Weather causes painful hand condition

Q: My husband has been diagnosed with erythromelalgia of the hands, although his pain isn’t triggered by heat but by cold weather. He is very rarely without severe pain and burning symptoms. Often times his hands are manageable but at others, they are not. He takes an aspirin every day. Hid physician has tried other medications but nothing has worked. Some of his symptoms are contrary to his diagnosis.

Is there any other condition that could manifest itself in this same manner? This is a very debilitating disease.

A: Erythromelalgia (EM), once known as acromelalgia, red neuralgia, erythermalgia and Mitchell disease is a rare disorder characterized by periods of burning pain, redness and warmth in the hands and feet. Blood vessels become blocked periodically, causing them to swell. The blockage is accompanied by bouts of severe pain that radiates in the soft tissue. Triggers may be from exertion, pressure, heat, insomnia, stress, and more.

EM may occur either as a primary or a secondary disorder. The primary type is associated with an issue in and of itself, or it may be a symptom of an underlying disorder. The secondary form may result from small fiber peripheral neuropathy or from other causes. EM may develop in individuals with mercury or mushroom poisoning, high cholesterol levels, specific autoimmune disorders, or in the presence of a normal platelet count in those with myeloproliferative disorder. Symptoms are often symmetric and affect the lower extremities more often than the upper ones. Primary form attacks vary from one extreme to another. They may last as short a period as one hour or as long as months at a time, may be infrequent or occur numerous times each day, present gradually taking years to be fully recognized or may be intense at onset. Raynaud’s phenomenon often co-exists in patients with EM.

EM is rare, occurring in 1.3% of every 100,000 individuals, with women being more prone than men according to recent research. About 5% of those with the condition have the primary inherited form of the disease.

The condition is difficult to diagnose and may take months since no specific testing is available for the condition. Once the primary form (not the secondary type) has been diagnosed, a plan of treatment can be initiated. Primary EM management focuses on treating painful symptoms only, and avoiding triggers that cause the attacks. Cold water baths or soaking the hands in cold water is heavily discouraged because the acts will precipitate problems, cause skin damage and ulceration. While unsupported medically and only anecdotal, there are medications patients have tried with some degree of success. Mild cases may respond to such medications as tramadol or amitriptyline, while more severe cases may necessitate opioids. Reduced capillary density has been seen microscopically during flareups, and reduced capillary perfusion is observed. When it comes to the secondary form, the best treatment method is to treat the underlying cause. Elevation of the extremities of the affected limbs is believed to lessen symptoms.

Because you admit some of your husband’s symptoms don’t fit what you’ve been told, I believe he should be under the care of a neurologist, simply because the paradoxical presentation suggests your diagnosis may be in question. You might ask him or her about Lyrica or other medications used to treat peripheral neuropathy as a possible treatment. Good luck.

Can magnesium citrate help certain medical conditions?

Q: Several months ago I read a comprehensive answer in your column to the issues of pernicious anemia. The column also included the patient’s restless legs syndrome. As a physician, I have found a remarkable response to oral magnesium citrate, usually 170 mg, taking two capsules after dinner. It’s a very conservative dosage and extremely effective, almost immediately.

Although this is an anecdotal suggestion, there is an enormous amount of literature discussing this relationship. Up to 90% of the population has some deficiency in magnesium. A red blood cell magnesium level could be obtained for a more “scientific approach.” I have found it exceptionally helpful in relieving the muscle cramps.

I hope this proves helpful. Keep up the good work.

A: For those individuals that may not have read the original article, I will cover the disorders briefly. Anemia is a deficiency in healthy red blood cells that provide oxygen to bodily tissues. One type of the disorder is pernicious anemia – a B12 deficiency. B12 is readily available in the diet and can be obtained from eating shellfish, eggs, meats, poultry, and dairy products. A protein known as intrinsic factors helps the intestines absorb vital B12. However, when the stomach fails to make a sufficient amount of intrinsic factor, the intestines cannot absorb adequate amounts of the vitamin. There are reasons for pernicious anemia to occur, including atrophic gastritis (a weakening of the stomach lining), autoimmune disorders, or in rare instances, heredity.

