I’m sorry to hear that your spine has caused you so much pain and interruption in your life.

Common causes of the degeneration of the spine you describe include osteoporosis, deterioration of the shock-absorbing discs that lie between the vertebrae (or bones) of the spine, and inflammation of the facet joints, which link the bones of the spine.

Genetics, your diet in adolescence (95 percent of peak bone mass is reached before the age of 20, therefore appropriate calcium intake is crucial), and the amount of activity you’ve taken over the years (exercise strengthens bones) also play a role.

In addition to the incapacitating agony you are suffering, there is also inflammation. This is the body’s attempt to repair the bone injury, but it can lead to a narrowing of the spinal canal, which carries the nerves that transmit messages between the trunk and the limbs.

This constriction puts pressure on the nerves, which is why you’re also experiencing leg pain.

Chronic spinal pain can be difficult to treat, which is why we now have so-called iPASS clinics (integrated pain and spinal service) dedicated to its management.

You state that you have been referred to an iPASS clinic in your extended letter. Essentially, you will be evaluated by a multidisciplinary team, to determine the optimal treatment method.

This may initially require consultation with a specialized physiotherapist. Even if the recommended physiotherapy has been ineffective, I would not attempt Pilates without further guidance from your care team.

A member of the neurology team or one of the neurosurgery specialists may recommend that you undergo surgery to relieve pressure on the nerves in your spine, for instance.

In the interim, I urge you to continue with the exercises, as the advantages of physiotherapy can take weeks or months to manifest.

Statins have been prescribed to me due to a small constriction of an artery. I’ve since learned that plant sterols provide the same function but are more “natural.” Are they a suitable substitute?

Anne Smith, via electronic mail.

Sterols and stanols are chemicals found in a variety of plants, including cereals, fruits, vegetables, and nuts, that inhibit the absorption of cholesterol from the food we eat. And they are now being added to several produced foods (such as spreads).

Your doctor has prescribed statins because he or she has identified early coronary heart disease, and there is substantial evidence that lowering cholesterol levels (especially LDL, or “bad” cholesterol) reduces the risk of a heart attack or stroke by preventing the accumulation of fatty deposits in the arteries.

Statins are the most effective method for achieving this, although they produce the best outcomes when paired with a balanced diet, such as the Mediterranean diet.

In addition, research confirms that ingesting sterols and stanols, in addition to taking statins, can further lower cholesterol levels.

Therefore, consuming foods rich in plant sterols and stanols may enhance the effects of statins, but they are not a replacement for them.