EAR DR. DONOHUE: My 35-year-old husband complained of back pain for more than four months. I issued an ultimatum to see a doctor. He has. The doctor says he has a special kind of arthritis that he will have all his life and that it might cripple him. Please provide some information for us. We are both worried. – S.A.

ANSWER:
It’s safe for me to say your husband has ankylosing (fusing of) spondylitis (inflamed backbones). It most often strikes men before the age of 40. The first joint involved is the sacroiliac joint, the joint that unites the lowermost part of the backbone – the sacrum – to one of the pelvic bones – the ilium. At first, pain and stiffness of the sacroiliac joint last for a few hours after wakening, improve once a person is up and moving but come back when the person sits or lies down. After a few months, the pain and stiffness can be constant.

The arthritis might work its way up the spine until the entire spine is ankylosed (fused) and the person walks in a frozen posture.

Two other elements of this arthritis are eye inflammation and heart-valve leakage.

Physical therapy and occupational therapy are essential. Physical therapists teach the patient what exercises are safe to keep the backbone limber. Occupational therapists teach patients how to make use of mechanical aids that keep patients independent.

There is a long list of medicines for this arthritis. Generally the first ones chosen are nonsteroidal anti-inflammatory drugs such as Indocin. I won’t mention the whole list, but I would like to mention two new drugs, Remicade and Enbrel. Both are used for rheumatoid arthritis, and they are currently under investigation for ankylosing spondylitis. Results look promising.

Lest you think your husband’s future is grim, take comfort in knowing that 75 percent of ankylosing-spondylitis patients work their entire lives with only a few restrictions.

DEAR DR. DONOHUE: I have read many of your articles about shingles in the past. I didn’t pay much attention to them because I never had it. I do now. Can I spread shingles to others? What do you do for pain that lasts after the shingles rash goes away? – K.S.

ANSWER:
Shingles comes from the chickenpox virus that lives in nerve cells from the time of childhood infection until death. When the shingles rash is in the blister stage, live chickenpox virus swims around in the blister. You cannot pass shingles to anyone. You can, under unusual circumstances, pass the virus to a person who never had chickenpox. The person has to come in contact with fluid from the rash. When that happens, the result is a case of chickenpox. This subject most often comes up when a grandparent with shingles takes care of an infant who has never had chickenpox or the chickenpox vaccine.

To subdue the pain of shingles and the pain that can persist after the rash has gone, there are a number of products. Lidocaine, a numbing agent, has been incorporated into skin patches, and the patches often effectively numb the pain. It has also been incorporated into creams. One such cream is Alocane (a new product from the Florida Institute for Research Science & Technology, Ashland, Ky.). Another cream with a different painkiller is Zostrix.

Shingles is a frequently recurring question. The shingles pamphlet answers many of those questions. People can obtain a copy by writing: Dr. Donohue – No. 1201, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.50 U.S./$6.50 Can. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What do you think of this? On weekends when I sleep in, I wake up with a migraine headache. I get them at other times, too, but why does this happen when I sleep a little longer? I have told this to other people, including doctors, and they look at me like I am crazy. – M.B.

ANSWER:
I don’t know the answer. I do know you are not crazy. Many people who suffer from migraine headaches get one from sleeping too little or too long.

I can’t even make a wild guess for you.

Readers, M.B. and I are looking for your help.

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.


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