One of the most common reasons why people visit a physician is because of back pain—usually for lower back problems, but also for neck pain. Statistics tell us that 90% of people will hurt their back or neck at some point in their life, usually while doing some common, every day activity. Surprisingly, most back and neck pain is not due to heavy lifting, but to simple bending or reaching for something. Usually there is no warning, just sudden pain and spasm in the back or neck. Why is this so common and what can we do to prevent back and neck injuries?

The fact is, our spines are not well designed for upright human activity, but would better serve a 4 legged creature! Thus, we are by nature more susceptible to back and neck injury. Add to this some lazy posture and extra weight and we have the “perfect storm” for back problems.

I emphasize three factors to prevent back pain:
1. POSTURE: Always try to keep your ears, shoulders and hips in line, even when bending or reaching for something. This really means more bending with your knees when standing and using some type of lumbar support when sitting, especially when sitting in a car or in front of a computer.

2. FLEXIBILITY: Stretching your neck, back, and leg muscles every day can help avoid pulls and strains. This is especially important after the age of 35 when we all gradually loose a lot of our normal tissue elasticity. Ask your doctor or a physical therapist for information on proper stretching to prevent injuries.

3. STRENGTHENING: Strengthening your back actually means strengthening your core muscles, especially your abdominal muscles; this can be done with simple “crunches” or by more formal training such as pilates or yoga. You do not need to life weights to make your back stronger!

When it comes to back pain (as with many other conditions), “An ounce of prevention is worth a pound of cure!”

Giving blood saves lives! We physicians struggle daily to save and improve lives, but honestly we often can’t make as much difference as a simple unit (about a pint) of blood. Donating blood is easy, without any risk of infection to the donor, costs nothing, and can make the real difference between life and death. We have no effective blood substitute and every pint is vital.

There are many blood types most commonly referred to by the A, B or O system with a second designation referring to being positive or negative. This second designation refers to “Rh” factor. Some blood types are less common than others, but that doesn’t affect the need for all types to donate. The fact that some blood types are more common only means that there are probably more people needing that type.

Blood is checked carefully for diseases before being given. In California, no payment is made for blood. This is thought to eliminate any motivation for providing blood other than “the goodness of your heart”. It also reduces the risk that someone would provide blood with any risk of disease.

The effects on the donor usually last only one or two days and unless the patient has high blood pressure or heart disease, these effects are minor. The time of donation is less than one hour and blood can be given about once per month. The long-term effects on donors have not been shown to be harmful. In fact, some reports have shown that donors live longer than those who do not give blood.

Please let us help you experience the sense of helping and making a difference by giving blood. The life you save could be your own or that of someone you love. Contact The Red Cross or your local hospital blood bank (Torrance Memorial Hospital Blood Bank 310-325-9110)

Acne is a very common skin condition in which the pores become blocked, causing pimples to develop. Acne is frustrating, embarrassing, and can be a source of significant emotional distress. If left untreated, it can lead to scarring and poor self-image. There are several effective treatments available to treat acne.

HOW DOES ACNE DEVELOP?
Acne is caused when hair follicles under your skin get clogged. Hair follicles become blocked with normal skin cells. The cells combine with an oily substance called sebum to create a plug in the hair follicle. Sebum is a naturally occurring oily substance produced by glands called sebaceous glands. We all have several sebaceous glands on our face, neck, back, chest and shoulders. If our sebaceous glands produce too much sebum, it allows for overgrowth of bacteria that normally lives on our skin. This can cause inflammation that ruptures the follicle and forms a pimple.

Sebaceous glands produce more sebum in response to hormones called androgens that increase in adolescence. Hormone changes related to pregnancy, or starting/stopping the birth control pill can cause acne. Acne can flare just prior to a woman’s menstrual period. Oils and greases in hair products or oil-based cosmetics can contribute to and worsen acne. Stress may worsen acne. There is no strong evidence that diet plays a role in causing acne. There may be an association with cow’s milk, due to the hormones found in milk.

TREATMENT FOR ACNE
If your acne is mild, you can use non-prescription topical products such as benzoyl peroxide, salicylic acid, sulfur, alpha hydroxy acids, and tea tree oil. Wash your face twice daily with a gentle facial cleanser and warm water. Do not scrub too vigorously or wash excessively because this can irritate your skin and worsen the acne. Use your hands to wash your face. This helps remove excess sebum and helps control the acne. If you have oily hair, shampooing daily decreases the amount of oil from your hair that reaches your skin. Choose oil-free skin products labeled “non-comedogenic” (does not cause blackheads or whiteheads) or “non-acnegenic” (does not cause pimples). If you have oily skin, choose a gel-based moisturizer. If you have dry skin, choose a cream or lotion. Choose a moisturizer with SPF 15 or higher. When using hair products, shield your face to prevent product from getting on your skin. Men who shave and who have acne should test both electric and safety razors to see which is more comfortable. Soften your beard with soap and water before applying shaving cream.

Consult your doctor if you have moderate or severe acne, or if the over the counter regimens are not helping. Depending on the type of acne you have, your family doctor may treat your acne with a topical medication, oral antibiotic, and/or a hormonal treatment. Dermatologists also use laser and light-based technologies to treat acne. If you have severe acne with nodules or cysts, then you may need to see a dermatologist to discuss Accutane.

