A: A variety of problems can put the squeeze on your sciatic nerve. Some of the more common culprits include:

• Herniated (slipped) discs between the vertebrae pressing on the sciatic nerve.
• Spinal stenosis, or narrowing of the spinal canal.
• Spondylolisthesis, when one of the vertebrae slips out of place.
• Piriformis syndrome, which occurs when the piriformis muscle deep in the derriere becomes tight or starts having spasms.

Don’t overdo it. Overuse of your back, such as lifting something that is too heavy, an injury from a fall, or having something hit your back, can also bring about an episode of sciatica. It can also be the result of excess body weight that increases stress on the spine, which can contribute to bone spurs and herniated discs. Other causes include a sedentary lifestyle or a job that forces you to sit for long hours.

A flare-up of sciatica differs from other types of back pain. Instead of a throbbing in one place, it can range from a mild ache to a sharp, shooting pain, or a burning sensation to an electric shock. Aside from pain, some people develop numbness, tingling, or weakness in a leg or foot, or multiple symptoms in different parts of the leg. Typically, though, people experience symptoms only on one side of their body.

Conservative Management. The good news is that mild sciatica usually dissipates over time with conservative management such as pain relievers, alternating heat and ice, avoiding lifting or bending, and physical therapy. Surgery is recommended in a small minority of cases.

To reduce your chances of flare-ups:

• Lose weight if you are overweight.
• Do warm-up stretches before participating in activities.
• Do regular aerobic exercises to strengthen your back and abdominal muscles.
• Lift properly, bending your knees and hips and keeping your back straight.
• Practice good posture.

If you experience a bout of sciatica that lasts more than a week or two, or becomes severe or progressively worse, it is time to seek out help from a physician.

Q: Since the start of the pandemic, my doctors have given me the option of scheduling tele-medicine appointments. I’m happy to use my computer to visit with friends, but I don’t feel fully comfortable with online health care. Should I?

A: Telemedicine has been around for a very long time. When it was first introduced, it referred to telephone appointments, which were particularly useful in rural areas where patients sometimes would have to travel hundreds of miles to see a specialist. Telemedicine has come a long way since then as a result of software technology that makes it safe to visit with your doctor in the privacy of your home via smartphone or computer.

Oftentimes, doctors will conduct the initial consultation visit in-person and use telemedicine only for follow-up visits. There are two benefits to this system: One is the ability to use hands-on exams to establish a diagnosis, and the other one is to establish a doctor-patient relationship prior to conducting visits by telehealth.

The short answer to your question is: Yes. You should be comfortable with virtual doctor visits and you should get on board with telemedicine because it’s here to stay. Doctors are doing everything possible to have fewer patients physically in their waiting rooms, in an effort to enforce social distancing. Virtual appointments are key to enforcing safety protocols. And many patients have embraced the convenience of seeing their doctor without leaving their home.

If you agree to a virtual visit, remember to check with your insurance provider about coverage. Insurance payments for telehealth services, especially at full cost, may only be temporary. Medicare’s coverage of a broad range of services may end when the novel coronavirus no longer poses a public health emergency.

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As it turns out, these drinks offer way more than a quick caffeine induced pick-me-up, especially for a very vulnerable patient population, according to a recent study. Drinking plenty of both green tea and coffee is linked to a lower risk of dying from any cause among people with type 2 diabetes, according to a Japanese study.

Bioactive Compounds. Previously published research suggests that regularly drinking green tea and coffee may be beneficial for health because of the various bioactive compounds these beverages contain. But few of these studies have been carried out in people with diabetes. People with type 2 diabetes are more prone to circulatory diseases, dementia, cancer, and bone fractures, and despite an increasing number of effective drugs, lifestyle modifications, such as exercise and diet, remain a cornerstone of treatment.

The researchers therefore decided to explore the potential impact of green tea and coffee, separately and combined, on the risk of death among people with this condition. They tracked the health of close to 5,000 Japanese people enrolled in The Fukuoka Diabetes Registry. Each participant filled out a 58-item food and drink questionnaire that included questions on how much green tea and coffee they drank every day. They also provided background information on lifestyle factors, such as regular exercise, smoking, alcohol consumption, and nightly hours of sleep.

