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BACK PAIN. For instance, “heat therapy dilates the
blood vessels of the muscles surrounding the lum-
bar spine. This process increases the flow of oxy-
gen and nutrients to the muscles, helping to heal
the damaged tissue.” Also, “heat application facili-
tates stretching the soft tissues around the spine,
including muscles, connective tissue, and adhe-
sions. Consequently, with heat therapy, there will
be a decrease in stiffness as well as injury, with an
increase in flexibility and overall feeling of comfort.
Flexibility is very important for a healthy back.”
Mooney, Vert, M.D. “Benefits of Heat Therapy for Lower
Back Pain,” Spine-health. Available online. URL:
http://www.spine-health.com/topics/conserv/heat_
therapy/heat_therapy01.html. Downloaded January
10, 2006.
Rouzier, Pierre, M.D., for McKesson Provider Technolo-
gies. “Heat Therapy,” University of Michigan Health
System (UMHS). Available online. URL: http://www.
med.umich.edu/1libr/sma/sma_htherapy_sma.htm.
Last reviewed July 22, 2002.
herbal therapy With the variety produced by
nature, herbal therapy comes in varied forms.
Depending on the intended usage, herbs may be
mashed into a paste or into a pasta sauce. They can
be ground into powder, pressed into a pill, or sprin-
kled over a baked potato. Leaves can be steeped for
hot tea, soaked in cold water, or fermented with
sugar and made into wine. With the addition of
honey, herbs can be cooked down into a syrup
for pancakes or for a rib-wrenching cough. Soak-
ing them in olive or grapeseed oil for a week or so
produces an herb-enhanced lubricant to rub into a
wound or mix with vinegar and tastefully toss onto
a salad. Added to petroleum jelly, herbs produce
a salve or ointment. When wetted and liberally
applied, an herb poultice can ease a
BACKACHE or
sore muscles and leave a soggy mess of leaves.
Often, herbal treatments come with fair warn-
ing: the FDA may not approve. Since the F in FDA
stands for foods including herbs, the U.S. Food
and Drug Administration (FDA) has issued warn-
ings to manufacturers of herbal products, taking
them to task for making unsubstantiated claims. As
the November 10, 2005, “FDA News” explained,
“under the federal Food, Drug, and Cosmetic Act
(FDCA), a product is considered to be a drug if it
claims to diagnose, cure, mitigate, treat or prevent
disease or, for products other than foods and dietary
supplements, if it claims to affect the structure or
function of the body. The Warning Letters further
state that FDA considers these products to be ‘new
drugs’ that require FDA approval before market-
ing.” While some patients may resent governmen-
tal interference with herb use, others see the FDA
stance as standing up for better testing, safety, and
standardization of herbal products.
Risks and Complications
Versatile though herbs may be, people with skin
sensitivities or food allergies know that natural
does not always mean safe. For example, black
walnut offers herbal therapy that can either detox
the body or poison it. Anyone who reacts strongly
to any food allergen risks anaphylactic shock just
by tasting an herb with properties similar to the
offending food. To avoid this risk, a physician can
prescribe medication to keep on hand for an anti-
dote. However, the shelf-life of such medications
may not be very long, so sensitive patients should
stock
OVER-THE-COUNTER antihistamines as well as
chewable
VITAMIN C to help the body produce its
own antihistamine. In a squeeze, sucking a lemon
may keep skin from breaking out in hives or lips
from swelling. If, however, those lips pucker with
lipstick from an herb shop, a rash of events may
follow, especially since some natural cosmetics con-
tain that nut-allergy nightmare, black walnut.
Another nightmare can arrive with adverse inter-
actions between an herb and a pharmaceutical drug.
As a general guideline, no herb should be taken for
the same condition being treated with a prescrip-
tion or an over-the-counter medication such as an
NSAID (
NONSTEROIDAL ANTI-INFLAMMATORY DRUG).
To treat pain, for example,
ASPIRIN should not be
used in conjunction with the white willow bark
from which it is derived, nor should it be used with
any herb, such as garlic, that shares its ability to thin
the blood. Natural foods boost any medicinal effects
they share with a drug, but herbs and vegetables can
also interfere with medications that have the oppo-
site effect. For instance, the
VITAMIN K in broccoli
and eggplant interrupts the action of drugs meant
116 herbal therapy
to slow blood clotting. Such herb-food-drug combi-
nations can cause serious complications, especially
for sensitive people,
CHILDREN, ELDERLY patients, and
anyone who takes medication for an ongoing condi-
tion. In addition, some herbs may be combined in a
single capsule or tonic, which makes label reading
even more important.