Diagnosis is commonly determined through blood drawing for a vitamin B12 level, a CBC, an MMA (methylmalonic acid) level, and more. When the diagnosis remains questionable, a bone marrow exam may be appropriate.

Restless legs syndrome (RLS) is a condition that presents with uncomfortable sensations in a person’s thighs, calves or feet. If lying down or sitting, the individual will experience an uncontrollable urge to get up and move about, rub the extremities, jiggle them, pace the floors for hours on end, stretch, and twitch. While questions remain unanswered regarding RLS, it is believed to be caused by an imbalance of dopamine, a brain chemical. Generally speaking, RLS does not have an underlying cause, although it may be accompanied by peripheral neuropathy, kidney failure, or an iron deficiency. Symptoms can be mild or almost incapacitating. Sleep may be totally interrupted because the individual is almost forced to walk most of the night away.

The RLS Foundation has four criteria that must be established in order to be so diagnosed. The first is the irresistible urge to move the legs. Symptoms will worsen while at rest, necessitating the complete need to get up to walk. Those symptoms may be relieved temporarily by walking or stretching; however, they will return once the individual ceases the exercise. Lastly, symptoms will worsen at night.

Treatment may begin with blood drawing to determine if an iron deficiency exists, followed by iron supplements. If sufficient relief isn’t found, prescription medications including Mirapex, Requip, and a combination carbidopa/levodopa commonly taken by Parkinson’s patients may follow.

Magnesium citrate is an essential mineral in the body important for muscles, nerves, and numerous other functions. It is often used as a laxative for combating constipation. Indications for a deficiency may include fatigue, weakness, vomiting, and appetite alterations. Patients may complain of numbness and tingling of the arms, legs, fingers, and toes. While deficiencies are less common than they are for anemia, they can occur – particularly when alcoholism, mal-absorption issues, and poorly controlled diabetes enter the picture. According to WHO the incidence of low magnesium is 10% in hospitalized patients, so your connection with anemia is extremely plausible. In fact, the NIH indicates the incidence of anemia in this country is 10%, while WHO places it at 25% worldwide. Whatever the statistics, laboratory testing can determine if a person’s levels are within normal limits or not.

Thank you for taking the time to write and offer what might be a valid treatment for countless readers.

So, is it legal to purchase Canadian drugs?

Q: In your opinion, are Canadian prescription drugs safe to use? According to Pharmacy Checker.com, there are some valid members. Please advise.

A: Individuals in this country can be confident that the drugs they purchase within the United States are both safe and effective. Manufacturers must meet stringent Food and Drug Administration standards before products can be released to the public. This is something that cannot be done when an individual chooses to purchase from foreign sources such as Canada. And, as you might imagine, this is a significant concern for the FDA.

Because of higher costs of purchase, more and more consumers in this country are considering obtaining their drugs from Canadian suppliers – or sources that are purported to be Canadian. The FDA has taken a stand that consumers are exposed to a number of risks when these purchases are made. The foreign outlets that dispense the drugs may be providing contaminated, counterfeit, sub-potent, and even expired medications. There have been concerns of incorrect doses, labeling, ingredients and instructions in a language other than English, and dosing that is incompatible with what a US physician prescribes. Information on potential side effects may be missing from the packaging. And, all the while, the sources may claim it is completely legal for them to sell drugs to US consumers. Wrong! It isn’t.

Some websites are taking orders from consumers that are ultimately filled by other pharmacies, making it difficult for a purchaser to even determine if the drugs they receive are filled by the company from which they were ordered. Some patients may receive the real deal. Others, however, may purchase drugs that contain counterfeit copies. And, keep in mind that if a consumer/purchaser has an adverse drug reaction, he or she has no recourse because the physical location of the “pharmacy” they are dealing with may be beyond reach or otherwise unavailable. Further, the FDA that protects us has little or no ability to take any meaningful action against foreign operators.

I cannot tell you not to order from sources outside our country; however, I urge you to shop around in this country. Some pharmacies, because of volume for one thing, are able to sell prescription drugs cheaper. And, there are more generic versions available than ever before. Price shop, staying in this country whenever possible. Good luck.

