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A totally new paradigm for treating back pain
Virtually every American will suffer from back pain at some point. Dr. Jack Stern, a neurosurgeon and professor at Weill Cornell Medical College, brings relief to these millions of sufferers (including himself) who literally ache for help. Based on the latest scientific data, Dr. Stern developed a five-step solution with a multidisciplinary, holistic perspective that’s been missing from conventional back pain wisdom:
Engagingly written and chock-full of enlightening case studies, Ending Back Pain finally shares the program that’s already helped more than 10,000 grateful patients.
Excerpted from Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. Copyright © by Jack Stern, M.D., Ph.D. Published by Avery. All rights reserved.
Most feelings of discomfort in life have clear solutions. For a stuffy nose, decongestants do the trick. For a pounding headache, aspirin or Tylenol comes in handy. But what do you do about a relentlessly aching back? As most of us know, the answer is not nearly as clear-cut as we’d wish. And unlike infectious diseases that often have targeted remedies (think antibiotics for bacterial infections and vaccines for viruses), ailing backs are like misbehaving, obnoxious family members—we can’t easily get rid of them or “fix” them. They also have a tendency to stick around and bother us nonstop, lowering our quality of life considerably and indefinitely.
Perhaps nothing could be more frustrating than a sore or hurting back. It seems to throw off everything else in our body, and makes daily living downright miserable. With the lifetime prevalence approaching 100 percent, virtually all of us have been or will be affected by low back pain at some point. Luckily, most of us recover from a bout of back pain within a few weeks and don’t experience another episode. But for some of us, the back gives us chronic problems. As many as 40 percent of people have a recurrence of back pain within six months.
At any given time, an astounding 15 to 30 percent of adults are experiencing back pain, and up to 80 percent of sufferers eventually seek medical attention. Sedentary people between the ages of forty-five and sixty are affected most, although I should point out that for people younger than forty-five, lower back pain is the most common cause for limiting one’s activities. And here’s the most frustrating fact of all: A specific diagnosis is often elusive; in many cases it’s not possible to give a precise diagnosis, despite advanced imaging studies. In other words, we doctors cannot point to a specific place in your back’s anatomy and say something along the lines of, “That’s exactly where the problem is, and here’s how we’ll fix it.” This is why the field of back pain has shifted from one in which we look solely for biomechanical approaches to treatment to one where we have to consider patients’ attitudes and beliefs. We have to look at a dizzying array of factors, because back pain is best understood through multiple lenses, including biology, psychology, and even sociology.
So, why is back pain such a confounding problem? For one, it’s lumped into one giant category, even though it entails a constellation of potential culprits. You may have back pain stemming from a skiing accident, whereas your neighbor experiences back pain as the consequence of an osteoporotic fracture. Clearly, the two types of back pain are different, yet we call them “back pain” on both accounts, regardless. Back pain has an indeterminate range of possible causes, and therefore multiple solutions and treatment options. There is no one-size-fits-all answer to this malady. That is why diagnosing back pain, particularly persistent or recurrent pain, is so challenging for physicians.
Some people are able to describe the exact moment or series of moments when they incurred the damage to their back—a car accident, a slip and fall, a difficult pregnancy, a heavy-lifting job at work, a sports-related injury, a marathon, and so on. But for many, the moment isn’t so obvious, or what they think is causing them the back pain is far from accurate.
The Two Types of Back Pain
If you are going to experience back pain, you’d prefer to have the acute and temporary kind rather than the chronic and enigmatic kind. The former is typically caused by a musculoskeletal issue that resolves itself in due time. This would be like pulling a muscle in your back during a climb up a steep hill on your bicycle or sustaining an injury when you fall from the stepladder in the garage. You feel pain for a few weeks and then it’s silenced, hence the term self-limiting back pain. It strikes, you give it some time, it heals, and it’s gone.
The second type of back pain, though, is often worse, because it’s not easily attributed to a single event or accident. Often, either sufferers don’t know what precipitated the attack, or they remember some small thing as the cause, such as bending from the waist to lift an object instead of squatting down (i.e., lifting with the legs) or stepping off a curb too abruptly. It can start out of nowhere and nag you endlessly. It can build slowly over time but lack a clear beginning. Your doctor scratches his head, trying to diagnose the source of the problem, and as a result your treatment options aren’t always aligned with the root cause of the problem well enough to solve it forever. It should come as no surprise, then, that those with no definitive diagnosis reflect the most troubling cases for patients and doctors.
