So let’s talk about some red flags that could you know kind of tell you if you’re having some back pain we have a graphic right here doctor let’s talk about them pain in the extremities can you express more of that oh yeah of course actually pain in the extremities is what usually gets patients to come to the doctor it’s just humans aren’t really capable of tolerating nerve pain that electrical pain and pain in the extremities both arms as well as legs that’s nerve pain so that’s definitely a reason to find out why the patient’s suffering and usually in conjunction with that they’ll have associated neck pain for those who have the arm or they’ll have back pain when there’s leg pain and then if they do have extremity pain it’s pretty easy to figure out which is the exact disc that’s causing their back pain because it’s usually the same one that’s causing the nerve pain all right there’s recent unwanted weight loss fever chills oh yeah those are scary so I always ask patients about that the first to me signifies a possibility of cancer so that needs to be worked out and the second especially in Miami I always look for weird infections so like tuberculosis of the spine is very possible and nighttime fevers that’s a concern all right and then finally growing numbness and incontinence oh yeah that’s a big one that’s a little bit what I really ask patients if that happens to come within 24 hours not to wait you