can up to 6 weeks so yes waiting till that time for the exact assessment is necessary.

I would appreciate considering an excellent rating.

Thank you.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.

Final comment


I did provide another rating.


 


My mother is 86 and has a number of other minor health issues. She was hoping so greatly for some back relief. She already has some liver impairment attributed to the Tylenol which she took well below the daily allowed limit


The RF procedures (to date) haven't yielded the results like the diagnostic shots did


So you are not recommending the epidural


thanks and goodnight

Expert:  Dr. Arun Phophalia replied 1 year ago.
You are welcome.

I would not recommend the epidural.

Good night.
Customer: replied 1 year ago.

Dr Arun

I researched epidural steroid injection since yesterday

One govt source states

1. No long term relief

2. Only partially effective if one has radiating pain into the legs and not general back pain

 

So, the clinic doesn't want to do another RF procedure. Again she had two procedures spaced two weeks apart. One was the left lumbar facet and then the right lumbar facet. That was three weeks ago. They want to cancel the next two in 6 months as the first ones were not beneficial

 

Deeming we wait another three weeks and still nothing has been seen - is there a good argument to insist they try again and does one have to wait 6 months

 

I am still trying to figure out even in the hands of a skilled doctor - is it hit and miss getting the nerve

 

Hello Dr Arun - are you ignoring me.......lol

Expert:  Dr. Arun Phophalia replied 1 year ago.
The nerves can be missed and they might regenerate also, if a tiny twig of nerve is left out. The argument for repeat RF is she benefited with the test injections and rest of treatments had not improved her.
Customer: replied 1 year ago.

Dr Arun


You appear to be the "only" orth surgeon out here with working knowledge of rf ablations or epi-dural steroid injections


 


So your stance is try the RF ablation procedure down the road again and forget the epidural steroid injection.


She had again yesterday a 10 minute spinal traction session through her chiropractor. She gets some immediate relief which doesn't last more than a couple of days. The table probably pulls on tight back muscles to lengthen them.


Its probably a combination of worn facet joints and tight muscles. She was so happy in the week she had the diagnostic shot as she had minimum pain


goodnight

Expert:  Dr. Arun Phophalia replied 1 year ago.
Thanks for your kind words.

Backache most of the time is collectively due to many factors involving joints, muscles, nerves, ligaments. The traction improves the ligament various spinal joints and muscle components. Heat soothes all the components. Thus all measures like physical therapy, heat, deep electrotherapy (diathermy), acupuncture, acupressure, massage etc may be needed many times.

Good night
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 7 other Health Specialists are ready to help you
Customer: replied 1 year ago.

Dr Arun


You will be my only technical resource in the online world or real one.


So the clinic is not willing to perform any other ablation


on my mother. As to 4 weeks post op, she has had some minor back pain reduction but not to the degree she had in the first week after the diagnostic facet injections.


Their own literature states two reasons why the rf ablation might fail. One is that they might miss the nerves with the heated needle in the first place.


 


Or that the result wasn't as dramatic as the diagnostic injections as the bathing anesthetic numbed some other body part other than the facet nerve which is responsible for the pain in the first place. In that case, rf ablation wouldn't be getting to that area as the anaesthetic injection.


 


Imagine they are hinting towards the latter reason and not to the aspect the doctor might have missed the nerve or didn't hit all of hit, you coined "twig"


They will argue they did two ablations as well


- left and right


 


So how does one advocate.


They only wish to do the epidural steroid injection now


 

Expert:  Dr. Arun Phophalia replied 1 year ago.
Epidural in your mother's age group in my opinion is not the right choice even for the short term relief. I feel that if you talk with them citing the medical literature and refuse for the epidural; they would budge and agree to repeat the RF ablation. Do you think that there may be some financial reason, as epidural steroid shots are less expensive than the RF ablation
Customer: replied 1 year ago.


I spoke to the clinic today.


They stated that with TWO rf ablations spaced 2 weeks apart, she should have gotten some noticeable pain relief. If one of the 2 ablations failed alright but not both. So they don't believe the facet nerve is the culprit.


 


All they will offer now is the epidural steroid injection.


Have no other choice than to try it.


 


She gets pain relief if she takes a hot shower, infrared heat but it doesn't last.


For a senior who is 86 to live with this chronic back pain is unfair.


