CONSERVATIVE TREATMENT: INJECTION THERAPY
Injection therapy-In some cases, pain can be relieved by injecting pain-relieving drugs directly into the area of the spine where the pain appears to be localised. It can be effective for treating ‘trigger points’ (fibrositis), small, very painful nodules of muscle and/or fibrous tissue often in the buttocks, neck and shoulders, tension or pressure on which often spreads the pain over a wider area.
A corticosteroid drug may be injected, together with a local anaesthetic to limit the inflammatory process. The relief may not be immediate, or long-lasting, and a number of injections may be required for the treatment to be effective.
Epidural injections have been are used for pain which has not yielded to any other methods. These injections are given into the epidural space between the dural tube and the spinal canal, at the lower end of the sacrum. They consist of a corticosteroid drug mixed with a local anaesthetic. This numbs the tube, and reduces inflammation, such as that set up by a prolapsed disc. The injection cannot put right the prolapse itself, but in most cases time is the best healer for this, and epidural injections, like other pain-relieving measures, make the period of waiting seem less interminable.
Much backache arises from the facet joints. Pain originating in facet joints can radiate down the leg and mimic sciatica. In some cases, injecting steroids and a local anaesthetic into the joint can modify the pain. If relief is only temporary, the nerve to the facet can be destroyed, producing permanent relief. The technique is one which is reserved for experts.
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UNDERSTANDING BACK TROUBLE OTHER BACK PROBLEMS-OSTEOPOROSIS
This is a bone condition associated with growing old, and may affect any bone, not just those of the back. It takes the form of loss of bone material (calcium and minerals), making the bones fracture more easily. The spine tends to shrink in overall length, so that the person becomes shorter. In advanced cases, the affected vertebrae may collapse in a series of crush fractures, so that the sufferer develops a curvature of the spine, becoming round-shouldered. The ‘dowager’s hump’ seen in elderly women may be caused in this way.
There is some association with the sex hormones, because osteoporosis is common in
post-menopausal women and women whose ovaries have been removed. In them, it responds dramatically to treatment with oestrogen-hormone replacement therapy.
Physically active people are less likely to develop osteoporosis. Exercise is thought to have some protective function. Bone loss can be the result of prolonged immobility, and is one reason why doctors discourage patients from staying in bed longer than absolutely necessary. Astronauts spending weeks and months in space beyond the reach of earth’s gravitational pull also suffer bone loss – but this is not yet a common hazard!
The loss of bone is not in itself painful, but there may be pain anywhere in the spine and in the joints between the spine and the ribs, as the spine adapts to its new conformation. Loss of spinal bone leading to crush fractures may lead to trapping of pain-sensitive structures, such as nerve roots.
A related but much less common complaint is osteomalacia, a softening of the bones caused by vitamin D deficiency in adults (in children the result is rickets). It is thought that osteoporosis and osteomalacia may respond to increased calcium and vitamin D in the diet. But this is in no way proven, and people should certainly not dose themselves with calcium supplements – these may even make you ill.
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THE ABDOMINAL MUSCLES
These share the task of keeping the spine upright by exerting a pull down the front of the trunk that counterbalances that exerted by the back muscles. They also help the spine to bend, by pulling the front of the rib cage closer to the pelvis.
Abdominal muscles also control twisting actions between the shoulders and the pelvis – no golfer could do without them – and they are used when pushing, and for holding the posture when leaning backwards. When the body is bent sideways, they share the work with the back muscles on that side.
A muscle called psoas (from the Greek for loin) passes from the lumbar vertebral bodies, round the pelvis, and over each hip joint to the upper end of each thigh-bone. It contracts when you sit up from lying down. When it is active, it pulls on the lumbar vertebrae, compressing the discs.
There is also an indirect mechanism by which the abdominal muscles support the spine. When a weight is being lifted, these muscles, in conjunction with the back muscles and the other muscles forming the abdominal cavity, tighten automatically. This increases the pressure inside the cavity, making it load bearing (in the same way that inflating a balloon makes it able to support a weight), and as the compressed abdomen presses against the spine, it absorbs some of the load on the spine, and helps the back to straighten up.
Weight-lifters deliberately increase their intra-abdominal pressure by wearing a special belt. For ordinary people, it is enough to keep the abdominal muscles in good condition: this is very important for preventing backache.
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ALLERGY: FOOD AND DRINK
The topic of food sensitivity – of allergy or intolerance to food and drink – is probably the most difficult area of this book. Not only is the subject the most controversial and the one which arouses most hostility from sceptics, but it is also the most demanding area to manage if you are trying to discover what upsets you. Futhermore, food sensitivity is one of the most difficult types of allergy or sensitivity to live with. Avoiding certain foods can affect your family life profoundly, particularly if children are involved. It impinges on your social life and your worklife, and engages you frequently on complicated endeavours of organisation and planning.
Working out a diet that suits you can often be a quite straightforward process if you go about it in an orderly fashion. The vast majority of people find that they can solve their problems by avoiding just one or a tiny number of foods – even if it takes them some time to work out which ones.
