How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. Arun Phophalia Your Own Question

Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29528
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
Type Your Health Question Here...
Dr. Arun Phophalia is online now
A new question is answered every 9 seconds

Dear Dr. Mark, I have had a recent MRI due to back and knee

Resolved Question:

Dear Dr. Mark, I have had a recent MRI due to back and knee pain. The following is a summary: Multilevel degenerative disc disease and facet arthrosis, most pronounced on the right at L4-L5 and on the left at L5-S1, with likely abutment of the exiting right L4 and left L5 nerve roots. I am an RN with a fairly good understanding of this report. What I don't know is how are these problems usually approached - is surgery the best(only) option?
Submitted: 9 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 9 months ago.

Hello,
I am Dr. Arun and will be helping you today.

Dr. Mark is offline. If you wish I can answer your question. Or do you want to wait for him?

 

What are your symptoms?

What are the treatment done?

Thank you.

Customer: replied 9 months ago.

You can answer my questions. I have severe right knee pain, sometimes right hip pain that affects my ability to walk. I have difficulty sitting for any length of time, because my back hurts, I get burning pain in my right buttock, and occasionally my right foot goes numb. The longer I am up on my feet during the day, the more my back hurts. Sometimes it feels as if someone has taken a sledgehammer to the top of my head and is bashing it to make me shorter.


I have had my hips and knees injected, which did not work. They are recommending physical therapy, which I have tried and failed before.

Expert:  Dr. Arun Phophalia replied 9 months ago.

Thanks for the opportunity to help you.

The indications of the surgery are;

1) Failure of the conservative treatment.
2) Progressive or severe / excruciating pain.
3) Increasing neurological signs and symptoms
4) Involvement of bladder and bowel.

Following investigations also would be required, if not yet done;

1) Nerve conduction velocity (NCV) study

2) Electromyography (EMG)

Following measures usually are advised for the conservative treatment;

1) Back care in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important thing which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activity helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze. Following more need to be done:

a) Avoid activities which increase the pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided till pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on floor

 

2) Anti-inflammatory analgesics like ibuprofen, other analgesics and muscle relaxants

 

3) Local analgesic gels or sprays / ointment

4) Hot fomentation

 

5) Electrotherapy like trans cutaneous electrical nerve stimulation: done by physical therapist. Other thing are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

 

6) Good supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

 

7) Lumbosacral corset or support or brace

 

8) If obese or over weight, reduce weight for long term benefit.

9) Epidural steroid shots

10) Radio frequency ablation of the nerves in facet joints.

 

Surgery is usually last resort, when the above conservative measures fail or symptoms are progressively increasing. You may start the following exercises, meanwhile;

 

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed / couch. Hold for ten seconds, then slowly lower to starting position. As strength builds, aim to complete one sets of ten curls. The exercise should be done twice a day (both the sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

http://www.mayoclinic.com/health/back-pain/LB00001_D

 

You can consult following specialists (apart from your GP);

 

a) Orthopedist

b) Neurologist

c) MD in Physical medicine and rehabilitation

Your knee and hip pain are due to concomitant conditions of osteoarthritis (degenerative / age related arthritis) and due to radiculopathy from the back. These may need hip and knee replacement if conservative measures as following have not helped;

1) Physical therapy; this is the mainstay of the management of the osteoarthritis. Stretching exercises, strengthening exercises, mild weight bearing exercises, swimming on the week-ends etc would be helpful. Going to pool on week-ends will further enhance the benefit. You need to incorporate the exercises in your routine as much as possible.

2) Deep electrotherapy; this entails going to physical therapy center and take care of specific issues which are more painful.

 

3) Glucosamine and chondroitin supplements

 

4) Diacerin too can be tried which suppose to regenerate the cartilage.

5) Local analgesic sprays

6) Acupuncture

7) Consideration of hyaluronic acid injection in the joints which are more painful. Some physician may inject steroid too for the pain relief.

