Dr. Kenneth Candido, MD

The prospect of "healing" arthritis of the hip or in any body part is unsupported by our current level of medical sophistication. Symptoms may be improved using nonsteroidal antiinflammatory type drugs; physical therapy; optimization of weight; cessation of smoking and alcohol consumption. Osteoarthritis tends to be chronic, recurrent, and progressive in most cases. However, aside from the use of stem cells and in some cases platelet rich plasma, actual "healing" does not typically occur. If one is willing to pursue treatment at legitimate centers wherein stem cells or regenerative medicine may be considered, then healing is potentially possible. However, from the standpoint of symptom management, it is more probable than not that this should be pursued due to cost considerations and logistics. Good luck!

Exercise is one of the foundations for solving many and most cases of low back pain. The best thing to do is to find exercises which do not add stress to the lower back but which are supportive of improving the strength and range of motion of the lumbar spine. Be sure to consult an exercise expert either in either a physical therapy session or else someone with a degree in exercise physiology. Some of the best exercises for the low back include swimming and cycling, both of which remove the stress off the low back. Avoid those types of things that add stress to the spine like weight lifting for squats or military presses. Good luck! Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Neurologists are excellent at diagnosing back pain and determining in many cases the source for that pain. In my experience, most do not actually treat the pain, but refer it out to pain management experts. They have expertise in certain tools like the use of electromyography and nerve conduction studies (EMG/NCV) to help pinpoint what areas are potentially affected by the pain and the underlying condition(s). But most neurologists, once making their assessments as part of a team, will then defer the patient back to the pain doctor, orthopedic surgeon, or neurosurgeon, for definitive care and management. Thank you! Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Back pain is a symptom with many possible diverse causes. There is no way to diagnose the causes without a comprehensive evaluation by a qualified specialist. Sitting is usually not associated with worsening back pain. Sitting usually reduces stress on the lower back. If your pain is increasing in frequency or severity, it demands immediate attention. If it is stable and non-severe, then a measured approach starting with visiting your personal physician for the appropriate referrals makes the most sense. Good luck!

Exercise, including those at home, and that with formal physical therapy, is one of the mainstays of recovering from back pain. However, if the symptoms do not resolve fairly quickly, a thorough evaluation by a competent spine specialist should be strongly considered. Good luck!

Hello, and thank you for your inquiry. I am not an obstetrician and cannot make formal recommendations about what can, and cannot be taken and in which trimester of pregnancy. I will say, however, that acetaminophen (Tylenol or equivalent) has been suggested to be acceptable for most stages of pregnancy for managing headaches. I would strongly suggest you consult the obstetrician managing your case, and consult standard references about what may, and what may not be used. The developing infant is extremely susceptible to many types of medications, and this is an extremely serious topic, so don't take anything before seeking and obtaining approval. Good luck! Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Tylenol and alcohol are both metabolized in the liver. You must not consume more than 4,000 mg of Tylenol in any 24 hour period, or there is a risk for your liver shutting down. 500 mg tablets X 8 is 4,000 mg. That is the maximum number of tablets you could take in 24 hours IF your liver is normal and is functioning normally. There is no absolute safe time from the consumption of Tylenol until consumption of alcohol. If you are going on vacation and expect to consume alcohol, it would be best to reduce your daily consumption of Tylenol to less than 3,000 mg / 24 hours (no more than 6 X 500 mg tablets). It would be in your best interest not to overdo it with alcohol while you are using Tylenol for any reason, vacation or not. It is always better to be safer than sorrier. Good luck!

Hello. There is a small risk of spinal bleeding using 81 mg aspirin/day when spinal cord stimulator trials are done. If you are using the aspirin to prevent heart attack or stroke on the advice of a cardiologist, ask the cardiologist if you can stop it for seven days, and then reschedule the spinal cord stimulator trial. If the cardiologist tells you that it is essential that you continue the aspirin, the decision to proceed is between you and the person performing the trial, with both understanding that there is a small but not negligible risk of a spine bleed. This is a serious consideration and is not one that should be made by you alone or by the doctor placing the device alone. This is a joint decision between you, the interventionist, and if you have one, your cardiologist. Good luck! KDC Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Neck pain is a common complaint. There is no single best way to manage neck pain. That is because the source of the neck pain may confuse the person making the assessment. There needs to be a comprehensive medical and pain history obtained first. And that is followed by a thorough examination of the painful area. In most cases, there will be a need for imaging studies like X-Rays or MRIs to be completed before providing a diagnosis and offering treatments. Treatments vary between physical exercise, physical therapy, medication use, and injections. At times, surgery is needed to address the underlying problem. However, without an examination and additional studies, there is no way to recommend a treatment for "neck pain". Good luck! Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Nobody "fixes" lower back pain, because lower back pain is merely a symptom. People treat lower back pain but that requires that we can identify the source of the pain. There are many potential things that can cause lower back pain and this requires someone who is a good diagnostician (pain doctor; chiropractor; orthopedic surgeon; neurosurgeon; neurologist) take a careful history; perform a comprehensive physical examination; and obtain appropriate diagnostic studies before devising a treatment plan based upon the most likely diagnosis. Good luck! KDC Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Heat is good for long-term low back pain, but cold is superior for acute