Fill ‘er Up. They found that drinking 4 or more daily cups of green tea plus 2 or more cups of coffee was associated with a 63% lower risk of death over 5 years. Compared with those who drank neither beverage, those who drank coffee or green tea or both had lower odds of dying from any cause, with the lowest odds associated with drinking higher quantities of both green tea and coffee.

Drinking up to 1 cup of green tea every day was associated with 15% lower odds of death, while drinking 2 to 3 cups was associated with 27% lower odds. Consuming 4 or more daily cups of green tea was associated with 40% lower odds. Among coffee drinkers, up to 1 daily cup was associated with 12% lower risk, while 1 cup a day was associated with 19% lower odds, and 2 or more cups was associated with 41% lower odds.

The risk of death was even lower for those who drank both green tea and coffee every day: 51% lower for 2 to 3 cups of green tea plus 2 or more of coffee; 58% lower for 4 or more cups of green tea plus 1 cup of coffee every day; and 63% lower for a combination of 4 or more cups of green tea and 2 or more cups of coffee every day.

Observations and Caveats. The researchers say the biology behind these observations isn’t fully understood, but add that green tea contains several antioxidant and anti-inflammatory compounds, including phenols and theanine, as well as caffeine. Coffee also contains numerous bioactive components, including phenols. They also point out an important caveat: As well as its potentially harmful effects on the circulatory system, caffeine is thought to alter insulin production and sensitivity.

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Tissue Degeneration. Known as fibrocartilage, this bioengineered cartilage helps connect tendons or ligaments or bones, and is primarily found in the meniscus in the knee. The meniscus is the tough, rubbery cartilage that acts as a shock absorber in the knee joint. Degeneration of the meniscus tissue affects millions of patients, and arthroscopic partial meniscectomy is one of the most common orthopedic operations performed.

With the Wake Forest research, the scientists have been able to 3D bio-print hybrid tissue for cartilage regeneration by printing two specialized bio-inks—hydrogels that combine the cells together to create a new formulation that provides a cell-friendly microenvironment and structural integrity. This work is done with the Integrated Tissue and Organ Printing System, a 3D bioprinter that was developed by the Wake Forest regenerative medicine team. The system combines both biodegradable, plastic-like materials to form the tissue “shape” and bio-inks that contain the cells to build new tissues and organs.

Promising Alternative. In this study, they were able to produce a highly elastic hybrid model for advanced fibrocartilaginous regeneration. The researchers say their results demonstrate that this bioprint system offers a versatile and promising alternative for the production of this type of tissue.

For the study, the research team tested various formulations and measured response to applied forces or stresses, the swelling ratio and the material strength and flexibility. One provided the proper cellular microenvironment to maintain the cells and help them grow while the other bio-ink offered excellent biomechanical behavior and structural integrity. The final formula of the two bio-inks used were co-printed layer-by-layer to create a mesh-like pattern. The models were implanted into a small animal model for observation for 10 weeks, and evaluated at intermittent time periods, showing proper function. The researchers say a larger study is still needed to further examine the body’s response and functional recovery of the joint when this regenerative tissue is used.

There is high demand for effective treatments and therapies to help patients deal with degenerative joint problems, especially the knee. The researchers say this study helps point their work in the right direction to eventually be able to engineer this innovative tissue that is so important for so many patients.

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National Study. A team of researchers analyzed data from 991 middle-aged and older U.S. adults who participated in a national study conducted at three time periods: between 1995 and 1996, 2004 and 2006, and 2013 and 2014. In each assessment, participants reported on a range of positive emotions they had experienced during the past 30 days. In one assessment, participants were asked, “During the past 30 days, how much of the time did you feel enthusiastic, attentive, proud, and active? In another assessment they were asked, “During the past 30 days, how much of the time did you feel cheerful, in good spirits, extremely happy, calm and peaceful, satisfied, and full of life?

