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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29642
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I am a nurse and had injury on the job three mths ago. My

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I am a nurse and had injury on the job three mths ago. My mri shows L4 L5 foraminal disc protrusion abuting nerve and L5 s1 broad based protrusion abuting S1 nerve root within spinal canal and neural foramin. I have had two rounds of po steroids and PT with pain down both legs and unrelieved by meds. Still awaiting workers comp for neuro surg consult. Anything else I can do to releive pain. Not getting any better and as a nurse I really do NOT want any surgery.
Submitted: 11 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 11 months ago.

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

What is your age?
Do you have radiculopathy symptoms too; numbness, tingling, pain, weakness in lower limb?
How severe are your symptoms?

Customer: replied 11 months ago.

I'm 40. I have been a nurse for 17 years. I have numbness tingling like electric down mainly left leg but pain also moves to groin and also to right thigh hip. Pain on and off is severe ache but again has flared up to constant shooting down legs even with no movement. Worse sitting and walking. I have had sciatica on and off for years and tx with chiro and massage therapy which has always helped. After moving pt off gurney I felt pop and sense then three months ago I have had little relief with flare up again this past week with PT. Workers comp denied my docs request for neuro surg consult and wants me to see a neurologist. My workers comp co also read my mri which my doc felt was conflict of interest. The mri showed osteophytes at t12 with mild stenosis and the L4 L5 and S1 have disc dissication. I wouldn't care about the finding except the pain is dibilitating. I don't want to use pain pills either as I see everyday the trouble they cause.

Expert:  Dr. Arun Phophalia replied 11 months ago.

Hello Lisa,

The surgery is indicated in following cases;

1) Increasing pain
2) Severe excruciating pain.
3) Bladder and bowel involvement.
4) Failure of conservative treatment.

Usually initially a neurologist is consulted and if he determines that issue is significant enough; neurosurgeon is consulted. Collective measures as following are recommended, meanwhile (many of which you have already tried);

 

 

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 increases 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; this is important in cases due to injury

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

9) Epidural steroid shots

10) Surgery is usually last resort, when the above conservative measures fail. You can start the following exercises;

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;

 

a) Orthopedist

b) MD in Physical medicine and rehabilitation


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.

 

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Customer: replied 11 months ago.

I have been doing PT...bracing excercises...e stim tx...working with therapists. Unfortunately I cannot limit what causes pain as it is sitting and walking both of which I need to do to work and live. I have lifted...bent 90 degrees etc since the injury. I guess my question is with the mri results and my ongoing symptoms would epidural injections be appropriate? Why would neurologist need to be seen to evaluate symptoms? Is there some kinda of a test a neurologist would do the internal md isn't qualified to do? Wouldn't a neurosurgeon review actual mri films? I feel this process has been drug out due to it being workers comp and even the physician I'm seeing feels it is odd to have neurologist consult instead of neurosurg. I'm hoping injection may help bc at this point I have seen little to no improvement with me following and participating in numerous of what you listed above.

Expert:  Dr. Arun Phophalia replied 11 months ago.
Hi Lisa,

The neurologist is considered to have slight bias for the surgery. So it has been a convention to consult the neurologist in worker's compensation cases. The neurosurgeon would review the original films of the MRI and do not go just by the MRI report, apart from assessing by physical exam. Epidural in your case has significant chance of abating your symptoms. The neurologist would usually get the following additional studies done;

1) Nerve conduction velocity study (NCV)
2) Electromyography (EMG).

It is privilege assisting you.

Dr. Arun
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 29642
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and other Health Specialists are ready to help you
Customer: replied 11 months ago.

Thank you. that's what I was looking for. Just wanted to know what other tests they might run and if it was normal for neurologist to be consulted bc my doc felt this was odd. I'm sure its bc workers comp trying to find any way to not have to pay for something. Awesome when you have spent your career taking care of people. Thank you for your advice.

Expert:  Dr. Arun Phophalia replied 11 months ago.

You are very welcome, Lisa.

Worker's compensation do go a bit slow and their protocol as you know and understand is slightly deviated from standards of protocol.

Wishing you all the very best.

Thanks for the excellent rating.

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