An article on the interactions between medi-
cines and herbs posted by Holistic-online.com
said that goldenseal may be used to treat
ARTHRI-
TIS but warned “the plant’s active ingredient will
raise blood pressure, complicating treatment for
those taking antihypertensive medications, espe-
cially beta-blockers. For patients taking medica-
tion to control diabetes or kidney disease, this herb
can cause dangerous electrolyte imbalance. High
amount of consumption can lead to gastrointesti-
nal distress and possible nervous system effects.”
Furthermore, goldenseal is “not recommended for
pregnant or lactating women.” Similarly, turmeric
“should be avoided by persons with symptoms from
gallstones.”
Statistics and Studies
Historically, turmeric has been used to lessen joint
pain and ease an aversion to the taste of catfish, but
recent studies took a closer look at this herb, which
has no known side effects and can be found in the
spice section of most grocery stores. In an article
for Better Nutrition, Amber D. Ackerson wrote,
“Numerous medical studies indicate that turmeric
has significant anti-inflammatory action, primarily
due to its active constituent, curcumin. Curcumin
has been shown to prevent platelet aggregation
(clumping) associated with the development of ath-
erosclerosis. Preliminary studies indicate curcumin
may have benefits in preventing numerous cancers
and cancer metastasis (spread), and it may be used
to enhance the effectiveness of chemotherapy and
radiation.” While this medicinal herb can be used
for culinary purposes, therapeutic amounts beyond
a kitchen dash include “standardized extract con-
taining 90–95 percent curcumin: 250–500 mg three
times daily,” “tincture (1:5 concentration): 3–3.5
mL three times daily,” or “fluid extract (1:1 con-
centration): 0.5–1.5 mL three times daily.” In most
herbal instances, a tincture or extract will be stron-
ger than a fresh or dried kitchen herb.
An article by Sara Altshul discussed the use of
devil’s claw, which is an herb not found on a spice
rack but frequently found by patients racked with
OSTEOARTHRITIS and other sources of LOW BACK PAIN.
According to the 2005 article in Prevention, “Last
fall, researchers from the universities of Toronto,
Freiburg (Germany), Sydney, and Maryland pub-
lished a thorough review and analysis of 12 devil’s
claw studies that involved a total of 1,105 partici-
pants. . . . The researchers concluded that there is
good evidence for using devil’s claw at certain dos-
ages as a treatment for chronic lower-back pain and
osteoarthritis.” Specifically, “a daily dose of 60 mg
of the devil’s claw compound, called harpagoside,
relieved back pain as effectively as did a standard
dose of rofecoxib (Vioxx).”
With future studies needed for most herbal ther-
apies, the National Center for Complementary and
Alternative Medicine (NCCAM) warned, “The active
ingredient(s) in many herbs and herbal supple-
ments are not known. There may be dozens, even
hundreds, of such compounds in an herbal supple-
ment.” Therefore, “scientists are currently working
to identify these ingredients and analyze products,
using sophisticated technology. Identifying the
active ingredients in herbs and understanding how
herbs affect the body are important research areas.”
Special Aids and Adaptations
Besides the ongoing aid of NCCAM and the FDA in
regulating and standardizing herbal therapies, some
patients may prefer their own garden plants. A good
place to start would be culinary herbs traditionally
used to ease pain and inflammation. Home-grown
herbs not only provide the freshest source of herb
therapy but may aid in reducing the side effects that
often come when only part of a plant is used.
An article in the Western Journal of Medicine
explained, “Practitioners of herbal medicine gener-
ally use unpurified plant extracts containing several
different constituents. Typically, they claim that these
can work together synergistically so that the effect of
the whole herb is greater than the sum total of the
effects of its components. They also claim that toxic-
ity is reduced when whole herbs are used instead
of isolated active ingredients (‘buffering’).” In other
words, unidentified constituents in a natural herb
may be inadvertently removed during processing yet
herbal therapy 117
be the very ingredients needed to prevent the side
effects found in a pharmaceutical version.
While this alleged advantage of fresh herbs bears
scientific scrutiny, most people agree that fresh
herbs just naturally taste better, smell better, and
look better as an aid to
NUTRITION. For most gar-
deners, spine-strengthening benefits also come
naturally with the daily
ACTIVITY of tending plants
intended, in turn, to tend them.
Ackerson, Amber D. “Turmeric (Curcuma longa),” Better
Nutrition 67, no. 3 (March 2005): 12.
Altshul, Sara. “Low-Back Pain Relief,” Prevention 57, no.
4 (April 2005): 90.
Holistic-online.com. “Medicine—Herb/Food Interac-
tions.” Available online. URL: http://holistic-online.
com/Herbal-Med/hol_herb_med_reac.htm. Down-
loaded January 10, 2006.
National Center for Complementary and Alternative
Medicine. “Herbal Supplements: Consider Safety, Too,”
NCCAM, National Institutes of Health. Available online.
URL: http://nccam.nih.gov/health/supplement-safety/.
