DEAR DR. ROACH: I’m a 75-year-old male and have had ache in my buttocks right down to my exterior thigh muscular tissues. My main care physician ordered an MRI of the decrease again and referred me to an orthopedic physician who makes a speciality of again points.
The physician identified my situation as lumbar spondylosis primarily based on disc compression impacting the nerves. Initially, the physician prescribed bodily remedy, which didn’t present any profit. The physician didn’t suggest surgical procedure, which I’d be reluctant to do anyway.
Subsequently, he referred me to a ache administration physician, the place I perceive that remedy is prone to be an epidural injection into the decrease again close to the backbone. I’m involved concerning the dangers and effectiveness of such a process and whether or not there are different choices, akin to medical marijuana or acupuncture. — C.B.
ANSWER: “Spondylosis” refers to degenerative arthritis of the backbone. This can result in arduous buildings like bone, bone spurs and ligaments compressing the nerves that come off the spinal wire, or the spinal wire itself. This can result in any mixture of ache, weak point and numbness, though ache is normally the primary symptom. Physical remedy is the mainstay of conservative administration.
Since the issue is anatomical, one would anticipate the definitive resolution to be surgical, however surgical procedure has limitations and isn’t extra useful than bodily remedy in most individuals. There are exceptions wherein case an pressing surgical procedure is indicated, akin to in an individual with progressive weak point.
When surgical procedure isn’t indicated, then a ache administration skilled is the best marketing consultant, for my part. They can take into account treatment (together with anti-inflammatories and medicines to scale back ache), injections and different remedies.
The knowledge on acupuncture is conflicting, though some individuals clearly get reduction. What isn’t utterly clear is whether or not it’s higher than “sham” acupuncture, the place needles aren’t inserted or positioned in places which can be a part of the standard acupuncture remedy for low again ache.
Cannabis has been proven to offer a short-term enchancment in ache in comparison with no remedy, however there are scant knowledge on its long-term use or the way it compares with different remedies.
A ache administration skilled also can talk about different prospects, together with side joint injections, different varieties of injections, electrothermal and radiofrequency remedies, Botox, and spinal wire stimulators. Epidural injections are simply one of many instruments they’ve.
DEAR DR. ROACH: My girlfriend just lately went to a neighborhood pharmacy the place she usually will get her vaccinations. She requested the high-dose flu vaccine for seniors. The paperwork reveals that she was given the Fluad vaccine. My analysis signifies this wasn’t the high-dose flu shot that’s now accessible. Should she nonetheless get the higher-dose flu shot? — L.I.
ANSWER: There are two varieties of flu vaccines made particularly for seniors over 65. High-dose flu vaccines like Flublok and Fluzone High-Dose include extra of the purified flu antigens than a standard-dose vaccine, which could have been what you have been anticipating.
The Fluad vaccine comprises an adjuvant, which is a substance added to make the vaccine simpler in seniors who usually have an immune system that isn’t fairly as sturdy because it was once. Any of those are thought-about excellent for seniors. Your girlfriend doesn’t must get any extra vaccines.
If these particular vaccines for seniors aren’t accessible, a daily flu vaccine remains to be a good suggestion. I wouldn’t wait — it’s extra essential to get one now.
Dr. Roach regrets that he’s unable to reply particular person letters, however will incorporate them within the column at any time when doable. Readers could e-mail inquiries to ToYourGoodHealth@med.cornell.edu or ship mail to 628 Virginia Dr., Orlando, FL 32803.
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