Vaccines are recommended for patients with no spleen
loss, lung infections and infection with Clostridium difficile, a type of diarrhea. The likelihood of these side effects is low: People who need proton pump inhibitors should stay on their medications.
I wrote the column because I often see people who have been taking proton pump inhibitors for years for only mild heartburn symptoms. Most people don’t need to take such powerful medications for a prolonged time.
DEAR DR. ROACH: After a compression fracture in my L-2 vertebra, which was repaired with surgery, I am dealing with arthritis in my lower spine. I have tried injections, a nerve block and acupuncture, without relief. What’s next? -- B.V.M.
ANSWER: There is no reliable medical treatment for arthritis of the back that can stop progression of the disease. You have identified some common treatments, but I have a few comments that might help.
The first is that, although they don’t stop the disease, medications can ease symptoms. Acetaminophen (Tylenol) is a reasonable first choice. Antiinflammatory drugs have more side effects, but may still be worthwhile in some people.
Exercise is my first-line treatment for arthritis. Exercise reduces pain, increases function and has few side effects beyond soreness, which comes especially after the first few sessions. A physical therapist can be a fantastic resource in helping to design a personalized program.
Spinal manipulation, as done by a chiropractor, osteopath, or massage or physical therapist, has been shown to have modest benefit.
Surgery for the back is an option that I recommend for very few. Those whose pain cannot be controlled with medication or people with progressive neurological symptoms deserve surgical evaluation.
Let me finish by saying that a compression fracture of the spine should lead to an evaluation for osteoporosis: If you haven’t had one, speak to your doctor.
DEAR ABBY: I am a divorced and remarried man with two teenage daughters. My ex-wife has custody of my girls one state away. I see them as often as time and the courts allow -- two months during the summer, a week during winter break, rotating Thanksgivings, etc.
Both of my daughters are failing miserably in school, but I am most concerned about my younger daughter. She is 13 and is rebelling badly. I recently spoke with the principal at her school and was told she puts forth zero effort. She arrives at school unclean, and fellow students have complained about the way she smells.
She blames her actions on my absence. This devastates me. I have always tried my best to make her understand that she was not any part of the reason her mother and I divorced. I try to call her often.
My biggest problem is I’m not good at casual conversation and idle chitchat. Generally when we talk, we end up sitting in silence until one of us says, “Well, I gotta go.” My question is, how do I get better at talking to my baby girl so I can let her know how important she is to me? -- “GOTTA GO” IN FLORIDA
DEAR GOTTA GO: Living one state away, you can’t force your child to shower and make sure she is clean and dressed in fresh clothes before she goes to school -- but her mother can and should. Shame on her for allowing it, because the girl will become a social pariah, if it hasn’t happened already. If her poor grades and hygiene are caused by depression, she should be seeing a counselor.