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To o l s f o r H e a l t h i e r L i v e s
Inside this issue
HEALTH TIPS . . . . . . . . . . . . . 3
Protein sources.
NEWS AND OUR VIEWS . . . . . 4
Nuts and popcorn don’t cause
diverticulitis. Ginseng may relieve
cancer treatment fatigue.
HOME REMEDIES . . . . . . . . . 4
Sometimes, a good option.
Can it lower risk?
KNEECAP PAIN . . . . . . . . . . . 7
Simple exercises may help.
SECOND OPINION . . . . . . . . 8
Spinal stenosis
Reducing pain,
improving mobility
On the go. That’s how you’d describe
yourself. Always on your feet, always
moving. But lately when you’ve been
out and about, a painful, aching sensation develops in your buttock and
spreads slowly down both legs. Sitting
down and leaning forward makes the
sensation go away, but that worries
you. Is your doctor going to tell you
that it’s time to start slowing down?
These symptoms suggest spinal
stenosis, a narrowing of the spinal
A little goes a long way.
Navigating a sea of choices.
A common thread
Your spinal column is made up
of 24 vertebrae. These are stacked on
top of one another and are each connected by two facet (fah-SET) joints.
Ve r t e b rae are separated and cush-
Coming in January
canal that may put pressure on the
spinal cord or spinal nerves. Th i s
problem is especially common in the
vertebrae of the lower back.
Fortunately, many people can
manage milder pain and discomfort
with physical thera py and va r i o u s
pain-relieving techniques. For more
serious and debilitating pain, surgery
often provides relief — and allows
you to get back on your feet.
Stenosis in
Restoring skin color.
Enhance your healing capacity.
Problems with the spinal cord and nerve roots can develop when one or more areas in the
spinal column become narrowed. Stenosis — a medical term for narrowing — can occur in
any part of the spine, but it occurs most commonly in the lower back.
Visit us on the Internet at the address listed to the left, where you’ll find more
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ioned by fibrous disks, and held
together by muscles and ligaments.
Problems with the spinal cord
and nerve roots develop when one
or more areas in the spinal column
become narrowed. Narrowing (stenosis) can occur in any part of the
spine, but occurs most commonly
in the lower back. Wear-and-tear
arthritis that occurs with aging is the
most common cause of narrow i n g
in older adults.
Not all pain is the same
When spinal stenosis occurs in
your lower back, the symptoms tend
to appear slowly over time. Over
months and years, symptoms may
advance and include:
■ A ching, burning, tingling or
cramping in the buttock, thigh and
calf muscles
■ Pain that radiates from the
buttock to the calf muscles
Symptoms generally get worse
with walking, standing upright or
lying flat on your back. How e ve r,
symptoms often improve if you sit
down, lean forward at the waist or
lie curled on your side. In fact, many
people who have pain while walking find that they can walk around
a store pushing a shopping cart just
fine. That’s because bending forward
creates a small amount of extra
space in the spinal canal.
Nonsurgical treatment
Most people with mild to moderate spinal stenosis experience
long-term relief and good quality of
life with weight loss, physical therapy and medication. This may allow
you to delay or possibly avoid
surgery. Treatments may include:
■ Physical therapy and exercise
— This may encompass many techniques, including stretching and
strengthening exercises, training of
posture and body mechanics, or
using heat pads or cold packs.
It’s also important to stay fit,
despite your pain. To do so, try walking at an incline on a treadmill, or
b i cycling. Swimming, doing the
b a ckstroke in particular, can be
helpful because it flexes your spine
in a way that minimizes narrowing.
■ Medications — Cautious use
of familiar pain-relieving drugs may
help relieve pain and, in some cases,
inflammation. Drugs that help quiet
irritated nerves can be used individually or in combination. These
include tricyclic agents such as
amitriptyline, wh i ch is a generic
form of Elavil, or nortriptyline (Pamelor, others) and other drugs such as
gabapentin (Neurontin, others) or
pregabalin (Lyrica). These may help
reduce pain that radiates through
the buttocks and legs.
■ S t e roids — Taken orally or
injected in the spine, steroids may
help reduce arthritis pain or reduce
inflammation and swelling of tissues
that may be contributing to the narrowing of your spinal canal. Some
people experience profound relief
that lasts for a year or more, while
others get almost no relief.
Managing Editor
Aleta Capelle
Medical Editor
Robert Sheeler, M.D.
Associate Editors
Carol Gunderson
Joey Keillor
Associate Medical Editor
Amindra Arora, M.D.
Medical Illustration
Michael King
Careful diagnosis
The symptoms of spinal stenosis share a particularly close set of
symptoms with the problem of poor blood flow to the legs (claudication). In fact, leg pain while walking that’s caused by spinal
stenosis is often called pseudoclaudication — in part because it
feels so similar to claudication pain that it may be mistaken for it,
and vice versa. Still, there are subtle differences, including:
You may have spinal stenosis
if …
Walking or leaning forward at
the waist helps relieve pain
Pain starts in the back or
buttocks and radiates down
the legs
Sleeping on your back, standing still or walking slowly can
cause pain
You can ride a bicycle without
You may have poor blood flow
to the legs if …
When walking, you can relieve
pain by stopping and standing
Pain while walking starts in the
calf muscles and radiates
You don’t feel pain when
sleeping, standing still or
walking slowly
Riding a bicycle causes pain
December 2007
Customer Service
Ann Allen
Editorial Research
Deirdre Herman
Miranda Attlesey
Donna Hanson
Administrative Assistant
Deborah Adler
Shreyasee Amin, M.D., Rheumatology; Amindra
Arora, M.D., Gastroenterology and Hepatology; Brent
Bauer, M.D., Internal Medicine; Tracy Berg, R.Ph.,
Pharmacy; Julie Bjoraker, M.D., Internal Medicine;
Bart Clarke, M.D., Endocrinology and Metabolism;
William Cliby, M.D., Gynecologic Surgery; Diane
D a h m, M.D., Orthopedics; Timothy Daley, M.D.,
Internal Medicine; Mark Davis, M.D., Dermatology;
Timothy Hobday, M.D., Oncology; Michael Mahr,
M.D., Ophthalmolo g y ; Lance Mynderse, M.D.,
Urology; Suzanne Norby, M.D., Nephrology; Robert
Sheeler, M.D., Family Medicine; Phillip Sheridan,
D.D.S., Periodontics; Peter Southorn, M.D., Anesthesiology; Farris Timimi, M.D., Cardiology; Mark
Wil l i a m s , M.D., Psychiatry; Aleta Capelle, Health
Information. Ex-officio: Carol Gunderson, Joey Keillor.
Mayo Clinic Health Letter (ISSN 0741-6245) is published
monthly by Mayo Foundation for Medical Education and
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■ Acupuncture — Studies indicate this may provide a number of
benefits, including reduced pain.
■ Spinal manipulation — This is
a physical treatment that seeks to
align the bones of the spine. It may
be helpful for some with back pain.
Health tips
Protein sources
Surgery warranted
The goal of surgery for spinal
stenosis is “decompression,” or
enlarging the narrowed area of the
spinal canal in wh i ch nerves are
being pinched or irritated.
Your surgeon may recommend
one of many “space creating” operations. Potential options include a
laminectomy or a laminotomy. Each
i nvo l ves removing a portion of the
lamina, which is the back part of the
bone over the spinal canal. More of
the lamina is removed in laminectomy than in laminotomy.
The removal of lamina itself can
create more space in your spinal
canal. It also allows your surgeon
access to the inside of your spinal
canal to remove any bone spurs or
ligaments that may be pressing on
your spinal cord. Although these
procedures decompress nerves and
likely will allow you to walk or stand
without pain, they generally don’t
relieve back pain from arthritis.
In a small percentage of cases
where the spine appears unstable,
spinal fusion may be necessary. In
this, two or more bones in your spine
are connected to make it more solid.
In recent years, a number of new
surgical technologies, such as laser
surgery or implantable bracing devices, have been developed as alternatives to laminectomy. Mayo Clinic
doctors say that some of these are
of interest, but unproven, and don’t
have the long-term success rate of
the more traditional procedures.
Surgery can be very effective,
but it’s not perfect. Aside from the
risks that accompany any surgical
Laminectomy involves removing a portion
of the lamina, wh i ch is the back part of the
bone over the spinal canal.
procedure, recovery can be painful
and often takes about six to 12
weeks. In addition, the degenerat ive process won’t stop and yo u r
symptoms may eventually return.
Surgery is generally reserved for
people in whom more conservative
therapies have n ’t worked — or for
those with more severe signs and
symptoms such as loss of muscle
strength, pain that impacts quality
of life and independence, pain that
doesn’t go away when sitting or, in
s e vere cases, when there’s permanent nerve damage or when bladder or bowel control is affected.
Studies indicate that improvements in leg pain, back pain and disability tend to be greater in those
who have surgery rather than use
nonsurgical approaches — at least
in the first couple of years. After 10
years, people who had surgical treatment report only slightly greater
symptom relief than do those who
chose nonsurgical approaches.
E a ch approach, whether surgical or nonsurgical, can be of value,
but is associated with certain risks.
Talk with your doctor to decide
what’s best for you. ❒
December 2007
It’s generally recommended
that adults eat about 9 grams
(g) of protein for every 25
pounds they weigh. Try to get
your protein from sources with
lower levels of saturated fat
and cholesterol, such as:
■ Beans and lentils — A
cooked half-cup typically gives
you between 6 and 10 g of
protein with almost no fat and
zero cholesterol. Peanuts and
s oybeans — both lentils —
contain heart-healthy monounsaturated fat.
■ Fish — A 3-ounce fillet
of mackerel, salmon, trout or
tuna provides between 18 g
and 25 g of protein. The fats
they contain are mostly the
good, unsaturated types —
including omega-3 fatty acids.
■ S oy products — A lthough products vary, 1 cup of
soy milk or a soy burger gives
you between 10 and 15 g of
protein with no cholesterol
and a small amount of saturated fat.
■ Skim milk and other fatfree dairy — One cup of skim
milk has about 8 g of protein.
One cup of fat-free yogurt has
about 14 g of protein. Both
have a negligible amount of fat
and cholesterol.
■ Egg whites — The whites
of two large eggs contain
about 7 g of protein and virtually no fat or cholesterol.
■ Nuts — An ounce of almonds or walnuts provides
about 5 g of protein and no
cholesterol. Most nuts are high
in fat, but for most it’s predominantly monounsaturated. ❒
News and our views
Nuts and popcorn don’t cause diverticulitis
If you’ve been forsaking popcorn to avoid a diverticulitis flare-up, it
may be time to close the curtain on some inaccurate advice.
In the past, many doctors recommended that people with colon
diverticulosis — in which small, bulging pouches (diverticula) form
in the wall of the large intestine — avoid seeds and nuts, including
popcorn and foods with small seeds, such as tomatoes and strawberries. It was thought that tiny, hard-to-digest particles could lodge
in the diverticula and cause inflammation (diverticulitis).
Scientific evidence to prove this cause-and-effect relationship has
always been scant. Now, a study by the University of Washington
involving 47,000 men has found no association between eating these
foods and risk of diverticulitis.
The study found that men who ate popcorn or nuts two or more
times a week had no increase in diverticular bleeding and about a 20
percent to 28 percent decrease in risk of diverticulitis over men who
ate those foods once a month or less.
Mayo Clinic experts say that this study is a welcome piece of
evidence to support their belief that eating nuts, popcorn and seeds
doesn’t increase diverticulitis risk. In fact, it’s long been known that
eating a high-fiber diet — wh i ch may include these foods — reduces
the risk of diverticulitis. Still, if you believe that these foods have triggered an attack of diverticulitis, it won’t hurt to avoid them, so long
as you get adequate fiber intake from other dietary sources. ❒
Ginseng may relieve cancer treatment fatigue
Could ginseng help people with cancer overcome some of the fatigue
so common during and after cancer treatment? Preliminary findings
of a Mayo Clinic study suggest there’s potential.
To see if a species of American ginseng might reduce fatigue,
researchers divided 282 study participants into four groups. One group
received an inactive drug, and each of the remaining groups received
a different dosage of the ginseng supplement. Those who took the
placebo or the lowest ginseng dosage — 750 milligrams (mg) daily
— during the eight-week trial had less improvement in fatigue than
did those who took ginseng at the higher doses of 1,000 mg and 2,000
mg. Those taking the two higher dosages had higher ove rall energy
levels and experienced a greater improvement in physical well-being.
Mayo Clinic researchers say results are promising, but more study
is needed to know whether ginseng significantly improves cancerrelated fatigue. Investigators hope to open a larger follow-up study in
early 2008. For now, they warn against automatically including ginseng supplements as part of a cancer treatment regimen. Although
ginseng generally has few side effects, it’s a dietary supplement and
as such isn’t regulated in the same way that drugs are. Therefore, product quality and consistency could vary widely, and there’s always the
potential for interactions with drugs you may be taking. ❒
December 2007
Sometimes, a good option
Despite the wonders of today’s medical care, who doesn’t take just a little bit of pride in successfully using
a simple home remedy to address a
relatively minor health issue?
The makings of seve ral home
remedies may be right in your kitchen. For instance, a saltwater gargle helps soothe a sore throat.
By no means are all home remedies medically sound — some may
even be detrimental to your health.
But there are a surprising number of
simple remedies that have real merit.
Wonders of wound care
Honey in tea can soothe a sore
throat, but did you know honey
might also help treat a minor burn
or cut? Applying honey to a minor
wound that has been thoroughly
cleaned cuts off air supply and exposure to outside contaminants. There’s
also a natural chemical interaction
involving an enzyme found in
honey and fluids from damaged tissue that creates a form of the disinfectant hydrogen peroxide.
Earlier this ye a r, the Food and
Drug Administration approved a
honey-impregnated dressing product for wound and burn care. And
New Zealand researchers have found
promise in the ability of one particular honey to kill antibiotic-resistant bacteria.
So what about the honey in your
kitchen? That’s an unknown because
the honey available for consumers
differs from the specialized honey
used in ongoing research and in
wound products. Plus, the honey
used in studies has generally been
treated to eliminate any bacteria.
Another option for burn or wound
care in the home is to break a spiky
leaf from your aloe plant and smear
the plant juice on the affected skin.
Th e r e ’s early evidence suggesting
aloe may promote healing of mild
to moderate skin burns, but study
results are mixed when it comes to
wound healing.
Cold and flu relief
Would you believe ch i ck e n
soup? Long a standard dished up by
mothers for sick children, ch i ck e n
soup has actually been put to the
test by scientists. They found it does
seem to help relieve cold and flu
symptoms in two ways:
■ It acts as an anti-inflammatory agent by inhibiting movement of
immune system cells called neutrophils that are invo l ved in the
body’s inflammatory process.
■ It helps relieve congestion by
temporarily speeding up mucus
m ovement through the nose and so
limits the length of time viruses have
contact with the nasal lining.
So does it have to be homemade
ch i cken soup? Researchers have
found that many canned soups work
just as well as do homemade soups
— but be aware the sodium content
may be pretty high in some.
Another remedy you might try
to relieve nasal congestion is to irrigate your nasal passages. One technique involves using a nonprescription sinus rinse kit, available in most
drugstores. These kits come with premixed salt packets, or you can mix
your own by using 1/8 teaspoon salt
to 1 cup warm water.
Using a small squeeze bottle or
a container called a neti pot — sold
in health food stores and many drugstores — tip your head forward and
slightly sideways over a sink. Put the
spout of the bottle or neti pot in one
nostril so that the solution runs into
that nostril, then out the other.
Repeat on the other side.
Nasal irrigation can also be
especially helpful for those wh o
have hay fever.
Acupressure is a traditional
Chinese medicine that relies
on applying physical pressure
to specific points to restore the
flow of life energy.
Studies have shown that
acupressure on a wrist point
identified as P6 may help
prevent and treat nausea
associated with surgery,
chemotherapy and morning
sickness. It may also reduce
motion sickness. P6 is about
three finger widths from the large
crease of the wrist.
Creature helpers in the medical world
Consider the wonders of common creatures approved for use by
the Food and Drug Administration to help in clinical wound care:
■ Leeches — These have been in use for thousands of years for
everything from gangrene to headaches. In the modern medical
setting, leeches may be used with skin grafts and reattachment
surgery. They extract excess blood that pools near damaged blood
vessels, which encourages circulation so that normal blood supply
and flow can be re-established. Their saliva has a powerful anticoagulant that keeps blood flowing properly in inflamed tissues. Plus,
leeches emit a natural anesthetic, which minimizes pain.
■ Maggots — In the medical setting, maggot debridement
therapy refers to the use of maggots to help clean difficult wounds.
Specifically, they may help clean wounds that won’t heal.
Skin relief
Skin is your body’s largest organ.
As such, common skin irritations
tend to garner plenty of attention. A
few home remedies that you might
find helpful include:
■ An oatmeal bath — Did you
know oatmeal can help soothe dry,
itchy or irritated skin? Try an oatmeal
bath for some relief. Start by putting
a cup of uncooked quick or oldfashioned oats in a food processor
or blender and grinding it to the
finest powder possible. Then, with
the bath water running full force at
a comfortable temperature, slow l y
sprinkle the oat powder under the
running water and stir the water to
avoid clumping.
December 2007
■ Canker sore dab — If you’re
bothered by the occasional canker
sore in your mouth, you may find
relief by dabbing on a small amount
of milk of magnesia. Do so three or
four times a day to take the sting out.
■ Wa rt re m over — Duct tape
may help get rid of common warts
that typically grow on fingers, the
backs of hands and feet. Cover the
wart with duct tape for six days, then
remove the tape and soak the wart
in water before gently rubbing it
with an emery board or pumice
stone. Give the wart an overnight
breather, then reapply tape to it the
next morning. Continue the same
six-day treatment cycle for up to two
months or until the wart is gone. ❒
Selenium and
prostate cancer
Can it lower risk?
If you could lower your risk of deve loping prostate cancer by 50 percent
simply by taking a small, daily dose
of a mineral supplement, would you
be interested in learning more?
Indeed, a lot of people became
interested in learning about the trace
mineral selenium, when it appeared
that it may do just that. In a 1996
s t u dy on skin cancer, male study
participants taking 200 micrograms
(mcg) of selenium daily were also
found to have 63 percent fewer
cases of prostate cancer than did
men taking a placebo. After an additional two years, rates of prostate
cancer remained 49 percent lower
in the group taking selenium.
Although exciting, experts were
quick to urge caution in draw i n g
firm conclusions from the results of
a single study. In addition, a study
published this year revealed that taking 200 mcg of selenium daily may
increase by 50 percent the risk of
developing diabetes. The potential
for benefit — and unanswered questions about risk — have spurred the
launch of a major study on the topic
that should provide more definitive
answers in about five years.
You are what you eat
Selenium is a trace mineral that
is essential to good health, but it’s
only needed in small amounts. Selenium is not itself an antioxidant,
but it participates in the synthesis of
proteins to make antioxidant enzymes. Dietary sources of selenium
include a wide variety of foods such
as nuts, meats, fish, poultry, eggs,
dairy and whole grains.
Selenium deficiency — wh i ch
is associated with a host of serious
health problems — is rare in A m e r-
Reducing risk
Selenium isn’t the only part
of your diet that may help
protect you from prostate
cancer. Although the evidence isn’t strong, small
preliminary studies suggest
that certain foods and
beverages may help reduce
risk. These include:
■ Fish rich in omega-3
fatty acids, such as salmon,
herring and mackerel
■ Tomatoes and tomato
■ Soy products
■ Green tea
■ Garlic and cruciferous
vegetables, such as broccoli,
cabbage and cauliflower
On the flip side, there’s
evidence that smoking, an
inactive lifestyle, family history, being overweight, and a
diet high in fat and total
calories may increase your
risk of prostate cancer, as
can a diet high in animal fat
and meat.
ica. How e ver, it can occur in people with severe gastrointestinal disorders that limit selenium absorption. It’s estimated that the average
American adult gets about 80 mcg
to 150 mcg of selenium daily from
diet alone. Th a t ’s well above the
Recommended Dietary Allowance
(RDA) of 55 mcg daily.
Still, the question remains as to
whether consuming amounts greater
than the RDA, or even nearer to the
Institute of Medicine’s tolerable
upper intake level of 400 mcg a day,
may help prevent prostate cancer.
In addition, questions have surfaced about the potential risks of taking supplemental selenium. A study
in wh i ch 1,200 participants took
either 200 mcg of selenium or an
inactive substance and were tracked
December 2007
for nearly eight years reported that
those taking selenium had roughly
a 50 percent increased risk of developing type 2 diabetes. While this is
a preliminary finding from only one
small study, it’s worth consideration
if you’re weighing the possible pros
and cons of selenium supplements.
SELECT the best
In order to provide definitive
answers about selenium’s effect on
prostate cancer risk — as well as the
effect of vitamin E, wh i ch has also
shown promise in protecting against
prostate cancer — the National
Institute of Health in 2001 launched
the Selenium and Vitamin E Cancer
Prevention Trial (SELECT).
At the study’s start, 32,400 men
were assigned to take either a daily
supplement of 200 mcg of selenium, 400 milligrams of vitamin E, a
combination of both, or a placebo. By its projected end in 2013, the
study will have data on prostate cancer diagnosis and treatment of these
men, as well as data on the benefits
and risks of these supplements.
But until then?
At this point, selenium supplementation isn’t recommended as a
preventive measure for prostate cancer. How e ve r, until more is know n ,
a well-balanced, heart-healthy diet
may be your best defense. If you do
decide to take a supplement, supplements containing selenomethionine or “high selenium yeasts” are
g e n e rally better absorbed and utilized than are other forms.
Still, it’s recommended that you
talk to your doctor before using any
new supplement. It’s important to
discuss whether selenium’s potential protective effect on prostate cancer — an effect that has yet to be
proved — outweighs the cost and
possible risks of taking it.
Remember, one way to minimize the impact of prostate cancer
is to have regular screening tests. ❒
Kneecap pain
Simple exercises may help
You’ve always enjoyed sitting for a
couple of hours to watch a mov i e .
But lately, as soon as you begin to
stand up, you experience pain under
and around your kneecap (patella).
You wonder about the cause.
Pain in the kneecap area is a
common problem. The medical term
is patellofemoral pain, and it may
be due to any number of factors.
Often, recovery includes strengthening the muscles that support the
knee as well as stretching tight muscles and tissues in the legs.
Knee mechanics
The knee is a hinge, lever and
s h o ckabsorber. The knee’s patella
aids the efforts of strong front thigh
(quadriceps) muscles. The quadriceps help control the amount of
knee bending and help push you up
from a chair. They also help control
side-to-side motion of the patella.
The knee joint has four bones
held together by ligaments. The top
part of the joint is the large thighbone (femur). The lower leg bones
are the tibia and fibula. The patella is the fourth. It slides in a groove
in the front of the femur as the knee
bends and straightens, much like a
train on a tra ck. A combination of
factors keep the patella on track,
including the femur and various
muscles, tendons and ligaments.
If the patella’s balance in the
groove is upset, it can lead to increased stress between the patella
and the femur. In that case, the more
activity you do over time, the more
likely you’ll experience pain. Often,
several factors contribute to the
slight misalignment of the patella.
These may include flat feet, weak
hip muscles — wh i ch cause the
femur to move out of its precise
alignment under the patella — leg-
The stretch and exercises below can be done as time and your physical ability allow.
In general, the exercises can be done with deliberate effort and to the point of fatigue
— but without pain — several times a week.
Hamstring stretch
Sit on a sturdy chair and position your legs as shown. Keeping
your back straight, lean forward from your hips until you
feel a gentle stretch of the muscles on the back
of your thigh. Don’t bend your elevated knee.
Hold the stretch for up to a minute.
Retro step-up
Stand as shown, at the bottom of stairs with
a handrail. Step up with your bothersome leg, and
then do the same with your other leg. Next, step
down with your good leg, and then step down
with your bothersome leg.
