Back Pain Caused by Arthritis [Credit: Robert Kneschke]/[Dreamstime.com]

Back Pain Caused by Arthritis
[Credit: Robert Kneschke]/[Dreamstime.com]

Many forms of arthritis that affect the joints, muscles and/or bones can cause problems like pain, stiffness and swelling in the back. While any part of the back can be affected, the lower back is the most common site of arthritis back pain.

To help you better understand back pain caused by arthritis, we sat down with Steven Levin, M.D., a Johns Hopkins Pain Management specialist on staff at HCGH, for a Q&A session.

Q: What is spinal arthritis?
Spinal arthritis is the breakdown of cartilage in the facet joints—the joints that connect the vertebrae together and enable the spine to move. As the joints deteriorate, the vertebrae impact each other, creating friction during movement. This can result in mild to severe pain and potentially lead to the development of other degenerative spine conditions including osteoarthritis—an abnormal bone formation in the joints.

Q: What causes spinal arthritis?
It is most commonly caused by the natural aging process, but other factors, such as lifestyle, obesity, gender, heredity and injury, can increase a person’s risk.

Q: How do I know if my back pain is from arthritis?
If you are experiencing recurring pain that does not subside with conservative treatment after two to three weeks, visit your family doctor for an evaluation. Sometimes arthritis can be seen on an X-ray and often is strongly inferred by palpating your spine during a physical exam. While any part of the back can be affected, the lower back is the most common site of arthritis back pain. Typically we see back pain caused by arthritis in patients over the age of 50.

Q: How can spinal arthritis be prevented?
While spinal arthritis is not always avoidable, it might be possible to delay its development by avoiding some of the controllable risk factors. Good posture and body mechanics as well as maintaining a healthy weight and diet, having strong core muscles, and being flexible are important to back health. Exercise is in many ways like medicine— you should do the right exercise in the right amounts at the right time.

Q: How is spinal arthritis treated?
Many patients find relief through conservative, nonsurgical treatment that lengthens the spine and removes pressure from the compressed nerve that is causing pain. Physical therapy can improve motion and teach you proper body mechanics which will lessen the strain on your spine. Other conservative treatments include heat, over-the-counter pain medication, exercises and stretching.

Q: What if spinal arthritis does not respond to conservative treatment?
When conservative treatment doesn’t work, many patients benefit from specialized interventional techniques such as facet nerve blocks which involves the injection of an anesthetic to the area surrounding a nerve to help identify the pain and possibly to treat it and, sometimes, minimally invasive procedures such as radiofrequency ablation – a specialized technique that decreases pain signals from a specific area of nerve tissue and can reduce the severity of pain that arthritis can cause.

Q: Is there a cure?
While there is no cure for arthritis, a comprehensive treatment plan can be very helpful at managing symptoms and maintaining function. Effective treatments are available to enable a healthy quality of life.

Steven Levin, M.D., is a pain management specialist with Johns Hopkins Pain Medicine Center at Howard County General Hospital. For an appointment, call 410-955-7246.

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Child Getting a Flu Shot

Child Getting a Flu Shot
[Credit: Monkey Business Images, Ltd.]/[iStock]/Thinkstock

The flu vaccine is the first and best way to prevent getting the flu, which causes approximately 250,000 illnesses and 36,000 deaths each year.

We contacted Maura J. Rossman, M.D., health officer at the Howard County Health Department, to provide you with the latest changes in vaccine options and tips for making your child comfortable when getting a flu shot.

Read what she shared with us.

The Nasal Spray and Shot 

Recent studies found from 2013 until 2016 the nasal spray showed “poor or relatively lower effectiveness” at only three percent, according to Centers for Disease Control and Prevention (CDC). Based on these findings, the CDC voted that the live attenuated influenza vaccine (LAIV) nasal spray should not be used during the 2016 – 2017 flu season.

Generally, vaccines containing a live virus cause a stronger immune response in our bodies. The nasal spray was thought to be comparable or better than the flu shot; it was not. To date, there is no explanation for its poor performance.