8) Warm shower in morning would open up the joints.

9) Capsaicin (Zostrix, ArthriCare) is an irritant derived from chili peppers that provide relief by depleting a chemical that transmits pain from nerve endings. Various strengths are available without prescription. (It causes a burning sensation thus one has to be careful while applying and should wear a disposable plastic glove).

10) Acupuncture; most popular forms of alternative or complementary medicine, particularly for pain relief.

 

11) Analgesic patches too are available for the pain relief.

If overweight is an issue; long term is achieved by weight reduction. High impact exercises should be avoided; like kneeling and bending.


Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

 

We have recently implemented a new rating and feedback system. Please be aware that you are rating my courtesy and service as a professional. If you have any questions whatsoever, or there is anything I can clarify for you, please temporarily bypass the rating system by clicking “Continue the Conversation” or "Reply."

Clicking either of the lowest two options reflects poorly on me so please reply to me if there is anything else I can do to help before choosing those options. I appreciate your patience while we work out the kinks. It's important to me that you are 100% satisfied with the service I have provided you. Thank you.

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29528
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 4 other Health Specialists are ready to help you
Customer: replied 9 months ago.

43 years of nursing, plus the increasing weight of our patient population has now made it impossible for me to work due to the pain. Over the past 6 months, the pain has gotten increasingly worse. I sent you separately the lengthy list of meds I am taking to deal with this, and many days it is not enough. It is better now that I am out on disability, as I can rest when I need to, and get off my feet.


The lidocaine patches did nothing for me. The TENS unit occasionally helps my knees, but that it inconsistent as well. It is better for the knee muscle spasms, or my restless leg syndrome (another blessing). What I really want to know is will all this physical therapy prevent or slow the disease process, or will I likely end up needing surgery in the future? I have been pursuing treatment for my knee pain for 18 years now, most of which I consider to have been wasted until my referral to the pain clinic. I don't want to stay on narcotics forever, and there are a limited number of physical therapy sessions I can afford to attend,as I have not yet received a disability check. Having been an OR nurse for 20+ years, I have to admit, I'd rather just "get better"

Expert:  Dr. Arun Phophalia replied 9 months ago.
I think on the right track. Pacing the activity and relative rest with these ailments is definitely important part of the management. Once you learn the tailor made exercise regime made by an MD in physical medicine and rehabilitation; you can do the exercises at home, with not much dependence on the physical therapy center. This is a slow process of improvement so give some time. I appreciate your concern and it is better to gradually taper off the narcotic analgesics gradually.

Rest Leg Syndrome can develop as a result of certain conditions, particularly iron deficiency and peripheral neuropathy. Other causes of RLS are folate or magnesium deficiency, amyloidosis, diabetes mellitus, lumbosacral radiculopathy, or vitamin B-12 deficiency. Following investigations are advised;

1) A complete iron panel including iron levels, ferritin, transferrin saturation, and total iron binding capacity.
2) BUN,
3) creatinine,
4) magnesium,
5) thyroid-stimulating hormone (TSH),
6) vitamin B-12, and folate.

 

These investigation results will help to treat the primary problem so symptoms are benefited.

Following measures usually are helpful;

1) Avoidance of caffeine, alcohol, or nicotine (if one takes them).
2) Exercise before the bed time
3) Medications
a) Pramipexole (Mirapex)
b) Ropinirole hydrochloride (Requip).

 

In addition to above and the medicines which you are already taking, non pharmacologic therapy comprises of the following components:

 

1) Iron replacement therapy

2) Mental alerting activities such as video games or crossword puzzles, may reduce symptoms at times of boredom.

It is privilege assisting you.
Customer: replied 9 months ago.

Thank you! You have been extremely helpful! I appreciate your time and your patience.


 


Marilyn

Expert:  Dr. Arun Phophalia replied 9 months ago.
You are most welcome, Marilyn.

Thanks for your kind words.

Wishing you all the very best

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery
 
 
 

Related Health Questions