Question and Answer: Sakit sa Balakang

Recently I got a message from a reader posted in the comment section of my article Mamang Hilot, regarding a specific medical problem, asking for advice.

I have received several medical questions in this blog in the past, and most of the time, I just gave a short answer and recommended that they see their local doctor. I was also asked on how to make gayuma or how to counter a kulam, but of course I have no idea how to answer those.

Anyway, I decided to answer this reader in a post, regarding her medical question. Hopefully this would be helpful to her, and to some other readers with similar issues.

A reader, named Ellaine wrote:

Good day po.

Nagpahilot po ako dahil parang kumikirot ‘yung right side ng balakang ko. Pinadapa n’ya ako, dinaganan ‘yung balakang ko, saka hinila ang hita ko pataas at may tumunog. After ilang days, parang makirot s’ya at hindi nawala ang sakit.

May 3 linggo rin ang lumipas at saka ako nag-pacheck up sa doctor. Wala naman makita sa ihi ko na infection. Kaya niresetahan lang ako ng gamot for 1 month, baka daw kasi may na-damage na nerve o nabigla ‘yung muscle ko dahil sa hilot.

Natapos ko na po ‘yung medication ko, pero still masakit pa rin s’ya. And the worst, parang gumagapang ‘yung kirot papunta sa hita, binti, paa at likod ko, kaya natatakot po ako. Kahapon po bumalik uli ako sa doctor at binigyan naman ako ng x-ray request. Agad naman po ako nagpa-xray para malaman, ngunit wala rin po nakita sa x-ray.

Sabi ng doctor baka dapat na daw ako magpa-MRI, baka daw may naipit na ugat sa balakang ko. Sabi ko po wala naman akong kakayahang mgpatingin ng ganun kamahal, dahil nasa mahigit 10 thousand daw po ata iyun.

Pag-babalewalain ko daw po ‘yung nararamdaman ko, posible daw akong malumpo. Totoo po ba na talagang maari akong malumpo? Natatakot po kasi ako. Ano po kaya ‘yung nararamdaman ko at ano ang dapat kong gawin. Baka po may maitutulong kayo.

Maraming salamat po..

Dear Ellaine,

Sa aking pagkakaintindi sa iyong tanong, ang problema mo ay low back pain, na hindi natatangal kahit may isang buwan na ang nakalipas. Parang lumala pa ito kamo nang ikaw ay magpahilot. Paumanhin na lang po kay Mama o Aleng Hilot.

From the symptoms you’re describing here (pasensiya na po at nag-English na ‘ko), I believe you are suffering from lumbosacral radiculopathy. Don’t mean to sound high falutin, but this just means low back pain with possible nerve impingement (ipit na ugat) or nerve involvement, as you describe the pain as “gumagapang sa hita, binti, paa, at likod.” One specific condition is sciatica, which is impingement of the sciatic nerve.

sciatica-pain-pic-pranic-healing-jpgw652

The nerve roots from the spinal cord as it comes out of the vertebra (gulugod), can be impinged by a muscle, or when there’s vertebral disc herniation, vertebral stenosis (narrowing), abscess or infection, or in rare cases, tumors. The nerves can also damaged by being stretched when certain physical injury or manipulation is done.

For all people with acute back pain though, the overall prognosis is quite good, as 70 to 90% of the time the pain will improve in 8 weeks or so. Very few will require invasive or surgical intervention.

Even though traditional thinking would say to stay in bed, the medical literature does not agree with this. Studies have showed that people who continue to be active, do better in dealing with their back pain and also have more shortened recovery time than those who did “bed rest.” Sorry, not an excuse to skip work. Though use common judgement when your work involves heavy lifting, like carrying sacks of rice or moving pianos.

Physical therapy when properly employed and specific exercises to strengthen the back and abdominal muscles can certainly help.

Medications like non-steroidal anti-inflammatory (NSAID), which I believe is what was prescribed to you is one of the mainstay of treatment. Sometimes it is combined with muscle relaxants. In severe cases of pain, narcotic analgesics can be used, but these are controlled drugs as they can be habit-forming or addicting. (Galit si Duterte sa mga adik!)

