Sciatica: Big Nerve Can Be Big Problem


DEAR DR. DONOHUE: I am a 78-year-old woman, and five months ago I came down with sciatica in my left leg underneath the buttock. It’s very painful. I’d like to know if there is something that can be done. — S.M.

ANSWER: The sciatic (sigh-ATTIC) nerve is the body’s longest and largest nerve. It springs from nerve rootlets that emerge from the spinal cord in the lower back. Those rootlets intertwine to form this big nerve. It travels from the back, through the buttocks and down the leg to the foot. Anything that presses on or irritates the nerve in its long course gives rise to sciatica (sigh-ATTIC-uh), painful inflammation of the nerve.

A bulging back disk can press on the nerve. Arthritic spurs on the spine are another source of irritation. A collapse of a backbone from osteoporosis is another trigger for pain, and the pain can be in the lower back, the buttocks or down the leg to the foot.

Have you tried Tylenol (acetaminophen) for pain relief? Aleve, Advil, Motrin and the many other nonsteroidal anti-inflammatory drugs dull pain and quiet inflammation. Icing the painful back area for 10 to 15 minutes three times a day is another way to numb pain. If ice doesn’t work, turn to heat — hot compresses or a heating pad.

Stretching the back might take pressure off the nerve. Sit on a firm chair with feet on the floor and knees shoulder-width apart. Turn slightly to the left. Then, with your right arm dangling down between the knees and left arm dangling down on the outside of the left knee, bend down to the floor as far as you can and hold that position for five seconds. Straighten up and reverse the process by turning to your right and arranging your arms with the right arm outside the right knee and the left arm between the knees. If this exercise hurts, stop. If it doesn’t, perform five bends each, to the right and then to the left. Do the exercise three times a day.

Five months is a long time to put up with back pain. I’m not sure if self-treatment will do much for you. You need a doctor’s intervention, along with physical therapy.

The booklet on back pain delves more deeply into its causes and treatments. To order a copy, write: Dr. Donohue — No. 303W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Some time ago, you answered a letter from an 80-year-old lady who asked if she still needed to have mammograms. I say an unqualified yes. Two years ago, at the age of 82 1/2, my mammogram detected cancer. Surgery was followed by radiation. Two years later, I am feeling fine and doing well. — A.S.

ANSWER: Experts argue about the value of mammograms late in life. Stories like yours make me side with those who promote having mammograms as long as a woman is in reasonable health. If a woman has an estimate of living at least four more years, mammograms are a good idea.

DEAR DR. DONOHUE: I haven’t seen an article about vaginal yeast infections. The doctor gave me an oral antiyeast medicine for it and a cream to apply. In addition, he gave me something to stop the itching. It seemed worse after the treatment, so the doctor gave me five more days of the oral medicine. What would you suggest if it comes back again? Could it be something I am eating or taking? — N.F.

ANSWER: Candida is the name of the yeast responsible for vaginal infections. Itching is a prominent sign. The vaginal lining also often is irritated and painful. Intercourse can be uncomfortable. White patches adhere to the vaginal lining, and there may be a white discharge. Close to 75 percent of all women will experience at least one Candida infection during their life. It has nothing to do with what you eat or take.

Somewhere between 20 percent and 50 percent of women harbor this yeast in their vagina but don’t have any symptoms of it. If these women are put on an antibiotic for an unrelated infection, the vaginal bacteria that keep the population of Candida at small numbers die off. Without those good bacteria, the Candida yeasts reproduce at a rapid rate and lead to symptoms.

You were put on a standard treatment for Candida. Those treatments are antiyeast medicines that come as ointments, creams or vaginal suppositories. There are many of them. The oral antiyeast fluconazole (Diflucan) is another approved treatment.

Recurrence of this infection is common and hard to abolish. If it happens, longer treatment with vaginal antiyeast medicines coupled with a weekly dose of oral Diflucan for six months is a reasonable action. If that fails, referral to a center that has the capability to check Candida’s sensitivity to antiyeast medication can end the problem. Unproven but popular ways of attacking this infection include eating yogurt with live lactobacillus in it to repopulate the vagina’s normal bacterial population. Another unproven approach is to treat the male partner. It hasn’t been shown that such an approach works, but some experts resort to it.

Vaginal infections are discussed at length in the booklet on that topic. To obtain a copy, write: Dr. Donohue — No. 1203W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: What can you tell me about hypothyroidism? Does taking iodine help? I hear that taking thyroid hormone is a lifetime commitment. — C.N.

ANSWER: Hypothyroidism is a thyroid gland that’s putting out way too little thyroid hormone. All body processes slow. People become weak and are exhausted. They’re cold when others are pleasantly warm. They gain weight without overeating. Their skin dries. The face becomes puffy. The heart beats slowly.

Worldwide, iodine deficiency is the main cause of a sluggish thyroid gland. It is not in North America. Here, the main cause is an attack on the gland by the immune system.

The appropriate treatment is supplying the hormone in pill form. It usually is a lifelong treatment, but it’s not an onerous one. It’s taking only one pill a day.

DEAR DR. DONOHUE: My husband is very nearsighted and has to wear thick glasses. I’m not. I don’t wear glasses at age 50. We have four children. What are their chances of having to wear glasses? — E.P.

ANSWER: Nearsightedness (myopia) indicates that the eyes can see things that are near. Nearsighted eyes don’t see distant objects clearly. It’s a common eye condition, and genetic involvement in it is high.

If one parent is nearsighted, the children have a 24 percent chance of also being nearsighted. If both parents are nearsighted, the children’s risk increases to 48 percent.

If neither parent is affected, the children have an 8 percent chance of developing nearsightedness. Factors other than genes have to be at work. (Don’t believe these percentages with unquestioning acceptance. I don’t.)

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.


Use the comment form below to begin a discussion about this content.

Requires free registration

Posting comments requires a free account and verification.