Spinal stenosis, a common cause of back pain
DEAR DR. DONOHUE: I’m a 67year-old woman whose back has been acting up for a year. My doctor told me I have spinal stenosis and to take Tylenol for it. The Tylenol doesn’t kill the pain all the time. My doctor says I just have to learn to live with it. I would like a second opinion from you. Is there something that can be done? — L.A.
ANSWER: A diagnosis of spinal stenosis indicates that the spinal canal has narrowed. The spinal canal is a tunnel that runs through the backbones (vertebrae). It provides a home for the spinal cord and the spinal nerves sprouting from the cord. It’s more than a home; it’s a place of protection for these delicate structures. When the narrowing is in the lower back, as it often is, it presses on spinal nerves and causes back pain. What causes the narrowing? Osteoarthritis of the backbones is one cause. Another is calcium spurs that form on the backbones and press on nerves. Backbone ligaments thicken, and they, too, can encroach on nerves. The pain of spinal stenosis is worse when standing or walking, and improves on sitting.
Spinal stenosis is rare before age 60, so aging is another cause of this problem.
Many things can be done. One is physical therapy. The therapist will teach you exercises that can reduce the pressure on spinal nerves. One special area of attention is the abdominal muscles. With weak abdominal muscles, the lower back curves inward, and that adds to the encroachment on spinal nerves.
Walking with a slight forward bend at the waist is one way to relieve nerve pressure.
Some doctors prescribe a corset for their spinal stenosis patients. The corset helps open the spinal canal. It is worn only for a few hours during the day. Constant use weakens back muscles.
If Tylenol doesn’t relieve your pain, you can step up to a nonsteroidal anti-inflammatory drug, like Motrin or Advil. Steroid injections in the area of spinal stenosis — epidural injections — reduce inflammation and can expand the canal. A surgical consultation will explain surgical corrections and whether they will benefit you.
The booklet on back pain delves into all the causes of this common malady. To order a copy, write to: Dr. Donohue — No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a cheque or money order (no cash) for $6 Cdn with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: I take the blood thinner Coumadin because I developed atrial fibrillation. I didn’t get any dietary instructions when I started the drug. My sister is also taking it, and she says she was told not to eat lettuce or spinach. Why not? It wouldn’t break my heart to give up either. — R.D.
ANSWER: Coumadin prevents unwanted clots from forming in the circulation. That’s popularly called “ blood thinning.” Atrial fibrillation is an abnormal heart rhythm that fosters clot formation. That’s the reason why so many patients take this drug. Coumadin works by countering the action of vitamin K. It’s the vitamin needed by the body for the manufacture of clotting factors, proteins essential to the formation of blood clots.
Spinach, lettuce, Brussels sprouts, kale, turnip greens, broccoli and cabbage are sources of vitamin K. Too much of them could override the effect of Coumadin. If you haven’t changed your diet, and if your blood tests for the action of Coumadin are good, then you don’t need to change a thing in your diet.
DEAR DR. DONOHUE: My 16-year-old son is active in all sports. When he was quite young, his pediatrician pointed out that his breastbone sinks in a bit. Nothing was ever said about correcting it. Does it need to be corrected? — E.T.
ANSWER: That breastbone depression is called pectus excavatum, something that happened during fetal life. If the depression isn’t pressing on the heart or lungs, then it can be ignored.
For a deeper depression, surgery corrects the malformation.