Be sure to purchase the correct product for nail strengthening

Q: I have used decolorized iodine on my nails after reading about it in your column several years ago and I have never had such strong nails. Now I am told by several pharmacists that they cannot even order it any more because it is used in the production of meth and maybe other illegal drugs. So, my question is, will regular iodine work as well? Other than being colored (and assuming I can buy that item), I wonder if it would be a good substitute. I really don’t want to resort to my same thin, peeling nails I lived with for years.

A: Iodine has been used for more than a century as an over-the-counter first aid antiseptic product for the prevention of infection from minor scrapes, cuts and lesions. The product was originally red in color and clearly visible when topically applied to skin lesions. Now, however, the product is available in a decolorized form that cannot be seen, nor does it dye clothing rubbed against it as is the case with red iodine.

Iodine tincture for antiseptic use on humans contains 2% iodine. There is a 7% concentration for veterinary use. The primary ingredients in iodine tincture are ethyl alcohol and water. The product is available through countless pharmacies under their brand name or via the internet by logging on to sites including Humco.com. I also did some brief research and found that brand readily available through CVS, Amazon and several other facilities.

Decolorized iodine is ideal for treating toenail fungus, strengthening nails, as a disinfectant, to treat patchy hair loss, as a treatment for alopecia areata, and more. When it comes to nails that are thin, weakened and break off easily, directions are to apply a cotton swab to the tip of the nails that has been soaked with decolorized iodine. Leave the product on the nails over night for a week, during which time period you should also avoid using soapy water and products containing hydrogen peroxide.

Iodine crystals that are used legally for a variety of commercial and medical reasons are sometimes used to produce illegal products. The Federal government regulates the sale of iodine crystals which are, under ordinary circumstances, available for legitimate reasons. However, officials points out that it is illegal to import, export, purchase, or sell iodine crystals in this country if their purpose is for the production of methamphetamine. Purchases are monitored. With regard to at least Humco (I am unsure of other brands), they do sell iodine tincture for pharmacy use. They do not encourage the sale of or promote the product for illegal purchases, which is why the company has encouraged all stores to switch to decolorized iodine that cannot successfully be used for illegal manufacturing. I recommend you try your local CVS pharmacy or contact a manufacturer directly to purchase the decolorized product that should strengthen your nails but won’t get you in hot water with the FDA.

Dentists differ on treatment for periodontitis

Q: Recently my husband and I went to a new dentist whose hygienist said we both needed periodontal scaling of our teeth where they scrape underneath the gums. It is quite painful. Anyway, I mentioned this information to my brother who advised against it…take metronidazole (Flagyl) instead. His father-in-law was a periodontist in Houston for over 50 years and when a dentist told my brother he needed the same procedure, he was told about the treatment instead of the painful scraping. The periodontist said he had a 90% success rate with his patients.

So, we refused the periodontal scaling at the dentist’s office and just had a regular cleaning procedure performed. I asked the dentist for prescriptions for both my husband and myself and he indicated he would have to check with his off-site periodontist. He acted like he wasn’t familiar with the Fagyl but indicated he would get back to me. Several weeks later my dentist gave me a prescription but not my husband and that was only after I showed him several articles regarding Flagyl. FYI, both of us are asymptomatic with no visible signs of gum disease.

Wouldn’t it be prudent for most patients with periodontal disease to take antibiotics as a first course of treatment before having a painful, invasive treatment performed? It is inexpensive and worth a shot. Please educate your readers and save them a lot of money and pain.

A: Periodontitis is a gum infection that damages the soft tissue and destroys the bone that holds teeth in place. The condition is often the result of poor oral hygiene. It is quite common but on the good side, it is commonly preventable simply by brushing and flossing at least twice daily and getting regular checkups from a dentist. Symptoms may include bad breath, a bad taste in the mouth, bright red to purple colored gums, receding gums, loose teeth, and more.