What Are the Chances?
Chances are good that you’ll experience back pain at some point in your life. Your lifetime risk is arguably close to 100 percent. And unfortunately, recurrence rates are appreciable. The chance of it recurring within one year of a first episode is estimated to be between 20 and 44 percent; within ten years, 80 percent of sufferers report back pain again. Lifetime recurrence is estimated to be 85 percent. Hence, the goal should be to alleviate symptoms and prevent future episodes.
Excerpted from Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. Copyright © by Jack Stern, M.D., Ph.D. Published by Avery. All rights reserved.
ABOUT THE AUTHOR:
Jack Stern, M.D., Ph.D., is the author of Ending Back Pain: 5 Powerful Steps to Diagnose, Understand, and Treat Your Ailing Back. He is a board-certified neurosurgeon specializing in spinal surgery, and cofounder of Spine Options, one of America’s first facilities committed to nonsurgical care of back and neck pain. Dr. Stern is on the clinical faculty at Weill Cornell Medical College and has published numerous peer- and non peer– reviewed medical articles. He lives and practices in White Plains, New York. For more information, please visit https://drjackstern.com/
Your Future Depends on Your Decisions
Sorting out our lives amidst chaos, confusion, and innumerable options is a process we all have in common. The decisions we ultimately make can affect our lives and the lives of others. It’s not always easy. In this empowering guide, an expert in business strategies shares the choices of notable, visionary decision-makers–from Harry Truman and Henry Ford to Marie Curie and Malala Yousafzai–and explains how you can apply their principles to your own personal and professional real-life scenarios.
Resolve, patience, and practical thinking–take it from these politicians, scientists, economists, inventors, entrepreneurs, theologians, activists, and commanders of war and peace. Their inspiring counsel will give you the tools you need to help change your life. Both big and small, your choices can shape the minutes, days, weeks, and years ahead. This book is the first motivating step in the right direction.
“Upgrade your daily decisions with the wisdom of two dozen renowned influencers who changed history.”
—Mehmet Oz, M.D., New York Times bestselling author of You: The Owner’s Manual
“A truly inspiring book about how to become a leader. Highly recommended!!”
—Douglas Brinkley, New York Times bestselling author of American Moonshot
“The best decision you will make today is to read and learn from this array of bold thinkers.”
—Harvey Mackay, New York Times bestselling author of Swim With The Sharks Without Being Eaten Alive (less)
Excerpted from DECISIONS by Robert L. Dilenschneider. Reprinted with permission from Kensington Books. Copyright © 2020 Robert L. Dilenschneider.
Abraham Lincoln was known throughout his life as an extremely gifted writer and speaker. Astonishing when you remember that he had very little formal education. But in addition to immense intelligence, Lincoln had an innate sense of what to say and how to say it both beautifully and effectively. And he worked at it!
I think that eloquence is part of strong decision-making. Writing and speaking well depend on clarity. You must know your thoughts and your facts and be aware of the needs and expectations of your audiences. You need to have a thesis statement, a clear-cut goal for what you are writing or saying. Just as with decision-making. You need to marshal all the factors that will, or might, affect what you are contemplating.
Beyond his carefully crafted speeches and letters, Lincoln used story-telling (or yarn-spinning) to marvelous effect. He could be ribald, humorous, or wickedly funny, homespun, serious—whatever it took to disarm his audience while he made a point or performed what research professionals have come to call “soft soundings.” You can do the same.
Confidence is an overlooked factor in effective decision-making. I don’t mean cockiness. I mean the personal strength that is rooted in knowledge, experience, and purpose.
Lincoln may have “freed the slaves,” but America continues to be haunted by the Civil War and what some have called our “original sin” of slavery.
Vicious disagreements about statues of Confederate generals, for example, are place-holders for larger issues of identity, history, racism, and inequity. Think about lynchings, beatings, murders, and assassinations, about lunch counters and city buses, about violence in minority communities, voter suppression, restricted real estate listings, affirmative action, integration, the 2008 Presidential election—and so much more.
