• Direct Sciatic Nerve Compression
• Inflammation

It is estimated that the annual incidence in the general population is between 1% to 5% and the lifetime incidence is between 10% and 40% [1].

1- How Long Will Sciatica Take to Heal?

Sciatica can lasts 4-6 weeks, however, it can last longer depending on the causes.

2- What is the Sciatic Nerve?

The sciatic nerve is responsible for sensations in the feet and legs.

It is hosted and protected by the spine and starts at the base of the brain and travels all the way to the lumbar region of the spine where it branches into right and left.

Each branch will continue its enervation route all the way to the feet (right or left).

2- What Triggers Sciatica?

• Direct Sciatic Nerve Compression

Our spine or vertebral column is made of 24 vertebrates, the sacrum, and the coccyx.

We have 7 vertebrates of the neck (cervical vertebrates), 12 of the midback (thoracic vertebrates), and 5 of the lower back (lumbar vertebrates).

Each vertebrate is joined to another vertebrate by a disc (intervertebral disk).

• Lumbar Herniated Disc

When a lumbar intervertebral disc bulges or herniates, it can compress the sciatic nerve resulting in pain.

Lumbar Herniated Disc causes 90% of the direct sciatic nerve compressions [2].

• Degeneration

The degeneration of the tissues of vertebrates in the lumbar part of the spine can result in the compression of the sciatic nerve.

• Spondylolisthesis

When a vertebrate slips out of position due to a stress fracture it can compress the sciatic nerve.

• Lumbar Spinal Stenosis

The spine canal through with passes the sciatic nerve may decrease in size due to factors, such as age, resulting in the compression of the sciatic nerve.

• Lumbar or Pelvic Muscular Spasm

Spasm in muscles such as the piriformis muscle can irritate or compress the sciatic nerve.

• Hematoma or abscess

Hematoma or abscesses around the sciatic nerve can cause compression of the sciatic nerve.

• Tumors

Spinal tumors that originate from the vertebra, spinal cord, or nerves can also compress the sciatic nerve.

• Inflammation

Within the spine, there is an acid substance known as hyaluronic acid. When the spine is damaged, this substance leaks into the surrounding tissues of the sciatic nerve causing its irritation, inflammation, or compression.

3- What Are the Risk Factors of Sciatic Nerve Pain (Sciatica)?

• Occupation and Sciatica

There is a predisposition for sciatica in workers including truck drivers, carpenters, and machine operators due to long hours in uncomfortable positions.

• Lack of Physical Activity and Sciatica

Lack of physical activity can weaken lower back muscles (lack of flexibility, tone, and movement) resulting in less support for the lumbar spine and potential compression of the sciatic nerve.

• Smoking and Sciatica

Although the mechanism is not well known, smoking appears to be a modest risk of sciatica [3].

• Mental Health and Sciatic

Depression and anxiety disorders have been associated with sciatica due to the release of inflammation factors (inflammatory mediators) in the lower back region which can irritate the sciatic nerve [4].

• Tall height in older age groups (50 to 60 years)

A study that included 13680 participants found a correlation between tall height and lower back pain or related surgery [5].

• Obesity and excess weight

Weight being carried in the front can be a weight on the spine and related muscles which may cause muscle strain that can potentially lead to sciatica.

• Genetic susceptibility

A study reported a higher incidence of sciatica or prolapsed disc in first-degree relatives of patients hospitalized for herniated lumbar disc or surgery [6].  

Another study of 9365 pairs of adult twins found a correlation between genetics and the incidence of sciatica [7].

• Previous injury

Previous injuries in athletes or workers can result in lumbar intervertebral disc bulges or herniation.

• Diabetes

Diabetes is a metabolic disorder that can cause damages to the sciatic nerve.

• Pregnancy

The growing baby during pregnancy can generate extra weight resulting in a weight that is applied on the spine and related muscles which may cause muscle strain.

• Recreational Activities

In a study that involved 2077 workers, regular walking and jogging have been shown to increase the incidence of sciatica [8].

5- What Are the Symptoms of Sciatica?

• Pain in the lower back, buttock, and leg which can be intermittent or persistent.
• Reduced movement and mobility together with moderate or severe pain.
• Weakness in the lower back and leg.
• Numbness or pins-and-needles sensations along the leg and foot.

6- When Should I Worry About Sciatica?

Sciatica can be due to severe or chronic conditions such as tumors, bilateral sciatica, scarred tissues, hematoma, cysts or abscesses, spinal tuberculosis, medications non-responsive infections, or fracture in the vertebrates of the lumbar spine.

These conditions may require surgery to restore the function of the lower spine and surrounding tissues.