The flu shot performed well during last year’s flu season, at 65% effectiveness, indicating that millions were protected from the flu. “Based on manufacturer projections, health officials expect that the supply of the vaccine for the 2016 – 2017 season should be sufficient to meet any increase in demand,” according to a written statement from the CDC in June 2016. The flu shot is available in good supply and safe for most people ages six months and up.

Tips for Getting Your Child Vaccinated

Parents who are having a young child vaccinated should consider following the CDC’s tips for making the experience less traumatic:

• Distract and comfort the child by cuddling, singing or talking softly.
• Smile and make eye contact with the child. Let him/her know everything is OK.
• Comfort the child with a favorite toy or book. A blanket that smells familiar helps him/her feel more comfortable.
• Firmly hold the child when he/she is sitting on their lap, whenever possible.

For older children:

• Take deep breaths with the child to help “blow out” the pain.
• Point out interesting things in the room to help create distractions.
• Tell or read stories.
• Support the child if he/she cries. Never scold the child for not “being brave.”

Parents can help keep their child healthy this flu season by having them vaccinated, and getting themselves vaccinated as well.

Maura J. Rossman, M.D. is the health officer at Howard County Department of Health.

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After learning you’re pregnant you’ll likely find yourself feeling excited and joyful while at the same time feeling overwhelmed with learning how to have a healthy pregnancy and the changes that are occurring in your body.

Watch Francisco Rojas, M.D., gynecology and obstetrics physician at Howard County General Hospital, briefly describe what you can expect during pregnancy including doctor visits, ultrasounds and health screenings.

Changes to Your Body
During pregnancy, your body experiences many changes that help nourish and protect your baby. In the first trimester, you can expect the following changes and symptoms.

  • Breasts swell and become tender as the mammary glands enlarge, in preparation for breast feeding. A supportive bra should be worn.
  • Areolas enlarge and darken, and veins on the surface of your breasts become more noticeable.
  • As the uterus grows and it presses on the bladder, causing frequent urination, and rectum and intestines, causing constipation.
  • Mood swings, similar to premenstrual syndrome, are partly due to surges in hormones.
  • Morning sickness, nausea and vomiting, occurs from increased levels of hormones to sustain the pregnancy. Though, nausea and vomiting do not only happen in the morning and rarely interfere with proper nutrition.
  • Heartburn, indigestion, constipation and gas may be experienced as muscular contractions in the intestines, which help to move food through the digestive tract, are slowed due to high levels of progesterone.
  • Clothes may feel tighter around the breasts and waist, as the size of the stomach begins to increase to accommodate the growing fetus.
  • Extreme tiredness is likely to be felt because of the physical and emotional demands of pregnancy.
  • An increased pulse rate occurs because cardiac volume increases by about 40 to 50 percent from the beginning to the end of the pregnancy. The increase in blood volume is needed for extra blood flow to the uterus.

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Did you know teens read nonfiction too? And, no, we don’t just mean Wikipedia or sources for research papers. A lot of questions come up during adolescence, and sometimes when you’re a teen, you want to find a reliable answer without having to consult another person (or swim in the sea of too many conflicting answers known as the Internet). This little video highlights some of the Teen Nonfiction Collection at HCLS.


Joanne Sobieck-Lingg is glad to blog about her many, disparate interests (though expert in none, except maybe parenthetical asides). In past lives, she was a writer, proofreader, editor, project manager, teacher, and even co-coordinator of a certain health blog. She has been happily ensconced among the fiction and teen books at the Central Branch of HCLS since 2003.


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Eliminating Gluten, Nuts and Dairy Photo

Brad Calkins | Dreamstime.com |Eliminating Foods Diet

With school starting soon, you’re probably busy with back-to-school activities, like buying clothes and school supplies, but is preparing your child’s school for his/her food allergies on the to-do list?

With a little organization, preparation and education, you can help keep your child safe from experiencing a food allergy reaction at school. We’ve created this list of tips to get you started.

