Dear Dr. Roach: I’m a 65-year-old male. I’ve had scoliosis since childhood. I experience stiffness, discomfort and some soreness. What is the best treatment for my scoliosis? Chiropractic was not helpful, and although I had only mixed results with physical therapy, I still do those exercises. What other treatments are available? I would like to avoid surgery; I’m not in extreme pain and don’t want the risks of it. What are your thoughts?
P.S.
The cause of childhood scoliosis is not known. Many people assume that it is due to poor posture, but that is clearly not the case. Scoliosis is more likely to progress and require corrective surgery in girls than boys.
Since you weren’t treated with surgery, you likely still have the scoliosis — it does not get better on its own, but usually does not progress during adulthood.
In general, there are three types of treatments for back pain, and scoliosis is no exception: medications, physical treatments and surgery. You haven’t mentioned medication, and while many people don’t wish to take medications all the time for symptoms, they can reduce discomfort and improve your quality of life. Plain Tylenol or low-dose anti-inflammatories carry a low risk and probably are worth a try. I recommend strongly against opiates for chronic back pain. If the pain is that bad, other treatments (including surgery) should be considered.
A review of nonsurgical treatments for symptomatic scoliosis in adults suggested that while physical therapy and chiropractic treatment do not provide long-term benefit, they may halt or slow worsening of symptoms. However, they may help some individuals.
Surgery is not commonly done on adults with childhood or adolescent scoliosis. If it is, it is generally reserved for people with severe curvature and symptoms.
Fortunately, complications from childhood scoliosis are rare in adults, and there is no reduction in life expectancy.
Dear Dr. Roach: I’ve always heard that only men get gout, and I wonder if this is true? If so, do women not get high levels of uric acid in their blood? Or if they do, then does it affect them differently?
K.C.H.
It is not true. Men get gout at younger ages than women, and there probably are more overall men with gout than women, but older women still are nearly as likely as older men to get gout.
The disease is a little bit different in women. Women certainly do get the classic acute gout of an exquisitely painful and tender joint, especially the big toe. In that case, the diagnosis is usually straightforward. But, sometimes the diagnosis in women is delayed or missed.
Women are more likely to be on medications that can trigger gout (especially thiazide-type diuretics) and less likely to have definitive diagnostic testing, suggesting that physicians do not think about gout in women as often as they do in men.
Women also are more likely to have chronic gout (called tophaceous gout, where there are masses of uric acid crystals, often in the ear or around the joints of the hand). Finally, women are less likely to receive uric-acid-lowering therapy than men, even when indicated.
Women also have lower levels of uric acid, in general, than men, but still need treatment. I suspect both women with arthritis symptoms and their doctors sometimes forget to think about gout. Knowing more about it may get women to speak to their doctors about the possibility.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