5- Sciatica Treatment

Sciatica treatment may involve non-surgical or surgical therapies.

• Non-surgical therapies

Exercises for Sciatica

Physical therapy aims at restoring strength to the spine and lower-back muscles, buttocks, hip, and abdomen which may involve swimming, walking, and specific stretching movements with a help of a physical therapist.

Lifestyle Changes

Losing weight through a healthy diet can significantly reduce chronic sciatica by decreasing the weight being carried in the front, and therefore, reducing the weight on the spine and related muscles.

This effort can be complemented with exercise to strengthen the spine and lower back muscles, buttocks, hip, and abdomen.

For workers with a predisposition for sciatica, preventing certain positions or intermittent stretching while working can prevent or reduce the risk of sciatica.

Alternative therapies

Acupuncture, yoga, and massages can relieve muscle spasms at the lower back and leg, and therefore, pain associated with sciatica.

Medication

Non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, and spinal injections of steroids (corticosteroids) are used to temporarily reduce pain associated with inflammation and swelling.

Myorelaxants are also used to relax the muscles and relieve the spasms.

• Surgery

Surgery is required to remove the tumors, abscesses, hematomas that compress the spine and the sciatic nerve.

When the sciatica is due to a hernia of a disc or multiple discs or to lumbar spinal stenosis, surgery is necessary to restore their function.

Conclusion

Sciatica is a very painful experience that can be due to lifestyle or working conditions but also to severely debilitating conditions that require several surgical procedures to restore the function of the lower spine and reduce the irritation or compression of the sciatic nerve.

The post What Causes Sciatic Nerve Pain? appeared first on .

Iron is the main component of hemoglobin which plays an essential role in oxygen transport by red blood cells, and therefore, the lack of a physiological amount of iron affects the oxygen-carrying capacity of the blood, leading to tissue hypoxia (deprivation of oxygen supply) [2]. 

What Are the Causes of Iron Deficiency Anemia in the Elderly?

Any disorder, condition, diet, or medication that limits the supply or absorption of iron will restrict the amount of hemoglobin available to transport oxygen; thus, leading to iron deficiency anemia.

1- Stomach ulcers

Stomach ulcers are associated with damages of the mucus layer that makes the lining of the stomach by the stomach own digestive acidic juices. The results of these damages are a reduction in iron absorption and gastrointestinal bleedings that lead to iron loss and reduction in the body’s iron reserves.

The damages are caused by the excessive use of non-steroidal anti-inflammatory drugs (NSAIDs) and the bacterium Helicobacter Pylori.

Helicobacter Pylori lives in the mucus layer of the stomach where it secretes proteins, toxins, and an enzyme named urease. The proteins are responsible for the inflammation of the mucus layer, while urease transforms the stomach urea into ammonia that neutralizes the digestive acidic juices [3].

The effect of excessive use of non-steroidal anti-inflammatory drugs (NSAIDs) is reported below.

2- Stomach Cancer

Stomach cancer or gastric carcinoma is cancer that develops from the lining of the stomach and which symptoms are associated with a loss of appetite, weight loss, heartburn, indigestion, abdominal pain, and blood loss through blood vomiting and blood in the stool.

It can be caused by Epstein-Barr virus infection, genetics, diet, and inflammation related to Helicobacter Pylori infection [4]. The loss of appetite and the bleeding result in significant losses in iron and iron reserves leading to iron loss and reduction in the body’s iron reserves.

3- Bowel Cancer (Colorectal Cancer)

This cancer develops in the colon or rectum and is associated with a loss of appetite, weight loss, constipation, nausea or vomiting, and rectal bleeding. While a small percentage is due to genetic factors, most bowel cancers are due to aging, and lifestyles [5].

Like stomach cancer, the loss of appetite and rectal bleeding result in significant losses in iron and iron reserves leading to iron loss and reduction in the body’s iron reserves.

4- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs such as Aspirin and Ibuprofen (Advil®) perform their anti-inflammatory action by inhibiting the enzymes cyclooxygenase/prostaglandin-endoperoxide synthase (PGHS-1 and PGHS-2), involved in the biosynthesis of the pro-inflammatory prostaglandin.

However, PGHS-1 is involved in the protection of the gastric mucosa and its excessive inhibition by NSAIDs results in a thinner mucus layer and stomach ulcer [6].

5- Diet

Although the impact of iron dietary deficiency is less frequent in western countries, the lack of iron supply through food consumption can significantly reduce the body’s iron reserves resulting in iron deficiency anemia; however, a diet rich in iron can reverse this disorder.

How Is Iron Deficiency Anemia diagnosed?

