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Suffering From Chronic Back Pain? Some Options… duration 6 minutes 1 second Suffering From Chronic Back Pain? Some Options… Suffering From Chronic Back Pain? Some Options Before Surgery	Suffering From Chronic Back Pain? Some Options Before Surgery If physical therapy or medications haven’t helped your chronic back pain, what do you try next? Dr. Tom Miller and Dr. Richard Kendall talk about one option—an epidural injection. They… u0358507 chronic pain u0035500 u0035500; surgery strive back pain spine surgery From Interactive Marketing & Web 276 plays 0 Date Recorded June 30, 2015 Health Topics (The Scope Radio) Family Health and Wellness Transcription Dr. Miller: You've tried physical therapy for back pain, and you're not ready for surgery. What other options are there? We're going to talk about that next on Scope Radio. Announcer: Access to our experts with in depth information about the biggest health issues facing you today. The specialists with Dr. Tom Miller is on the Scope. Dr. Miller: I'm here today with Dr. Richard Kendall. He's a professor of rehabilitative medicine, and he's also the Chair of the Department of Physical and Rehabilitative Medicine. Rich, tell us a little bit about what patients can do prior to surgery. I've heard about injections into the back for those patients who have sort of ongoing low back pain or pain in other parts of their back, but there are now injections that can be tried that might relieve their pain. Dr. Kendall: So that's true. For people who have not done well with physical therapy program or medications like anti-inflammatories or Tylenol or even opiate medications, epidural injections are a tool for us to use to decrease pain. That's just what they are, they can decrease pain, they don't heal or cure a tissue, but getting rid or decreasing the pain is one option hopefully to let somebody go on, and further function before surgery. Dr. Miller: So what exactly is an epidural injection? Where does that go on the back? Dr. Kendall: The epidural space is the space around your spinal cord, and it's in the middle of the safe protection of the bones of the spine. It's a nice protected space that's filled with fat that we can put in some steroids and some Novocain in that can really help reduce inflammation as well as reduce pain. Dr. Miller: Is this a difficult procedure or what does a patient expect when they come in to have this done? Dr. Kendall: Honestly most of our patients expect the worst, but when we come in, we finish the procedure, and they say, "Wow, that's it? Are you kidding me? That's easier than the dentist." So . . . Dr. Miller: That's pretty easy. If it's easier than the dentist, that's pretty easy. Dr. Kendall: The thought of somebody poking a needle in your back is somewhat anxiety provoking but we do them with a lot of Lidocaine, and numbing under X-Ray guidance so most people really experience very little symptoms. Dr. Miller: What are you injecting into that space that actually reduces the pain? Dr. Kendall: We put in two medicines. One is corticosteroid or cortisone, and that gets rid of the inflammation. It'll sit in the fat cells for about two weeks around your spine and get rid of inflammation. The second is just a Novocain or a Lidocaine which is an anesthetic, and it'll numb those nerves and areas for several hours. Dr. Miller: That lets you know that you're probably making a difference. I mean if the Novocain is working in the area where the back pain is emanating from, you'll know you're at the right place I guess, right? Dr. Kendall: Yes, many people will be pain free when they leave. Some people that's only for four, five hours. However the Lidocaine does sometimes essentially stung the nerve if you will, and people's pain does disappear for much longer afterwards depending on the diagnosis. Dr. Miller: How effective is this in reducing pain? Is it 80% effective, 50%, 30%? What's the story on that for patients that might be considering an epidural injection? Dr. Kendall: Well in certain conditions, it can be very effective with disc herniations and people with radiculopathy or pain down the leg from that disc herniation. If you take all patients who could be surgical candidates and you do the injection, 60% of them choose not to have surgery because their pain improves significantly with the injection, and they choose to just not have the surgery because they're doing better. Dr. Miller: So a great option to may be postpone or prevent surgery. Dr. Kendall: So a great option for more than half the people . . . Dr. Miller: That's great. Dr. Kendall: . . . to really decrease pain, get them on, and avoid a surgery that lays you up for a few weeks or more. Dr. Miller: Now can you have repeated injections if necessary or is there a limit on the number of injections one can have? Dr. Kendall: There's not an actual limit, however we usually say three or so a year would be the most we would consider. Some people, it does take one or two injections to really get rid of that leg pain that they have and avoid the surgery. However if we do two injections and your pain comes back within a week, then actually surgery is probably a much better choice. Dr. Miller: So you do these under imaging, and that helps direct the shot into the area that needs to be infused I guess. Dr. Kendall: We do these all under X-Ray guidance, so we know exactly where we're going, we know exactly where the needle tip is. We inject a little bit of contrast die to make sure we're not in a nerve or a blood vessel. So overall these are very, very safe injections. Dr. Miller: Now how would a patient find a physician that would be qualified to do these kinds of treatments? I don't think they necessarily need to go to a surgeon per se, do they? Dr. Kendall: No, in fact most surgeons don't do these epidural injections. Most are non-operative either anesthesiology or physical medicine rehabilitation physicians. Most people who are pain board certified have done significant amounts of injections, and finding a physician who specializes in back pain and pain will certainly have enough training to do these. Dr. Miller: Now last question is, if the injection is effective, how long could someone expect to have the effect last? Dr. Kendall: Most of the time, I tell people until they do something that irritates their back again, it's really not easy for us to say a time frame. It's mostly until you bend funny again or slip or shovel too much snow or do something again that may irritate that disc again. Dr. Miller: I'm assuming you'd also have them follow up with exercise therapy and physical therapy as another modality to continue to strengthen the back and prevent further injury. Dr. Kendall: Yes, we always have our patients continues with their exercise program throughout this even before and afterwards just because that's going to decrease the likelihood of you flaring it up again. Announcer: The ScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