I don't if there are home apparatus which helps for a senior but anyhow, goodnight

Expert:  Dr. Arun Phophalia replied 1 year ago.
Yes this is very unfair. You may try epidural but my bet would be on following collectively;

1) local analgesic cream
2) very mild massage
3) deep electrotherapy
4) spinal traction
5) acupuncture
6) acupressure
7) physical therapy
8) back brace
Customer: replied 11 months ago.

Dr Arun


My mother went back into the pool last week after 6 month layoff. She swam 4 lanes and walked 2.


She didn't have any back pain during the swimming.


The chronic lower back pain seems worse in the morning and again after standing.


Her chiropractor stated don't swim and the physiotherapist said go ahead so your spinal joints don't get more stiff


I got her a wireless tens device that stays on her lumbar area for the day and she can activate with a remote. She feels it overall comfortable and has felt a bit of relief.


 


I also ordered the pillow below which supposedly puts the back into more of a relaxed position for sleeping if she sleeps on her back.


Someone stated they aren't good as the put extra strain on the heart to pump blood to the lower limbs


See picture at bottom. Another source states it helps circulation as well


Questions


 


1. How much of a tens treatment can one do daily?


2. What is your opinion on the effectiveness of pillows below - can they really help the back or marketing sh.t and cause more health problems


ie. heart strain


Expert:  Dr. Arun Phophalia replied 11 months ago.
TENS can be used for about half and hour every day.

These pillows are not bad and some people definitely are helped in their back pain. This do help in circulation too. Usually no harm employing them.
Customer: replied 11 months ago.

The tens device manufacturer states the unit can be used a number of times daily with half an hour rest between sessions.


Its a half an hour treatment at a time.


She has been doing it 3 to 4 times daily in the last couple of days


The unit stays insitu all day to the back


 


 

Expert:  Dr. Arun Phophalia replied 11 months ago.
TENS can be used for prolonged period of time too but more one uses it; less effective it becomes as one becomes tolerant to it. The usual recommendations if one want to use it for longer duration are 20 minutes twice or thrice a day but if one uses it for longer and feels good, no harm in it.
Customer: replied 10 months ago.

Dr Arun


My mother has attempted to use the Tens device a few times a day. The chiropractor attempted to convince her not to use it much. 2 hours in between each use. You are saying, it simply would lose its effectiveness. He is implying it would somehow would increase the pain in some manner.


---


The other lifestyle change which my mother did was use a regular pillow under her knees when she slept on her back.


Prior to the pillow, she would have bad back pain in the morning and stiffness. The first night she had a pillow under her knees, her back pain was significantly less in the morning. She was really happy.


That lasted three weeks. Now in the last couple of days, the morning back stiffness/pain has returned and she is truly unhappy. Don't know if the pillow had any true bearing but for a 87 year old, she is unhappy. She has slight elevated liver enzymes and doesn't want to take Tylenol either anymore


It causes me distress that she has to bear this backpain


with no solution in sight

Expert:  Dr. Arun Phophalia replied 10 months ago.
The pain is not increased by the TENS. But prolonged use would create tolerance and thus efficacy is lost.

I am sorry that her pain is not resolved. Try again the physical therapy, diathermy and ultrasound.
Customer: replied 9 months ago.

Dr Arun


On the positive, it appears the pillow compressed.


Getting a couple of firm pillows and ordered a specific wedge


to keep the knee flexed at night.


This appears to alleviate the back stiffness in the morning.


I took my mother to another physiotherapist. She recommended a few strengthening/stretches for her back and abdominals.


Over a decade ago, my mother (87) had a large abdominal hernia repaired with a mesh, it runs central near the navel.


She feels that after a few years, she had a bit of a protrusion develop again. She has been examined by a couple of doctors since then. A gastro doctor did it last a couple a months ago, patting the whole abdomen down and felt no real concern. They don't deem it to be significant.


My concern is that even though she has lost 30lbs and has kept it off, probably another 20lbs around the abdomen that needs to be lost.


The physiotherapist hinged on the fact, if she wants to be more active to reduce the back pain, she has to strengthen the core muscles.


But is there a significant chance to tear the mesh or cause another real hernia with certain abdominal exercises?