Plaque forms on teeth when bacteria normally found in the mouth interacts with the sugars and starches from the foods we ingest. Regular brushing and flossing will remove the plaque, but the problem is ongoing since plaque will form again within a day once we forget to brush. Plaque that remains on teeth longer than two or three days can harden under the gum line. The longer it remains, the more damage can result. Initial problems begin with irritation and inflammation that, if left untreated, may cause pockets of bacteria, tartar and plaque to develop. Inflammation at the gum line at the base of the teeth is called gingivitis – a mild form of periodontal disease. Could there have been some confusion as to whether you both had active gingivitis, periodontitis, or were you being referred for prophylactic cleaning because of a buildup of plaque? If, indeed, it was the latter, there are no studies available justifying the use of Flagyl in lieu of cleaning.

Here is where issues can occur. Many dentists feel it is necessary to completely clean the pockets around the teeth in an attempt to prevent damage to nearby bone. If the condition is mild, a dentist, dental hygienist or periodontist may remove the bacteria and built up tartar beneath the gums and on the surface of the teeth. Then come the antibiotics to fight the bacteria, followed by a surgical procedure for advanced cases of the disease.

Antibiotics in varying forms are often used to treat gum disease and Flagyl (metronidazole) is one of the choices. While other choices may be applied topically (for gum disease in its earliest stages), some are in pill or capsule form, some in the form of a mouthwash, or actually inserted into the pockets of infection at the gum line(for periodontitis). There are even toothpastes available OTC with antibacterial components to help fight gingivitis and reduce plaque that may be used. Because of potential side effects, I recommend patients speak with their dentist prior to initiating any course of treatment. So , thank you for sharing your story. Prevention is paramount. Brush and floss regularly. Visit your dentist on a timely schedule. And, above all, refuse a recommended treatment if you disagree with the course of action.

OTC has many patients writhing in pain

Q: I enjoy your column and thank God it is available. It has helped me a number of times. I am grateful that I am able to write to you.

My 22-year-old daughter has been on Zyrtec daily for almost six years for allergies. She began getting allergy shots and decided to stop the Zyrtec. The first time was for five days. It was winter and she complained about being very itchy, she had heart palpitations, woke up with night terrors, and had bad anxiety. We attributed it to winter, dry skin, snowy days, and being cooped up in the house. She went back on Zyrtec because of feeling like liquid was in her ears and everything was back to normal. About two months later she decided to stop the Zyrtec again. All the same symptoms appeared and the anxiety was so bad she had to leave work. She was sobbing and shaking and this time it was with the feeling of impending doom. We discussed what had changed in her life and tried to make sense of it. The only thing we could figure was her stopping the Zyrtec.

We searched the internet and found many message boards with tale after tale of people, young and old, experiencing these same symptoms in various degrees after stopping Zyrtec. Of course when we went on Zyrtec’s website, there was nothing about withdrawal problems. Have you heard anything about this and what would you suggest for her t5o do to wean herself off this?

Please get the word out that something sold OTC can have wild side effects when stopped. Thank you for your attention to this. I eagerly look forward to your response.

A: Zyrtec is an antihistamine prescribed to lessen the effects of naturally occurring histamine that can produce symptoms of watery eyes, sneezing, itching, vision problems, tremors, insomnia, cardiac arrhythmias, fatigue, and more. Hypersensitivity side effects have been reported by patients who discontinue the product, as have depression, delusional thinking, and aggressive behavior. Serious reactions are rare according to packaging details. Despite this, some individuals appear to have symptoms that are comparable to those your daughter has — rash, dizziness, difficulty breathing, and itching.

Controlled and uncontrolled clinical trials on Zyrtec conducted in both the US and Canada have included more than 6,000 patients aged 12 and older. More than 3,900 individuals on doses of between 5 and 20 mg daily for a period of between one week and six months were involved in the studies. Most negative reactions were mild to moderate. Adverse reactions in patients 12 and older taking a maximum dose of 10 mg report somnolence in 13.7% of patients, fatigue in 5.9%, dry mouth in 5.0%, and headaches and nausea in more than 2%.