Last modified October 19, 2005.
U.S. Food and Drug Administration. “FDA News, FDA
Issues Warning Letters to Marketers of Unapproved
‘Alternative Hormone Therapies’ Items Promoted for
Treatment or Prevention of Cancer, Heart Disease,
and Osteoporosis,” FDA, Department of Health and
Human Services. Available online. URL: http://www.
fda.gov/bbs/topics/news/2005/NEW01260.html.
Originally issued November 10, 2005.
Vickers, Andrew, Catherine Zollman, and Roberta Lee.
“Herbal Medicine,” Western Journal of Medicine (WJM)
175, no. 2 (August 2001): 125–128.
heredity See GENETIC FACTORS.
herniated disc Whether ruptured, prolapsed,
slipped, or herniated, a misshapen disc causes
ACUTE PAIN. Usually, the discomfort begins when
the bulging area of a vertebral disc presses against
spinal nerves.
Symptoms and Diagnostic Path
Although sharp, shooting pain characteristically
occurs, some people experience tingling or numb-
ness as the first sign of a herniated disc. If her-
niation happens in the
CERVICAL SPINE, symptoms
often include neck pain that radiates into the arms
or causes numbness in the arms and hands. In the
THORACIC SPINE, chest pains may be felt, whereas
a herniated disc in the
LUMBAR SPINE presents the
intense pain, weakness, or numbness of
SCIATICA.
If a patient loses mobility or control of bowel and
bladder function, those symptoms may signify
CAUDA EQUINA SYNDROME or other medical emer-
gency that, most likely, will require
SURGERY.
UCLA Neurosurgery offered an online chart
showing various levels of disc herniation and resul-
tant symptoms. For instance, spinal root compres-
sion emanating from the C5 neck vertebra may be
felt as shoulder weakness. A herniation at C6–C7
produces sensory loss in the middle finger, while a
herniated disc between C7 and the first vertebra in
the thoracic spine, T-1, causes numbness in the ring
and little fingers.
To locate the specific area of herniation, X-
RAYS
may help, but
MAGNETIC RESONANCE IMAGING or a
COMPUTED TOMOGRAPHY SCAN provide clearer details.
Also, a
MYELOGRAM may highlight any spinal nerve
involvement.
Besides tests and a medical history, a diagnosis
includes a physical examination such as Dr. James
C. Farmer described for patients with
LOW BACK PAIN:
“The physical examination of a patient suspected
to have a lumbar disk herniation should include a
thorough motor and sensory as well as reflex exam-
ination.” For example, straightening and raising
each leg may help to identify patients with lumbar
disk herniations, since “the maximal tension within
the sciatic nerve itself occurs between 35° and 70° of
elevation of the leg . . . In the higher-level disk her-
niations involving the L2, L3, and L4 nerve roots,
testing is performed using a . . . stretch test or a
reverse straight leg raise.”
Treatment Options and Outlook
Regardless of the location of a herniated disc,
TRAC-
TION may relieve painful pressure caused by disc
compression. Usually though, conservative treat-
ment begins with bed rest alternated with
EXERCISE
or physical therapy a doctor has prescribed. For gen-
eral pain,
NONSTEROIDAL ANTI-INFLAMMATORY DRUG
THERAPY helps most patients, about 80 to 90 percent
118 heredity
of whom eventually improve without surgery. If a
DISCECTOMY or MICRODISCECTOMY is needed, patients
often return to normal daily
ACTIVITY within a few
weeks.
In discussing various types of surgery to treat
herniated discs, the American Association of Neu-
rological Surgeons (AANS) listed several options on
their Web site. For example, a discectomy involves
“surgical removal or partial removal of an interver-
tebral disc,” whereas a
LAMINECTOMY means, “sur-
gical removal of most of the bony arch, or lamina
of a vertebra.” Laminotomy requires “an open-
ing made in a lamina, to relieve pressure on the
nerve roots,” while spinal fusion is “a procedure
in which bone is grafted onto the spine, creating
a solid union between two or more vertebrae; and
in which instrumentation such as screws and rods
may be used to provide additional spinal support.”
The AANS also said, “Fortunately, the majority of
herniated discs do not require surgery. However,
a very small percentage of people with herniated,
degenerated discs may experience symptomatic or
severe and incapacitating low back pain which sig-
nificantly affects their daily life.”
Information from the North American Spine
Society reported, “Most patients respond well to
discectomy; however, as with any surgery, there
are some risks involved. These include bleeding,
infection and injury to the nerves or spinal cord. It
is also possible that pain will not improve follow-
ing surgery or that symptoms may return. In about
3–5% of patients, the disc will rupture again and
cause symptoms at a later time.”
