DEAR DR. DONOHUE: Sixty-two must be the age when everything falls apart. I’m there. My latest body part to give way is my back. I have back pain a considerable amount of the time. It finally brought me to a doctor, who tells me I have spinal stenosis. I have been told to take Aleve for my pain, and I’m scheduled for physical therapy. I don’t have great hopes of a cure. What exactly is this? What else can be done for it? – T.R.

ANSWER: Spinal stenosis accounts for about one-third of all cases of low-back pain. It’s an elusive concept that calls for an anatomy lesson. The backbones (vertebrae, spinal column) have a tunnel running through them – the spinal canal. In that canal or tunnel is the spinal cord and spinal nerves. Spinal stenosis signifies that the spinal canal has narrowed and is pressing on the spinal cord or spinal nerves. That, in turn, produces back pain that can spread to the buttocks, the back of the thighs or the lower leg. The pain worsens on standing or waking, and goes away when the person sits.

Aging is the most important factor in developing spinal stenosis. Back ligaments, which hold the backbones in place, thicken and calcify. Arthritic changes in the backbones sprout bone spurs that impinge on the canal. Back discs – the spongy shock absorbers between adjacent backbones – degenerate and crumble, and that narrows the canal and exerts pressure on the spine and spinal nerves.

Nonsurgical treatment employs physical therapy to strengthen and stretch back muscles in an attempt to relieve pressure on the spine and its nerves. Anti-inflammatory medicines like your Aleve control pain. You might need stronger pain medicines. Epidural injections of cortisone ease inflammation and give the spinal canal and spinal nerves more room. “Epidural” means the injection is made into a space in the spinal canal above its covering membrane. Surgery is a solution when these measures fail.

The pamphlet on back pain discusses the many conditions that lead to one of medicine’s biggest problems. It describes different conditions and their treatments. To obtain a copy, write to: Dr. Donohue – No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My doctor told me I had a lacunar stroke. I had a brain scan for headaches, and that was the only thing found. Is this the cause of my headaches? I have no signs of a stroke. I can talk, walk and use my arms well. Please explain. – B.B.

ANSWER: “Lacunar” (luh-CUE-nur) is a Latin word meaning “small hole.” Lacunar strokes are tiny, empty gaps seen on a brain scan. They represent a blockage in a small brain artery, and the gaps are areas where brain tissue died. In some, like you, lacunar strokes produce no signs or symptoms. Or they might cause a bit of weakness or numbness on one side of the body, or a little clumsiness in using the hands, arms or legs.

Frequently, lacunar strokes are associated with high blood pressure. The major emphasis in people with such strokes is blood pressure control.

You have to do all the other things good for optimum circulation — lower cholesterol, reduce weight, increase physical activity, limit alcohol intake and go easy on salt.

Speak with your doctor to see if he or she wants you to take a small dose of daily aspirin.

The lacunar stroke is unlikely to be the cause your headaches.

DEAR DR. DONOHUE: What’s the purpose of ear wax? I seem to produce tons of it. I can’t find an answer to this question, so I thought I would write to you. – C.N.

ANSWER: Ear wax keeps the ear canal moist. Without it, the canal’s lining dries up and itches. It also traps foreign debris, including bacteria, viruses and fungi that find their way into the ear canal.

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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