You are correct in that there are countless notations from patients reporting on the internet regarding withdrawal of Zyrtec yet nothing appears on the package insert warning patients of potential ill effects. The FDA has guidelines on when to place warnings but apparently those warnings haven’t yet been included on Zyrtec packaging. When a product – OTC or via prescription — appears to affect numerous individuals, I agree that a warning panel should be included, so congratulations for doing your part to spread the word.

On the home front, one recommendation for control is that a gradual decrease in dosing may help. After about two weeks, the itching should be reduced and is reported to gradually disappear. Another possibility is a short course of corticosteroids while weaning off the OTC. Your daughter might ask about a steroid for control. One last thought is that an antihistamine might provide a degree of treatment. She should speak with her prescribing physician in regard to these possibilities for management.

Anxiety can be hurtful for everyone

Q: I have been under a lot of personal stress lately and have become very anxious. I had been on Kloniin for anxiety for some time but it didn’t seem to be as effective as it once was so, my doctor switched me to Vistoril. Well, this medication makes me tired but it sure doesn’t help me manage my stress level. Can you give me some direction? Did I make a mistake by changing medication and expecting I would be in better control?

A: Let’s take things one step at a time and determine if we can make any sense of things. Klonopin (clonazepam) is in a group of drugs known as benzodiazepines. It is prescribed to treat seizures, purposes related to panic attacks such as anxiety, and for other unrelated purposes as determined by a health care professional. Caution should be taken if you suffer from asthma, emphysema, COPD (chronic obstructive pulmonary disease), kidney or liver disease, if there is a history of depression, or because of an addiction to alcohol. You don’t state your age, but it should not be taken if you are pregnant or may become pregnant. There can be respiratory depression caused by this medication at the time of delivery. The reason not to take it if you were to become pregnant is that there is evidence of human fetal risk. Having said this, if you are pregnant, you should not discontinue the drug without first speaking with your physician or gynecologist. The use of alcohol may increase some of the potential side effects in some people. It may also have a bearing on your thinking or reactions. Side effects of the drug may include hallucinations, confusion, heart palpitations/chest fluttering or a pounding heartbeat, seizures, and more.

A common guideline is that you not take the drug for longer than nine weeks without the prescribing physician’s approval. And, the prescriber may choose to modify the dosage to be assured you are getting the best results from the drug.

With this in mind, he or she may have chosen to consider the Vistaril which also treats anxiety and tension. This drug is a first generation antihistamine. And, while an effective sedative, hypnotic and anxiolytic, it is free of the potential for dependence, addiction and toxicity of other drugs used for similar therapeutic purposes. Again, the drug should not be taken in the first trimester of pregnancy. You should advise your physician of any history of asthma, emphysema, breathing problems, heart disease, or hypertension. Be sure to tell him or her if you take any sedatives, sleeping pills, muscle relaxers, or anti-depressants, as excessive sleepiness may result.

My recommendation is that you speak with your prescribing physician regarding giving another medication a try, perhaps Lexapro, which is in a different class of drugs. Consider adding counseling to the mix. You may be able to reduce or completely diminish the drug if you have a therapist you can open up to that can get you through your difficult times. Ask your doctor for a referral. Don’t let stress control your life. Reduce your caffeine intake if appropriate, try breathing exercises, keep a positive attitude, manage your time wisely, avoid situations that cause anger, don’t rely on alcohol or a smoking habit to solve your problems and most of all spend time with people you feel most comfortable with. Your overall health will thank you for it. Good luck.

A simple blood pressure reading shouldn’t hurt

Q: I am a 71-year-old female in very good health I take a lot of vitamins and a 75 mg Voltaren daily for shoulder arthritis. My problem, though not truly medical, is one that I’m sure affects more people than just me. Whenever I visit the doctor, they take my blood pressure. I have extremely large upper arms (20” in diameter) plus my upper arm is very short. The nurse has to use an extra large cuff for me and during the inflation process, I am in EXTREME pain. Since the new procedure for BP is to inflate the cuff, deflate it and then re-inflate it a few minutes later, I get a double dose of pain. I have a high pain tolerance but this is something else. Consequently, my BP shows up in the doctor’s office as 190-195/90-95 which is a very high reading. Whenever I take my pressure at home with a wrist cuff that I have had checked for accuracy, my BP is 115-125/62-74.