The symptoms depend on the speed of onset of anemia, its severity, and the characteristics of the patient, but they generally include the following symptoms [7]:

• Pale complexion
• General weakness and fatigue
• Shortness of breath
• Heart palpitations
• Difficulty swallowing
• Irritability
• Poor concentration
• Headache
• Intolerance to exercise. 

Although the symptoms would indicate a potential iron dietary deficiency, the diagnosis is confirmed by routine blood tests that measure the levels of serum iron, ferritin, and transferrin saturation levels [8].

How Is Iron Deficiency Anemia Treated?

The treatment of iron deficiency relies on iron supplements that can be obtained from rich-iron food such as dark-green leafy vegetables, nuts and seeds, meat, fish, tofu, eggs, brown rice, and dried fruit.

However, medications in a form of tablets or liquid preparations such as Ferrous sulfate, ferrous gluconate, and ferrous fumarate can also be recommended by the doctor. Supplementation with ascorbic acid (Vitamin C) can enhance iron absorption.

A follow-up through measuring the hemoglobin concentration and red cell indices at intervals is also performed for monitoring to ensure recovery. In this case, the hemoglobin concentration should rise by 2 g/dl after 3–4 weeks [9].

Conclusion

Iron dietary deficiency anemia in elderly individuals can be associated with an iron unbalanced diet that is restored  by adequate supplementation with iron-rich food; however, in some cases, it is due to much complex disorders or diseases that require more specific treatments

References

[1] Anía, B.J., Suman, V.J., Fairbanks, V.F., Rademacher, D.M. and III, L.J.M., 1997. Incidence of anemia in older people: an epidemiologic study in a well defined population. Journal of the American Geriatrics Society, 45(7), pp.825-831.

[2] Chaudhry, H.S. and Kasarla, M.R., 2017. Microcytic hypochromic anemia.

[3] Blaser, M.J., 1996. The bacteria behind ulcers. Scientific American, 274(2), pp.104-107.

[4] Brenner, H., Rothenbacher, D. and Arndt, V., 2009. Epidemiology of stomach cancer. Cancer epidemiology, pp.467-477.

[5] Boyle, T., Keegel, T., Bull, F., Heyworth, J. and Fritschi, L., 2012. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. Journal of the national cancer institute, 104(20), pp.1548-1561.

[6] Bindu, S., Mazumder, S. and Bandyopadhyay, U., 2020. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective. Biochemical pharmacology, p.114147.

[7] Bermejo, F. and García-López, S., 2009. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World journal of gastroenterology: WJG, 15(37), p.4638.

[8] Rimon, E., Levy, S., Sapir, A., Gelzer, G., Peled, R., Ergas, D. and Sthoeger, Z.M., 2002. Diagnosis of iron deficiency anemia in the elderly by transferrin receptor–ferritin index. Archives of internal medicine, 162(4), pp.445-449.[9] Goddard, A.F., McIntyre, A.S. and Scott, B.B., 2000. Guidelines for the management of iron deficiency anaemia. Gut, 46(suppl 4), pp.iv1-iv5.

The post The Most Common Cause of Anemia in the Elderly appeared first on .

What Are the Causes of Dizziness?

The common causes of dizziness are labyrinthitis, stress and anxiety, headache and migraine, hypoglycemia, vertebrobasilar insufficiency, and dehydration. Less common causes are associated with excessive alcohol consumption (binge drinking), Illness, and Carbon Monoxide Poisoning.

1- Labyrinthitis

Labyrinthitis is an inflammation of the inner ear and specifically of the membranous labyrinth that leads to its irritation and swelling. This ear structure is made of a network of passages full of liquid which play an essential role in the control of sound detection and balance by the inner ear. Labyrinthitis is usually caused by a bacterial or viral infection (e.g., cold or flu).

2- Stress and Anxiety

Dizziness has been associated with panic symptoms in stressed and anxious individuals due to central-neurologic links between the vestibular system which controls the sense of balance and spatial orientation and the autonomous nervous system controls the nervous system’s unconscious activity [2].

3- Migraine

Dizziness is one of the symptoms of vestibular migraine whose causes are unknown. However, one possible explanation is a potential link between pain and swelling during inner ear inflammation and migraine and dizziness.

4- Hypoglycaemia

To function the brain requires energy that is produced from glucose that is supplied by the blood. Normally, glucose is maintained in the range of 3.9 to 6.1 millimoles per liter (mmol/L) of blood; however, diabetes patients receiving a diabetic treatment can periodically experience hypoglycemia (Low glucose level) which causes dizziness, fatigue, and weakness.

5- Hypotension

The normal blood pressure in a healthy adult is between 90/60 and 120/80 mmHg. A blood pressure of less than 90/60 mmHg can lead to dizziness. This is commonly observed in individuals with diabetes or cardiovascular diseases.

