DEAR DR. DONOHUE: I am a 78-year-old, semiretired man. I am very active and look a lot younger. I work part-time as a truck driver delivering auto parts to garages. Now I am out of work because of pain in my lower back. The pain runs down to my foot. I have been diagnosed with sciatica. My doctor sent me for an MRI, and it showed a bulging disk. What is the best remedy? I use ice packs, heating packs and hot packs. I am on crutches to take pressure off my leg. Would surgery help? — J.S.
ANSWER: Back pain is one of the leading problems that send people to doctors. Most cases of back pain go away on their own, even if they’re due to things like a bulging (also called herniated or ruptured) disk. Even though your back hurts, you can be as active as your pain allows. Don’t sit for prolonged periods; sitting puts more pressure on your back than does standing or walking. Sleep on your side with a pillow between your knees. Continue with heat, cold or alternating heat and cold, whichever gives you the most pain relief. Tylenol or a nonsteroidal anti-inflammatory medicine (Aleve, Advil, Motrin, etc.) can make you more comfortable.
If the pain doesn’t let up in six weeks, you have chronic back pain. Sciatica is pain that travels from the back down the leg to the foot. It comes from pressure on the sciatic nerve. In your case, the pressure most likely comes from your bulging back disk. Back disks are cartilage pads placed between adjacent backbones to absorb the shock those bones take from our walking, bending and pushing. The disk has a tough outer ring. Gelatinous material makes up the inner core. If there’s a break in the outer ring, the inner core pushes through — a bulging, herniated or ruptured disk, whichever term you want to use.
If sciatica doesn’t resolve on its own, a doctor can inject the back with cortisone to reduce inflammation. That can relieve pressure on the sciatic nerve. The procedure is called an epidural.
Surgeons, aided by a microscope, can remove the bulge through small incisions, about an inch long. This technique is called a microdiskectomy and usually is quite successful.
The booklet on back problems covers this topic in detail. Readers can obtain a copy by writing: 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: I can’t get rid of jock itch. I have tried over-the-counter medicines for the past six months. I still itch. What can I do? — R.P.
ANSWER: You can make certain that what you have really is jock itch, a fungal skin infection whose name is tinea cruris. A doctor can make the diagnosis for you by examining scrapings of the involved skin with a microscope. You might need prescription medicine, including oral prescription medicine.
The yeast infection Candida, the bacterial infection erythrasma and psoriasis look like jock itch. You could be treating the wrong condition.
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