Is there any other method that can be used in a medical office for someone like me that would be more humane and give a more accurate reading without the pain? Thank you.

A: According to a Consumer Reports article from three years ago, wrist monitors were easier to deal with then because of the bulk of a regular cuff but readings were less accurate than those taken at the upper arm. Advances, however, have been made, leading to more accurate readings than were previously available. The report went on to say that of all the wrist models on the market at the time, two were found to be more accurate than the others – the Omron and the Rite Aid units. Since then, numerous other brand names have joined the ranks of better rated devices. The reason for this may be that the individual sat in a chair and held his or her arm across the chest as if saluting the flag, whereas most units recommend holding your arm out from the body with the elbow facing downward. And, despite every technician’s efforts to assure proper alignment, the models available couldn’t equal the top-rated wrist models with across-the-chest positioning.

Units in local pharmacies today are relatively simple and commonly involve placing a finger only into a device, pushing the appropriate buttons, and obtaining a reading. Those monitoring units that are available for home use may be slightly more complicated with more bells and whistles, including wrist bands, upper arm units, battery operated devices, semi-automatic or automatic inflation units and more.

Approximately one in three adults in our country have been diagnosed with hypertension, a condition that may have no signs or symptoms. This is unfortunate in some respects, since the condition may go undiagnosed indefinitely and cause damage to the kidneys, heart, blood vessels, and other parts of the body. This makes annual or timely examinations (if there are other medical conditions or a family history of hypertension) with a physician an important part of health care. Readings will not remain the same for an individual all the time. If we are nervous, anxious or physically active, our levels may rise. On the opposite spectrum, readings will lower when we are at rest or asleep. And, readings tend to elevate with age. Following a healthy lifestyle will help some patients at least delay if not prevent unwanted rises in blood pressure.

You indicate your wrist unit has been checked for accuracy. There are instances when a device will require recalibration because of several reasons. Therefore, I recommend you bring your unit to your physician’s office the next time you have an appointment. Begin by checking (or having the nurse check) your numbers using your wrist unit. Promptly thereafter, have her use the arm cuff that causes you so much pain only once. If the numbers are compatible, you should be able to continue with them using your wrist unit. If they aren’t, you might jot down both sets of numbers, repeat the process on your following visit, and compare them to determine if there is continuity of the arm unit being, say, 10 or 15 points higher. If this is the case, perhaps you can use your unit, add the differential, and have the nurse make a notation in your chart that the reading was with your personal unit and not theirs. As a point of information, the journal Circulation suggests that an arm greater than 17.3 inches in circumference requires that the BP be checked with a thigh cuff. Should your physician’s office have such a unit, it would be the way to go.

You shouldn’t have to experience pain each time you visit your physician. Ask them to work with you in a way that is satisfactory to all involved.

Oh, those confusing vegetarian diets!

Q: Can you tell me the difference between being a vegetarian and being a vegan? My grandson will be coming home for the holidays very soon and I understand he is now a vegan. What on earth can I prepare for him when he comes to dinner and what should I avoid cooking? As grandparents, we worry a great deal about him and whether he is receiving a sufficient, healthy diet.

A: Yes, I can. Your question is quite timely, since November was named World Vegan Month to celebrate the founding of the world’s first Vegan Society some 70 years ago. Individuals on a vegan diet avoid all animal products and animal-derived ingredients such as meat, milk, and eggs. A strict vegan diet includes fruits and vegetables, grains, beans, and legumes. And interestingly, the fastidious shopper can find vegan versions of ice cream, hot dogs, cheese, and mayonnaise. And while milk isn’t allowed, you can also find soy milk, almond milk and rice milk – all of which can replace the milk we commonly purchase for baking and drinking purposes. Soy milk is healthy, inexpensive, has less fat, no cholesterol, and is a good source of calcium. When making a purchase, be sure it is fortified with vitamin B12. Almond milk has a creamy consistency and a somewhat nutty flavor, making it an excellent substitute for creamy drinks, smoothies, and desserts. Rice milk is not as thick as soy, and has less protein.

