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FOR A LICENSED CHIROPRATOR ONLY. I am quite sure I have a…

FOR A LICENSED CHIROPRATOR ONLY. I...
FOR A LICENSED CHIROPRATOR ONLY.
I am quite sure I have a nasty case of sciatica. I have had it before and the symptoms seem the same. Nasty pain from the base of my spine, in the hip, knee, ankle, and heel.
I have been to my PC MD and he agrees except it has gotten worse to the point where I can only walk a few steps and then the pain is too excruciating to go on. He is having me get an MRI tomorrow just to be sure.
I am asking you this question because I feel there is a good chance that Chiropractic could resolve the situation easily and quickly (assuming it is sciatica). However I feel gun shy as in the past I have had a couple adjustments increase the pain and I'm not sure I can handle that.
Do you have any thoughts or suggestions?
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Answered in 1 day by:
3/13/2018
Dr Stan
Dr Stan, Doctor
Category: Medical
Satisfied Customers: 3,001
Experience: Physician at Stanley L Simpson, DO
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Hello, my name is***** am US trained, Board Certified with 30 years of patient experience. Please allow me a moment to review your question.

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This may indeed be compression of the Sciatic Nerve at L4 to S1. This may also be Acute Arachnoiditis. Until a cause is determined for your pain, do not consider any treatment. If it does become Herniated Disc Syndrome, then the first treatment should be Physical Therapy and NSAIDs such as Advil or Aleve. But before doing anything, you need a diagnosis of your problem.

I hope I have addressed your concerns. Have I?

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I am available to answer any additional questions you may have.

I hope your medical problem(s) are resolved soon and you feel better. I sincerely ***** ***** I have helped you and that I have earned your 5 star rating today.

Please remember to rate my service by selecting the 5 stars at the top of the screen ( rating me now does not close your question). We can continue here until you are satisfied, simply use the reply box and let me know. Thank you.

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Customer reply replied 1 month ago
Thank you Dr. Stan. Since entering my question I got the results of my MRI with comments from my primary care physician. I don't understand it all but I did notice that he commented that there was no subluxation. I have an appt to see an Orthepedist on Friday. If you have any further thoughts based on the MRI, I would appreciate it:EXAM: MR SPINE LUMBAR WO CONTCLINICIAN'S HISTORY: worsening left sciaticaHISTORY REPORTED TO TECHNOLOGIST: Patient with severe back pain for 3
weeks, most pain in lumbar region into Lt hip/leg. pain controlled by
external stimulator and prescription regimentCOMPARISON: None.TECHNIQUE: Multiplanar multisequence MR imaging of the lumbar spine
was performed using a 1.5 Tesla scanner. No gadolinium enhancement.FINDINGS: There are 5 lumbar vertebrae. Alignment is normal. Marrow
signal is unremarkable.T11-T12 through L1-L2: Normal posterior disc margins with no central
or foraminal narrowing. Small Tarlov cysts are seen in the right T12,
L1, and L2 neural foramina without significant impingement on the
exiting nerve roots. Similar appearance on the left at the L2 neural
foramen.L2-L3: No central stenosis or foraminal narrowing.L3-L4: Normal disc height with no central or foraminal narrowing.L4-L5: There is a focal disc extrusion in the left paracentral region,
extending 8 mm posteriorly and 8 mm caudally. It impinges on the
traversing left L5 nerve root. Mild lateral recess narrowing on the
right contacting the traversing right L5 nerve root, related to
bilateral mild facet arthropathy and ligamentum flavum thickening.
Mild central canal stenosis.L5-S1: Normal posterior disc margin with no central or foraminal
narrowing. Moderate bilateral facet arthropathy.Bilateral S2 Tarlov cysts, measuring up to 1 cm on the left.
Impression
IMPRESSION:
1. At L4-L5, there is a focal left paracentral disc extrusion,
extending 8 mm posteriorly and 8 mm caudally, impinging on the
traversing left L5 nerve root. There is mild lateral recess narrowing
on the right which contacts the traversing right L5 nerve root without
significant deformity. Mild central canal narrowing due to bilateral
facet arthropathy.
2. Tarlov cysts are noted of doubtful clinical significance.

Thank you for the report. There is evidence to support the reason for your pain, nerve root compression and the Tarlov cysts. It does not appear that you have a spinal stenosis (narrowing of the spinal canal). Tarlov cysts are sacks in the covering of the spinal cord filled with fluid which usually doesn't cause any problems but they can add to the pressure on the nerve root which will increase your pain. You may benefit from Physical Therapy and anti-inflammatory medication before considering surgery. Discuss this with your doctor before committing to surgical intervention.

I hope I have addressed your concerns. Have I?

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Customer reply replied 1 month ago
Thank you for your quick reply. My dilemma is that I have a history of bleeding ulcers so even over the counter aspirin and ibupufren are out of the question. I have been taking prednisone which seems to give me some relief (especially when the syptoms first started). So I guess physical therapy may be the only practical solution. I have ready about surgery in the hip area and I get the impression it is very serious, to be avoided if possible, plus a possible long recovery. I did try Acupuncture which has given me great pain relief for other spinal issues. Even though I got relief during the treatment, the next day the pain was worse. I understand this can be part of the healing process but I can barely manage the pain as is. (Up to 2 5/325 Lortab every 4-6 hours).
I will leave the question open temporarily in case you have any further thoughts.

At this time you have two considerations, surgery or physical therapy. In my 30 year experience, therapy should be the initial treatment (10-12 weeks, 3 times weekly). I'm sorry that you can't take NSAIDs, but taking Lortab (Hydrocodone and Acetaminicine) alone is not the answer either. You need a long-acting drug such as OxyContin with your Lortab. Please discuss this with your doctor or consult with a Pain Management Specialist. By taking both long and short-acting pain medication, there is less chance of becoming dependant on the medication.

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Customer reply replied 1 month ago
Yes thanks. I know pain medication is definitely not the answer and can even worsen things. That is why I am using also a TENS solution but the results are modest at this level of pain.
I have a "kidney stone rescue kit" always available to me. I took some Oxycontin from it yesterday and it gave me quite of bit of relief and made me comfortable with more physical activity which seemed theraputic. As you recommended, I will discuss this with my PC Physician who knows I am very disciplined about taking opiods.

You are welcome.

Dr Stan
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Category: Medical
Satisfied Customers: 3,001
Experience: Physician at Stanley L Simpson, DO
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