However, a small handful of people have much more severe problems, discovering that they are sensitive to a wide range of foods. Often such people do not suspect wide-ranging sensitivity before embarking, and only discover it in the process of eliminating and testing foods.
It is best to do any exclusion dieting under medical supervision, because the process of identifying food allergy and intolerance can occasionally be complicated, because some (rare) individuals can become quite ill in the process of sorting out their diet, and because specialist advice on nutritional balance is often necessary. This is especially important if you are working out a diet for a baby or child.
Some doctors, however, are unsympathetic or even hostile to the idea of reactions to food. Many GPs will not consider giving you any help in the process, let alone refer you to someone else who can help. If you meet this reaction from your doctor, remember that it is worth persisting in asking for a referral to a specialist. Your doctor may eventually agree, if only because he or she believes it will exclude food allergy or intolerance as a possible cause of your symptoms. You have also the right to change your doctor without giving a reason and, if you meet with real hostility, it may be necessary to do this. For how to find doctors who specialise in the field.
If, despite all your efforts, you cannot get satisfactory help from a doctor, you may decide to carry through a limited exclusion diet by yourself. If you do so, go gently. You should only exclude foods selectively, rather than go for a comprehensive exclusion diet (see below for full advice), and take your time, rather than to try to identify problem foods quickly. Never go on a fast or a one- or two-food-diet without supervision.
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ALLERGY: FOODS
Opinion among doctors and experts as to the degree of cross-reaction between foods varies widely; you will often encounter differing (sometimes conflicting) advice on which foods cross-react.
Foods, as all living things, are classified biologically into groups and sub-groups according to their inter-relationships. These categories include ‘family’ and ‘sub-family’ groupings. It is argued that cross-reaction is more likely to occur within a food family, and diets may be planned and managed on this basis. If you are on a rotation diet, for instance, you will often be advised to leave an interval of two days or more between eating foods that belong to the same family. This can be quite restrictive.
In practice, the family model is not always helpful. Some families, such as the legume family, which includes peas, beans, pulses and peanuts, are very broad. Some foods within such a family are very distantly related, and cross-reaction can be rare. Sometimes cross-reaction only occurs consistently within sub-families. The grass family includes the wheat sub-family, the corn sub-family, and the rice subfamily, and cross-reaction often occurs within the sub-families, but less commonly between them. If you react to wheat, for example, you are more likely to cross-react to oats, which is part of its sub-family, than to rice, which is related but belongs to a separate sub-family.
Like many aspects of allergy and sensitivity, the cross-reaction of foods can be very confusing, and you will probably have to work out for yourself, with expert guidance, what you tolerate and what causes cross-reaction in you.
The best way to deal with the question of food cross-reaction is probably to adopt a strict and conservative approach initially, when you are first working out what you react to. On an elimination diet (or on a rotation diet, if this is advised), start by being careful about the food families, and then relax gradually in order to find out what you can tolerate. You may not need to observe the families at all eventually. (For full advice on planning diets, a full list of food families.
Some foods contain moulds and can cause cross-reaction. Oils and terpenes in foods can also cause cross-reaction. Some foods cross-react with pollen.
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ALLERGY TO CLEANING PRODUCTS: WHAT CAUSES PROBLEMS?
Certain chemicals in cleaning products often cause sensitivity and allergy. Chlorine, ammonia and phenol are released from common bleaches, disinfectants and cleaners and can cause reactions if inhaled or touched. Fragrances and perfumes are added to virtually all cleaning products, either to add a pleasant fragrance, or as a masking chemical to block strong odours. Many products contain organic solvents, either used directly as cleaning agents, as in stain removers or dry cleaning fluid, or as solvents to carry other chemicals, as in polishes. Natural chemicals are not automatically safer. Some people are sensitive to chemicals, such as pine oil, coconut lemon oil, acetic acid (vinegar) and lavender oil, which are used in some cleaners. Nor are ‘green’ or environmentally safer products necessarily less likely to cause reactions. Most contain perfumes and some contain troublesome natural chemicals.
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ALLERGY BABYCARE: IF YOUR BABY IS TOTALLY BOTTLEFED
If your baby is totally bottiefed, make sure you have taken basic precautions against other things that the baby may be ingesting before you investigate its feed.
If your baby is on a cow’s milk formula feed, the first thing to try is giving smaller, more frequent feeds. This may help babies who are intolerant of lactose, the sugar found in milk, for the reasons explained on page 250 in connection with breastfeeding.
If this does not work, you can try alternative formula milks, with your doctor’s advice. Soya-based milks (e.g. Wysoy, Nutrition Soya) are most people’s first option; these are readily available in chemists’ shops, and are sometimes a good solution for babies sensitive to cow’s milk. Use a soya milk formula for at least a week to see if your baby settles – if he or she is clearly worse straightaway, see your doctor at once – but if the baby has been having colic, diarrhoea, or other gut disturbance, it can take a couple of weeks for these symptoms to clear.