Acne treatments prevent new pimples from forming. It takes 1- 2 months to effectively treat acne. Do not pick, pop, or squeeze pimples while waiting for treatment to work. This can worsen the acne and cause scarring. Be patient and work with your family doctor to find a treatment that works for you!

There are times we need to see how things are working and other times we need to know what things look like. See the different tests called “heart scans.” They are ranked by complexity and cost and separated into two categories (physiologic and anatomical)

A)Physiologic (how things are working) An EKG looks at the electricity going through your heart and sees what has happened, but rarely predicts the future. Scans often do.

1) Treadmills Pros: These see how the heart responds to stress. They show how long people can run compared to others, how fast the heart beats compared to other people at the same level of stress, they show if the heart beat becomes irregular under stress, and the doctor and computer look for signs of strain in the EKG (ST segments) under stress. This is probably the best bargain of all the tests. They predict really well who will and who won’t have a heart attack in the next year or two. They are done at SBFMG offices.
Cons: There must be about 80% blockage in the coronary arteries before these show a strain pattern and some people can’t walk fast or long enough to perform the test. As with all tests, there are no guarantees, only predictions with treadmills.

2) Echocardiograms (Echos or ultrasounds of the heart): Using dopler techniques the doctor can see blood flow through valves and the aorta.
Pros: Excellent to see how valves and muscles work and whether they are stressed by blood pressure, age, wear and tear or diseases. No x-ray, needles or dyes are used and they are done at SBFMG several days per week. They are usually covered by insurance as “diagnostic” to monitor a problem such as a murmur.
Cons: Moderately expensive and don’t’ see coronary arteries (too small) so little value in predicting heart attacks

3) Stress Echos: Pros: more sensitive (more likely to find blockage of arteries) in predicting heart attacks than regular treadmills, done at cardiologists’ offices rather than hospital, have no x-rays, dyes, or needles. Usually covered by insurance if you fail regular treadmill
Cons: Expensive, requires cardiologist, requires fast walking

4) Nuclear studies (like Cardiolyte tests): Pros: can be performed either with exercise or IV chemicals to make heart work as if you were running. They are more sensitive than plain treadmills in predicting heart attack risks. Insurance usually cover if you fail a regular treadmill. It lights up areas of heart if adequate blood supply exists through the coronary arteries instead of looking at the arteries themselves.
Cons: Usually done in a hospital, requires injection of trace amount of radioactive substance (less than most common x-rays), and very expensive

B)Anatomical (what thinks look like, not how they work)

1) CIMT (Carotid Intima-Medial Thickness). Pros: Using ultrasound the carotid arteries in the neck are measured for hardening compared to people in same age group. Done at SBFMG. Inexpensive at $295, but not covered by insurance as it is considered a “screening” test. It is different from inexpensive blood flow tests that take only a few minutes to check for stroke risk. It is the up and coming test used by universities to see if medications to prevent heart attacks are working. No pain, x-ray or needles.
Cons: Looks at neck not heart arteries and, therefore, doesn’t make sense that it predicts the relative risk of heart attacks (it does!) Gives percentile, not percentage of blockage (on a scale of 1 to 100, we know where you would stand relative to a problem, not what percentage each of your own arteries are blocked)

2) EBCT (now replaced by 64 slice CT scanner) Pros: Using x-rays the coronary arteries, which when blocked cause heart attacks, can be seen without dye or needles. It is inexpensive (about $395, but not usually covered by insurance) and “makes sense” because is looks directly at the heart’s arteries.
Cons: Only the calcium can be measured. It takes a few years of plaque being present before you can see the calcium deposits. The inside diameter, or amount of blockage, can’t be seen. As with CIMT a computer calculates what “percentile” (not percentage of blockage) the patient’s arteries are in and allows the doctor to determine if you are high, medium or low risk for a heart attack compared to others your age.

3) Echocardiogram (also described in physiology section) sees anatomy of muscles and valves, but not the coronary arteries

4) CT Coronary Angiogram: Pros: this adds intravenous dye (contrast) to the scan in #2 and allows us to find what percentage of blockage exists in the arteries. The arteries themselves are not punctured and it takes only an hour or two. Recent studies (i.e. Mayo Clinic) show it correlates really well with a conventional angiogram (#5)
Cons: It requires contrast (dye) to be placed in your veins and you could be allergic (rare). You must have a blood test first to be sure your kidneys are working well enough to get rid of the dye. It is rarely covered by insurance, costs at least $1,200 at current centers and has x-ray exposure.

5) Angiogram: Pros: this is the “gold standard” to see the anatomy of your coronaries and is needed to see if and where stents should be placed. It sees exactly how much blockage you have in your coronary arteries. It is almost always covered by insurance
Cons: requires all day in hospital, artery in groin is punctured (risks bleeding) through which a tube is maneuvered up to your heart to place the contrast right into the coronary openings. Allergic reactions, bleeding, x-ray exposure are all risks involved, but bleeding requiring transfusions is rare.