So, what might vegans have eaten for recently celebrated Thanksgiving? More than likely, they feasted on Tofurkey – a stuffed vegan roast made from GMO-free. USDA organic ingredients such as tofu, wheat, gluten and canola oil. Tofurkey has been available in supermarkets for 19 years, yet lately it has become much more popular than it has been in the past. Even Trader Joe’s has a Tofurkey version – a product that is filled with vegan stuffing and has a vegan gravy on the side. Their roast is made from wheat, ancient, soy and peas. Questions remain as to whether honey is allowed in a vegan diet. Generally speaking, it is not.

A vitamin D deficiency is prevalent in today’s society, with most individuals completely unaware they are even deficient. There are some vitamin D supplements available on the market, yet many are derived from animal products such as fish oil and sheep lanolin that are not allowed on a true vegan diet. So, if you are considering a vitamin supplement as a stocking stuffer for the upcoming holiday, be sure to read the ingredient panel prior to making a purchase.

The interpretation of a vegetarian diet varies from person to person. For example, a lacto-vegetarian diet excludes meat, fish, poultry and eggs and all food products and dishes that contain them. The lacto-ovo vegetarian excludes fish, poultry and meat (no fish) but allows eggs and dairy products. An ovo-vegetarian diet is essentially the same but allows eggs. The variations may appear complicated to those individuals who freely consume meats, fish, poultry, and the vast array of dairy products available on the market but the key here is to avoid deficiencies by paying attention to vital nutrients such as calcium, omega-3 fatty acids, iron, iodine, protein, Vitamins D.

Keep things simple for your grandson. Consider his own Tofurkey, squash, potatoes, cranberry sauce, and soy milk. You’ll be a big hit!

Another texting and driving issue

Q: About three months ago while driving in a busy city down a side street, I was hit from behind by a gentleman driving a Volvo. I was stopped with my flashers on and he was texting. He didn’t see me, hit me hard enough to sever the anchor bolts that held my seat down and in what seemed like a nanosecond following impact, he put his car in reverse, did a U turn in the middle of the street and disappeared, never to be seen again.

The problem is not the accident but the fact that a day or two following it and continuing through today, I have pain that I think is sciatica. It begins in my lower back/buttock area and continues down my leg. At this stage I am never without pain and I just don’t know what to do. Please don’t suggest I contact the police. I couldn’t prove other than the make of the car who was driving or where he went. What can I do to lessen the pain that troubles me constantly?

A: Sciatica is described as pain that travels from the lower back to the hips, buttocks and down the leg to the back of the thigh and calf. Some individuals may experience tingling and muscle weakness. It is generally present on one side of the body only. If this description fits your symptoms, my guess is that your sciatic nerve has become pinched, either because of the trauma from your accident, a herniated disc in your spine or because of a bone spur on your vertebrae. Other possible causes include the aging process, obesity, leading a sedentary lifestyle, and diabetes.

While it isn’t necessary in all cases to receive treatment, because of the time period of your complaint I recommend you be seen by your family physician. He or she may check your reflexes and muscle strength. You may be asked to do specific exercises and movements such as lifting your legs straight into the air from a lying position. If you have sciatica, the exercise may exacerbate the symptoms you have been having.

Testing for diagnosis may include a routine imaging test which will identify a bone spur if one is present and which, as was indicated above, could be the cause for your sciatica . Then there is an MRI that will reveal soft tissues, bone and soft tissues like herniated discs.

Treatment for sciatica might begin with over-the-counter anti-inflammatory drugs or muscle relaxants, hot or cold packs, and specific exercises designed to help relieve nerve root compression. Should they fail to be effective, prescription tricyclic antidepressants or anti-seizure drugs might relieve the pain. Then there is always acupuncture and chiropractic manipulation. In some instances, a steroid injection into the affected area might control the inflammation around the affected nerve. On the downside, the injection is not a permanent solution and might have to be repeated. For cases that fail to show improvement to the stage the condition is tolerable, surgery may be a final option; however, surgery is commonly a consideration when incontinence or appreciable weakness is present.

Get a diagnosis from a health care professional. Then you can work on methods to improve your condition.