Q: Do you have any tips that may stop further attacks of lower back pain?
A: Maintain good posture when standing, walking or running. Keep your backbone straight by pulling in your stomach and chin and holding your shoulders back.
Maintain good posture when sitting by supporting your spine and supporting muscles.
Lose weight to lessen the burden on the lower spine and supporting muscles.
Exercise to strengthen the muscles of your back and abdomen. Ask your physician for instructions for appropriate exercises.
Avoid stiffness produced by long periods of sitting (or standing) in the same position. Get up often when on plane flights or sitting at a desk for prolonged periods. Take frequent breaks when on long drives.
Sleep on a firm mattress or use a bed board. Sleep on your back or on your side with your legs pulled up slightly toward your chest.
Use your leg muscles when lifting any object. Bend your knees, and keep your back straight, then lift slowly without a jerking motion.
Warm up before exercising and avoid sports involving sudden stops, starts and twists.
Q: After my doctor retired, another doctor who examined me recommended an operation to have an abdominal aneurysm removed. Despite his explanations, it is hard for me to accept the idea of an operation when I feel perfectly fine. Is this right?
A: An aneurysm is an egg-shaped bulge in an artery caused by stretching of a segment of the vessel wall weakened by atherosclerosis (hardening of the arteries). The most common site for such aneurysms is in the abdominal portion of the aorta just below the kidneys. They occur most frequently in men over 60.
Abdominal aneurysms can cause back pain, but as in your case, they often produce no symptoms and are first discovered during a routine examination. The doctor probably felt a pulsating, balloon-like mass just above your belly button. Ultrasound examinations can confirm the presence of the aneurysm and determine its size.
Surgery is often recommended to repair this condition because the aneurysm can rupture, a potentially catastrophic event with rapid bleeding that is usually fatal. The larger the aneurysm, the greater the risk of rupture.
Because all abdominal aneurysms slowly increase in size, small ones can often be watched closely for awhile with periodic ultrasound examinations. Surgical replacement of the stretched piece of the aorta is indicated when the aneurysm is larger than 6 centimeters, enlarging too fast or causing pain or other symptoms. The risk of elective surgery of an aneurysm is rather small, whereas most people do not survive surgery undertaken after a rupture.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.