DEAR DR. DONOHUE: Please discuss sciatica and its treatment. Whenever I bend, twist or stand after sitting, a shooting pain originates in my lower back and buttock, and travels down my left leg. Over-the-counter pain remedies like NSAIDs and Tylenol are of no help. – G.K.

ANSWER: There is a pair of sciatic nerves, the body’s longest and biggest nerves. Nerve roots emerging from the spinal cord in the lower back twist together to form the right and left sciatic nerves. Each nerve travels from the lower back through the buttock and down the leg to the foot. Irritation of the nerve anywhere in its long course causes pain. That is sciatica.

Often the irritation comes from a spinal disk pressing on the nerve in the lower back. Pain is then felt in the lower back and the buttock, and the sensation shoots down the leg.

Frequently, sciatica clears in a matter of weeks to two months. If your pain has persisted longer, you should see a doctor.

While you’re waiting to do so, use ice or heat on the lower back for 15 minutes at a time and repeat three times a day. You decide which brings you greater relief. Sit in a chair with a firm back and sit as far back in the chair as possible. When standing, prop one foot up on a stool or small, sturdy box or anything that’s handy. As far as pain relievers, you have to find one that suits you. Your doctor might give you a prescription for something stronger than over-the-counter medicines, or he or she might combine a mild pain reliever with a muscle relaxant such as Flexeril or Robaxin. The combination often brings pain relief. If you don’t obtain relief, injections of cortisone into the space above the spinal cord can suppress irritation and pain. That injection is an epidural block.

Don’t neglect the help of physical and occupational therapists. A physical therapist can teach you muscle-sparing exercises, and an occupational therapist can show you how to use devices that save your back.

The back booklet discusses the many causes of back pain and their treatments. 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: Several years ago, I came up from our cellar to our family room and foolishly left the cellar door open. Our 1-year-old daughter was in her walker and reached the door and fell down the stairs. The neurologist at the hospital said she suffered a contusion. Though it’s been several years since this happened, could there be a problem in later years? Is there something that can be done now to prevent such problems? – J.R.

ANSWER: A contusion is a bruise. Such an injury is not going to cause future trouble.

A cerebral contusion is a brain bruise. It’s more serious than a skin bruise, but it doesn’t usually cause any future troubles.

A concussion is a more serious injury. Here there’s temporary interruption of brain activity. When football players or boxers say their bell was rung, they suffered a concussion. Single, mild concussions do not lead to impairment down the road.

Stop mulling over this. You’ve tortured yourself enough. Your little girl was examined by a neurologist, who didn’t say any serious damage had been done. I imagine she underwent a number of tests that must not have showed any cause for concern. Forget the unfortunate incident.

DEAR DR. DONOHUE: Is a hiatal hernia the same as acid reflux? – C.J.

ANSWER: No, a hiatal hernia is a bulge of the stomach through the diaphragm muscle that separates the abdominal cavity from the chest cavity. Some, but far from all, hiatal hernias allow the upward splashing of gastric juices into the esophagus, where they cause heartburn. Not all people with heartburn have a hiatal hernia. The regurgitation of stomach acid into the esophagus is more properly called gastro-esophageal reflux disease, or GERD.

DEAR DR. DONOHUE: My doctor thought I might have gallbladder trouble and ordered an ultrasound. It showed a “shadow” on my right kidney that was further investigated by an MRI scan. It was kidney cancer. The kidney was removed. Are there tests for kidney cancer, or do people just walk around until the cancer is discovered by accident? What causes it? Is it likely I will get cancer in my other kidney? – E.G.

ANSWER: The classic signs and symptoms of kidney cancer are abdominal pain, a mass felt in the abdomen or side, and blood in the urine. Often the urine blood is detected only upon microscopic examination of the urine. Less-specific signs and symptoms include fever and weight loss.

In these days of ultrasounds and scans, many people are discovered to have a kidney mass from an ultrasound or scan taken for an unrelated reason, just as yours was discovered.

About 36,000 people on this continent develop kidney cancer every year. The peak years for developing it are those between 50 and 70.

Its cause hasn’t been discovered, but cigarette smoking, obesity and high blood pressure seem to influence its occurrence.

A comprehensive review of kidney cancer was published in a prestigious medical journal only two months ago. The article makes no mention of cancer arising in the second kidney. A recently published pathology textbook makes no mention of that, either. Both would have if second cancers were common.

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. Readers may also order health newsletters from www.rbmamall.com.


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