Some babies also start to react to soya formulas, either straightaway or after some time. If this happens, there are other special formula milks that you can try. These are available on a doctor’s prescription. One type is based on chicken, highly processed to make it digestible (e.g. Chix). Another type is called hydrolysed formula, and is based on cow’s milk and corn, treated with digestive enzymes in order to break down and pre-digest allergens. Examples of these are Pregestimil and Nutramigin. These are sometimes tolerated by even highly allergic babies.
If you have a lot of problems with bottle-feeding, it is worth working your way through these alternative formulas, as one may suit where others do not. Each time you try a new one, give it a week to show effects if you can, unless the baby reacts strongly against it early on. Consult your doctor as you try each one.
A goat’s milk formula milk for babies has recently been introduced in the UK. There is no current evidence that it is of benefit to babies sensitive to other milks. Do not use it without consulting a doctor.
Other so-called hypoallergenic brands of cow’s milk formula are soon to be marketed in the UK. Hypoallergenic does not mean they are ‘safe’, only that cow’s milk allergens have been modified to make them better tolerated. These may not be tolerated by extremely allergic babies and have been known in the United States to cause anaphylactic (shock) reactions. Always consult your doctor before using any of these to be sure it is advisable for your baby. Only use them on prescription and under supervision. Do not buy over the counter.
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HOUSE DUST MITES ALLERGY: DRAWBACKS AND BENEFITS OF ANTI-DUST TREATMENTS
Apart from the need for follow-up vacuuming, the major disadvantage of chemical products is the need to re-apply (recommended between fortnightly and every six months, depending on make, except for the anti-mite paint) and the consequent cost. The cost of re-applying the treatments runs at somewhere between £100-£200 a year, depending on how extensively you do it, and on which chemical you use. You could pay for an increase in your heating bills to keep things dry, several vacuum filters or a large share of an allergy vacuum cleaner with the same amount of money. You can treat soft toys with sprays, but being often an awkward shape, the treatment does not always reach every part of the surface. If you treat furniture and mattresses, make sure they dry off thoroughly. Light or delicate fabrics can stain.
The nitrogen gas treatment is done by a contractor but is expensive, needs follow-up vacuuming, and has to be repeated frequently if you take no other precautions. It could be useful if you moved into a new home and wanted a once-off treatment to get rid of mites, then followed it up with basic avoidance measures.
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SEALING LEAKY VEINS SABOTAGE ERECTION
As you know, a man with leaky veins can find his erection sabotaged with amazing and disheartening efficiency. Until recently, leaky veins have been largely ignored by the medical profession, but now surgical solutions to this problem are receiving increased attention. One solution is to surgically tie off or remove the leaky veins, thus removing the source of the problem.
Belgian doctors have demonstrated just how effective vein surgery can be on certain patients. Out of 80 patients with potency problems, 20 were found to have impressive vein leaks.
Significantly, the leak involved the deep dorsal vein, a major source of blood flow out of the penis. The surgeons tied off the vein. Results were dramatic: 16 men found themselves with enough restored potency to allow intercourse. The 4 men who didn’t benefit from such improvement were found to have serious artery problems.
The best candidate for vein surgery has only his veins to blame for his potency difficulty; his arteries and nerves are normal. Usually the surgeon will make an incision somewhere on the penis, find the offending veins (which have previously been identified by a type of X-ray) and remove or tie them off, thus preventing them from carrying blood out of the penis. At the time of surgery the doctor can actually measure the extent of the leak by infusing fluid into the penis and measuring how fast it leaves. This way, he can gauge when enough veins have been tied off. Depending on where the veins are located, the procedure can be major or relatively minor surgery.
Unfortunately, no one knows how likely it is that a man with some leaky veins will develop others at some future time. Nevertheless, vein surgery holds the promise of a real advance in the treatment of some potency problems, making implants less necessary for some men.
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IMPOTENCE: THE DRUG MOST COMMONLY USED FOR THE SHOT
The drug most commonly used for the shot is papaverine, either by itself or in combination with another medication, phentolamine. The shot causes the arteries and sinuses to relax and allows increased blood flow into the penis. In some men, in fact, the blood flow produced by these shots may be somewhat greater than that which occurs during usual erections. Consequently, men whose nerves and blood vessels don’t work properly may be able to get an erection from a shot. After the shot, a small amount of pressure on the injection site is necessary to prevent bleeding.
If the shot works, results can be dramatic. In just a few minutes, a man who has had potency problems for years may find himself fully erect—and very happy. Jerry, a 50-year-old construction worker, had been unable to get an erection for ten years, ever since he fell on the job and suffered a painful and serious back injury. Jerry considered himself lucky to have recovered enough from the accident to be able to walk, but his potency did not return.
Jerry came to see a urologist, hoping that something new would be able to help his sex life. He had never heard about the shots, but was eager to try them. The first shot produced an erection—which surprised and pleased Jerry and his wife. The shots confirmed the doctor’s belief that Jerry’s erection problems were caused by nerves damaged in the fall. The shot, in effect, opened up the arteries and did the job the nerves were supposed to do. Subsequent shots resulted in the same reaction. After a decade without intercourse, this couple’s dry spell was over, Jerry ended up using the shots for regular treatment.
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