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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 32602
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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52 yr old healthy, active male, with dull aching in right

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Hi - 52 yr old healthy, active male, with dull aching in right side of low back. Pain is mostly while in bed. Labs are normal except for slightly low lympho-auto, ABS (.96) and Bilirubin (2.1) which has which has always been high. CT shows nothing of concern but noted constipation. I do not feel constipated and have regular daily bowel movements. In your opinion does anything else need to be explored before I assume this is just back pain?
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.
Hello,
I am Dr. Arun and will be helping you today.
I am sorry that your question was unanswered for long.
This should be explored further just for caution (I do not think, further work up is likely to find anything serious or significant)and you should get an abdominal MRI, colonic transit time, and colonoscopy before labeling it as a musculoskeletal backache.
There can be concomitant issues which can be Irritable Bowel Syndrome or lazy colon (which is the most likely diagnosis here)and backache due to age related spinal changes.
Following measures would be helpful for your backache;
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. Following more need to be done:
a) Avoid activities which increases the pain.
b) Rest intermittently
c) Avoid bending at 90 degrees
d) Pushing and pulling should be avoided till pain subsides
f) Avoid prolonged sitting and standing
g) Avoid sitting or sleeping on floor
2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants
3) Local analgesic gels or sprays / ointment
4) Hot fomentation
5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.
6) 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.
7) Lumbosacral corset or support or brace
8) If obese or over weight, reduce weight for long term benefit.
9) Epidural steroid shots
10) Surgery is usually last resort, when the above conservative measures fail. You can start the following exercises;
1) 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.
2) 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 eat lots of raw fruits and vegetables, especially dark green leafy vegetables and orange, yellow, purple and red colored fruits and vegetables. Tomatoes, Beetroots and broccolis are very good for liver and also offer protection against cancer.
Saturated fats like: full-cream dairy products, margarines, processed vegetable oils (hydrogenated fats), deep fried foods should be avoided.
Please consider oat, rice, almond or soy milks.
Please avoid artificial chemicals and toxins such as insecticides, pesticides, and artificial sweeteners and colorings, (especially aspartame), flavorings and preservatives. Excess alcohol should be avoided.
Please consume a wide range of proteins from grains, raw nuts, seeds, legumes, eggs, seafood, and free range chicken (without the skin), and lean fresh red meats.
If you want to be vegetarian, then be sure to take supplements like, vitamin B 12 (1000 mcg daily), iron ( 60 mg daily), taurine and carnitine (1000mg daily) to avoid poor metabolism and fatigue. To obtain first class protein, strict vegetarians need to combine 3 of the following 4 food classes at one meal – grains, nuts, seeds and legumes; otherwise valuable essential amino acids may be deficient.
It is privilege assisting you.
Please let me know if you have further queries or unanswered questions.
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Thank you.
Wishing you all the very best in life.
Expert:  Dr. Arun Phophalia replied 1 year ago.
It is privilege assisting you.
Please let me know if you have further queries or unanswered questions.
Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.
Thank you.
Wishing you all the very best in life.
Expert:  Dr. Arun Phophalia replied 1 year ago.
Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.
Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.
This additional service offer can be used for
- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.
Thank you.