The Holy Grail of Men's Health duration 4 minutes 48 seconds The Holy Grail of Men's Health The Holy Grail of Men's Health	The Holy Grail of Men's Health If you could only concentrate on just one thing to live a healthier life, what do you think that one thing would be? According to Dr. Tom Miller at the University of Utah Hospital, so many other… u0035500; men's health From Interactive Marketing & Web 62 plays 0 Date Recorded November 14, 2013 Health Topics (The Scope Radio) Mens Health Transcription Announcer: Interesting, informative, and all in the name of better health. This is The Scope: Health Sciences Radio. Scot: It's the month of November or, as some people know it, Movember. Have you heard of Movember, Dr. Miller? Dr. Miller: No, Scot. What is Movember? That's a new one to me. Scot: Movember is where men go clean-shaven on November 1st, and then they grow mustaches throughout the month, and it's to raise awareness for men's health issues. Why am I getting this look from you? Dr. Miller: Well, I think I was watching the Boston Red Sox, and all those guys have beards so maybe it's Sox month. I don't know. All I know is if I try to grow a mustache I get told to shave it by the weekend or so. Scot. Most guys do, and that's the whole point. It creates conversation. Dr. Miller: All right. Okay. Scot: Today I wanted to talk about . . . It's all about raising awareness of men's health issues. I want to talk to you about, as a physician, what do you think is the most important men's health issues are men should know about? This is stuff we don't talk about it so we're going to talk about it now. Dr. Miller: Yeah, on this show we've talked about high blood pressure and we've talked about cholesterol. But I guess if there was one thing for men to think about from a health perspective this month, I would say think about B.M.I. Scot: B.M.I., body mass index. Dr. Miller: Body mass index. What is body mass index? Body mass index is a good way to assess your proper weight given your height. You can go online and Google "B.M.I." and a number of websites will come up so you can quickly calculate your B.M.I. Now normal B.M.I. is between 18 and 25. And if you're in that range, in general, that is a healthy weight for you. So what's the problem with having a high B.M.I.? Scot: Yeah, what's the big deal? This seems kind of boring. Dr. Miller: Do you know there's an epidemic of obesity in this country? Scot: Oh. Dr. Miller: And so, when B.M.I.s are above 30, 35, 40, as they increase so do your health problems. Hypertension increases. Your risk of diabetes increases. It's really tough on your joints, your hips and your knees over long periods of time. So for many reasons, I think men, if they want to focus on one thing to stay healthy in the long run, track your B.M.I. If you're not between 18 and 25, find ways to get into that range, meaning usually a good weight loss program. But then the second thing would be to exercise consistently. Shoot for seven days a week. If you get five in, that's perfect. And then work out a half hour to forty-five minutes a day and even more, if you have time. Meaning you can walk, you can trot, you can swim. You don't have to be a marathoner. You don't have to do ultra sports to meet that definition, but you should do something active. Scot: I think a lot of people, men especially, think there's the two extremes, like there's the guys who are sitting on the couch, and then there's guys that think in order to be healthy and in shape you've got to do all this. Dr. Miller: That's the man thing. If I don't do it 100%, then it's not worth doing. Scot: But a walk is great. Dr. Miller: A walk is great. Scot: Go for a walk. Take your dog out. Dr. Miller: That's terrific. It's easy on the joints. If you have joint problems and it still counts, so I would say, I could say, well, you should check your blood pressure. We talked about that. You should know what your cholesterol count is. All true, but tell you what? You should keep your weight within the right realm between that B.M.I. of 18 to 25. You know, the one thing I tell people is or I ask them, "What did you weigh in high school? In general, what you weighed in the first or second year in high school is generally what your B.M.I. should be. Scot: Really? Dr. Miller: Yeah. Scot: Not plus a few extra pounds? Dr. Miller: Yeah, maybe a little bit. For some people it's on the outside, but in general. So I would say track the B.M.I. Scot: All right. Question about B.M.I: is it accurate in so far as what if somebody is really muscular and dense? Dr. Miller: That's a really good question. So that's true. If you're really muscular, if you're a muscular athlete and you're working out a lot, then . . . Scot: Then you kind of know anyway. Dr. Miller: You kind of know anyway. On the other side, it's for ethnic grace groups that have thin bones, or they tend to be a little smaller, it over estimates sometimes, so you have to make considerations for that. But in general, it's a pretty darn good measure, and it's a simple measure to do. Scot: Pretty decent and accurate. Dr. Miller: Given the fact that 30% of our country is now obese or 25 to 30%, you really should know your B.M.I. You should target yourself to a B.M.I. between 18 and 25. Scot: All right. There you go, Mo bros. That's what they call them. Dr. Miller: You can't count the weight of your mustache toward the B.M.I. So if you shave your mustache, it's not going to cut your B.M.I. very much. Scot: All right. There you go from Dr. Tom Miller from the University of Utah Hospital. The thing you should be most concerned about as a man: your B.M.I. because so many other health concerns revolve around it. Dr. Miller: Revolve around it. Scot: All right. Thank you very much. Appreciate it. Dr. Miller: Good enough, Scot. Thank you. Announcer: We're your daily dose of science, conversation and medicine. This is The Scope, the University of Utah Health Sciences Radio.

