Medical opinion: Sometimes no treatment is the best treatment

Editor's note  Board-certified specialists from a panel of Yuma-area physicians provide to-the-point answers to questions submitted by Sun readers. The answers are only the opinions of the answering physicians and are not meant to be a substitute for medical consultation or physician care.
 
Submit questions by e-mail to medicalopinion @yahoo.com, or via regular mail at Yuma County Medical Society, P.O. Box 4476, Yuma 85366.

Q - We have a son about 33 years old who has lower back pain. For the last 10 years, it has become more frequent. It is very painful and difficult to walk normally. The doctor prescribed a painkiller (naproxin) and about an hour later, he feels better. He has had X-rays, CT scans, MRI, etc., but nothing was found or detected. Two or three years ago, a local physician ordered another CT scan. When the report came back, he also found nothing. Now the pain is affecting his normal life. What should he do to alleviate the pain? Would you suggest the best solution for him?
 
He also feels weak at times. Blood tests were run and there is talk about EBV, which there is no cure. This adds more worries on his health. Any response will be appreciated. - Worried Parents
 
A - There are many reasons for back pain, and not all are due to spinal disorders. This is why no treatment or advice is meaningful without a complete examination and review of the medical history.
 
It is quite common, however, to have nonspecific low back pain chronically for years. A lifetime of bending and lifting creates small, daily damage to the little joints in the back and to the discs. Over years this daily "micro-trauma" can create pain that we term "degenerative" - in other words, as a result of wear and tear.
 
Early in the process, all studies of bone are normal. The MRI, which shows soft tissue, may demonstrate darkening of the discs, the shock-absorbing cushions between the spinal bones. Later, X-rays usually show evidence of degenerative arthritis. Most people over the age of 50 have some X-ray-visible arthritis of the spine.
 
Lifestyle contributes significantly to the risk of developing progressive degenerative back pain. The leading causes are obesity, poor abdominal muscle tone, using the back improperly and cigarette smoking. One cigarette decreases the blood supply to the discs by 50 percent for 12 hours. Without good blood supply, the disc is much more susceptible to trauma. Our perception of pain also depends on our own psychology and life situation.
 
These are my rules for a healthy back:

-Decide to be happy. Pain is part of living, but how we deal with it is up to us. We can dwell on our misfortunes and spend our lives dying, or we can work at living well. Avoid stress. Simplify your life.

-Stay or become physically fit. Especially important is core strength - the strength in our trunk muscles. Stay thin.

-Don't smoke.

-Use good back mechanics. Your doctor can refer you to a "back school" or you can read books such as "Treat Your Own Back" by Robin McKenzie.

-Arrange your lifestyle to avoid bending. In my kitchen all the pots and pans are in the above-counter cupboards, my computer chair allows me to reach the keyboard sitting straight, etc.

-Avoid injury/re-injury. Don't lift that air conditioner by yourself! Don't get suckered into lifting more than you can easily. Be aware of the risk of extreme sports.


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Lee D. Hieb, M.D., is an orthopaedic surgeon of the spine, practicing in Yuma.

Q - Can you explain what is swimmer's ear and how to prevent it? I enjoy swimming and other water sports, but it seems like every time I go in the water, my ears get infected. - Julie
 
A - Swimmer's ear is a common term used to describe inflammation of the ear canal usually caused by bacterial infection. Even though it is usually seen after swimming activity, it can happen without any exposure to swimming or any water. It is very common in humid, tropical climate and has been referred in the past also as "jungle ear" by soldiers in the South Pacific.
 
The ear canal is the only cul-de-sac in the human body lined with skin and built to resist the accumulation of water and infection. It is 2.5cm long and 0.7cm wide. Its outer two-thirds is made up of cartilage and inner one-third is bony.
 
Isthmus is the junction, the narrowest part of the canal. It is "S" shaped and its outer portion is at lower and anterior level compared with its inner bony portion. This is what prevents the accumulation of water.
 
The outer canal has hairs, cerumen and sebaceous glands. The cerumen (wax) secretion and the acidic environment prevent the bacterial growth. There is also regular shedding of the outer layer of skin epithelium called keratin from the eardrum and canal, which naturally migrates outward. The ear canal is also rich in blood supply, which supports the growth of microorganism, most of which are harmless.
 
The canal is an efficient structure designed to keep itself clean and protect itself against infection. What makes these barriers break down and cause infection?
 
The most important barriers to infection are the acidic environment (pH of less than 7) and intact skin epithelial lining. If water gets trapped in the ear canal, the canal gets soggy and humid raising the pH and facilitating growth of pathogenic or harmful microorganism. Attempts to clean the ear with a finger or Q-tip can cause enough trauma to break the delicate skin of the ear canal enabling those microorganism to enter and cause the infection.
 
The earlier symptoms are itching and plugging sensations. These can progress to pain and increasing difficulty hearing and, if not treated, can advance and spread to adjacent structures, causing painful swelling of face, neck lymph nodes and also fever and discharge.
 
In the early stages, the infection can be managed by drying the ears and using over-the-counter eardrops containing 70 percent ethyl alcohol or simple homemade mixture of equal parts of vinegar and alcohol.
 
If this does not work, or in advance cases, person should seek medical help. It may require an ear specialist to clean the debris with suction and use antibiotic and topical steroid drops and sometimes even appropriate oral antibiotics, analgesics and other treatments.
 
Swimmer's ears can be prevented. There is no need to give up the fun of swimming or other water activity. Just follow two simple rules. Keep ears dry and avoid trauma to ears. The old adage of "not putting anything smaller than your elbow in ear" still holds true.
 
Earplugs made up of soft, waterproof material may be used to prevent water from getting into the ears while swimming. If the ear gets wet, dry it with a soft cloth and use a blow dryer at a low setting to dry the ear canal. Over-the-counter drops are also good for drying the ears.


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A. Sultan Lalani, M.D., is a board-certified ear, nose and throat specialist in private practice in Yuma. He is also the president of Yuma County Medical Society.