There are two basic ways to determine if the back pain is disc related, or not. One way, the simpler way, is to undergo an MRI study of the lumbar spine and assess for disc changes (annular tear; bulges; protrusions; herniations; foraminal or central spinal canal stenosis). The second way, a more difficult and possibly more complicated way to determine whether or not the back issues are due to the disc is to undergo a provocation disc injection of dye contrast (discography) study. This requires a special team (anesthesiologist; pain doctor; X-ray technician) and is potentially somewhat painful and riskier. Besides those two ways, there is no foolproof way to determine the involvement of the discs as being pain generators. Good luck! Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Chiropractors are trained in conditions of the spine, including herniated discs and related pain syndromes. While all chiropractors are not created equal, there are many who are excellent at diagnosing and treating herniated disc pain. Do your homework and read the ratings of the intended chiropractor and make wise choices. There is a good chance doing so may save you from an unnecessary surgery or possibly having to undergo steroid epidural injections. Good luck! KDC Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Knee surgery might include arthroscopy for meniscal tear; anterior cruciate ligament reconstruction; and total knee replacement. Pain control is entirely contingent upon which surgery type you had, since some types of surgery preclude you from having antiinflammatory type drugs due to abnormal healing. Some cases respond to acetaminophen (Tylenol); some to NSAIDS (Advil if not contraindications); topical local anesthetics (Lidocaine 4% or equivalent); topical antiinflammatories (Diclofenac 1.3% cream); and some require stronger medications like Tramadol. I encourage you to ask your surgeon about what is appropriate depending upon the nature and extent of your unique surgery type. Good luck!

Hello. Shoulder "bone pain" could refer to many things. You first need to have plain X-Rays of the shoulder in question to assess two major joints-the acromioclavicular joint (AC Joint) and the Glenohumeral joint (GHJ). That is because true bony pain might be due to an abnormality in the bone itself, or to abnormal movement of the joints. Once that is accomplished, the next step is to see a qualified orthopedic shoulder surgeon who can conduct a comprehensive physical examination. This would include putting you through a range of motion (abduction, adduction, internal rotation, external rotation) to determine if there is a "clicking" sound with movement, or restricted movement. Finally, the orthopedic shoulder expert might recommend taking antiinflammatory type medications (Advil; Motrin, or equivalent) or possibly inject the shoulder with local anesthesia and steroids. If those remedies fail to benefit you, surgery might be an option to release whatever it is that is causing this bony pain. But the key to improving is to be evaluated by the orthopedic shoulder expert first and foremost. Good luck!

In general, chiropractors are trained to treat spine conditions including those of the neck and back. However, the level of expertise varies from chiropractor to chiropractor, just as with medical doctors. Be sure to do a thorough assessment of the chiropractor you are intending on seeing, and make a wise selection based upon the best information available to you from reviews and summaries from other patients. Good luck! Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Professor of Clinical Surgery-UIC ASIPP Board of Directors-to 2023 CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Phone: (773) 562-9549 Kdcandido1@gmail.com kdcandido@yahoo.com kdcandido2@gmail.com (assistant)

Pain in that area could represent a pilonidal cyst, a recurring area of accumulation of pus which needs to be evaluated by an ultrasound, and possibly opened and drained. The fact that it went away once before is good, and in that case, may represent more of a response to some type of trauma, and not a cyst. But in either case, an evaluation by your primary care physician or at an urgent care center is the best option for you. Good luck!

"Hives" implies an allergic type of reaction to something. That requires some visit to an urgent care facility, or Emergency Room. The pain in both shoulders and radiating down the arms can be symptoms of a herniated disc in the neck. Each of these reported symptoms does require a physician evaluation, including a visit to a nearby clinic or ER. My recommendation is to do this today. Good luck!

Hello. "Piercing Pain"; "Red" (I'm not quite sure what is red), for one day, likely should be seen in the nearest emergency room. I suspect they will be more able to figure this out. Good luck!

Thank you for requesting information on a possible hernia. The small raised central straight line up from your umbilicus towards your chest seems to me to be the "linea alba" (white line) that separates the right and left sides of your abdominal muscles. The tiny "bump" looks not like a hernia, but perhaps a defect or tear in the rectus abdominis muscle on that side, which is similar to a hernia. It seems more likely that the situation is one of either a torn muscle, or muscles, or a severely strained one. You should rest your abdominal muscles (no snowboarding; no abdominal exercises like crunches or sit-ups); seek medical attention where an ultrasound can be done of your abdominal wall; and wear an abdominal binder until the situation is resolved. An abdominal binder is a velcro like "girdle" that you can buy at any pharmacy without a prescription; I recommend that merely to maintain the integrity of your abdominal muscles until someone can actually make the correct diagnosis. Good luck! Kenneth D. Candido, M.D. Professor of Clinical Anesthesiology-UIC Pain Fellowship Director & Pain Clinic Medical Director Department of Anesthesiology and Pain Management ASIPP Board of Directors CEO & President of Chicago Anesthesia Associates CEO & President of Chicago Anesthesia Pain Specialists Advocate Illinois Masonic Medical Center 3000 N. Halsted St. Suite 823 Chicago, IL 60657 Phone: (773) 296-7937 Fax: (773) 296-3995 kdcandido1@gmail.com *kdcandido@yahoo.com <kdcandido@yahoo.com>*