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Dr. Robert
Dr. Robert, Doctor
Category: Medical
Satisfied Customers: 6027
Experience:  M.B.B.S, Experienced Family Physician
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Five months ago I was diagnosed with Sciatica caused by herniated

Customer Question

Five months ago I was diagnosed with Sciatica caused by herniated disc on my right side. MRI findings reveal "the possibility of a sequestered disc fragment in the right lateral recess and foramen at L5-S1. There is an associated degenerative changes in the disc with a broad bulge."

The above condition caused pain in my right leg and numbness down to my right foot. As recommended by my physiatrist and physical therapist I had been doing several back stretches and exercises twice a day up to now. Although the pain has subsided I still feel the numbness in my right leg and mainly in my right foot that cause some imbalance in my walking and standing.

Aside from a surgical procedure, what is the best treatment for my condition, how long before the numbness go away for good, and what is the possibility of this problem to recur in the future? Will the services of a chiropractor do me any good? What is your best solution to my problem
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Robert replied 1 year ago.
Hello,
Welcome here and thank you for your question.
I am Dr.Robert & will do whatever I can to help answer your questions.First I need a little more information-

Are you taking any oral medications/pain killers for sciatica?
Is there any other known medical illness?
Are you overweight?

I am waiting for your reply.
Kind Regards,
Dr. Robert
Customer: replied 1 year ago.
No oral medication taken for sciatica

Diabetes Type II, taking metformin 100 mg 2xday.
Bad LDL, taking Atorvastatin 10 mg. daily

Not overweight. current weight of 180 lbs., 6ft. height.
Expert:  Dr. Robert replied 1 year ago.
Dear Ernest,
Thank you for providing quick additional info.

The main underlying cause of your sciatica is herniated disc.Sciatica is generally caused by the compression of lumbar nerves L4 or L5 or sacral nerves. Any compromise of the nerve space in the spinal column can lead to compression of the nerve endings.

Non surgical treatment options for herniated disc are:Nonsteroidal anti-inflammatory medications (NSAIDs),Cold therapy, heat therapy or both,Oral Steroid Medications,Transcutaneous electrical nerve stimulation (TENS) delivers a tiny electrical current to key points on a nerve pathway,Epidural Steroid Injections.

Injections of cortisone can be administered directly in the area of nerve compression.Your doctor may have advice you to wear a back brace or corset for a short time to increase your comfort and help you to regain mobility.

Rehabilitation typically includes exercises to help correct your posture, strengthen the muscles supporting your back and improve your flexibility. Prescribed exercise may include light stretching, walking, and aerobic type exercise.

Recurrences of sciatica are common.Following steps can prevent recurrence:

-Proper lifting techniques-hold the item close to the body, lift with the back straight using the strong leg muscles.

-Avoid movements that involve extreme body rotation

-Good posture during sitting, standing, moving, and sleeping

-Do not sit cross-legged. This places pressure on the sciatic nerve.

Numbness & other symptoms usually go away from few weeks to few months.Approximately 80% to 90% of patients with sciatica get better over time with rest without surgery.

Yes,definately services of a chiropractor will help you greatly but also consult your doctor for the best treatment option & oral medications like NSAID's.Epidural steroids may be required accordingly.As you have normal weight,do maintain it.

Hope this helped.

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your business!

Kind Regards,
Dr. Robert






Customer: replied 1 year ago.
Thank you for your response, and I would appreciate your clarifying me on the following additional questions based on your response of 05/20/2013:

1 What are examples of NSAID’s and their generic equivalents?
2.Is cold therapy and heat therapy done with devices?
3.What are examples of oral steroid medications and their generic equivalents?
4.How can TENS be administered and who can do it?
5.What are examples of Epidural Steroid Injections and their generic equivalents?
6.What are the side effects of each of the above medications and procedures?
7.What kinds of examples of exercises do you recommend?
8.Will the above medications, procedures and exercises restore in place my bulging disc and fix the compression of lumbar nerves L4 or L5 sacral nerves?
9.What is the time frame for this restoration period?
10.Would you recommend the use of a spinal decompression machine, and what are the side effects of using it?
11.Would surgery be a better option to fix my problem in a shorter period of time?
12.What are the pros and cons of said surgery, and how long is the time to recover?