Risk Factors and Preventive Measures
People whose jobs involve
LIFTING or other manual
tasks that exceed their
LOAD TOLERANCE may be par-
ticularly at risk for a disc herniation. People with
poor
POSTURE and those adversely affected by WEIGHT
or
ERGONOMIC FACTORS encounter more risks too.
So do
ELDERLY patients prone to a fall and CHILDREN
or
ADOLESCENTS who disregard BACKPACK SAFETY.
For almost everyone though, general dehydra-
tion makes vertebral discs less flexible. Therefore,
most people do well to drink lots of water. Regular
exercise also aids overall flexibility and strength,
whereas a good mattress can aid the repairs a body
needs during restful
SLEEP.
Dawson, Edgar G., M.D. “Herniated Discs,” SpineUniverse.
Available online. URL: http://www.spineuniverse.com/
displayarticle.php/article1431.html. Last updated July
7, 2005.
Farmer, James C., M.D. “Lumbar Disk Herniation,” AAOS
Clinical Topic, American Academy of Orthopaedic
Surgeons. Available online. URL: http://www3.aaos.
org/memdir/academic/eletter/2004/topics/Lumbar%
20Disk%20Herniations.htm. Downloaded January 10,
2006.
NeurosurgeryToday.org. “Herniated Disc,” American
Association of Neurological Surgeons (AANS.) Avail-
able online. URL: http://www.neurosurgerytoday.org/
what/patient_e/herniated.asp. Downloaded January
10, 2006.
North American Spine Society. “Herniated Cervical Disc,
Herniated Lumbar Disc,” NASS. Available online. URL:
http://www.spine.org/fsp/prob_action-degen-hern.
cfm. Downloaded January 10, 2006.
Scholten, Amy. “Herniated Disc (Ruptured Disk, Pro-
lapsed Disk, Slipped Disk),” Holy Cross Hospital.
Available online. URL: http://healthychoice.epnet.
com/GetContent.asp?siteid=holycross&docid=/dci/
herniatedisk. Downloaded January 10, 2006.
University of California. “What Is Cervical Disc Disease,”
UCLA. Available online. URL: http://neurosurgery.
ucla.edu/Diagnoses/Spinal/SpinalDis_1.html. Down-
loaded December 5, 2005.
University of Michigan Health Center. “Herniated Disk,”
UMHC, McKesson Provider Technologies. Available
online. URL: http://www.med.umich.edu/1libr/sma/
sma_herndisk_crs.htm. Downloaded January 10,
2006.
homeopathic medicine Similar to many phar-
maceutical drugs and
OVER-THE-COUNTER PRODUCTS,
homeopathic remedies stem from natural sources
that can usually be obtained directly from
HERBAL
THERAPY or regular NUTRITION. Unlike other therapies,
however, homeopathic medicine treats like with
like, which means the remedy produces the same
symptoms as those of the condition being treated.
The concept originated in the late 18th century
when German doctor and chemist Samuel Hahn-
emann apparently tired of bloodletting and other
treatments in common use at the time. After care-
fully observing and recording the natural responses
homeopathic medicine 119
of the body in an attempt to heal itself, Dr. Hahn-
emann derived the principle of like curing like. For
instance, as a response to chest congestion, a person
typically coughs. Therefore, a homeopathic remedy
would not suppress a cough but provoke one, thus
relieving the congestion. Figuratively speaking, the
concept seems like fighting fire with fire.
Dosage and Potential Side Effects
Because of substantial dilutions, most homeopathic
remedies are considered safe. As with any new
medicine, herb, or food, however, a person should
proceed with caution, trying only one ingredient at
a time. If a remedy comes as a combination prod-
uct, a minimal amount should be taken only once
on the first day. If the person has no side effects, the
amount can be gradually increased each day until
reaching the recommended dosage.
For
BACKACHE, FIBROMYALGIA, OSTEOARTHRITIS,
or
RHEUMATOID ARTHRITIS, homeopathic remedies
often include arnica, which reportedly relieves
CHRONIC PAIN. For OSTEOPOROSIS, a product may
contain silica, phosphorus, calcarea carbonica, cal-
carea fluorica, or other significant names.
An article posted by the National Center for Com-
plementary and Alternative Medicine (NCCAM)
discussed another unique aspect of homeopathy.
Instead of relying on potency, a homeopathic medi-
cine will be diluted numerous times. As the NCCAM
explained, “A concept that became ‘potentization,’
which holds that systematically diluting a substance,
with vigorous shaking at each step of dilution, makes
the remedy more, not less, effective by extracting the
vital essence of the substance. If dilution continues
to a point where the substance’s molecules are gone,
homeopathy holds that the ‘memory’ of them—that
is, the effects they exerted on the surrounding water
molecules—may still be therapeutic.” In traditional
allopathic medicine, for example, a correlation might
be made with some types of inoculation, which, in
essence, place the memory of a previous illness into
the body in order to prevent that particular ailment.