Non-medical intervention like cold or heat therapy to the area can be applied but mostly used during the acute phase of the back pain or injury. Massage, acupressure, and acupuncture (using long needles) have been employed but data on their effectivity is variable. Please don’t just stab multiple needles in your back.

Other procedures available are steroids injection to the spine and of course surgical intervention.

If you’re condition does not improve with conservative management (exercises, physical therapy and medication), then further work-up may be needed. Unfortunately, the imaging study to best visualize the structures in the back are MRI and CT scan of the vertebrae, which I agree are expensive tests. A plain x-ray will not be very helpful.

About the concern “na maari kang malumpo?” The pain na “gumagapang” does not necessarily means it is really bad. As I said most people with back pain recovers in time. However if you’re already experiencing focal weakness in your legs, like having difficulty climbing stairs or tiptoeing, then it can be serious. Kung hindi lang ‘yung sakit, at ikaw na ang gumagapang, eh seryoso na iyon.

So in the end, I would still recommend that you see your local doctor. An Orthopedic Surgeon or Physical Medicine and Rehabilitation specialist (also known as physiatrist) may be the best doctor to see regarding this problem. I’m hoping that you’ll just need physical therapy and a sprinkle of time to fully recover.

Hope this help Ellaine, and God bless.

Sige, padala mo na lang iyong bayad mo sa akin: tatlong Choc-Nut, ok na.

Pinoytransplant

 

(*sa mga susunod na kokonsulta, mas mahal na po ang bayad:  5 Choc-Nut na.)

**********

Post Script: Sa lahat po ng may katanungan pa, pakibasa na lang po ang aking article: “Sakit sa Balakang: Final Answer”

 

 

The Art of Rubbing

Massage therapy is over-rated. At least in my opinion. But before all the spas, massage parlors and masseurs detest me, I have to put a disclaimer that this opinion is not based on scientific nor medical facts but purely on my personal experience.

I grew up in Manila, where a massage parlor has a connotation of something else. Something shady. Where there is more hanky-panky “extra-service” occurring than a real massage. Maybe it has changed now. But that somehow influenced my view of them. I just don’t go to them.

During our recent trip to Colorado, our group went to Sulphur Hot Springs Resort and Spa. One of our friend paid for all our entrance to the resort as a treat. There we spent half a day soaking in the mineral-rich natural hot spring. (see previous post)

They also have massage services available in that resort. Due to the prompting from my friends and from my wife, encouraging me to have a massage to complete the spa experience, I obliged.

Before the masseuse started working on me, she asked me when was the last time I had the massage. To this I answered: “never.” She was kind of surprise in my answer, but am I the only one who never had a massage therapy?

Well, that’s not true, I had massage therapy before. There was Mamang Hilot who treated me when I was a kid for my “pilay” (see previous post). Then when I was older, Mang Tony, the barber in Sta. Mesa will give me back and shoulder rub, after slapping a whiff of alcohol in my neck and face at the end of my haircut. Do they count?

Back to the massage, when the masseuse was giving me the therapy, I was so uptight that my muscles were so tensed. I was as relax as I was when having my teeth cleaned at the dental chair. The masseuse even told me at least twice, “Relax and let go.” But how can I, when I feel it was somewhat painful to have my muscles squeezed and mashed? Must have been a deep-tissue massage, eh?

relaxing massage?*

The scientific evidence on massage therapy is quite limited. Though this therapy dates back thousands of years with references appearing in writings from ancient China, Japan, India, Arabic nations, Egypt, Greece and Rome. Hippocrates defined medicine as “the art of rubbing.” Would he define bad medicine as “rubbing the wrong way?”

Massage became widely used in Europe during the Renaissance. In 1850’s, two American physicians who had studied in Sweden introduced massage therapy in the US, where it became popular and was promoted for a variety of health purposes. (Now, I know where the Swedish massage originate.) However, with scientific and technological advances in medical treatment during the 1930’s and 1940’s, massage fell out of favor. Interest in massage revived in the 1970’s, especially among athletes**. Today, with proliferation of massage parlors and spas, massage has been mostly used to relieve stress and promote relaxation.