Suffering From Chronic Back Pain? Some Options…

duration 6 minutes 1 second

Suffering From Chronic Back Pain? Some Options…

Suffering From Chronic Back Pain? Some Options Before Surgery

If physical therapy or medications haven’t helped your chronic back pain, what do you try next? Dr. Tom Miller and Dr. Richard Kendall talk about one option—an epidural injection. They…

From Interactive Marketing & Web 276 plays 0

Date Recorded

June 30, 2015

Health Topics (The Scope Radio)

Family Health and Wellness

Transcription

Dr. Miller: You've tried physical therapy for back pain, and you're not ready for surgery. What other options are there? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in depth information about the biggest health issues facing you today. The specialists with Dr. Tom Miller is on the Scope.

Dr. Miller: I'm here today with Dr. Richard Kendall. He's a professor of rehabilitative medicine, and he's also the Chair of the Department of Physical and Rehabilitative Medicine. Rich, tell us a little bit about what patients can do prior to surgery. I've heard about injections into the back for those patients who have sort of ongoing low back pain or pain in other parts of their back, but there are now injections that can be tried that might relieve their pain.

Dr. Kendall: So that's true. For people who have not done well with physical therapy program or medications like anti-inflammatories or Tylenol or even opiate medications, epidural injections are a tool for us to use to decrease pain. That's just what they are, they can decrease pain, they don't heal or cure a tissue, but getting rid or decreasing the pain is one option hopefully to let somebody go on, and further function before surgery.

Dr. Miller: So what exactly is an epidural injection? Where does that go on the back?

Dr. Kendall: The epidural space is the space around your spinal cord, and it's in the middle of the safe protection of the bones of the spine. It's a nice protected space that's filled with fat that we can put in some steroids and some Novocain in that can really help reduce inflammation as well as reduce pain.

Dr. Miller: Is this a difficult procedure or what does a patient expect when they come in to have this done?

Dr. Kendall: Honestly most of our patients expect the worst, but when we come in, we finish the procedure, and they say, "Wow, that's it? Are you kidding me? That's easier than the dentist." So . . .

Dr. Miller: That's pretty easy. If it's easier than the dentist, that's pretty easy.