To describe the dilution process further, infor-
mation from the National Center for Homeopathy
said, “A plant substance, for example, is mixed in
alcohol to obtain a tincture. One drop of the tinc-
ture is mixed with 99 drops of alcohol (to achieve a
ratio of 1:100) and the mixture is strongly shaken.
This shaking process is known as succussion. The
final bottle is labeled as ‘1C.’ One drop of this 1C
is then mixed with 100 drops of alcohol and the
process is repeated to make a 2C. By the time the
3C is reached, the dilution is 1 part in 1 million!
Small globules made from sugar are then saturated
with the liquid dilution. These globules constitute
the homeopathic medicine.”
The online article, “Understanding Homeopathic
Potency,” explained, “Homeopathic potencies are
designated by the combination of a number and a
letter (for example, 6X or 30C). The number refers
to the number of dilutions the tincture has under-
gone within a series to prepare that remedy. The
letter refers to the proportions used in each dilution
of the series (the Roman numeral X means 10, and
the Roman numeral C means 100), as well as the
number of succussions the vial of solution under-
goes in each successive stage.”
Statistics and Studies
Today, the research begun by Dr. Hahnemann con-
tinues, often with mixed reviews. As the NCCAM
article reported, “Research studies on homeopathy
have been contradictory in their findings. Some
analyses have concluded that there is no strong evi-
dence supporting homeopathy as effective for any
clinical condition. However, others have found pos-
itive effects from homeopathy. The positive effects
are not readily explained in scientific terms.”
That assessment is not surprising in light of the
individualization of the treatment. As the NCCAM
described the concept, “treatment should be selected
based upon a total picture of an individual and his
symptoms, not solely upon symptoms of a disease.
Homeopaths evaluate not only a person’s physical
symptoms but her emotions, mental states, lifestyle,
nutrition, and other aspects. In homeopathy, differ-
ent people with the same symptoms may receive dif-
ferent homeopathic remedies.” Although some may
view this very old medicinal approach as a hoax,
others see the value of different treatments coaxing
cures for different folks. For example, patients with
sensitivities to medicines may prefer the idea that,
with homeopathy, less is usually more.
Homeopathy. “Understanding Homeopathic Potency,” Vita-
minShoppe and HealthNotes Online. Available online.
120 homeopathic medicine
URL: http://www.homeopathyhome.com/services/
rshop/vshoppe/remguide/potency.shtml#HN. Down-
loaded January 11, 2006.
National Center for Complementary and Alternative Med-
icine. “Questions and Answers About Homeopathy,”
NCCAM, National Institutes of Health. Available online.
URL: http://nccam.nih.gov/health/homeopathy/. Last
modified August 24, 2004.
National Center for Homeopathy. “What Are the
Medicines?” Available online. URL: http://www.
homeopathic.org/meds.htm. Downloaded January
11, 2006.
hormone replacement therapy (HRT) This treat-
ment option may combine estrogen with proges-
tin to lessen the risk of a
VERTEBRAL COMPRESSION
FRACTURE in postmenopausal women and younger
women prone to
OSTEOPOROSIS or other bone-
thinning conditions that affect the
BACK and SPINE.
However, hormone replacement therapy (HRT)
may not present the best choice for every woman.
The American Medical Association (AMA) cau-
tioned readers that “the 2004 Surgeon General’s
report stated that any decision to use HT must take
into consideration its impact on overall health out-
comes, including not only its potential to reduce the
risk of fractures, but also its potential to increase the
risk of other health problems. The FDA has advised
that postmenopausal women who use or are con-
sidering using estrogen or estrogen with proges-
tin discuss its benefits (e.g., relief from moderate to
severe hot flashes . . . ) and risks with their physi-
cians. Although HT is effective for the prevention of
postmenopausal osteoporosis, it should only be con-
sidered for women at significant risk of osteoporosis
who cannot take non-estrogen medications.” H
ERBAL
THERAPY and HOMEOPATHIC MEDICINE also offer options
but without the proven benefits of HRT.
Dosage and Potential Side Effects
Available in pill, patch, or gel forms, hormone
therapy often provides daily continuous treatment.
However, MedicineNet advised, “Because the risks
outweigh the benefits of long-term hormone ther-
apy (HT) for most women, women who are at risk
of, or who have been diagnosed with, osteoporo-
sis should talk to their doctors about non-estrogen
medications . . . in preventing and treating osteo-
porosis.” Those choices might include
ALENDRONATE
(Fosamax),
CALCITONIN (Miacalcin) RISEDRONATE
(Actonel), raloxifene (Evista), teriparatide (Forteo),
and other
BISPHOSPHONATES, SELECTIVE ESTROGEN
RECEPTOR MODULATORS (SERMS), or ANTIRESORPTIVE
DRUGS.