To evaluate memory, participants were read a list of 15 unrelated words, with a one-second pause between each word. Each word was read once, and participants were instructed that words would not be repeated. They were then given 90 seconds to produce as many words in any order from the list as possible immediately (to test immediate recall) and after 15 minutes (to test delayed recall).

The researchers examined the association between positive affect and memory decline, accounting for age, gender, education, depression, negative affect, and extroversion, and their analysis showed that memory declined with age; however, individuals with higher levels of positive affect had a less steep memory decline over the course of almost a decade.

Healthy Aging. We may wish some memories could last a lifetime, but many physical and emotional factors can negatively impact our ability to retain information throughout life. While feeling enthusiastic and being cheerful, attentive, and proud play a starring role in memory, the nature of that role is clearer as a result of this study. The results add to a growing body of research on positive affect’s role in healthy aging. The scientists say future research might address the pathways that could connect positive affect and memory, such as physical health and social relationships.

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Pandemic Effects. The COVID-19 pandemic has led to more than 200,000 deaths in the U.S. and more than 1 million globally. There is a growing body of research looking into specific ways that the SARS-CoV-2 virus impacts different populations, including why some people are infected and are asymptomatic, as well as what increases one’s mortality as a result of infection.

While SARS-CoV-2 is a relatively new pathogen, there are many other types of coronaviruses that can cause the common cold and pneumonia. These coronaviruses are genetically related to SARS-CoV-2, and the immune responses from these coronaviruses can cross-react against SARS-CoV-2.

Bad Cold/Good Cold. In this study, the researchers looked at electronic medical record (EMR) data from people who had a respiratory panel test (CRP-PCR) result between May 18, 2015, and March 11, 2020. The CRP-PCR detects diverse respiratory pathogens, including the “common cold” coronaviruses. They also examined data from individuals who were tested for SARS-CoV-2 between March 12, 2020, and June 12, 2020. They found that patients hospitalized with COVID-19 who had a previous positive CRP-PCR test result for a coronavirus had significantly lower odds of being admitted to the intensive care unit (ICU), as well as lower odds of being put on a ventilator for breathing assistance during COVID. The probability of survival was also significantly higher in COVID-19 hospitalized patients who had a previous positive test result for a coronavirus “common cold.” However, a previous positive test result for a coronavirus did not prevent someone from getting infected with SARS-CoV-2.

What This Means for You: If you’ve had a previous infection from a coronavirus “common cold” you will have less severe COVID-19 symptoms if you become infected. People are routinely infected with coronaviruses that are different from SARS-CoV-2, and these study results could help identify patients at lower and greater risk of developing complications after being infected with SARS-CoV-2. The test results also provide important insight into the immune response against SARS-CoV-2, which could have significant implications on COVID-19 vaccine development. The researchers say this study can be the springboard for identifying the types of immune responses—not necessarily for preventing SARS-CoV-2 infection, but rather for limiting the damage from COVID-19.

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Previous research has shown a clear link between psoriasis and the development of high-risk coronary plaque. This study provides additional information about a dangerous type of coronary plaque made up of dead cells and cell debris that is prone to rupture. Ruptured plaque can lead to a heart attack or stroke. The analysis involved 209 patients ages 37 to 62 with psoriasis. Of these participants, 124 received biologic therapy, and 85 were treated only with topical creams and light therapy.

To measure the effects of biologic therapy on arteries of the heart, the researchers performed cardiac computed tomography (CT) scans on all participants before they started therapy and one year later. The CT results between the two groups were then compared. After one year of treatment, the researchers found that biologic therapy was associated with an 8% reduction in coronary plaque. In contrast, those who did not receive biologic therapy experienced slightly increased coronary plaque progression.

This study has implications for people with psoriasis and possibly for people with other chronic inflammatory conditions such lupus and rheumatoid arthritis, who also have increased risk of heart disease.

