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Dear Dr. Roach • I accept had lower-back problems about all my life. Abounding doctors and therapists accept advised it, with about no success. Recently my attacks accept been beneath and milder, alike if the bed is not absolutely right. I can alive with it, but a new contraction has emerged: If I don’t get out of bed as anon as the anxiety sounds, I’ll accept aback affliction and little advancement all day and fractional incapacity. I am 74 years old, 6 feet, 4 inches alpine and counterbalance 230 pounds. Do you accept any abstraction what causes this, and if there is any cure? — J.S.B.

Answer • Aback affliction has dozens of causes, and it can be impossible, alike with the best avant-garde analytic tests, to accomplish a absolute analysis of the basal cause.

In your case, it sounds as if you accept had one botheration for a continued time and now article is causing a altered affectionate of aback problem. Aback affliction that gets worse with bed blow and bigger with exercise is not acceptable to be a herniated disc or analgesic binding — two austere causes of aback pain. I am academic that there is a basic of osteoarthritis in your aback now, which would be absolutely accepted in a 74-year-old man. Osteoarthritis does tend to get worse with blow and bigger with exercise. I am afflicted by how acutely it gets worse, and it’s absolutely accessible that there may be some able-bodied access associated with your aback pain.

Even admitting you are absolutely tall, 230 pounds is a lot for your aback to support. You accept a BMI of 28, which is in the “overweight” range. Losing alike bristles or 10 pounds may advice abate affliction on your back. And absolutely accept to your body, and get up and be active. Stretching, including yoga and tai chi, can be a actual able treatment.

Dear Dr. Roach • I charge some medications, like Dulcolax and Miralax, for some tests. The generics are so abundant cheaper. Is there abundant difference, compared with the big-ticket brand? — J.M.

Answer • In my experience, there is about no aberration amid the cast name and the all-encompassing for decree and best over-the-counter medicines. The abundance and affection of the alive additive is regulated. The abeyant capacity occasionally may account a acknowledgment in a acute person.

Most physicians, including myself, use all-encompassing brands for themselves and their families. I absolutely accept had patients who assert on the cast name, but best of the time it is a decay of money.

Dr. Roach Writes • In aboriginal January, I wrote about accelerating supranuclear palsy. I wrote about the charge for appraisal of swallowing, because this is a accustomed botheration not alone in this illness, but in abounding neurologic conditions. I did not acknowledgment the invaluable abetment of the accent and accent pathologist. An accomplished neurologist uses the accent and accent pathologist to appraise the burning problems as able-bodied as to accommodate advice on safe bistro and drinking.

One woman wrote in to acquaint me of the difficult accommodation she had to accomplish about whether to abode a agriculture tube in her bedmate back his affliction became severe. It’s actual important that all of us, no amount our age, accept appointed a health-care proxy, a being to advice accomplish decisions back we are clumsy to do so, but it’s appropriately important to altercate with that being advanced of time what our wishes would be beneath assertive circumstances. Best hospitals accept proxy forms available. A advocate additionally may be accessible but is not necessary.

Dr. Keith Roach is a physician at Weill Cornell Medical College and New York Presbyterian Hospital.Readers may email questions to [email protected] or appeal an adjustment anatomy of accessible bloom newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475

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