Statistics and Studies
In considering
BONE MINERAL DENSITY (BMD), the
AMA discussed trials by the Women’s Health Ini-
tiative (WHI), a prevention study begun in 1991 to
address the most common causes of death, disabil-
ity, and impaired quality of life in postmenopausal
women, that “confirmed for the first time the effects
of combined continuous hormone therapy on osteo-
porotic fracture reduction at several sites, includ-
ing the hip. Hip and vertebral fractures decreased
by at least one-third in both of the trials and total
fractures decreased by 24%–30%.” However, “the
clear fracture benefits of postmenopausal hormone
therapy (HT) are offset by the adverse effects (e.g.,
increased risk of stroke, cognitive impairment . . .)
encountered in the women taking HT. The WHI tri-
als also found that HT provided no cardioprotective
benefit, and increased the risk of breast cancer.”
Karin H. Humphries and Sabrina Gill spoke of
the importance of individualized choices to con-
sider the personal risks and benefits. In considering
the back and spine, the authors said, “HRT has been
shown to increase bone mineral density, but data
supporting reduction of vertebral and nonvertebral
osteoporotic fractures with HRT are inconsistent.
Consequently, the U.S. Food and Drug Adminis-
tration indicates HRT for the prevention, not the
treatment, of osteoporosis. Similarly, the Scientific
Advisory Council of the Osteoporosis Society of
Canada recommends HRT as first-line preventative
therapy in postmenopausal women who have low
bone density but as second-line treatment in post-
menopausal women who have osteoporosis. Alter-
natively, there are considerable data demonstrating
vertebral and nonvertebral fracture reduction with
bisphosphonates, and vertebral fracture reduction
with selective estrogen-receptor modulators and
calcitonin.”
While estrogen and other hormonal treatments
have been shown to slow bone loss in women,
hormone replacement therapy 121
similar studies of testosterone for men seem to be
lacking. As quoted in an article for Geriatrics, Dr. E.
Darracott Vaughan Jr. of Weill Medical College at
Cornell University in New York said, “I was sur-
prised at the weakness of the literature. We looked
at over 400 articles and there were fewer than 50
with any evidence-based research.” As testosterone
levels decline with age, so do muscle mass and bone
strength. Yet men frequently request this form of
hormone replacement therapy, not to strengthen
bones but to enhance sexual function. Since 1999,
the number of doctors who prescribed testosterone
increased 170 percent. Seeing the trend as “patient
driven,” Dr. Vaughan pointed out that available
studies indicate escalation in prostate cancer too, so
he suggested that physicians test for present testos-
terone levels before prescribing more.
American Medical Association. “Antiresorptive Ther-
apy: Hormone Therapy,” AMA. Available online.
URL: http://www.ama-cmeonline.com/osteo_mgmt/
module05/04anti/index.htm. Downloaded January
10, 2006.
Humphries, Karen H. and Sabrina Gill. “Risks and Ben-
efits of Hormone Replacement Therapy: the Evidence
Speaks,” Canadian Medical Association Journal (CMAJ)
168, no. 8 (April 15, 2003): 1,001–1,010.
Mathur, Ruchi, M.D. “Hormone Therapy (Estrogen Ther-
apy, Estrogen/Progestin Therapy),” MedicineNet, Inc.
Available online. URL: http://www.medicinenet.com/
hormone_therapy/article.htm. Downloaded January
10, 2006.
MedicineNet.com. “Estrogen/Progestins—Oral,” First
DataBank, Inc. Available online. URL: http://www.
medicinenet.com/estrogenprogestins-oral/article.htm.
Last reviewed March 2, 2005.
Staff. “Testosterone Prescriptions Jump 170% since 1999,
yet Uses Remain Unproven,” Geriatrics 59, no. 1 (Jan-
uary 2004): 15.
humpback or hunched back See KYPHOSIS.
hydrotherapy From therapeutic baths in ancient
Greece and Rome to the natural hot springs found
in the United States, hydrotherapy usually joins
HEAT THERAPY in easing an aching BACK or SPINE.
At home treatments include whirlpool baths or
hot tubs, while professional spas offer soothing hot
towels wrapped up with
MASSAGE THERAPY.
Procedure
Each type of hydrotherapy follows its own method,
but basically, hydrotherapy involves relaxing in
water. Being in a pool also offers a way to
EXER-
CISE without adding pressure to joints affected by
ARTHRITIS, OSTEOARTHRITIS, or DEGENERATIVE DISC
DISEASE. To encourage 45-minute to one-hour
exercises two to three times a week, the Arthritis
Foundation developed the Aquatics Program for
exercising in a swimming pool. Simply walking in
knee-high water can strengthen muscles and bones
too, while swimming improves flexibility and tones
PARASPINAL MUSCLES.