Brain ‘Volume Control’ Supports Learning and Memory. A “molecular volume knob” regulating electrical signals in the brain helps with learning and memory, according to a Dartmouth study. The molecular system controls the width of electrical signals that flow across synapses between neurons. Identifying this control mechanism and the molecule that regulates it could help researchers in their search for ways to manage neurological disorders, including Alzheimer’s disease, Parkinson’s disease, and epilepsy. For decades, researchers have searched for molecular regulators of synaptic plasticity by focusing on the molecular machinery of chemical release. Until now, measurements of the electrical pulses had been difficult to observe due to the small size of the nerve terminals. The new research finding was made possible by technology developed at Dartmouth to measure voltage and neurotransmitter release with techniques using light to measure electrical signals in synaptic connections between neurons in the brain.

Knee Replacement Risks Increase with Tourniquet Use. The risk of developing serious complications following a knee replacement could be up to 73% higher when a tourniquet is used, compared to surgery without a tourniquet. Serious complications during knee replacement surgery are rare. However, researchers at the University of Warwick, Coventry, England, found that 5.9% of patients whose operations involved a tourniquet had serious complications needing additional health care, compared to 2.9% in those operated on without a tourniquet. The conclusions are drawn on from 41 previous clinical trials on tourniquet use during knee replacement surgery. The differences became clear when the results from multiple studies around the world were combined. The researchers concluded that surgeons should discuss the benefits and risks of using a tourniquet with patients prior to surgery. The report suggests that a change in surgical practice to not using a tourniquet might avoid up to 1,987 serious complications in the United Kingdom each year.

Experimental Drug Could Prevent Anaphylaxis. Popping a pill to prevent anaphylaxis could be life changing for folks with allergies. A recent Northwestern Medicine study shows there might be a pill that can be taken pre-emptively to prevent mild-to life-threatening anaphylaxis, no matter the cause.

Anaphylaxis is a severe, potentially life-threatening allergic reaction that can occur within seconds or minutes of exposure to an allergen. It occurs in about one out of every 20 people, according to the Asthma and Allergy Foundation of America. If a person’s blood pressure drops so low during anaphylaxis or their airway closes up enough that they can’t get enough oxygen to their organs, they enter anaphylactic shock. This pill would be the first known treatment to prevent anaphylaxis—other than avoiding the allergen.

People who are at high risk of allergic exposures to life-saving antibiotics or people about to undergo oral food desensitization—gradually eating foods to build up a threshold to an allergic reaction—could take the pill as a preventive measure. If the drug turns out to be safe and cheap enough for daily use, theoretically anyone with a serious allergy could take it and be able to eat the foods they’ve been avoiding. Once further testing is complete, if the drug is deemed safe it would likely be used preventively—unlike an EpiPen, which injects epinephrine into someone experiencing an allergic reaction to reverse the symptoms. The research team is exploring whether the experimental medication could be reformulated to be added to the EpiPen to be injected along with the epinephrine to see if it would better stop or abort anaphylaxis after it has begun.

Heartfelt Thanks for a Good Night’s Sleep. A well-known adage suggests that those who are early to bed and early to rise will be rewarded with health, wealth and wisdom. No research supports the assertions regarding wealth and wisdom, but a recent clinical study suggests that there are significant health benefits associated with a good night’s sleep.

Researchers at the Obesity Research Center at Tulane University, in New Orleans, found that adults with the healthiest sleep patterns had a 42% lower risk of heart failure regardless of other risk factors compared to adults with unhealthy sleep patterns. They define healthy sleep patterns as rising in the morning, sleeping 7 to 8 hours a day, and an absence of frequent insomnia, snoring, or excessive daytime sleepiness.

More than 6 million Americans are living with heart failure, and over 900,000 new cases are diagnosed each year. The most common conditions that can lead to heart failure are coronary artery disease, high blood pressure, and previous heart attack.

