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QUESTION: Aren’t the two terms “lumbago” and “sciatica” one and the same
thing? It seems to me I have heard them both used to refer to the condition
of a bad back even by physicians
Maybe it is just calculated to confuse the
patient, but I want to know.

ANSWER: Here is the information you requested
No, they are not the same.
Lumbago, from the Latin word “lumbus” or loin, may refer to any pain in the
lower back, usually of muscular origin, but applicable to arthritic or bony
pain as well
Sciatica or sciatic pain is caused by a compression on the
sciatic nerve which runs from the low back, across the buttocks, the back of
the thigh, into the leg, calf and foot
The pressure on the nerve may be
caused by bony changes in the vertebrae, or from the bulging of cartilage that
occurs with a “slipped disc” (intervertebral disc)
The treatment in lumbago
is to reduce the spasm or pain in the muscles, and in sciatica, to reduce or
remove the pressure on the sciatic nerve
Frequently heat and analgesics are
used in both cases, which may be the origin of the confusion, for I am unaware
of the use of this term, or any other, just to confuse patients.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: We have received mail from a cousin who will soon be undergoing a
marrow transplant
As a member of the family is it possible that our marrow
would be useful? How is the marrow obtained and what is the process used for
transplantation? Is this safe for both the donor and the patient? Please
help us with the information we need to be of help.

ANSWER: Although you did not mention your exact relationship with the
patient, nor his disease, I think it is pretty safe to state that you would
not be any more likely to be a potential donor than someone not related to
him
The marrow, which contains all of the primary or stem cells that divide
and produce all the cellular elements of the blood and the immune cells as
well, must be carefully matched to the patients immunologic type
An
identical twin would be best (syngeneic transplant) but a brother or sister
might serve, or any individual who is tissue type compatible (allogenic)
In
some cases, marrow can be removed from the patient (autologous) before
treatment by irradiation or high intensity chemotherapy, and replanted after
the therapy is completed
The marrow is obtained from the donor under strict
sterile conditions, after the donor has been placed under a general
anesthesia
The marrow is sucked (aspirated) from the marrow of the pelvic
bones, and placed in a tissue culture media, treated to prevent coagulation.
It is then given to the patient through an intravenous infusion directly
following collection
There are few risks for the donor, primarily those
associated with the anesthesia
Patients who are to receive this transplant
must be treated in advance to reduce their own immunity system, which could
reject the transplant and render the whole procedure useless
It takes time
for the transplant to grow and produce enough cells to take over all the
needed functions
Patients may have to remain hospitalized for as much as 3
to 12 months after transplantation, guarded closely against infections which
would have dire consequences as they can spread uncontrolled through the
system that lacks of a functioning immune system
The technique, known and
used for some thirty years, is not without difficulties, and expensive; but it
may provide the only hope in some otherwise fatal diseases.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: My mother, who is 69 years old, now suffers from Meniere’s Disease.
She also has a constant ringing in one ear
Her attacks are not very severe,
but she is now hesitates to leave the house fearing an attack while she is
out
What can be done to help her?

ANSWER: Meniere’s Disease can provoke serious attacks of vertigo that are
associated with nausea and vomiting which are completely unpredictable
They
appear quite suddenly, may last from just a few hours up to 24 hours, and then
gradually ease off
Tinnitus, which is a ringing in the ear, may be constant,
although in some patients it too comes and goes, and usually affects but one
ear
The hearing in this ear also can come and go, but over a period of time
tends to become increasingly impaired
In from 10 to 15 percent of the
patients with Meniere’s both ears are affected
Although known since Meniere
first described the condition in 1861, the cause of the disease is still
unknown, and other than it affects the inner ear apparatus (vestibular
system), its mechanisms are poorly understood
There is no absolute treatment
but a number of possibilities to diminish both the severity and frequency of
attacks do exist
Anticholinergic medications, atropine or scopolamine are
useful to diminish the symptoms associated with the stomach, and
antihistamines act to sedate the inner ear
General sedation using
barbiturates is of some help
Diazepam may also be used to reduce the misery
of severe vertigo attacks and also acts by sedating the inner ear apparatus.
Your mother should be encouraged to maintain her life activities accompanied
by a friend who knows about and understands her condition, and can assist if
an attack should occur.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: Although I try to maintain a regular exercise program, I am plagued
by muscle cramps
They come at frequent but unpredictable times, and can
certainly mess up my scheduled work outs
What causes these cramps, and do
you have any advise for treating them?

ANSWER: Muscle cramps, sometimes called spasms, can bother even the most fit
of athletes, and the causes are varied, and in many cases not at all well
understood
Some of the possibilities include low sugar in the blood, poor
conditioning, pushing to hard (overexertion), and an imbalance in the level of
electrolytes in the blood (sodium, potassium and chlorides among others).
Fatigue may also be a contributing factor, and most authorities agree that
fluid loss and dehydration is an important element in the physiology of muscle
cramps
While it is impossible to drink enough during active competition,
small sips of water can be of great help in both preventing and overcoming
muscle spasms
The most common treatment consists of stretching the affected
muscle and holding that position until the cramp subsides
Some sports
medicine consultants also apply pressure to the relaxed muscle to overcome a
spasm, a bit like acupressure
Recently, eating bananas to supply potassium
has become a favorite of some professionals.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I have had multiple sclerosis for some time year and am doing quite
well
I try to learn as much about my condition as I can
While I have been
told that the cause is still unknown, certainly there must be more information
about the disease than that
Can you please fill me in with some of the
results of your own study of this disease?

