DEAR DR. DONOHUE: I am seeking advice for my dad. He is 75. He has gone to doctor after doctor, to no avail. He sits in his recliner 24/7. He has been diagnosed with spinal stenosis and arthritis. He is so bent over, it’s pathetic. He says his back feels weak. He walks with a shuffle. Any suggestions? – C.D.
ANSWER: Stenosis is a narrowing and, spoken of here, it refers to the spinal canal. The backbone – the spine – is a series of blocklike structures called vertebrae, which are stacked one on another. The spinal cord is a delicate structure, about the width of a little finger, that runs from the top of the neck to the lower back. It passes through a tunnel in the spine – the spinal canal.
Narrowing of the canal – spinal stenosis – puts pressure on the spinal cord or the nerves that emerge from it. When the process develops in the lower back, as it often does, it generates pain in the back. The pain often runs down into the buttock and leg. Sometimes there is numbness, tingling or muscle weakness.
Arthritis of the spine is often responsible for spinal stenosis. It leads to bone spurs that compress spinal nerves. Thickening of spinal ligaments can also squeeze the cord, spinal nerves or both.
Your dad needs a physiatrist (fizz-EYE-uh-tryst). This doctor is not a psychiatrist. Physiatrists are specialists in rehabilitation medicine. They devise exercise programs for people like your dad. They prescribe medicines for pain and evaluate back patients to see if they are candidates for steroid injections to mobilize the spine. They can also assess people’s potential for spinal surgery to enlarge the spinal canal or to remove bones spurs or anything else that might be compressing the cord or nerves. They can tell you if your dad is a candidate for newer treatments such as spacers. Spacers are devices that push spinal structures apart to give the cord and spinal nerves some breathing space.
Your dad must become more active, if that’s possible. Disuse is going to weaken all his muscles.
The back booklet gives a rundown on the many causes and treatments for back pain. Readers can order a copy by writing: Dr. Donohue – No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Your response to the woman who wondered about the delay in making a diagnosis of appendicitis for her 18-month-old son reminded me of a personal experience. Our 2-year-old son awoke one morning and promptly vomited. He then went on to eat, play and vomited several more times without any other signs of being ill. I was a nurse and my husband, a physician. My husband examined him thoroughly. The child had no pain or temperature. A pediatrician and two other doctors could make no diagnosis. A blood count revealed elevated white blood cells, so surgery was chosen. He had a gangrenous appendix that was on the verge of rupturing. You’re right. Appendicitis is hard to diagnose. – M.W.
ANSWER: The appendix is a slender structure about 3 inches long with a hollow tube. It hangs down from the first part of the colon. If rock-hard stool blocks the hollow center, the appendix swells. The swelling cuts off its blood supply, and that’s appendicitis. Bacteria multiply within the hollow center. Pressure builds. If the pressure is not relieved, the appendix bursts and spews germs throughout the abdominal cavity.
Newer tests have made the diagnosis easier. A CT scan of the abdomen gives information that was not available in your son’s infancy. We have made some progress.
DEAR DR. DONOHUE: I have been looking desperately for information on pemphigus in your column. My sister has been suffering from this autoimmune disease for two years. Her sores are in her mouth and sometimes her throat. She has seen specialists. One doctor put her on steroids, which help, but there is danger in using them too much. She is 63. She would like to talk to people without worrying about her breath and these sores. Can this condition be cleared? – K.C.
ANSWER: Pemphigus is an uncommon, distressing illness where painful blisters break out on the skin, mouth, throat and genitals. The blisters burst and form sores that eventually crust. When the mouth is involved, the breath is often offensive.
As you say, it is an autoimmune disease, one of those illnesses where the immune system turns on the skin and lining membranes.
Steroids – cortisone drugs – are effectively used to calm the immune system. Prednisone is the steroid most often chosen. These drugs, in large doses and used for long times, do create problems. Without prednisone, pemphigus can be lethal. Combining it with other immune-regulating drugs such as azathioprine or mycophenolate mofetil often permits a reduction of the prednisone dose and a lessening of its side effects.
Mouth odor can sometimes be controlled by using a mouthwash made with equal parts Maalox and liquid Benadryl, both over-the-counter medicines. She should swish the mouthwash around but not swallow it.
A new drug has brought new hope for many with pemphigus – rituximab. Your sister can ask her doctor if she’s a candidate for it. She should contact the International Pemphigus and Pemphigoid Foundation for information and support. Its Web site is: www.pemphigus.org. The telephone number is 916-922-1298.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.