Dr. Kendall: The thought of somebody poking a needle in your back is somewhat anxiety provoking but we do them with a lot of Lidocaine, and numbing under X-Ray guidance so most people really experience very little symptoms.

Dr. Miller: What are you injecting into that space that actually reduces the pain?

Dr. Kendall: We put in two medicines. One is corticosteroid or cortisone, and that gets rid of the inflammation. It'll sit in the fat cells for about two weeks around your spine and get rid of inflammation. The second is just a Novocain or a Lidocaine which is an anesthetic, and it'll numb those nerves and areas for several hours.

Dr. Miller: That lets you know that you're probably making a difference. I mean if the Novocain is working in the area where the back pain is emanating from, you'll know you're at the right place I guess, right?

Dr. Kendall: Yes, many people will be pain free when they leave. Some people that's only for four, five hours. However the Lidocaine does sometimes essentially stung the nerve if you will, and people's pain does disappear for much longer afterwards depending on the diagnosis.

Dr. Miller: How effective is this in reducing pain? Is it 80% effective, 50%, 30%? What's the story on that for patients that might be considering an epidural injection?

Dr. Kendall: Well in certain conditions, it can be very effective with disc herniations and people with radiculopathy or pain down the leg from that disc herniation. If you take all patients who could be surgical candidates and you do the injection, 60% of them choose not to have surgery because their pain improves significantly with the injection, and they choose to just not have the surgery because they're doing better.

Dr. Miller: So a great option to may be postpone or prevent surgery.

Dr. Kendall: So a great option for more than half the people . . .

Dr. Miller: That's great.

Dr. Kendall: . . . to really decrease pain, get them on, and avoid a surgery that lays you up for a few weeks or more.

Dr. Miller: Now can you have repeated injections if necessary or is there a limit on the number of injections one can have?

Dr. Kendall: There's not an actual limit, however we usually say three or so a year would be the most we would consider. Some people, it does take one or two injections to really get rid of that leg pain that they have and avoid the surgery. However if we do two injections and your pain comes back within a week, then actually surgery is probably a much better choice.

Dr. Miller: So you do these under imaging, and that helps direct the shot into the area that needs to be infused I guess.

Dr. Kendall: We do these all under X-Ray guidance, so we know exactly where we're going, we know exactly where the needle tip is. We inject a little bit of contrast die to make sure we're not in a nerve or a blood vessel. So overall these are very, very safe injections.

Dr. Miller: Now how would a patient find a physician that would be qualified to do these kinds of treatments? I don't think they necessarily need to go to a surgeon per se, do they?

Dr. Kendall: No, in fact most surgeons don't do these epidural injections. Most are non-operative either anesthesiology or physical medicine rehabilitation physicians. Most people who are pain board certified have done significant amounts of injections, and finding a physician who specializes in back pain and pain will certainly have enough training to do these.

Dr. Miller: Now last question is, if the injection is effective, how long could someone expect to have the effect last?

Dr. Kendall: Most of the time, I tell people until they do something that irritates their back again, it's really not easy for us to say a time frame. It's mostly until you bend funny again or slip or shovel too much snow or do something again that may irritate that disc again.

Dr. Miller: I'm assuming you'd also have them follow up with exercise therapy and physical therapy as another modality to continue to strengthen the back and prevent further injury.

Dr. Kendall: Yes, we always have our patients continues with their exercise program throughout this even before and afterwards just because that's going to decrease the likelihood of you flaring it up again.

Announcer: The ScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.

The Holy Grail of Men's Health

duration 4 minutes 48 seconds

The Holy Grail of Men's Health

If you could only concentrate on just one thing to live a healthier life, what do you think that one thing would be? According to Dr. Tom Miller at the University of Utah Hospital, so many other…

u0035500;

men's health

From Interactive Marketing & Web 62 plays 0

Date Recorded

November 14, 2013

Health Topics (The Scope Radio)

Mens Health

Transcription

Announcer: Interesting, informative, and all in the name of better health. This is The Scope: Health Sciences Radio.

Scot: It's the month of November or, as some people know it, Movember. Have you heard of Movember, Dr. Miller?

Dr. Miller: No, Scot. What is Movember? That's a new one to me.

Scot: Movember is where men go clean-shaven on November 1st, and then they grow mustaches throughout the month, and it's to raise awareness for men's health issues. Why am I getting this look from you?

