Sciatica: Big trouble in a large nerve


Editor’s note: Dr. Paul Donohue’s column, long a popular feature in the Sarasota Herald-Tribune, now has an online home, as well. Check out the medical questions and answers Mondays through Fridays on Health + Fitness. CLICK HERE TO READ MORE DR. DONOHUE COLUMNS.

DEAR DR. DONOHUE: I have sciatica. What can be done for it? I hurt from hip to toes. I am a 75-year-old male. -- B.S.

Dr. Donohue

ANSWER: Sciatica (sigh-AT-ik-uh) is trouble in the sciatic nerve, the body's largest nerve, which is composed of roots springing from the spinal cord in the lower back. The roots twist together to form a single nerve that travels from the lower back through the buttock and hip down the back and side of the leg to the foot. Any pressure on the nerve in its long journey irritates the nerve and leads to discomfort and pain.

In many instances, the trouble lies with one of the back's discs, the shock-absorbing, pancake-like disks placed between adjacent backbones. A bulging disk (also called a herniated disk or a ruptured disk) presses on the nerve and causes the painful sensations you feel. Other variations and locations of the site of pressure exist.

No magic potion relieves sciatica. Treatment often sounds banal. Don't stay inactive for more than one day. Walking is something that most can do; start walking within a day of the onset of pain. Tylenol often can diminish pain so the pain becomes tolerable. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Aleve and Advil also are useful. Muscle relaxants, Flexeril and Soma are two examples, can alleviate pain when used in conjunction with an NSAID. Cold compresses, applied to the area of most pain for 20 minutes, three times a day, bring relief. It numbs the nerve. If that doesn't work, try heat. It decreases muscle spasms. You have to experiment to see which works better for you.

A good number of people feel much better in one month, and by three months 70 percent are their old selves.

If pain is unrelenting, prolonged and severe, then consideration has to be given to surgical correction of sciatica.

DEAR DR. DONOHUE: Please explain the difference between dementia, Alzheimer's disease and senility. -- J.P.

ANSWER: "Dementia" is a word that covers many illnesses. It's a catchall word that describes the loss of many brain functions. Memory is one of those functions. So are the abilities to calculate, make plans, hold intelligent conversations and react normally to both old and new situations. In its final stages, dementia robs a person of the basic ability to perform the ordinary chores of daily life, like feeding oneself and dressing.

Alzheimer's disease is the most prevalent form of dementia. About half or more of all dementia patients have this illness.

Other dementing illnesses include dementia with Lewy bodies, frontotemporal dementia, multi-infarct dementia, Creutzfeldt-Jakob disease and progressive supranuclear palsy. All have the features I mentioned in addition to features that are unique to each one of these illnesses.

Senility isn't used these days as a diagnosis. In former years, before the more precise nature of dementia varieties became understood, "senility" (the mental decline that often comes with age) was the word used for all older people whose thinking had become clouded. Now it has been supplanted with these more specific illnesses of brain decline.

DEAR DR. DONOHUE: I am trying to prepare healthy foods for my family. I've started to cut back on the amount of red meat that we eat. Is pork considered a red meat? It looks white to me. -- A.S.

ANSWER: What makes red meat red is the amount of myoglobin it contains. Myoglobin is a substance that holds onto oxygen so muscles can perform without tiring.

Pork has more myoglobin than poultry or fish. It is classified as a red meat by the Food and Drug Administration.

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Dr. Donohue

Dr. Paul Donohue writes a daily column titled "To Your Health" that is syndicated to more than 175 newspapers. The question-and-answer series is one of the oldest health columns in the North America, having first appeared in the 50s. Dr. Donohue took over the series nearly 20 years ago. Dr. Donohue is board-certified in his primary specialty, internal medicine, the specialty that emphasizes diagnosis and non-surgical treatment of illnesses. He also is board-certified in the subspecialty of infectious diseases. He graduated from the University of Michigan Medical School in Ann Arbor, Michigan. He has a master's degree in public health from Tulane University in New Orleans and did advanced work on infectious diseases at the University of California, Davis. After completing medical school, he served two years in the Army Medical Corps and 18 months as battalion surgeon in the 173rd Airborne Brigade-for which he was awarded two Bronze Stars, one of which was for valor during combat. Write to Dr. Paul Donohue at P.O. Box 536475, Orlando, FL 32853-6475.
Last modified: June 30, 2012