ANSWER: As you must already know, multiple sclerosis (MS) is a slowly
progressive disease of the central nervous system, known as a “demyelinating”
disease
“Myelin” is the material that forms a sheath or covering around the
nerves and acts as an electrical insulator would, to help maintain the flow of
current within the nerve
In MS this substance is gradually destroyed,
preventing the nerves from doing their work and producing many varied
neurological symptoms and signs which wax and wain as the disease progresses
through remissions and exacerbations
MS is the most common of these
demyelinating diseases, with about 8,800 new cases reported each year
It
affects women a bit more frequently than men, and occurs in the temperate
zones of the world
In fact the greater your latitude, North or South, the
greater the possibility of developing MS, with high risk areas including the
United States, Canada, Great Britain, and the Scandinavian countries in the
northern hemisphere, while in the southern hemisphere the greatest number of
cases are found in New Zealand and Tasmania
Asia is almost completely free
of the disease, and no definite cases have been seen in Black Africans.
According to some investigators, these environmental factors are at work up
until the age of 15 years, and that moving from a high risk area to a low risk
part of the globe before that age will reduce the chances of it developing.
This is certainly not the whole story, as increased incidence in certain
families points to possible genetic factors, and the possibility of viral
infections playing a role must also be considered, as well as altered immune
responses
The disease shows its first signs in adults in the age range of 20
to 40 and may continue over a period of more than 25 years
While no specific
treatment exists, prednisone is often used to help combat symptoms
All
patients are counseled to maintain an active life style while avoiding
overwork and fatigue.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: While your recent answer about mitral valve prolapse (MVP) was
informative and for the most part correct, you failed to mention the need to
take antibiotics before dental work
My cardiologist is always warning me
about this, and I think your readers should also be informed of the dangers.
Please include this information in your column soon.

ANSWER: Thank you for your suggestion and your concern
And you certainly
make a good point
The American Heart Association does suggest that
antibiotics be given to all individuals with mitral regurgitation or leakage
around the mitral valve before even minor surgery, including dental work
In
about 95 percent of people who have some sort of dental treatments, bacteria
will enter the blood stream for at least a short time
However, individuals
with normal heart valves and normal immune systems are able to combat this
invasion, and no serious illnesses develop
People with faulty valves are
less able to resist, and antibiotics are given
A recent article in the
Journal of the American Medical Association concludes that people over the age
of 60 were four times less likely to be advised to take these antibiotics by
their physicians than younger patients
This could be due to the fact that
the number of patients with MVP becomes less as patients are older, or that
elderly people just don’t receive preventive measures as often as younger
folks
There is still some controversy about the need for this intervention,
as even the chance of infection among high risk patients is relatively low,
and data to support the recommendations is limited
However, if you know you
have MVP and are about to undergo dental work, a little hint to your physician
requesting an appropriate antibiotic seems in order.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: I read your columns regularly, and now desire some information for
myself
I have Non-Hodgkins Lymphoma
Maybe someday you can discuss this
disease in your column
What is it, medications and cures?

ANSWER: Well let’s make “someday”

today
Non-Hodgkins Lymphomas (NHL)
are a group of diseases that affect the lymphoid cells, causing growths that
spread throughout the body
Hodgkin’s Disease arises in a class of cells
from the monocyte-histocyte series and is diagnosed by the presence
of large cells with many nuclei (Reed-Sternberg cells)
NHL springs from T
cells (thymus derived) or B cells (bone marrow derived)
NDL, with 7000
to 8000 new cases diagnosed each year in the United States, is much more
common than Hodgkin’s, which accounts for 5000 to 6000 new cases each
year
It strikes all age groups and is thought to be caused by viral
infection
Another risk factor that is present in many is an impaired
immunity system, either inherited or acquired as in AIDS
Most of the
lymphomas seen in AIDS patients are of the B cell type
While symptoms may
vary from patient to patient, enlarged lymph glands in the neck or groin are
common
Weight loss, fever, night sweats and weakness indicates that the
disease has spread throughout the body
A positive diagnosis depends upon
obtaining a tissue specimen (biopsy) and examining the cells under the
microscope
This also allows the pathologist to classify the state of
progression of the disease and its specific cell type, which are important
considerations in planning the therapy and treatment
Lymphomas may also be
classified according to their cell types by using antibodies that can
recognize and tell T cells from B cells
Various types of X-rays, including
CT scans, are used to establish the extent of the disease, and rarely
exploratory surgery (laparotomy) is needed to determine the spread of the
tumors to spleen and abdominal lymph nodes
This process is known as
Classification and Staging
Once the nature of the disease has been
determined, the treatment can consist of one of more drugs (chemotherapy) with
or without the use of radiation therapy
Modern cancer therapy has achieved
its greatest results in the fields of leukemia and lymphoma, and there is a
wide range of medications available that have been shown to be effective in
these conditions
Some of these are cyclophosphamide, vincristine,
prednisone, adriamycin and others used in combinations with strange names like
CHOP and MOPP
Complete remission may be seen in from 60 to 80 percent of
patients, cures can run to 50 percent depending upon the state of the disease
at initial treatment
Because of the nature of the disease, these figures may
only be considered as generalizations, and your case may differ
There is
even more hope on the horizon with a wide range of new treatments already
being investigated, or to begin soon
Being considered are monoclonal
antibodies, lymphokines, interferons and growth factors
With improved
techniques developing in bone marrow preservation, intensive treatment
programs that replace bone marrow after high dose chemotherapy is under
investigation for selected patients who do not respond to standard treatment
programs
The marrow can be obtained from the patient before treatment or
from a matched donor such as a brother or sister
With this much already
accomplished, and all the new prospects on the horizons, it is not
unreasonable to provide you with a positive report rather than a gloomy
outlook.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: Can you list for me the causes of infertility in women? I know
that there are many, and that they may frequently be cured, but what type of
doctor should I consult for treatment?