Dr. Miller: Well, I think I was watching the Boston Red Sox, and all those guys have beards so maybe it's Sox month. I don't know. All I know is if I try to grow a mustache I get told to shave it by the weekend or so.

Scot. Most guys do, and that's the whole point. It creates conversation.

Dr. Miller: All right. Okay.

Scot: Today I wanted to talk about . . . It's all about raising awareness of men's health issues. I want to talk to you about, as a physician, what do you think is the most important men's health issues are men should know about? This is stuff we don't talk about it so we're going to talk about it now.

Dr. Miller: Yeah, on this show we've talked about high blood pressure and we've talked about cholesterol. But I guess if there was one thing for men to think about from a health perspective this month, I would say think about B.M.I.

Scot: B.M.I., body mass index.

Dr. Miller: Body mass index. What is body mass index? Body mass index is a good way to assess your proper weight given your height. You can go online and Google "B.M.I." and a number of websites will come up so you can quickly calculate your B.M.I. Now normal B.M.I. is between 18 and 25. And if you're in that range, in general, that is a healthy weight for you. So what's the problem with having a high B.M.I.?

Scot: Yeah, what's the big deal? This seems kind of boring.

Dr. Miller: Do you know there's an epidemic of obesity in this country?

Scot: Oh.

Dr. Miller: And so, when B.M.I.s are above 30, 35, 40, as they increase so do your health problems. Hypertension increases. Your risk of diabetes increases. It's really tough on your joints, your hips and your knees over long periods of time. So for many reasons, I think men, if they want to focus on one thing to stay healthy in the long run, track your B.M.I. If you're not between 18 and 25, find ways to get into that range, meaning usually a good weight loss program.
But then the second thing would be to exercise consistently. Shoot for seven days a week. If you get five in, that's perfect. And then work out a half hour to forty-five minutes a day and even more, if you have time. Meaning you can walk, you can trot, you can swim. You don't have to be a marathoner. You don't have to do ultra sports to meet that definition, but you should do something active.

Scot: I think a lot of people, men especially, think there's the two extremes, like there's the guys who are sitting on the couch, and then there's guys that think in order to be healthy and in shape you've got to do all this.

Dr. Miller: That's the man thing. If I don't do it 100%, then it's not worth doing.

Scot: But a walk is great.

Dr. Miller: A walk is great.

Scot: Go for a walk. Take your dog out.

Dr. Miller: That's terrific. It's easy on the joints. If you have joint problems and it still counts, so I would say, I could say, well, you should check your blood pressure. We talked about that. You should know what your cholesterol count is. All true, but tell you what? You should keep your weight within the right realm between that B.M.I. of 18 to 25. You know, the one thing I tell people is or I ask them, "What did you weigh in high school? In general, what you weighed in the first or second year in high school is generally what your B.M.I. should be.

Scot: Really?

Dr. Miller: Yeah.

Scot: Not plus a few extra pounds?

Dr. Miller: Yeah, maybe a little bit. For some people it's on the outside, but in general. So I would say track the B.M.I.

Scot: All right. Question about B.M.I: is it accurate in so far as what if somebody is really muscular and dense?

Dr. Miller: That's a really good question. So that's true. If you're really muscular, if you're a muscular athlete and you're working out a lot, then . . .

Scot: Then you kind of know anyway.

Dr. Miller: You kind of know anyway. On the other side, it's for ethnic grace groups that have thin bones, or they tend to be a little smaller, it over estimates sometimes, so you have to make considerations for that. But in general, it's a pretty darn good measure, and it's a simple measure to do.

Scot: Pretty decent and accurate.

Dr. Miller: Given the fact that 30% of our country is now obese or 25 to 30%, you really should know your B.M.I. You should target yourself to a B.M.I. between 18 and 25.

Scot: All right. There you go, Mo bros. That's what they call them.

Dr. Miller: You can't count the weight of your mustache toward the B.M.I. So if you shave your mustache, it's not going to cut your B.M.I. very much.

Scot: All right. There you go from Dr. Tom Miller from the University of Utah Hospital. The thing you should be most concerned about as a man: your B.M.I. because so many other health concerns revolve around it.

Dr. Miller: Revolve around it.

Scot: All right. Thank you very much. Appreciate it.

Dr. Miller: Good enough, Scot. Thank you.

Announcer: We're your daily dose of science, conversation and medicine. This is The Scope, the University of Utah Health Sciences Radio.