Civil rights activism remains its own war. And theologically, the nature of original sin is that it is forgiven and removed but its effects remain. Does this gloomy assessment mean that Lincoln’s decision about the Emancipation Proclamation was wrong or ineffectual? This is something that all of us worry about as we make decisions large and small.
My answer is a resounding No. Abraham Lincoln’s decision was of the highest moral order. It was right, in the true sense of that word. It was good. The changes it caused in America have become worldwide.
I’ll close by suggesting a visit to the Lincoln Memorial in Washington DC. If you’ve been there before, you’ll know why. If this would be your first visit, you have much to look forward to. Picture yourself standing there, dwarfed and humble, as you gaze up at the magnificent and massive statue of a brooding, seated Lincoln. What is he pondering? Surrounded by the shadowing, sheltering, and towering classical columns of the Memorial edifice, resolve to make your own decisions—right ones and good ones. They will change your world.
This greatest of American presidents offers us these lessons:
ABOUT THE AUTHOR:
Robert L. Dilenschneider has hired more than 3,000 successful professionals, and advised thousands more. He is founder of The Dilenschneider Group, a corporate strategic counseling and public relations firm based in New York City. Formerly president and CEO of Hill & Knowlton, he is the author of the bestselling books Power and Influence, A Briefing for Leaders, On Power and newly released Decisions: Practical Advice from 23 Men and Women Who Shaped the World. For more information, please visit https://robertldilenschneider.com
From the New York Times bestselling, celebrated, and award-winning author of Empire of the Summer Moon and Rebel Yell comes the spellbinding, epic account of the dramatic conclusion of the Civil War.
The fourth and final year of the Civil War offers one of that era’s most compelling narratives, defining the nation and one of history’s great turning points. Now, S.C. Gwynne’s Hymns of the Republic addresses the time Ulysses S. Grant arrives to take command of all Union armies in March 1864 to the surrender of Robert E. Lee at Appomattox a year later. Gwynne breathes new life into the epic battle between Lee and Grant; the advent of 180,000 black soldiers in the Union army; William Tecumseh Sherman’s March to the Sea; the rise of Clara Barton; the election of 1864 (which Lincoln nearly lost); the wild and violent guerrilla war in Missouri; and the dramatic final events of the war, including the surrender at Appomattox and the murder of Abraham Lincoln.
Hymns of the Republic offers angles and insights on the war that will surprise many readers. Robert E. Lee, known as a great general and southern hero, is presented here as a man dealing with frustration, failure, and loss. Ulysses S. Grant is known for his prowess as a field commander, but in the final year of the war he largely fails at that. His most amazing accomplishments actually began the moment he stopped fighting. William Tecumseh Sherman, Gwynne argues, was a lousy general, but probably the single most brilliant man in the war. We also meet a different Clara Barton, one of the greatest and most compelling characters, who redefined the idea of medical care in wartime. And proper attention is paid to the role played by large numbers of black union soldiers—most of them former slaves. They changed the war and forced the South to come up with a plan to use its own black soldiers.
Popular history at its best, from Pulitzer Prize finalist S.C. Gwynne, Hymns of the Republic reveals the creation that arose from destruction in this thrilling read.
Washington, DC, had never, in its brief and undistinguished history, known a social season like this one. The winter of 1863–64 had been bitterly cold, but its frozen rains and swirling snows had dampened no spirits. Instead a feeling, almost palpable, of optimism hung in the air, a swelling sense that, after three years of brutal war and humiliating defeats at the hands of rebel armies, God was perhaps in his heaven, after all. The inexplicably lethal Robert E. Lee had finally been beaten at Gettysburg. Vicksburg had fallen, completing the Union conquest of the Mississippi River. A large rebel army had been chased from Chattanooga. Something like hope—or maybe just its shadow—had finally loomed into view.
