Most back pain resolves on its own
DEAR DR. DONOHUE: I am a 78-year-old, semiretired man. I am very active and look a lot younger. I work part-time as a truck driver delivering auto parts to garages. Now I am out of work because of pain in my lower back. The pain runs down to my foot. I have been diagnosed with sciatica. My doctor sent me for an MRI, and it showed a bulging disk. What is the best remedy? I use ice packs, heating packs and hot packs. I am on crutches to take pressure off my leg. Would surgery help? — J.S.
ANSWER: Back pain is one of the leading problems that send people to doctors. Most cases of back pain go away on their own, even if they’re due to things like a bulging (also called herniated or ruptured) disk. Even though your back hurts, you can be as active as your pain allows. Don’t sit for prolonged periods; sitting puts more pressure on your back than does standing or walking. Sleep on your side with a pillow between your knees. Continue with heat, cold or alternating heat and cold, whichever gives you the most pain relief. Tylenol or a nonsteroidal anti-inflammatory medicine (Aleve, Advil, Motrin, etc.) can make you more comfortable.
If the pain doesn’t let up in six weeks, you have chronic back pain. Sciatica is pain that travels from the back down the leg to the foot. It comes from pressure on the sciatic nerve. In your case, the pressure most likely comes from your bulging back disk. Back disks are cartilage pads placed between adjacent backbones to absorb the shock those bones take from our walking, bending and pushing. The disk has a tough outer ring. Gelatinous material makes up the inner core. If there’s a break in the outer ring, the inner core pushes through — a bulging, herniated or ruptured disk, whichever term you want to use.
If sciatica doesn’t resolve on its own, a doctor can inject the back with cortisone to reduce inflammation. That can relieve pressure on the sciatic nerve. The procedure is called an epidural.
Surgeons, aided by a microscope, can remove the bulge through small incisions, about an inch long. This technique is called a microdiskectomy and usually is quite successful.
The booklet on back problems covers this topic in detail. Readers can obtain 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 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: My 18-year-old African-American grandson has had a consistently low white blood cell count (from 3,100 to 4,100). He is monitored by a hematologist on a regular basis. He has no symptoms. What is the significance of his low count? — J.F.
ANSWER: White blood cells are the body’s warriors against infection. One type battles invaders in hand-to-hand combat. Another kind makes antibodies, ammunition against germs. The other three kinds of white blood cells are support troops with less direct influence on the body’s defenses.
The normal white blood cell count is 4,300 to 10,800. While your grandson’s count is lower than normal, it isn’t dangerously low. Proof of that is the fact that he hasn’t had repeated or serious infections. His hematologist has looked for the various causes of a depressed count — autoimmune illnesses, bone marrow failure, an overactive spleen and vitamin deficiencies — and found none. A significant number of people carry a lower count and never suffer a single symptom from it. Some African-Americans have a count that’s lower than normal, and that seems to be nothing more than an ethnic trait. For the present, nothing needs to be done. Your grandson is healthy in spite of his reduced white blood cell numbers.
DEAR DR. DONOHUE: What is a double pulmonary embolus? My grandnephew passed away from it; so did my brother, who died 36 years ago — Anon.
ANSWER: A pulmonary embolus is a piece of a leg blood clot that was carried to the lung in the blood. Large pieces can be lethal. A double embolus indicates a clot to both lungs. With a family history such as yours, a clotting problem might be suspected. The doctors probably looked for it in your nephew. Thirty-six years ago, they wouldn’t have suspected it in your brother.
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.