Which ones to do or not to do at all


 


thankyou again for your advice where none really exists in the real world

Expert:  Dr. Arun Phophalia replied 9 months ago.
You are welcome. Physical therapy is not going to tear the mesh. But since she has a small protrusion; an ultrasound should be done to rule out recurrence of the hernia. This recurrence is not due to tearing of mesh but due to new hernia formation which occurs because of abdominal muscle weakness. If the hernia is absent, almost all the exercises for abdominal muscles strengthening can be done.
Customer: replied 9 months ago.

The gastro doctor performed two abdominal ultrasounds in absence of her declining a colonoscopy. Nothing was ever heard back.


The physiotherapist tried to stress if the spine is weak, muscles must be strengthened to make up for that, otherwise there is no other recourse.


So you think she can proceed based on two ultrasounds


thanks

Expert:  Dr. Arun Phophalia replied 9 months ago.
Welcome.
Yes, she can go for the physical therapy. No problems.
Customer: replied 9 months ago.

Dr Arun



I don't understand though.


Isnt a protrusion, a hernia already.


The initial surgery with the mesh was 10 years ago,


the protrusion developed a few years ago and has stayed the same.


I just want to ensure she doesn't worsen it through physio


However you make it sound like the ultrasounds will give you key information about its significance


The doctors here don't care about a senior.......as they have lived their lifes.


thanks

Expert:  Dr. Arun Phophalia replied 9 months ago.
You are welcome.

A normal ultrasound rules out hernia.

A protrusion can be due to just accumulation of the fat.
Customer: replied 9 months ago.

Dr Arun


I wish you a safe/healthly 2014.


There are no competent physiotherapists where my mother resides.


She is 87 and now is making statements she loses hope to live with the chronic back pain.


She will be moving to my residence in the next year from a town of 5000 to a city of 500,000.


She got a special foam pillow which flexes her knees at night than a regular pillow that compresses. This has significantly reduced the back pain and stiffness in the morning.


But when she walks or stands for 15 minutes, she has to sit as the pain makes her almost lose her breath. She is overweight and the winter makes people more dormant.


She gets immediate relief from sitting and thus she sits alot.


Any further thoughts. thanks

Expert:  Dr. Arun Phophalia replied 9 months ago.
You are most welcome.

It is good that she is shifting to a bigger city and with you. It would definitely provide her a better medical care. Pain returning on standing and walking can be due to combination of causes like;

1) Weak back muscles; physical therapy would improve it. Meanwhile she may stand and walk with a back brace.
2) Increasing degenerative disc disease and age related arthritis of the spine.
3) Overweight

If the pain radiates to the hip, thigh or leg; she may need a colored doppler study of the lower limb to assess the arterial blood flow. An atherosclerosis may be responsible for the pain in lower limb while standing and walking which resolves on sitting (called intermittent claudication).

You may consider a positive rating.

Wishing you too a very happy, safe and prosperous year 2014.
Customer: replied 9 months ago.

She has no radiating pain.


You still recommend swimming.


She swam 7 weeks in a row once a week and felt okay



Then one week, she swam and with the same routine had back pain in the morning.......and thus stopped.


 


This is frustrating.


SInce she has had good relief with the knee foam pillow, I was hoping it is tight muscles but no one in the real world can assist


goodnight!

Expert:  Dr. Arun Phophalia replied 9 months ago.
Swimming can help, but she has to increase it very gradually. Tight muscles can be concomitant with the lumbar spondylosis (degenerative arthritis) and this is the reason, I mentioned that physical therapy would still be the mainstay of the management.

It is privilege assisting you.
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29729
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 7 other Health Specialists are ready to help you
Customer: replied 9 months ago.

Dr Arun


Other than my mothers back pain.


She has experienced a bit of wheeziness and feels she doesnt get enough air when she climbs the stairs or descends them.


She has no heart pain at the time, she can go on a bicycle for 6 minutes with no problems either or when she swims 6 lanes


SHe did fall 4 years ago on the side of her ribs on a bathtub avoiding a dog in an unlit bathroom.


She sees her cardiologist in a months time and the ER's are booked 4 hours when you go there.


When would it be imminent not to wait and go anyway.


She doesnt seem to have any obvious heart problems other than the breathing aspect. Could this be just costochrondritis - even its on the side ribs not the sternum?


 


thanks


 


 

Expert:  Dr. Arun Phophalia replied 9 months ago.
Her symptoms need an earlier evaluation to rule out following;

1) Anemia; would need anemia profile.

