Dear Doctor: My wife is 77 and has spinal stenosis. She’s often in pain. We read about a new procedure called “minimally invasive lumbar decompression,” which we are hoping might help. She really wants to avoid surgery. What can you tell us about it?

Dear Reader: To understand spinal stenosis and its treatment, we should start with the structure of the spinal column, or backbone. It’s a collection of 33 bones, known as vertebrae, which enclose and protect the spinal cord, along with the fluid that surrounds it. It also includes the muscles, tendons and other tissues that provide support and allow movement. The spinal column rises from the coccyx, or tailbone, and runs the length of the back to the base of the skull. The spinal cord, which serves as the master communications pathway between the brain and the body, houses 31 pairs of spinal nerves. These connect to the spinal cord and enter and exit the spinal column at various points, depending on their function. In between the vertebrae are discs, rubbery pads that provide additional space and cushioning.

In people who develop spinal stenosis, the spaces within the spine become constricted. (The word "stenosis" refers to the abnormal narrowing of a passage within the body.) This is often due to osteoarthritis, which damages the joints and discs in the neck and lower back, and may cause the growth of bone spurs. This results in pressure on the nerves in the region of the narrowing, which can cause symptoms such as a tingling sensation or numbness, muscle weakness and cramping, and pain in the lower back, buttocks and legs that can become severe. If nerve compression lasts long enough, numbness, weakness and, in more serious cases, even paralysis can become permanent.

Spinal stenosis usually occurs in the lumbar region, which is the lower portion of the spine. It’s typically treated with nonsurgical pain management, or with surgery such as laminectomy or discectomy. These are procedures that, in different ways, surgically excavate additional space within the spinal column. As with all surgeries, they carry a certain degree of risk.

However, as you mention in your letter, there is now a new approach to correcting spinal stenosis. Known as minimally invasive lumbar decompression, it uses a small implanted device that acts as a lift to create additional space within the spinal column. The device, which doesn’t use connecting hardware, is implanted via a small incision. The bone and tissue removal associated with traditional back surgery is usually not necessary. The procedure takes from 45 to 90 minutes and is often performed under local anesthesia. Patients may be asked to participate in physical therapy following the procedure and will have follow-up visits to assess progress. Many return to normal activities two to six weeks after receiving the implant.

Factors such as bone density and the degree of spinal stability play a role in whether this approach is appropriate. Complications can include fracture or tissue tears at the site of the implant. Unfortunately, studies regarding success rates aren’t yet available.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I saw my doctor because my heart was beating funny and I was losing weight even though I wasn’t dieting. She did a blood test, and it turns out to be Graves’ disease. Why did I get that? Is there a cure?

Dear Reader: When someone has Graves’ disease, it means a malfunction of their immune system has caused their thyroid gland to become too active. Known as hyperthyroidism, it’s a condition that causes the overproduction of thyroid hormones. Since these hormones play an important regulatory role in many parts of the body, the symptoms of Graves’ disease can be quite varied.

The thyroid is part of the collection of glands located throughout the body known as the endocrine system. Their job is to produce hormones, which are chemical messengers. They regulate bodily processes such as metabolism, sleep, mood, growth and development, reproduction, tissue function and sexual function, to name just a few.

The thyroid itself is a small gland. It weighs less than an ounce and is shaped roughly like a butterfly. It’s located at the base of the throat, just below the larynx, and consists of a pair of matching lobes that sit on either side of the windpipe. The thyroid takes the iodine in our diet and manufactures two main hormones, which help regulate vital functions throughout the body. These include heart rate, body weight, body temperature, muscle strength, breathing, cholesterol levels, the central and peripheral nervous systems, and in women, menstrual cycles. So you can see how any malfunction of the thyroid can have a wide-ranging effect on general health.

When it comes to Graves’ disease, the cause is unknown. It usually develops before the age of 40, and is more common in women than in men. People with existing autoimmune disorders are at increased risk of developing Graves’ disease, and family history can play a role. Cigarette smoking is a risk factor, as well.

Symptoms of Graves’ disease include the unexplained weight loss and irregular heartbeat that you experienced, as well as anxiety or irritability, sleep disturbance, fatigue, reduced libido, sensitivity to heat, and tremor in the fingers or hands. Some people develop Graves' ophthalmopathy, which is a collection of eye-related symptoms such as pressure, grittiness, light sensitivity and vision problems. Graves’ dermopathy, which is rare, causes the skin on the shins or tops of the feet to thicken and become red.

Diagnosis is via blood tests to determine thyroid hormone levels, imaging tests to look at the size of the thyroid or tests that assess the rate at which the thyroid is using iodine. There is no cure at this time. Instead, treatment focuses on slowing thyroid activity. This can be achieved through radioactive iodine therapy, which gradually destroys overactive thyroid cells; medications that either interfere with the thyroid’s ability to produce hormones or block the effects of thyroid hormones on the body; or thyroid surgery. Lifestyle changes such as a healthful diet, regular exercise and doing what you can to ease stress are also important for managing the condition. Complications can be serious, including heart disorders and problems during pregnancy, so it’s important to seek treatment.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I live alone, and stay-at-home orders have been hard. I’ve heard people say that being lonely is really bad for your health, and now I believe them. What problems can it cause? Also, I’m going to start seeing friends and family again. What can we do to stay safe?

Dear Reader: While it’s easy to understand the link between loneliness and depression, anxiety and other psychological ills, the connection to physical effects on the human body can seem like a bit of a stretch. However, ongoing research has shown that loneliness, as well as the social isolation we have all been asked to practice for several months now, do, indeed, take a physical toll.

Individuals who experience chronic loneliness have been found to be more vulnerable to a number of diseases and conditions than are people who enjoy strong emotional connections. These include an increased risk of developing heart disease, metastatic cancers and having a stroke. Older adults who are socially isolated are also more likely to become cognitively impaired or to develop dementia, including Alzheimer’s disease. Researchers have even tied loneliness to an increased risk of premature death. Adults in midlife who are chronically lonely are 25% more likely to die prematurely. Older adults, whose social connections have shrunk due to factors such as retirement, have double the risk of premature death as those who are socially connected.

You’re not alone in being determined to rekindle your social contacts. We’ve all seen an increase in the number of people returning to a semblance of normal life. The challenge is that each and every contact with someone outside of your quarantine circle becomes a calculated risk. This is because of the highly transmissible nature of the novel coronavirus and the existence of asymptomatic carriers, who can unknowingly pass along the virus. Still, several months into the pandemic, the medical community has gained a clearer understanding of mitigation measures. As a result, the focus has begun to shift from strict quarantine behavior to risk management and mitigation.

Before we go any further, we have to repeat that any contact with people outside your quarantine circle puts you at risk of infection. The best way to lessen that risk is to stick to small gatherings that are held only outside -- never indoors. And it’s crucial to maintain the social distancing guidelines we are all now familiar with. That means tables or chairs or picnic blankets spaced at least 6 feet apart. No handshakes or hugging, no matter how tempting it may be. Everything about the gathering should be BYO -- bring your own. That includes food, drink, condiments, disposable plates, cups and utensils, and a large garbage bin for safe disposal. Wear masks except while eating or drinking. No sharing of food or drink or condiments. If things get lax and you become uncomfortable, make a polite excuse and leave. This is all a far cry from the way we visited with each other in the pre-COVID-19 world, but the potential consequences of skipping or relaxing even one of these steps are too grave.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)