Expert:  Dr. Robert replied 1 year ago.
Dear Ernest,
Thank you for asking follow up questions.

Here are the answers:

1.Example of NSAID's are: Aspirin (Bufferin, Bayer, and Excedrin)
Ibuprofen (Advil, Motrin, Nuprin),celecoxib (Celebrex)
diclofenac (Voltaren).

2.Cold therapy & heat therapy can be done with equipments or without equipments.Put ice in a plastic bag, wrap the bag in a towel.Do not apply ice directly to the skin. Wrap the icepack in a towel.Apply heat in the form of a warm wash cloth applied to the area for 10 minutes or so 2 or 3 times a day.

3.Examples of Oral Corticosteroid medications are:cortisone, hydrocortisone and prednisone.

4.Transcutaneous electrical nerve stimulation (TENS) is a therapy that uses low-voltage electrical current for pain relief.The gentle electrical current is passed through electrodes which are taped to the skin near the site of the pain.Physiotherapists use TENS machines – both in hospitals and in private practice. You need to consult physiotherapist for this treatment.

5.Using a needle, relatively small amounts of corticosteroids together with a local anesthetic are injected into the epidural space around the spinal cord and spinal nerves.

Example:

-Betamethasone(Celestone Soluspan)
-Methylprednisolone (Depo-Medrol)
-Triamcinolone

6. Each meddication/procedure has a long list of side effects but not all of them occur in everyone.Any of them can occur.Your doctor can choose the best option accordingly considering various fators.

7.Click here to know the details about exercise of sciatica:

http://www.nhs.uk/Livewell/Backpain/Pages/sciatica-exercises.aspx

8.Yes,these medications & procedures help to treat the bulging disc/herniated disc & releases the compression of nerves and hence the pain relief.

9.Restoration times varis according to various factors from person to person.It may take from few weeks to few months.

10. Currently, there are no scientific studies in the peer-reviewed literature that demonstrate the clear or long-lasting effectiveness of computerized spinal decompression therapy.It should be used only if recommended by your spine doctor.

11.If you have tried for these medications & injections,non-surgical treatments & other conservative treatment for atleast about six months, and they haven't helped reduce your pain, then surgery is the option.It is usually last resort.

12.Surgical procedures may involve removal of bone and disk tissue or may remove bone spurs or disk material (decompression) and provide lasting pain relief.You may need either decompression surgery or a stabilization surgery, and often, a decompression and fusion are done at the same time. Recovery time varies according to the procedure done & other factors.

For more details click here:

http://www.spine-health.com/conditions/degenerative-disc-disease/lumbar-degenerative-disc-disease-treatment-options


Hope my detailed answer helped

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your business!

Kind Regards,
Dr. Robert



Customer: replied 1 year ago.
Hello Doctor,

I feel that your main answers to my follow up questions are more focused on the remedies to relieve the pain caused by my sciatic condition.

As indicated in my initial query on May 20th, the pain has subsided but the numbness in my right leg towards my right foot still persists that cause severe imbalance in my walking and standing. As a matter of fact I walk with a limp on my right side.

This numbness with occasional cramping is my main concern that I would like you to address on how it can be fixed aside from exercises and stretches that I had been doing religiously. Thanks for your prompt reply.
Expert:  Dr. Robert replied 1 year ago.
The numbness you are having can be treated once you will start taking anti inflammatory medications.

The best treatment option is oral medications like NSAID's..Example of NSAID's are: Aspirin (Bufferin, Bayer, and Excedrin)
Ibuprofen (Advil, Motrin, Nuprin),celecoxib (Celebrex)
diclofenac (Voltaren).

This will cure the numbness & cramping also.

Hope my detailed answer helped

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your business!

Kind Regards,
Dr. Robert
Customer: replied 1 year ago.

