Spinal steno­sis, a com­mon cause of back pain

Cape Breton Post - - LIFESTYLES -

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.

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