The Tulane study examined the relationship between healthy sleep patterns and heart failure by evaluating data on 408,802 participants, ages 37 to 73. Researchers recorded 5,221 cases of heart failure during a follow-up period spanning 10 years. They analyzed sleep quality, such as sleep duration, insomnia and snoring; as well as sleep patterns, including whether the participant was an early bird or night owl, or if they had a habit of unintentionally dozing off during the day.

In addition to learning that participants with the healthiest sleep pattern had a 42% reduction in the risk of heart failure compared to people with an unhealthy sleep pattern, they also found the risk of heart failure was independently associated with specific sleep habits. Heart failure risk was 8% lower in early risers; 12% lower in those who slept 7 to 8 hours daily; 17% lower in those who did not have frequent insomnia; and 34% lower in those reporting no daytime sleepiness.

The researchers say their findings highlight the importance of improving overall sleep patterns to help prevent heart failure.

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It may sound more like science fiction than fact, but researchers have found that microscopic packets of proteins—known as extracellular vesicles (EV)—are capable of keeping cells functioning during a heart attack, which can mean the difference between life and death.

EVs derived from stem cells have previously been shown to help heart cells recover after a heart attack, but exactly how they help and whether the beneficial effect is specific to EVs derived from stem cells has remained a mystery. Until now.

Special Delivery. Now, researchers from the Harvard John A. Paulson School of Engineering and Applied Sciences (SEAS) have unraveled potential mechanisms behind the healing power of EVs and demonstrated their capacity to not only revive cells after a heart attack but to keep cells functioning while deprived of oxygen during a heart attack. The researchers demonstrated this in human tissue using a heart-on-a-chip with embedded sensors that continuously tracked the contractions of the tissue.

Heart attacks occur when blood flow to the heart is blocked. The best way to treat a heart attack is to restore blood flow, but that process can also damage cells in the heart. This damage, known as ischemia-reperfusion injury or reoxygenation injury, happens when blood supply returns to tissue after a period of lack of oxygen.

This complex process has historically represented a challenge for the development of effective therapies. That’s where the endothelial-derived EVs (EEVs) come in. The researchers tested the effect of EEVs on human heart tissue using a heart-on-a-chip model. They simulated a myocardial infarction—heart attack—and reoxygenation on chips that were infused with EEVs and those that were not. They induced injury by three hours of oxygen restrictions followed by 90 minutes of reoxygenation and then measured the fraction of dead cells and the contractile force of the tissue. They found that tissues treated with EEVs had half as many dead cells as those that were not treated, and that cells treated with EEVs continued to contract even without oxygen.

New Therapeutic Approaches. The researchers say their findings indicate that EEVs could protect heart tissue in part by supplementing injured cardiac cells with proteins, and that these findings can pave the way for new therapeutic approaches.

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A Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety. Ongoing sleep deficiency can raise your risk for some chronic health problems. It also can affect how well you think, react, work, learn, and get along with others. Importantly, sleep helps your brain work properly. While you’re sleeping, your brain is forming new pathways to help you learn and remember information.

If you’re sleep deficient, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change. Sleep deficiency also has been linked to depression, suicide, and risk-taking behavior.

Right Sleep, Right Time. Getting enough quality sleep at the right times helps you function well throughout the day. People who are sleep deficient are less productive in all aspects of their life. They take longer to finish tasks, have a slower reaction time, and make more mistakes.

After several nights of losing sleep­­—even a loss of just one to two hours per night—your ability to function suffers as if you haven’t slept at all for a day or two.

Some people aren’t aware of the risks of sleep deficiency. In fact, they may not even realize that they’re sleep deficient. Even with limited or poor-quality sleep, they may still think that they can function well.

Drowsy Driving. For example, drowsy drivers may feel capable of driving. Yet, studies show that sleep deficiency harms your driving ability as much as, or more than, being drunk. It’s estimated that driver sleepiness is a factor in about 100,000 car accidents each year, resulting in about 1,500 deaths.

Bad sleep habits and long-term sleep loss will affect your health. If you’re worried about whether you’re getting enough sleep, try using a sleep diary for a couple of weeks.  Write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel during the day. Show the results to your doctor, and talk about how you can improve your sleep.