Risks and Complications
Holistic-online.com warned, “Saunas should not be
taken by persons with acute rheumatoid arthritis,
acute infection, active tuberculosis, sexually trans-
mitted diseases, acute mental disorder, inflammation
of an inner organ or blood vessels, significant vascular
changes in the brain or heart, circulatory problems
or acute cancer.” Patients with high blood pressure,
RHEUMATOID ARTHRITIS, and SPINAL INFECTIONS should
avoid heated forms of hydrotherapy. Although
CHIL-
DREN and ELDERLY patients often respond well to a
sauna, care should be taken to avoid dehydration
and damage to sensitive skin. “For overall tension
reduction, use a neutral bath (temperature between
92 to 94 degree F) that is close to the skin tempera-
ture.” While higher temperature may work better
for easing stress and encouraging restful
SLEEP, tem-
peratures over 105 degrees can induce a fever. As a
precaution, Holistic-online advised, “Do not spend
more than 15 to 20 minutes at a time in a sauna.
Wipe your face frequently with a cold cloth to avoid
overheating.”
Water therapy does not have to tap into heat,
however. In comparing hot and cold therapies, a
SpineUniverse article said, “Warmer water induces
vasodilation: drawing blood into the target tissues.
Increased blood flow delivers needed oxygen and
nutrients, and removes cell wastes. The warmth
decreases muscle spasm, relaxes tense muscles,
relieves pain, and can increase range of motion.”
122 humpback or hunched back
Conversely, “cold-water therapy produces vasocon-
striction, which slows circulation reducing inflam-
mation, muscle spasm, and pain.”
Outlook and Lifestyle Modifi cations
To keep from becoming dehydrated from hydro-
therapy or other heated treatments, people should
drink plenty of water throughout the day. Fresh
fruit and raw vegetables also bring moisture and
add good
NUTRITION too.
Davis, Dana L. and Susan Spinasanta. “Hydrotherapy and
Aquatic Therapy,” SpineUniverse. Available online.
URL: http://www.spineuniverse.com/displayarticle.
php/ article1489.html. Last updated July 6, 2004.
Holistic-online.com. “Hydrotherapy.” Available online.
URL: http://www.holistic-online.com/hydrotherapy.
htm. Downloaded January 11, 2006.
Tilden, Helen M. “Water Exercise,” Arthritis Founda-
tion. Available online. URL: http://www.arthritis.org/
conditions/Exercise/water_exercise.asp. Downloaded
January 11, 2006.
hyperparathyroidism See PARATHYROID HORMONE.
hyperpituitarism See GROWTH HORMONE DISORDERS.
hypoparathyroidism See PARATHYROID HORMONE.
hypophosphatasia GENETIC FACTORS cause this
metabolic disorder that produces skeletal problems
similar to
OSTEOGENESIS IMPERFECTA or RICKETS. The
age of onset determines whether the person has the
infantile, childhood, or adult type of hypophospha-
tasia, but
INFANTS have the most severe symptoms
and shortest life span.
Symptoms and Diagnostic Path
A fact sheet from the National Institutes of Health
(NIH) reported, “The severity of hypophosphatasia
is remarkably variable from patient to patient. The
most severely affected fail to form a skeleton in the
womb and are stillborn.” To diagnose patients of all
ages, a routine blood test will show low levels of an
enzyme called alkaline phosphatase (ALP) but, as
NIH pointed out, “it is important that the doctors
use appropriate age ranges for normal ALP levels
when interpreting the blood test.”
According to the online report “Hypophosphata-
sia, Infantile” posted by Johns Hopkins University,
“three more or less distinct types can be identified:
(1) type 1 with onset in utero or in early postnatal
life, . . . severe skeletal abnormalities . . . and death
in the first year or so of life; (2) type 2 with later,
more gradual development of symptoms, moder-
ately severe . . . skeletal changes and premature
loss of teeth; (3) type 3 with no symptoms, the con-
dition being determined on routine studies.”
For any age group, X-
RAYS help to assess the
severity of the disease and the presence of skeletal
deformity. With severe chest distortion, for exam-
ple, frequent episodes of pneumonia may occur.
Patients may also experience recurrent
FRACTURES.
Treatment Options and Outlook
According to the NIH, “severe forms of hypophos-
phatasia occur in approximately one per 100,000
live births. The more mild childhood and adult
forms are probably somewhat more common.
About one out of every 300 individuals in the
United States is thought to be a carrier for hypo-
phosphatasia.” Regarding the overall outlook, the
NIH stated, “Cases detected in the womb or with
severe deformities at birth almost invariably result
in death within days or weeks.”