The season had begun as always with a New Year’s reception at the Executive Mansion, hosted by the Lincolns, then had launched itself into a frenzy whose outward manifestation was the city’s newest obsession: dancing. Washingtonians were crazy about it. They were seen spinning through quadrilles, waltzes, and polkas at the great US Patent Office Ball, the Enlistment Fund Ball, and at “monster hops” at Willard’s hotel and the National. At these affairs, moreover, everyone danced. No bored squires or sad-eyed spinsters lingered in the shadows of cut glass and gaslight. No one could sit still, and together all improvised a wildly moving tapestry of color: ladies in lace and silk and crinolines, in crimson velvet and purple moire, their cascading curls flecked with roses and lilies, their bell-shaped forms whirled by men in black swallowtails and colored cravats.
The great public parties were merely the most visible part of the social scene. That winter had seen an explosion of private parties as well. Limits were pushed here, too, budgets broken, meals set forth of quail, partridge, lobster, terrapin, and acreages of confections. Politicians such as Secretary of State William Seward and Congressman Schuyler “Smiler” Colfax threw musical soirees. The spirit of the season was evident in the wedding of the imperially lovely Kate Chase—daughter of Treasury Secretary Salmon P. Chase—to Senator William Sprague. Sprague’s gift to Kate was a $50,000 tiara of matched pearls and diamonds. When the bride appeared, the US Marine Band struck up “The Kate Chase March,” a song written by a prominent composer for the occasion.
What was most interesting about these evenings, however, was less their showy proceedings than the profoundly threatened world in which they took place. It was less like a world than a child’s snow globe: a small glittering space enclosed by an impenetrable barrier. For in the winter of 1863–64, Washington was the most heavily defended city on earth. Beyond its houses and public buildings stood thirty-seven miles of elaborate trenches and fortifications that included sixty separate forts, manned by fifty thousand soldiers. Along this armored front bristled some nine hundred cannons, many of large caliber, enough to blast entire armies from the face of the earth. There was something distinctly medieval about the fear that drove such engineering.
The danger was quite real. Since the Civil War had begun, Washington had been threatened three times by large armies under Robert E. Lee’s command. After the Union defeat at the Second Battle of Bull Run in August 1862, a rebel force under Lee’s lieutenant Stonewall Jackson had come within twenty miles of the capital while driving the entire sixty-thousand-man Union army back inside its fortifications, where the bluecoats cowered and licked their wounds and thanked heaven for all those earthworks and cannons.
A year and a half later, the same fundamental truth informed those lively parties. Without that cordon militaire, they could not have existed. Washington’s elaborate social scene was a brocaded illusion: what the capital’s denizens desperately wanted the place to be, not what it actually was.
This garishly defended capital was still a smallish, grubby, corrupt, malodorous, and oddly pretentious municipality whose principal product, along with legislation and war making, was biblical sin in its many varieties. Much of the city had been destroyed in the War of 1812. What had replaced the old settlement was both humble and grandiose. Vast quantities of money had been spent to build the city’s precious handful of public buildings: the Capitol itself (finished in December 1863), the Post Office Building, the Smithsonian Institution, the US Patent Office, the US Treasury, and the Executive Mansion. (The Washington Monument, whose construction had been suspended in 1854 for lack of funds, was an abandoned and forlorn-looking stump.)
But those structures stood as though on a barren plain. The Corinthian columns of the Post Office Building may have been worthy of the high Renaissance, but little else in the neighborhood was. The effect was jarring, as though pieces of the Champs-Élysées had been dropped into a swamp. Everything about the place, from its bloody and never-ending war to the faux grandiosity of its windswept plazas, suggested incompleteness. Like the Washington Monument, it all seemed half-finished. The wartime city held only about eighty thousand permanent residents, a pathetic fraction of the populations of New York (800,000) and Philadelphia (500,000), let alone London (2.6 million) or Paris (1.7 million). Foreign travelers, if they came to the national capital at all, found it hollow, showy, and vainglorious. British writer Anthony Trollope, who visited the city during the war and thought it a colossal disappointment, wrote:
Washington is but a ragged, unfinished collection of unbuilt broad streets.… Of all the places I know it is the most ungainly and most unsatisfactory; I fear I must also say the most presumptuous in its pretensions. Taking [a] map with him… a man may lose himself in the streets, not as one loses oneself in London between Shoreditch and Russell Square, but as one does so in the deserts of the Holy Land… There is much unsettled land within the United States of America, but I think none so desolate as three-fourths of the ground on which is supposed to stand the city of Washington.