ANSWER: You are correct, there are many situations that can disrupt the
delicate mechanism that provides for reproduction
To begin, any disease or
process that interferes with the production of eggs (ovulation) must be
considered
If the tubes (Fallopian) that lead to the uterus are blocked by
infection, malformations or scars, the egg is unable to reach the uterus.
Endometriosis ranks high as a cause of infertility, as does any disease that
changes the shape of the uterus
Fibromas, myomas, and congenital
malformation may be the cause of such changes in uterine configuration
If
the production of the cervical mucous is abnormal, fertilization is hampered
and impaired
The type of abnormality causing the problem pretty well
dictates the kind of physician who may be able to help you
If hormonal
problems are the primary cause, a gynecologic endocrinologist may be of help,
while it takes surgical skills to repair a damaged Fallopian tube or remove a
tumor from the uterus
If you initiate the search for the cause of your
problem with your regular family physician, the referral problem will easily
be resolved as the cause of the infertility becomes clear.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: Our adolescent son has taken to retiring to his room and spending
much time alone
He also has begun to act funny, spaced out, and finally over
my protests, his father searched his rooms for drugs
All we found were some
gray tubes that look like the ones used to put bubbles in water, for making
sodas
Does this mean anything? We are desperate for some information and
hope you will help us.

ANSWER: You were right in seeking answers for unusual behavior by searching
the room of your son
Forget the guilt feelings, as you have found an
important clue that may help you counsel your son, and indeed, may save his
life
You have discovered cylinders of nitrous oxide, or Whippets, which are
used by many adolescents to gain a high
This gas has a legitimate use as a
pre-ignition booster in auto racing, or as a propellant for whipping cream,
but is also frequently abused to provide a quick “hit”, by inhaling the gas
either directly from the cylinder or from a balloon which has been inflated
with the nitrous oxide
The intoxication can generate a feeling of
exhilaration, lightheadedness and hallucinations
The abuser’s senses become
distorted, gradually become lost and with continued inhalation, a loss of
consciousness may occur
The high rapidly disappears as normal room air or
oxygen is breathed, but prolonged exposure to the gas can result in coma,
seizures and even death
When this gas is used, many of the skills and senses
needed for safe driving become impaired, accidents can occur with the real
cause going undetected
In the long run both the bone marrow and nervous
system can become affected
Your course of action is clear
You must
confront your son with your find, in a considerate and nondamning fashion,
offering him professional guidance rather than recriminations
Inhalant abuse
is serious and dangerous, and you must act accordingly
You took a courageous
first step; now follow through, in the best interests of your son and family.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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QUESTION: After feeling listless for some time, and tired of being told how
pale I looked, a visit to the doctor revealed an anemia due to blood loss
during my monthlies
I have a prescription for iron pills, but wonder if this
is enough medicine? Can you please comment?

ANSWER: It certainly will do the job, if the diagnosis is correct, and I have
no reason to doubt a finding of iron deficiency anemia in a woman with
excessive blood loss during her periods
In fact that is the most common
cause of this finding
In men and postmenopausal women, the most common cause
is bleeding in the stomach and intestines
A complete blood count, including
hemoglobin testing and blood smears, coupled with a test for blood in the
stool is usually sufficient to make a diagnosis, although additional tests may
be necessary in some cases
Capsules of ferrous sulphate should be enough to
replenish your iron stores in about three to four months, but your hemoglobin
will be close to normal before that, and your listlessness will disappear
It
will be necessary for a few more blood tests to be taken as you continue your
medication, as the results obtained will mark your progress and prove that the
iron preparation you have been given is being properly absorbed by your body.

The material contained here is “FOR INFORMATION ONLY” and should not replace
the counsel and advice of your personal physician
Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.

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