After 30 minutes in the massage table, that seemed forever for me, my “agony” was finally over. I was more relieved that it ended. The masseuse then asked me when will I have my next massage. Honestly? Never again! But that’s not what I said. “I’ll think about it,” was my less emphatic and genteel reply.

Don’t get me wrong, it was not the fault of the masseuse, who I know was a competent massage therapist, and who I later learned was also a licensed physical therapist. Nor was there anything wrong with the parlor, for it was indeed a world-class resort and spa. It was just me. I am not used to this kind of pampering, and I have a different view of unwinding.

I left the massage room more bent, not straight, than when I entered it. I then went back and soaked in the hot spring pool with temperature of 105 – 107 F. I felt the almost scalding hot water more relaxing, than the squishing and kneading of my neck and back.

That evening, my muscles were all sore, as if I just played basketball with Jaworksi, with shoving, elbowing and all. That could have been more fun and relaxing.

*****

*(image from here)

**source: National Center for Complementary and Alternative Medicine (National Institute of Health)

Mamang Hilot

Kasama sa hibla ng kultura at tradisyon nating mga Pilipino ay ang pagpapatingin sa mga manghihilot at albularyo. Sa katunayan, lalo na sa mga probinsiya at maliliit na barrio, ay maaaring mas marami pang mga tao ang natutulungan ng mga ito kaysa sa isang duktor.

Noong isang araw habang ako’y nakikinig sa live stream ng AFP (Armed Forces of the Philippines) radio mula sa Pilipinas, ay tinalakay ang tungkol sa mga alternatibong manggagamot sa Pilipinas. Kanilang ipinamamalita ang tungkol sa alyansa ng mga hilot at albularyo ng Pilipinas. Sangayon sa alyansa, sila ay nagbibigay ng pagtuturo at pagsasanay, para maging isang mahusay na hilot o albularyo. Lalong dadami ang kumpetisyon ni Mang Kepweng.

Naalala ko tuloy ang matandang hilot sa aming lugar, noong ako’y bata pa.

mga kamay ng hilot

Hindi ko alam ang kanyang tunay na pangalan, ngunit tinatawag lang namin siyang Mamang Hilot. Hindi ko rin alam kung paano namin siya natuklasan, pero kilala siya ng marami sa aming lugar, kaya maaring sa pamamagitan ng salin sabi o mga rekomendasyon ng aming mga kapitbahay.

Siya ay may katandaan na, at maaring siya ay nasa sesenta anyos na. Malamang siya ay walang pormal na pagsasanay, kundi sa pamamagitan lamang ng mahabang eksperyensiya. Maari rin naman na siya ay sinanay at tinuruan ng kanyang mga magulang o mga ninuno. Kadalasan kasi, ang kaalaman ng panghihilot ay ipinamamana ng mga nakatatanda sa kanilang mga anak.

Maraming beses din naming tinatawag si Mamang Hilot noon sa aming tahanan. Tulad ng matapilok ang aking kapatid at namaga ang kanyang bukong-bukong. Natatawag din siya sa mga simpleng kirot o pilay. May ilang beses ding nahagod ng hilot ang aking likod, dahil madalas akong napipilay sabi ng aking nanay, dahil sa aking kalikutan. Minsan pa nga pati sa mga linalagnat, sinisipon o inuubo ay natatawag din ang matandang hilot. Hindi ko lang alam kung tumutugon din siya sa pagpapa-anak.

Ang hilot ay gumagamit ng “chiropractic” na manipulasyon at husay sa pagmamasahe. Tunay na may siyensiya naman na sumusuporta sa sining ng panghihilot. Ang kanyang mapagpagaling na kamay ay nakakapawi ng sakit ng katawan, pangangalay, pilay, naipit na ugat, at nagbibigay ginhawa sa kumikirot at pagod na kalamnan. At ang instrumento lang niyang gamit ay langis ng niyog, at ang malalakas niyang kamay.