2) An echocardiography; this evaluates the pumping of the heart and a lack of pumping power is called as congestive heart failure. This does not cause heart pain / chest pain.

A GP / family physician can get these work up.

These symptoms are unlikely to be due costochondritis.
Customer: replied 9 months ago.

I understand your rationale with the echo which was done in 2010/2011


and blood profile last year was okay other than 1 elevated liver enzyme


ALT 120.


 


You had indicated earlier that costcochrondritis could perhaps cause a bit of shortness of breath but unlikely.


 


Other than an echo, there is no other diagnostic test to pinpoint early heart failure. A physician with a stethoscope can only decipher significant symptoms, correct?


 


Not early??


 


A person could simply be out of shape too - correct?


 


 

Expert:  Dr. Arun Phophalia replied 9 months ago.
Shortness of breath on climbing and descending the stairs will require investigations.

Costochondritis will not cause shortness of breath only on exertion. Anything exertional will need a look at heart and anemia. Anemia profile is;

1) Complete blood count (CBC)

2) Peripheral blood film

3) Vitamin B-12

4) Folate

5) Reticulocyte count

6) LDH

7) Thyroid-stimulating hormone

8) Serum creatinine and estimated glomerular filtration rate

9) Serum ferritin

10) Serum iron

11) Total iron-binding capacity

Customer: replied 8 months ago.

Dr Arun


I shall continue to authorize bonuses.


My mother sees a cardiologist on Monday.


-


My sister (54) who lives in the same household recently had an knee xray and the report came back as severe arthritis. She seemed to have walked okay in the months prior.


She doesnt see the ortho. surgeon til September 2014


She is taking Glucosamine Chrondritin MSM now


What is the best remedy to do in these circumstances - do you rest, or be active.


She feels she has liquid on the knee


thanks

Expert:  Dr. Arun Phophalia replied 8 months ago.
You are most welcome.

Activity pacing is done by the individual. Thus one should be active but the activity is tailored individually. Never go beyond where the pain is aggravated or increase. This is called as knee care in the activities of daily living;

1) Avoid prolonged walking or standing.
2) Do not squat or sit on floor.
3) Keep the leg on a stool or side chair when one is sitting.
4) Move the knee intermittently every 10-15 minutes even when you are sitting.

Following would also help;

1) Physical therapy; this is the mainstay of the management of the osteoarthritis. Stretching exercises, strengthening exercises, mild weight bearing exercises, swimming on the week-ends etc would be helpful.

2) Deep electrotherapy; this entails going to physical therapy center and take care of specific issues which are more painful.

 

3) Glucosamine and chondroitin supplements

4) Diacerin too can be tried which suppose to regenerate the cartilage.

5) Local analgesic sprays

 

6) Very mild massage

7) Consideration of hyaluronic acid injection in the joint. Some physician may inject steroid too for the pain relief.

8) Warm shower in morning would open up the joint.

9) Capsaicin (Zostrix, ArthriCare) is an irritant derived from chili peppers that provide relief by depleting a chemical that transmits pain from nerve endings. Various strengths are available without prescription. (It causes a burning sensation thus one has to be careful while applying and should wear a disposable plastic glove).

 

10) Acupuncture; most popular forms of alternative or complementary medicine, particularly for pain relief.

 

11) Analgesic patches too are available for the pain relief.

If overweight is an issue; long term is achieved by weight reduction. High impact exercises should be avoided; like kneeling and bending.

Customer: replied 8 months ago.


When someone feels they have water on the knee - is it common to remove the liquid through an operation or is this typically not done?


 

Expert:  Dr. Arun Phophalia replied 8 months ago.

No, the water removal is not needed and is not done. Physical therapy show be able to decrease the water filled feeling

Customer: replied 7 months ago.

Dr Arun

 

WHY ARE YOU not responding. I always add bonuses!

 

My mother had a lung catscan on Friday.

They found two small bloodclots and she is taking a stronger blood thinner now

xarelto.

 

She was receiving twice a week light massage, ultrasound and spinal traction

because of a car accident a couple of weeks ago where her car got rear ended for back pain.

 

She had bruising on her right leg and that's the same lung where she had the clots

 

She has cancelled her back treatments fearing it will cause more problems with existing clots

 

If you are on a strong blood thinner, can you take massage, traction etc?

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery