Q. My orthopedic surgeon has suggested that spinal fusion may be my answer to years of battling back pain. What can I expect from fusion?
A. Back problems have a number of causes, including muscle strains, herniated disks, osteoarthritis, spinal stenosis and others. After nonsurgical measures, such as physical therapy, core strengthening, nonsteroidal anti-inflammatory drugs, and activity modification, have been attempted and found insufficient, surgery is considered as a last resort. Fusion becomes an option when people experience nerve pain from spinal stenosis. Spinal stenosis occurs when the spinal canal or the neural foramen (spaces between the vertebrae through which nerves exit the spinal canal) narrow and put pressure on the nerves. This can press on the sciatic nerve, causing sharp pain, numbness, tingling and weakness in the buttocks and/or leg. Usually, a laminectomy, in which a portion of the vertebra and anything else causing the narrowing is removed, creates more room for the nerves. However, if you also have instability in your spine, you may be a candidate for fusion. Fusion surgery permanently fuses two vertebrae together, to stabilize the spine. The most common fusion procedure is a one- or two-level fusion plus decompression (laminectomy). An X-ray and MRI can help determine if fusion is suitable for you. The laminectomy treats the neurologic symptoms, while the fusion treats the spinal instability. Be prepared for a four- to six-week recovery period, with full recovery taking a bit longer.
Q. What is so good about whole grains? And, how can I incorporate them into my daily diet?
A. The Dietary Guidelines for Americans recommends that half of our three daily grain servings come from whole grains. Food manufacturers continue to incorporate whole grains into many of their products. Whole grains are good for you because the bran and the germ hold most of the grain’s fiber, vitamins, minerals, and antioxidants intact. Refined grains result when the bran and germ are stripped away from the whole grain, leaving just the starchy endosperm. According to recent studies, increasing daily whole grain intake appears to lower the risk of death from heart disease, cancer, and other chronic diseases. Other studies suggest whole grains can help lower levels of abdominal body fat, and also have beneficial effects on the gut microbiome. Here’s how to incorporate more whole grains into your daily menu: Mix whole grains into a salad; make hot cereal out of spelt and barley flakes, or teff and amaranth; toast 100 percent whole wheat English muffins; add grains to soups; eat air-popped popcorn; use whole grain pita or flatbreads for pizza bases; replace all-purpose flour with whole wheat flour in baked goods.
Q. After months of feeling slow and lethargic, I just learned I have an underactive thyroid. How could I have gone this long without being diagnosed properly?
A. Thyroid disease is an autoimmune disorder that affects about 27 million Americans, of whom eight out of 10 are women. However, about 50 percent go undiagnosed, usually because they are symptom-free, and because many of the symptoms of hypothyroidism (underactive gland) and hyperthyroidism (overactive gland) can be mistaken for normal changes that occur with aging. Other symptoms of underactive thyroid include weight gain, sluggish bowel movements, decreased appetite, falling, incontinence, and increased sensitivity to cold. Less common symptoms include memory loss, or a reduction in cognitive functioning, symptoms commonly attributed to aging. Untreated, thyroid disease raises the risk for heart problems, and also can damage your peripheral nerves. Depression, type 2 diabetes, and obesity also are more common in people with an underactive thyroid. Conversely, an overactive thyroid causes the body’s metabolic rate to increase, leading to weight loss. Other symptoms include excessive perspiration, more frequent bowel movements, anxiety, poor sleep, and heart palpitations. Some people develop swelling (goiter) at the base of their necks. Untreated, overactive thyroid raises the risk for atrial fibrillation, high blood pressure, and sudden cardiac arrest. You are fortunate in that you’ve been diagnosed and can restore your hormone balance with the drug thyroid hormone levothyroxine (Synthroid). It can restore you to a more “normal” state after several weeks.
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