He might have added that the place smelled, too. Its canals were still repositories of sewage; tidal flats along the Potomac reeked at low tide. Pigs and cows still roamed the frozen streets. Dead horses, rotting in the winter sun, were common sights. At the War Department, one reporter noted, “The gutter [was] heaped up full of black, rotten mud, a foot deep, and worth fifty cents a car load for manure.” The unfinished mall where the unfinished Washington Monument stood held a grazing area and slaughterhouse for the cattle used to feed the capital’s defenders. The city was both a haven and a dumping ground for the sort of human chaff that collected at the ragged edges of the war zone: deserters from both armies, sutlers (civilians who sold provisions to soldiers), spies, confidence men, hustlers, and the like.
Washington had also become the nation’s single largest refuge for escaped slaves, who now streamed through the capital’s rutted streets by the thousands. When Congress freed the city’s thirty-three hundred slaves in 1862, it had triggered an enormous inflow of refugees, mostly from Virginia and Maryland. By 1864 fifty thousand of them had moved within Washington’s ring of forts. Many were housed in “contraband camps,” and many suffered in disease-ridden squalor in a world that often seemed scarcely less prejudiced than the one they had left. But they were never going back. They were never going to be slaves again. This was the migration’s central truth, and you could see it on any street corner in the city. Many would make their way into the Union army, which at the end of 1863 had already enlisted fifty thousand from around the country, most of them former slaves.
But the most common sights of all on those streets were soldiers. A war was being fought, one that had a sharp and unappeasable appetite for young men. Several hundred thousand of them had tramped through the city since April 1861, wearing their blue uniforms, slouch hats, and knapsacks. They had lingered on its street corners, camped on its outskirts. Tens of thousands more languished in wartime hospitals. Mostly they were just passing through, on their way to a battlefield or someone’s grand campaign or, if they were lucky, home. Many were on their way to death or dismemberment. In their wake came the seemingly endless supply trains with their shouting teamsters, rumbling wagon wheels, snorting horses, and creaking tack.
Because of these soldiers—unattached young men, isolated, and far from home—a booming industry had arisen that was more than a match for its European counterparts: prostitution. This was no minor side effect of war. Ten percent or more of the adult population were inhabitants of Washington’s demimonde. In 1863, the Washington Evening Star had determined that the capital had more than five thousand prostitutes, with an additional twenty-five hundred in neighboring Georgetown, and twenty-five hundred more across the river in Alexandria, Virginia. That did not count the concubines or courtesans who were simply kept in apartments by the officer corps. The year before, an army survey had revealed 450 houses of ill repute. All served drinks and sex. In a district called Murder Bay, passersby could see nearly naked women in the windows and doors of the houses. For the less affluent—laborers, teamsters, and army riffraff—Nigger Hill and Tin Cup Alley had sleazier establishments, where men were routinely robbed, stabbed, shot, and poisoned with moonshine whiskey. The Star could not help wondering how astonished the sisters and mothers of these soldiers would be to see how their noble young men spent their time at the capital. Many of these establishments were in the heart of the city, a few blocks from the president’s house and the fashionable streets where the capital’s smart set whirled in gaslit dances.
This was Washington, DC, in that manic, unsettled winter of 1863–64, in the grip of a lengthening war whose end no one could clearly see.
Excerpted from HYMNS OF THE REPUBLIC: The Story of the Final Year of the American Civil War, by S.C. Gwynne. Copyright © 2019 by Samuel C. Gwynne. Excerpted with permission by Scribner, a Division of Simon & Schuster, Inc.
About the Author:
S.C. Gwynne is the author of Hymns of the Republic: The Story of the Final Year of the American Civil War and the New York Times bestsellers Rebel Yell and Empire of the Summer Moon, which was a finalist for the Pulitzer Prize and the National Book Critics Circle Award. He spent most of his career as a journalist, including stints with Time as bureau chief, national correspondent, and senior editor, and with Texas Monthly as executive editor. He lives in Austin, Texas, with his wife. For more information, please visit https://scgwynne.com
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