Acupuncture is one of the few complementary therapies that has a large body of evidence in the conventional medical literature showing some efficacy as the therapy of low back pain.
By RX FOR READERS/JUDY SIEGEL-ITZKOVICHAn artistic interpretation of the thyroid.(photo credit: TNS)I am a 35-year-old married woman and mother of three young children. I was recently diagnosed with a hyperactive thyroid. I was given pills, but they disrupted my liver function. My endocrinologist said I would have to undergo radioactive iodine treatment to destroy the thyroid gland and then for the rest of my life take a daily pill. I was told I would have to be totally isolated for a week from my family, not see anyone at all and even use only disposable plates and other things in the kitchen. Is this the only solution to hyperthyroidism? Does this treatment constitute a cure? Are there any side effects from the treatment or the pill? How does one manage to be totally isolated for a week? Why can’t I use regular dishes and plates? Z.M., JerusalemDr. Gavriel Munter, head of the endocrinology department at Jerusalem’s Shaare Zedek Medical Center, answers: Your hyperthyroid condition is called Graves’ disease. It is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Because thyroid hormones affect a number of different body systems, signs and symptoms associated with Graves’ disease can be wide-ranging and significantly influence your overall well-being. Although Graves’ disease may affect anyone, it’s more common among women and before the age of 40.Among the symptoms are irritability and anxiety, more-than-normal perspiration, tiredness, weight loss even though you eat the same amount of food, a light tremor of your hands or fingers, frequent bowel movements and enlargement of the thyroid gland. It can also affect the eyes, causing them to bulge, put pressure on the eyes or make them painful, cause sensitivity to light and other symptoms, while the skin on the top of the feet or the hands can become red and thick.There are three treatment options – medication, radioactive- iodine treatment and surgery to remove the thyroid gland.In Israel and Europe, it is customary to start drug treatment. There are two suitable medications on the market – propylthiouracil and methimazole. One of the side effects of these preparations is liver enzyme disorder. The question of whether to take methimazole if propylthiouracil upsets liver activity depends on the intensity of the disruption that may result. If the disorder is mild, it is possible to use the second drug, but if the liver injury is significant, it is not worth trying.Treatment with radioactive iodine destroys or almost destroys the overactive thyroid and results in the low production of its hormones in more than 90% of the patients. The patient as a result must take a suitable dose of thyroid gland hormones permanently.After radioactive iodine treatment, the patient must be in complete isolation for a week (usually at home) to prevent radiation from the patient reaching the environment. The patient’s secretions are also contaminated with radiation, so it’s recommended to use disposable plates and utensils. There may be some discomfort, but most patients go through it without difficulty.I am a 73-year-old very active woman who works and babysits for grandchildren. Thirty-two years ago, I had a laminectomy (surgery that creates space by removing the lamina, the back part of the vertebra that covers the spinal canal) to relieve pressure on the spinal cord or nerves because I had back problems. After six weeks’ bed rest, I was losing the use of my right leg – and I was operated on as an emergency. Fortunately, since then I have had few problems with this aspect of my health except pain occasionally in my legs.
A couple of years ago, I saw a pain expert privately about the pain. After a CT scan, I was told to take analgesics as there was nothing to be done. In the past month, the pain in my right leg has become acute during the night so I have very disturbed sleep. I have tried several painkillers and muscle relaxants, none of which help me. Even if taken at about 10 p.m., four or five hours later I toss and turn, trying to find a way to be comfortable. A pillow under my leg is no help. I feel very sleep deprived and desperate to find a solution. Is there a chance that some form of complementary medicine could help me?N.S., Jerusalem Dr. Menachem Oberbaum, director of the Center for Integrative and Complementary Medicine at Jerusalem’s Shaare Zedek Medical Center, replies:Your symptoms suggest that the condition might have a connection with your medical history of back problems. But there might also be other reasons for your suffering. You must go urgently to a neurologist. Assuming that your back is the cause of the pain, at least three promising possibilities can be suggested: acupuncture, chiropractic and osteopathy.Acupuncture is one of the few complementary therapies that has a large body of evidence in the conventional medical literature showing some efficacy as the therapy of choice in cases of low back pain and its complications.Chiropractic and osteopathy are manipulative therapies. There are clinical publications in the medical literature presenting clinical benefits in low back pain and its complications, but a clear conclusion is limited by the small number of studies. Therefore, future research is likely to have an important impact on these estimates. The decision to refer patients for manipulative therapies should be based upon costs, preferences of the patients and providers and relative safety of manipulative therapies compared to other treatment options. Reflexology might also be beneficial for patients with lower-back pain, especially when combined with exercises, but there is still not much medical evidence.Food supplements and herbal medicines will not help.Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@ jpost.com, giving your initials, age and place of residence.