Make an appointment with the allergist.
Discuss and update your child’s food allergy emergency plan for school, making sure the plan includes a photo of your child and your and the doctor’s contact information. Also, ask for any prescriptions that may need to be filled for the school.

Order a medical alert bracelet.
Along with your child’s name and allergy types, consider including that epinephrine should be given for a severe reaction.

Gather your child’s medical supplies.
Make sure all of your child’s medications are packed and ready to go to school. If it’s possible, provide the school with medications that will not expire; otherwise, make a note of the expiration date(s) on a calendar, so you’ll be ready to replace them before the expiration date.

If your child won’t have an epinephrine auto-injector on him/her at all times, provide one to the school nurse, your child’s teacher and any other school staff who will spend time with your child. The epinephrine container should be labeled with your child’s name, photo and emergency contact information.

Develop emergency plans with the school.
Speak with the school’s staff and make emergency plans for different scenarios, like snack time, lunchtime, classroom parties and field trips. Remind school staff they should give epinephrine immediately, then call 911 in the event of a severe allergic reaction.

Attend the school meeting.
Ask questions related to your child’s food allergy, including:

  • Where is the food kept, and where will your child eat?
  • Are tables cleaned with disposable disinfecting wipes? Sponges can spread allergens.
  • Which staff oversees snack and lunchtime, and do they discourage food sharing?
  • Can teachers give you several days’ notice of food-related events, including birthday parties?
  • Is food used as a reward in the classroom, and if so, can alternative rewards be given?
  • Are kids urged to wash their hands, instead of using hand sanitizer, before and after eating? Hand sanitizer gels do not remove allergens.
  • Is training provided to teachers on how kids describe allergic reactions (e.g. kids may say their food tastes spicy, tongue feels hot, mouth feels itchy or funny, or lips feel tight)?

Write a letter to other parents.
Your letter should include the allergies your child has, what can cause a reaction and the serious effects of a reaction. Explain cross contamination and how preventative measures can keep your child safe.

For year-long tips, read “Going to School With Food Allergies” at Johns Hopkins All Children’s Hospital website.


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One of the first steps women, who are thinking of having a baby and want to make sure they have a healthy pregnancy, should take is to see a gynecology and obstetrics physician. The first visit to a gynecology and obstetrics physician doesn’t have to happen after becoming pregnant. Actually, it’s best to visit before becoming pregnant.

Proper health before becoming pregnant is almost as important as maintaining a healthy pregnancy. That’s where the pre-pregnancy exam can help.

Watch Francisco Rojas, M.D., gynecology and obstetrics physician at Howard County General Hospital, briefly describe the pre-pregnancy exam.

In addition to the pre-pregnancy exam, other steps can be taken to reduce the risk of complications and help prepare for a healthy pregnancy and delivery, including:

  • Ceasing smoking – Studies have shown that babies born to mothers who smoke tend to be born prematurely, be lower in birth weight and are more likely to die of sudden infant death syndrome (SIDS).
  • Eating healthy foods – A balanced diet before and during pregnancy is essential for nourishing the fetus.
  • Maintaining proper weight and exercise – Overweight women may experience medical problems, like high blood pressure and diabetes, and women who are underweight may have babies with low birth weight.
  • Taking folic acid and prenatal vitamins – Folic acid helps reduce the risk of brain and spinal cord birth defects. Prenatal vitamins, prescribed by your healthcare provider or a midwife, provides your body with the necessary nutrients that’s needed to nourish a healthy baby.
  • Avoiding harmful substances – Exposure to high levels of some types of radiation and some chemical and toxic substances may negatively affect the fetus.
  • Limiting exposure to possible infections – Pregnant women should avoid eating undercooked meat and raw eggs and coming into contact with cat litter and feces, which may contain the Toxoplasma gondii parasite that can cause a serious illness in or death of a fetus.

Look for the next post in our series, What to Expect Early in Your Pregnancy.

Francisco Rojas, M.D., practices obstetrics and gynecology at Johns Hopkins Community Physicians – Howard County and Odenton. For an appointment, call 443-367-4700.

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