My aching back'; my narrow spinal canal

BY PAUL G. DONOHUE, M.D.
Mar 11, 2003

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DEAR DR. DONOHUE: I have been told I need surgery for something I have never heard of -- spinal stenosis. I have low back pain, but I am able to get around. The doctor tells me that if I don't have surgery, I will be paralyzed. Please enlighten me. -- T.S.

ANSWER: The spinal cord is a mass of nerve cells and nerve cables sending messages to the brain and receiving messages from the brain that it transmits to muscles and organs throughout the body. It is a delicate structure with a diameter no larger than the little finger. Drop a soft eraser on an exposed spinal cord from a height of three feet, and the eraser would shatter the cord.

To protect the spinal cord, Nature encased it in a canal that runs through all the vertebrae (backbones).

Spinal stenosis is a narrowing of the spinal canal. Bone spurs, arthritic changes and thickened spinal-column ligaments can constrict the spinal canal and compress the spinal cord and the nerves that sprout from it.

The result is back pain that often shoots down the legs. People with a narrow spinal canal frequently stand in such a way that they look like they are leaning forward on a grocery cart.

In some cases, surgery is the answer. If your doctor is correct and you are on the brink of paralysis from the narrowing, before submitting to surgery, get a second opinion. If matters are not so pressing -- and they rarely are -- a physiatrist (not a psychiatrist) can design a rehabilitation program to strengthen back muscles and to realign backbones so they do not compress the spinal column and its nerves. A physiatrist (FIZZ-ee-AT-wrist) is a doctor who specializes in rehabilitation.

There are, of course, medicines for pain. With medical supervision, try nonsurgical means of correcting spinal stenosis before plunging into the operating room -- if you are not in immediate danger of spinal cord injury.

Back problems are universal. The pamphlet on that topic explains their causes and treatments. To obtain a copy, write to Dr. Donohue -- No. 303, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6 Can. along with the printed name and address of the recipient. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I take a multivitamin every day. In addition, I take an extra capsule of vitamin A. I have been warned about taking too much of this vitamin. They tell me it can cause osteoporosis. What is a safe amount? -- D.K.

ANSWER: Vitamin A is essential for eye health, night vision, the functioning of reproductive organs and the health of the immune system.

Too much vitamin A can be toxic. It can lead to osteoporosis, and it can cause bone and joint pains. It might blunt the appetite and lead to nausea and vomiting.

The recommended daily dose for women is 700 micrograms (2,330 IU) and for men, 900 micrograms (3,000 IU). The daily maximum of the vitamin for both men and women is 3,000 micrograms (10,000 IU).

When adding up your vitamin A intake, don't forget what you get from food. Liver, kidney, fish and dairy products have a good supply of the vitamin. Some salmon has as much as 4,000 IU in three ounces. Eight ounces of milk has 460 IU. Beef liver is the clear winner with about 30,000 IU in 3.5 ounces. Don't let that stop you from eating beef liver. It's not dangerous to exceed the recommended daily upper limits for vitamin A once in a while. Only when a person makes it a daily practice of eating large amounts for a fairly extended amount of time does vitamin A toxicity loom as a potential problem.

DEAR DR. DONOHUE: Can a lady avoid becoming pregnant by having her partner withdraw before ejaculation? -- G.F.

ANSWER: That is not a safe way to avoid pregnancy. Nineteen percent of couples practicing this kind of birth control will have a pregnancy within one year.

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Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

(c) 2003 North America Syndicate Inc.

All Rights Reserved


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