Hindi mayaman si Mamang Hilot. Kahit pa mayroon siyang angking galing sa pag-gagamot, at kahit marami siyang napagsisilbihan, ay hindi niya ginamit iyon sa pagpapayaman. Marahil maliit lamang sumingil ang matandang hilot. O marahil, kadalasan pa ay libre ang kanyang serbisyo. Hindi ko lang alam kung tumatangap siya ng itlog o sisiw bilang bayad. Ngunit dahil kami ay naninirahan sa siyudad, malamang walang ring mga alagang manok ang aming mga kapitbahay, maliban sa mga ilan-ilan na tandang na pang-sabong.

Kapag kailangan namin ang matandang hilot, ay susunduin ko siya sa kanilang bahay. Siya ay nakatira sa tabi-tabing maliliit na bahay-bahay na nakatungtong sa sapa na nasa dulo ng lupang kalsada. Ang mga bahay doon ay nakalutang sa ibabaw ng tubig sa pamamagitan ng mga tungkod na poste (stilts). Tumutulay ako sa mga pinagdugtong-dugtong na tablang kahoy, na ang ilalim ay itim na tubig at mga kangkungan, para makarating sa kanilang bahay.

Dito rin sa mga tulay-tulay na ito, kung saan, masaklap mang aminin, ay minsan akong nahulog. Naghahabulan yata kami ng aking kaklase nuong Kinder, nang ako ay mawalan ng panimbang. Buti na lang at hindi ako tuluyang tumambog sa tubig, ngunit napuno ng putik at burak ang aking isang kamay hanggang balikat. Hindi hilot ang kinailangan ko, kundi paligo, at pingot ng aking nanay. Mabuti naman at hindi ako nabansagang Nardong Putik ng aking mga kaklase.

Isang araw, ako ay naglalaro sa silong ng aming bahay. Lumukso ako na ala-Spiderman. Ngunit napasama ang aking bagsak. Sa aking paglagpak ay naitinukod ko ang aking braso. Ako ay napilay! Mabilis na pinatawag si Mamang Hilot, at dali-dali naman siyang dumating. Ngunit nang makita niyang hindi na diretso at komang na ang aking braso, ay hindi niya ito ginalaw. Sabi niya ang kailangan ko’y Orthopedic at hindi hilot. Alam din ng matanda ang kanyang limitasyon.

Dinala ako sa Orthopedic Hospital ng Maynila. Doon itinuwid, isinauli ang na-dislocate kong siko, at sinemento ang aking braso. Anim na linggo ring nakasimento at nakasukbit sa aking leeg ang aking kanang braso. Natuto tuloy akong magsulat sa kaliwang kamay. Tinawag akong “Komang”der na aking mga kaibigan. Magpipitong gulang ako noon.

Iyon na ang huling alaala ko kay Mamang Hilot. Dahil hindi nag-tagal, sa isang proyekto ng lungsod ng Maynila, ay pinatabunan ang sapa. Sinementado, pinalawak, at ginawang lagus-lagusan ang kalye kung saan nakatira ang matandang hilot. Ipinagiba din ang mga dikit-dikit na bahay na nasa ibabaw ng sapa. At lahat ng mga naninirahan doon ay ipina-relocate ng gobyerno sa mas malaking sapa….doon sa Sapang Palay.

Nasaan na kaya ngayon si Mamang Hilot? Buhay pa kaya siya? Naisalin kaya niya sa iba ang kanyang galing at husay sa paghihilot? Naipamana kaya niya sa kanyang mga anak ang kanyang kaalaman sa panggagamot?

Hindi ko alam kung ilan pang mga matatanda o mga batang katulad ko ang napaglapagan ng kanyang mga kamay. Ngunit nakatitiyak akong marami siyang natulungan, napaginhawa, at napagaling.

Nais ko lang sanang ipahatid, na isa sa mga batang hinilot niya noon, ay isa na ring manggagamot ngayon.