Q I’ve always been a little extra sensitive to heat and cold, but lately my fingers feel like icicles. What’s going on?

A If your fingers feel virtually frozen, this symptom is almost always due to the veins and arteries tightening up and closing down. This constriction, or vasospasm, reduces circulation to the hands and fingers and makes them feel very cold and numb. The severity of your cold finger symptoms is dependent on the cause and how much they affect your daily life.

• Not serious: Occasionally experiencing cold and mildly discolored fingers is probably not serious, as long as the fingers warm up and feel normal quickly once you are out of the cold.
• Moderately serious: Fingers that are often painfully cold can certainly interfere with your ability to work and with quality of life in general.
• Serious: If left untreated, very poor circulation can lead to tissue damage, tissue death, and gangrene.

Common Causes

Autoimmune diseases. An autoimmune disease is one in which the body’s defenses turn against itself. The nerves, cartilage, skin, joints, or other organs can be attacked as though they were invaders, causing illness and damage. Some autoimmune diseases cause inflammation of the veins and arteries. This inflammation interferes with circulation and causes long-term damage. Raynaud’s syndrome causes cold fingers when the arteries running to the extremities—including feet—spasm and reduce blood flow.

Iron deficiency anemia. Iron deficiency anemia is a condition in which the body does not have enough iron to form hemoglobin, the protein in red blood cells that carries oxygen throughout the body. The condition can be caused by acute blood loss through injury, or surgery.

Hypothyroidism, or “underactive thyroid,” means that the thyroid gland in the neck does not produce enough of its hormones. This causes a slowing of the body’s metabolism. This condition is often found among older women with a family history of the disease. Common symptoms include fatigue and constantly feeling cold.

You should see a doctor if your cold finger symptoms are persistent or worsening. Discuss getting physical therapy. This can improve circulation and help your symptoms.

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Data Evaluation. Researchers evaluated information supplied by 204,689 people ages 25 to 75, from three previously established clinical trial study groups. At enrollment and every two years after that, participants updated information on their health behaviors, medical history, and newly diagnosed conditions. Participants were asked whether they had used PPIs regularly in the preceding two years, and regular use was defined as two or more times a week.

After taking into account potentially influential factors, including high blood pressure, high cholesterol, physical inactivity and use of other medication, the researchers found that those who regularly used PPIs were 24% more likely to develop type 2 diabetes than those who didn’t. And the longer these drugs were taken, the greater the risk of developing type 2 diabetes. Use for up to two years was associated with a 5% increased risk, and use for more than two years was associated with a 26% increased risk.

A Deeper Dive. Further analysis showed that diabetes risk among PPI users wasn’t affected by sex, age, family history of diabetes, smoking, alcohol intake, diet, physical activity, high cholesterol, or regular use of anti-inflammatory drugs. But it was higher among participants who were not overweight or who had normal blood pressure.

For comparison, the researchers also looked at the potential impact of H2 blockers, another type of drug used to curb excess stomach acid production. Regular use of these drugs was associated with a 14% increased risk. Similarly, longer-term use was associated with a higher risk, while longer time since stopping was associated with a lower risk.

In addition to acid reflux, PPIs are used to treat peptic ulcers and indigestion. In addition to an increased risk of type 2 diabetes, long-term use of PPIs has been linked to an increased risk of bone fractures, chronic kidney disease, gut infections and stomach cancer.

A mounting body of evidence suggests that changes in the type and volume of bacteria in the gut, also known as the microbiome, may help explain the associations found between PPI use and an increased risk of developing type 2 diabetes, according to the researchers.

Treatment Implications and Study Limitations. The researchers suggest that doctors should weigh the pros and cons of prescribing these drugs, and suggest screening for abnormal blood glucose and type 2 diabetes for patients who receive long term PPI treatment. By the same token, they note that the study had several limitations: For instance, detailed data on PPI use, including dosage, frequency, and brand, were not collected, so further analysis based on those factors could not be completed.

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