6- Vertebrobasilar Insufficiency

Vertebrobasilar Insufficiency is transitory ischemia of the vertebrobasilar circulation associated with decreased blood flow in the posterior circulation of the brain that is provided by the basilar artery. Diseases such as atherosclerosis can block or narrow this artery causing a reduced blood supply to several parts of the brain leading to dizziness and imbalance [3].

7- Dehydration

Dehydration prevents a sufficient supply of water and electrolytes to the body resulting in blood dehydration and a decrease in blood flow leading to an insufficient supply of nutrients to tissues and organs, including the brain.

8- Excessive Alcohol Consumption

Excessive alcohol consumption leads to alcohol intoxication and alcoholic ketoacidosis reduces the secretion of insulin by the pancreas which affects glucose usage by the cells in tissue and organs of the body. Diabetes can also lead to ketoacidosis, known as diabetic ketoacidosis.

9- Medication

Discontinuation of antidepressant medication, such as selective serotonin reuptake inhibitors (e.g., Prozac) results in a high frequency of dizziness that may be due to their role in improving balance control and cognitive functioning [4]. Blood pressure medication can also induce hypotension leading to dizziness.

10- Illness

Disorders such as vestibular neuritis or diseases such as Ménière’s Disease comprise dizziness as one of the main symptoms.

• Vestibular neuritis

This disorder affects the vestibulocochlear nerve within the inner ear that sends balance and head position information from the inner ear to the brain. Damage to this nerve (e.g., viral infections) disturbs the function of the nerve which results in dizziness and unbalance [5].

• Ménière’s Disease

Although the causes are not well known, this disease affects the inner ear, and its symptoms include tinnitus (Perception of internal sounds), loss of hearing, and vertigo.

11- Carbon Monoxide Poisoning

The blood transport oxygen to tissues and organs of the body to produce the energy necessary for their functions. Following, carbon monoxide exposure, blood oxygen is replaced by carbon monoxide which results in cellular toxicity.

What Is the Difference Between Dizziness and Vertigo?

Although dizziness and vertigo have been interchangeably used, dizziness is a perception associated with feeling light-headed and unsteady, while vertigo is the perception of being in movement or that your surrounding is in movement. Vertigo is also characterized by symptoms such as nausea, vomiting, sweating, and walking difficulty.

How to Prevent or Treat Dizziness?

The prevention or treatment of dizziness is focused on dealing with its causes. For instance, labyrinthitis and Vestibular neuritis, are treated with antihistamines or motion-sickness tablets. Vestibular rehabilitation through physiotherapeutic exercises is also recommended to help restore balance. Changes in lifestyle, staying hydrated, avoiding binge drinking, and reducing stress levels can prevent dizziness.

Conclusion

Dizziness is not generally associated with a serious condition; however, in certain cases, it can be due to chronic conditions such as diabetes and cardiovascular diseases which require specific treatments. It can also be related to mental disorders such as migraines, and anxiety, which also rely on anti-depressant treatments.

Unfortunately, the causes of Ménière’s disease are not well-known and the potential involvement of hereditary transmission has been proposed. In this case, the treatment relies on the use of medications that reduce nausea and diuretics to reduce liquid build-up in the inner ear.

Finally, dizziness is a symptom that is shared by several disorders such as vertigo, and therefore, it is confusing to differentiate between the two if the right questions are not asked during the diagnostic stage.

References

[1] Neuhauser, H.K., 2016. The epidemiology of dizziness and vertigo. Handbook of clinical neurology, 137, pp.67-82.

[2] Balaban, C.D. and Thayer, J.F., 2001. Neurological bases for balance–anxiety links. Journal of anxiety disorders, 15(1-2), pp.53-79.

[3] Lima, A.C., Bittar, R., Gattas, G.S., Bor-Seng-Shu, E., Oliveira, M.D.L., Monsanto, R.D.C. and Bittar, L.F., 2017. Pathophysiology and diagnosis of vertebrobasilar insufficiency: a review of the literature. International archives of otorhinolaryngology, 21, pp.302-307.

[4] Ramos, R.T., 2006. Antidepressants and dizziness. Journal of Psychopharmacology, 20(5), pp.708-713.

[5] Jeong, S.H., Kim, H.J. and Kim, J.S., 2013, July. Vestibular neuritis. In Seminars in neurology (Vol. 33, No. 03, pp. 185-194). Thieme Medical Publishers.

[6] Harcourt, J., Barraclough, K. and Bronstein, A.M., 2014. Meniere’s disease. Bmj, 349.

The post Why Am I feeling dizzy all the time? appeared first on .