Dr. Donohue: Sciatica -- a pain in the back and often the leg

Syndicated Columnist
Published Tuesday, October 26, 2004

DEAR DR. DONOHUE: Just what is sciatica? I have it. I have back pain, and the pain runs down my right leg. How long can I expect that this is going to last? Will I need surgery? -- P.P.

ANSWER: Nerve roots from the spinal cord in the lower back intermingle to form the body's largest nerve, the sciatic nerve. It runs from the back to the foot. Irritation or compression of the nerve, anywhere from its origin to its final destination, can bring on pain. That might also bring on numbness and muscle weakness.

In younger people, the most common cause of sciatica is a bulging, or herniated, back disk that presses on the nerve. Disks with the thickness of a medium-sized hamburger are located between adjacent backbones to give the back flexibility and to absorb the pounding the back takes day in and day out. The inner core of each disk is a gelatinous material. That's the stuff that can protrude through the disk's wall and press on nerve roots. One clue of disk involvement is back pain that worsens upon prolonged sitting.

In older people, a narrowing of the spinal canal -- spinal stenosis -- is a common cause of sciatica. Arthritic changes and bone spurs are two components that narrow the spinal canal. The narrowed canal squeezes nerve roots and produces pain. Spinal-stenosis-caused sciatic pain, unlike the pain from a herniated disk, usually gets worse from walking or prolonged standing.

The pain should run its course in four weeks. If it lasts longer, then a search for dangerous causes of sciatic-like pain must be made. Those conditions include cancer that has spread to the back, back infections, bulges of the aorta and osteoporosis.

Rarely is surgery needed. A physiatrist -- pronounced fizz-EYE-uh-tryst (not a psychiatrist) -- is a specialist who can analyze an individual's particular needs and devise a back exercise and rehabilitation program that can get a person back into action sooner and keep a second attack from occurring.

The back booklet addresses many back problems and how to cope with them. 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 $4.50 U.S./$6.50 Can. with the recipient's printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I want to stop smoking, but I live in mortal fear of the weight I know I will gain when I stop. Why does this happen? Does it always happen? What can be done to prevent it? -- T.C.

ANSWER: There is no end to the explanations offered about the reasons for weight gain that comes when people stop smoking.

One goes like this. Nicotine revs metabolism. The revved-up metabolism burns calories. When a person stops smoking, metabolism slows, fewer calories are burned, and weight is gained.

A second explanation has it that nicotine is an appetite suppressant. People who stop, therefore, find themselves munching more frequently.

Both theories are based on calorie increase.

Six pounds is the average weight gain for people when they stop smoking. Weight gain does not happen to all. Even when it does happen, six pounds is a trifle compared with the health benefits that come from abstinence from cigarettes.

How to prevent the weight gain? A little bit of exercise is a sure bet to keep the pounds off.

DEAR DR. DONOHUE: I would appreciate any information you can give me on a dermoid cyst. My daughter, who is 46 years old, has been told she has one. She is checked regularly to make sure it has not grown. -- I.S.

ANSWER: Dermoid cysts are cysts containing hair, teeth, bones and calcium -- all or some of these. Usually they are found on the ovary. Only a very small number ever transform into cancer. Checking the size of a dermoid cyst is an acceptable way to follow it. Why they form is an unanswered question.

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(c) 2004 North America Syndicate Inc.

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