Straight leg abduction
Lie as shown, on your side. Lift your
top leg a few inches, holding briefly
before lowering it back. Repeat to fatigue.
Switch sides and repeat for the other leg.
Straight leg flexion
Lie flat. With your knee bent
and your foot flat on the floor, lift
your other leg off the floor, keeping
it straight. Hold one second, then return
to the floor. Repeat to fatigue. Switch
sides and repeat for the other leg.
length differences, tight muscles on
the front and back of the upper leg,
weak quadriceps, or tight tendons.
If osteoarthritis affects the knee, this
also can contribute to pain.
Stabilize and strengthen
E f f e c t ive treatment for patellofemoral pain usually involves treating the cause and modifying activity. To relieve pain, ice the knee for
15 to 20 minutes several times daily
December 2007
and take acetaminophen (Tylenol,
others) as directed. A knee sleeve
may help hold the patella in place.
Avoid activities that cause pain.
Your doctor or physical therapist
may direct you to do specific exercises. Some work for most people.
Doing them twice daily for as long
as four to six weeks is generally suggested. Beyond that, continue doing
the exercises three or four times a
week to keep the knee stable. ❒
Second opinion
Questions and our answers
long term, improve your calcium
absorption by:
■ Taking calcium citrate, a soluble form of calcium that’s absorbed
well even in an environment of decreased stomach acid
■ Taking smaller amounts of a
calcium supplement seve ral times
a day, with meals
■ Having adequate vitamin D
■ Increasing your intake of
dietary calcium — such as from
dairy products — at mealtimes
Q: I have a Zenker’s diverticulum.
It makes it hard to swa l l ow food
and makes me cough at night. At
83, can I have surgery for this?
A: If you’re reasonably healthy, you
probably can. Procedures to treat
Zenker’s diverticulum are very effective and have low complication rates.
Zenker’s diverticulum, also called a pharyngeal diverticulum, is a
pouch in the wall of the lower throat,
usually occurring in adults over 50.
It’s caused by a muscle in the
upper esophagus that wo n ’t relax.
With every swallow, bits of food and
even pills can become trapped in
the pouch. As the pouch fills, you
m ay notice throat irritation, bad
breath or a gurgling noise. When the
p o u ch becomes large, it may also
spill food into the throat hours after
eating, causing coughing and spitting up of food — especially when
you’re lying down.
When Zenker’s dive r t i c u l u m
becomes troublesome, surgery to
cut the muscle that won’t relax —
with or without removal of the
pouch — is often recommended.
These procedures can often be
performed using a less invasive technique that involves operating with
a flexible endoscope through your
mouth. Many people who have this
done are out of the hospital in less
than one day.
H ow e ver, the studies of flexible
endoscopic procedures are somewhat limited and the complication
rate remains less well studied.
I read that the acid-suppre s sing drugs I take to stop acid reflux
i n c rease risk of osteoporosis and
hip fra c t u re. Can I do anything to
help prevent osteoporosis?
Yes you can. A recent study
showed that acid-suppressing drugs
called proton pump inhibitors —
including Aciphex, Nexium, Prevacid, Prilosec, Protonix and Zegerid
— can significantly increase risk of
hip fracture in older adults wh e n
taken consistently for a year or more.
Unfortunately, the same acidsuppressing effect that makes these
drugs work so well for acid reflux
may also inhibit proper absorption
of calcium — particularly calcium
carbonate, which is a common type
of calcium supplement requiring a
mildly acidic environment to diss o l ve. It’s been theorized that this
poor calcium absorption over time
can increase hip fracture risk. But
more study is needed to prove a link.
If you take a proton pump inhibitor or another class of acid-suppressing drugs called H-2-receptor
blockers (Pepcid, Zantac, others)
Q: I bought some sugar-free candy
as a gift. However, “sugar alcohol”
is listed as an ingredient. Is this OK
for recovering alcoholics?
Sugar alcohols are a group of
sugar replacers, or reduced-calorie sweeteners. They’re chemically
completely different from ethanol
in alcoholic drinks and not a concern for recovering alcoholics. ❒
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