The report “Hypophosphatasia, Adult Type”
from Johns Hopkins University said, “The domi-
nant disorder may be one of osteoblasts, whereas
the recessive form is a defect of alkaline phospha-
tase.” Differentiating between the two can be cru-
cial since treatments vary. For instance,
VITAMIN
D therapy may help the form of hypophosphata-
sia similar to rickets, but that same treatment can
cause kidney damage in patients with other types
of the disease.
Risk Factors and Preventive Measures
If instances of hypophosphatasia have been diag-
nosed within a family, potential parents may want
to seek genetic counseling. As yet, no established
medical treatments have been determined nor pre-
ventives found.
hypophosphatasia 123
McKusick, Victor A., M.D. et al. “Hypophosphatasia,
Adult Type,” OMIM™, Online Mendelian Inheritance
in Man™, Johns Hopkins University. Available online.
URL: http://www.ncbi.nlm.nih.gov/entrez/dispomim.
cgi?id=146300. Downloaded January 9, 2006.
———. “Hypophosphatasia, Infantile,” OMIM™, Online
Mendelian Inheritance in Man™, Johns Hopkins
University. Available online. URL: http://www.ncbi.
nlm.nih.gov/entrez/dispomim.cgi?id=241500. Down-
loaded January 9, 2006.
Whyte, Michael, M.D. “Hypophosphatasia,” The National
Institutes of Health (NIH) Osteoporosis and Related
Bone Diseases, National Resource Center. Avail-
able online. URL: http://www.osteo.org/newfile.asp?
doc=i102i&doctitle=Hypophosphatasia&doctype=
HTML+Fact+Sheet. Downloaded January 9, 2006.
124 hypophosphatasia
125
ibandronate
This treatment for OSTEOPOROSIS
became the third
BISPHOSPHONATE approved by the
U.S. Food and Drug Administration. Then adver-
tising fame quickly came with the brand Boniva,
approved as the first bisphosphonate tablet for
once-a-month use.
Dosage and Potential Side Effects
Other bisphosphonates, such as
ALENDRONATE, can be
injected every three months or even annually, but
ibandronate can be taken monthly by mouth in a dos-
age of 150 mg. For daily dosage, ibandronate is also
available in tablets of 2.5 mg. Either way, the tablet
must be taken with a full glass of water at least one
hour before ingesting any other beverage or food.
As Dr. Jay W. Marks explained in an article for
MedicineNet, “Absorption of ibandronate from the
intestine is poor, and any potential further decrease
in absorption by food or medications needs to be
avoided.” Equally important, “ibandronate tablets
also should be swallowed whole with six to eight
ounces of plain water while in an upright posi-
tion, in order to be certain that the tablets enter the
stomach.” If the medication sticks along the way,
severe irritation of the mouth, throat, or esopha-
gus will almost inevitably occur. Therefore, neither
ibandronate nor any other bisphosphonate should
be given to patients who can not remain upright for
an hour or who can not delay eating.
Other than side effects that result from not fol-
lowing instructions, ibandronate is considered safe
for anyone who does not have a blood calcium
problem. Pregnant women should discuss other
options with their doctor since the effects on an
unborn child have not been adequately studied.
Although patients in general may experience back
pain or stomach upset, allergic reactions rarely
occur. If, however, a patient erupts in hives or has
difficulty breathing, emergency medical attention
should be sought immediately.
Statistics and Studies
Highlights from the 2005 National Osteoporosis
Foundation meeting addressed interim findings of
the two-year MOBILE (Monthly Oral Ibandronate in
Ladies) study. With the participation of nearly 1,600
postmenopausal women, the trial studied the effects
of four different dosages of ibandronate: 2.5 mg
daily, 50 mg on two consecutive days (50/50), once-
a-month doses of 100 mg, and once-a-month doses
of 150 mg. According to the summary reported in
Contemporary OB/GYN, “all of the monthly regimens
were at least as effective as daily administration, but
the 150-mg dosage produced the best response.”
Specifically, “lumbar spine bone mineral density
(BMD) increased 4.9% in that group, compared to
4.3%, 4.1%, and 3.9% in the 50/50, 100-mg, and
daily groups, respectively.” Those who received the
highest dose of ibandronate had the most flu-like
symptoms, yet none of the women experienced gas-
trointestinal problems, including those who previ-
ously had that medical history.
Drug.com™. “Boniva,” Drug Information Online. Avail-
able online. URL: http://www.drugs.com/boniva.html.
Last revised March 30, 2005.
Marks, Jay W., M.D. “Ibandronate,” MedicineNet. Avail-
able online. URL: http://www.medicinenet.com/
ibandronate/article.htm.
National Osteoporosis Foundation: Meeting Highlights.
“Monthly Ibandronate Effective for Osteoporosis,”
Contemporary OB/GYN 50, no. 6 (June 2005): 17.
ibuprofen Like other NONSTEROIDAL ANTI-INFLAM-
MATORY (NSAID) DRUGS, ibuprofen relieves pain
I
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