Dear Dr. Roach: What do you know about Himalayan salt? Is it harmful to take every day? I am told that it can help lower blood pressure because it has minerals and trace elements.
Dear M.S.: Himalayan salt, though it has a pretty pink color and trace minerals, is still almost all table salt — sodium chloride — and salt raises blood pressure for most people. Keeping sodium intake down is likely to reduce risk of heart disease and stroke. Generally, people with a healthy diet get all the trace minerals they need. Most studies on multivitamin and mineral supplements have shown no benefit.
Dear Dr. Roach: In two weeks, I’m scheduled to have a pain-management doctor do a spinal injection after being diagnosed with DISH. My MRI showed “compression of the left S1 nerve root.” I have had numbness in my left foot (big toe and second toe) for about five years, numbness in my right foot’s big toe and second toe for about two years. The anesthesiologist I met with said that the injection may not help with numbness, but may be of “diagnostic value.” Today I saw an article in the New England Journal of Medicine that said these injections are “overused and of little value.” Even the pain doctor said I may need back surgery if the shot does not work. Would I be a fool to have the injection done?
Dear J.A.: DISH, diffuse idiopathic skeletal hyperostosis, is a condition where connective tissue becomes calcified and bone-like. In the back, this can cause compression of the nerve. Injection into the area, usually with a combination of a glucocorticoid similar to cortisone and a local anesthetic, may have some benefit in relieving pain, but as your anesthesiologist has mentioned, if your numbness (and pain, if any) goes away, it suggests that surgery on the area would be effective if necessary. If pain relief is long-lasting, the injection can be repeated. However, DISH is less likely than other causes to have long-lasting relief, since DISH is not inflammatory and glucocorticoids act primarily as anti-inflammatories.
The trial in the New England Journal you mentioned was looking at people with spinal stenosis, not necessarily from DISH. In that study, injection with a steroid had no better pain relief at three weeks and six weeks. However, an analysis of 23 previous studies on this subject, published in 2012, did show modest improvement for injection compared with placebo in the short term.
It is possible that any improvement you may have after the injection is a result of a placebo effect. Also, steroid injections are not risk-free: Rarely, infections can result, and repeated doses of steroids can affect the body’s ability to make its own necessary steroids.
With all this in mind, you need to decide how bad your symptoms are. If they are really not very bad, you might decide not to get anything done, since the risks, even though they are small, aren’t worth the small benefit.
If you are having significant distress from pain or numbness, I wouldn’t say you would be a fool to get it done, but you would need to interpret the results cautiously. I also would advise even more caution before considering surgery.
Email questions to ToYourGoodHealth@med.cornell.edu.