Doc,


 


I have tried the NSAID's oral medication and taking them on daily basis but they don't seem to work? Any other remedies you may suggest?


 


Would you recommend lumbar spinal decompression machines, and what types would be suitable for my condition?


 


This prolonged numbness is a great physical impediment and I'd like to have it cured as quickly as possible. Again, thanks for your help.

Expert:  Dr. Robert replied 1 year ago.
Dear Ernest,
Thank you for asking follow up questions.

As you have tried for these medications & injections,non-surgical treatments & other conservative treatment for last 5 months, and they haven't helped reduce your pain, then surgery is the only option.

Currently, there are no scientific studies in the peer-reviewed literature that demonstrate the clear or long-lasting effectiveness of computerized spinal decompression therapy.It should be used only if recommended by your spine doctor.

Surgical procedures may involve removal of bone and disk tissue or may remove bone spurs or disk material (decompression) and provide lasting pain relief.You may need either decompression surgery or a stabilization surgery, and often, a decompression and fusion are done at the same time. Artificial disc replacement (ADR), sometimes called total disc replacement (TDR), is a newer and somewhat more complex procedure than fusion.

Hope my detailed answer helped

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your business!

Kind Regards,
Dr. Robert

Customer: replied 1 year ago.

Dear Doctor,


 


1. Is the surgical procedure an outpatient or inpatient type of surgery?


2. How long does it take to recover from the operation?


3. Would you consider the numbness without pain the residual symptoms of nerve damage, and is there a special nerve healing medication and/or procedure aside from the ones you mentioned before?


 


Thanks for your prompt reply.

Expert:  Dr. Robert replied 1 year ago.
Dear Ernest,
Thank you for asking follow up questions.

1.Most of the surgical procedures are inpatient & you need to stay in the hospital for few days.

2.The recovery time depends upon the type of surgery.It may take from few days to few weeks.

3.Yes,the symptoms you are having can be because of nerve damage/nerve root compression.There is no such medication that can cause nerve healing.

So I advice you to make an appointment with your spine doctor so as to choose the best option accordingly.

Hope my detailed answer helped

My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

Thank you for your business!

Kind Regards,
Dr. Robert


Dr. Robert, Doctor
Category: Medical
Satisfied Customers: 6027
Experience: M.B.B.S, Experienced Family Physician
Dr. Robert and 5 other Medical Specialists are ready to help you
Expert:  Dr. Robert replied 1 year ago.
Hi Ernest

I'm just following up with you to see how everything is going. Did my answer help?

How is your pain now?
Have you consulted the spine doctor for surgicsl options as your treatment?

Let me know,
Dr.Robert
Customer: replied 1 year ago.

Hi Doctor,


 


The pain has long gone, a week after I initially suffered from sciatica, about 5 months ago. But the numbness in my lower foot and leg still exists and does not seem to go away.


 


My physiatrist recommended that before going into a surgical procedure I should see a chiropractor. What do you think a chiropractor can do to relieve the numbness in my leg?


 


Again, thanks for your answer.

Expert:  Dr. Robert replied 1 year ago.

Hi Ernest,
Thanks for asking follow up question.

Have you consulted chiropractor ever before for this issue?
Do you have numbness through out the day?

Kind Regards,
Dr. Robert

Customer: replied 1 year ago.


Hi Doctor,


 


This is my first time to see a chiropractor. Yes, I feel the numbness through out the day.


 


Again, thanks for your reply.


 


Ernest

Expert:  Dr. Robert replied 1 year ago.
Hi Ernest,

Well, Chiropractor will find the source of the nerve blockage and use manual adjustments to correct the spinal misalignment.
The adjustments are designed to remove the blockage that is pinching the sciatic nerve and causing the pain and numbness.
Also he may use Massage therapy and Ultrasound and ice therapies to relive numbness.

Chiropractic care would be helpful in this condition and would be very beneficial for your health.

Please let me know how I can be of further assistance.
My goal is to provide you with excellent service – if you feel you have gotten anything less, please reply back, I am happy to address follow-up questions.

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