Save surgery till the last for back pain
DEAR DR. DONOHUE: I would like to know more about low backache, especially the kind due to a disk that deteriorates at older ages. I am 76. Is there anything I can take, other than Advil? Should I have an operation if the pain gets worse? — D.E.
ANSWER: Disks are round shock absorbers placed between neighboring backbones. They cushion the many jolts the backbones get on a daily basis from bending, lifting and twisting. With age, disks might flatten out and lose their shock-absorbing properties (degenerated disk). Or the inner gel of a disk can protrude through the outer disk rim and press on a spinal nerve to cause pain (a herniated disk). Only rarely does either of these conditions call for surgery.
Applying heat or cold to the back often lessens pain. You have to experiment to see which works better for you. Start out with heat. Tylenol, when used exactly as directed, is a good pain reliever. It has fewer side effects than do anti-inflammatory medicines like Advil. Those medicines can lead to ulcers. Sleep on your side with a pillow between your knees, another strategy to protect your back. Massage can be helpful. Physical therapy, where a trained therapist directs an exercise program, is another way to put an end to back pain.
If you want to try an anti-inflammatory medicine, you might find that applying Voltaren topical gel to the back or wearing a Flector skin patch works as well as oral anti-inflammatory medicines. Since these two are not taken by mouth, they lessen the chance of irritating the stomach.
Disk problems are only one cause of back pain. Arthritis, fractures of backbones weakened by osteoporosis and narrowing of the spinal canal are other conditions that produce similar pain. You should get an exact diagnosis from your family doctor before trying any treatment.
Surgery is often the last resort.
The booklet on back pain discusses this common problem 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: I have been a vegetarian since I was 24. My father died of a heart attack at age 50, and his brother, my uncle, died of one when he was 47. I don’t have good genes, and that’s what prompted me to go off meat and dairy products. I would like your opinion about eliminating fat altogether. I am scared of having a heart attack too. — B.C.
ANSWER: With such a family history, you’re not overreacting by minimizing as many risks for heart disease as you can. A vegetarian diet is a healthy diet. You have to make sure you’re getting enough B-12, a vitamin found only in meat, milk and some fortified foods. And you have to be careful about not becoming deficient in iron and calcium. I don’t know how strict a vegetarian you are.
Fat isn’t a terrible thing. It provides a lot of our energy. One gram of fat yields nine calories, whereas 1 gram of protein or carbohydrate has only four calories. Fat insulates us and preserves body heat. It aids in the absorption of vitamins A, D, E and K.
A healthy diet obtains 30 percent of its daily calories from fat. You can decrease that amount to 20 percent, but don’t entirely abstain from all fats.
DEAR DR. DONOHUE: Please help. I have a neighbor who rants about chlorine in the water. He says it’s a poison and causes cancer. Are there any grounds for concern in this? He has a bunch of other weird ideas, so I don’t know if this is a real worry or not. — J.J.
ANSWER: It’s not a real worry.
Chlorine added to drinking water has prevented epidemics of infectious diseases. It’s such a simple solution, and it probably has saved as many lives as any other preventive-medicine measure.
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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