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Lumbar stenosis, fear and recovery
I am 60 and living in rural Japan. Two months ago I suddenly found it difficult to walk long distances. I had noticed symptom of a pulling between right knee and lower back for about a year prior--mostly on waking--I sleep on my side--as well as arthritic feelings (tightness when initially walking after sitting a long time). But I still could walk long distances and ride my bike. What triggered the walking difficulty was when I tried to pick up my cat carrier with one hand. It got worse over the course of a week, and then I could not move at all upon rising from the toilet.
In hospital 2 weeks....too much bed rest, but I was scared and the MRI room was booked until the 6th day. Diagnosis was moderate lumbar spine stenosis...no mention of herniated disk...just Inteverterbral disk generation. 8 years ago i fell backward...leaving a dent in my posterior..and after walking on one side to avoid pain, I developed a herniated disk. PT then --extension stuff-- helped. Not sure if relatedto the canal stenosis. I also have mild numbness at times from cervical spine spondylosis, but usually a symptomatic. Especially with moderate exercise.
Hospital this time judged stenosis not severe, and the rehabilitation of assisted walking in hospital was not continued as my case did not warrant it. I felt it very useful, maybe essential, and I had to find another hospital doing PT at its sports rehab center on my own. Lots of massage and manipulation, flexing stuff. I can walk fairly well now, though there is a burning sensation between right knee and thigh. PT says I also have lots of muscle tightness, and also right leg muscles have shrunk, contributing to tightness in the right leg. He does therapy every two days 3 times a week since sometimes therapy induces a bit of pain, and the muscles need to rest. He says the pulling of the muscles on the lumbar spine should decrease over time with strength and endurance. Some of the stretching of the hamstrings, ETS. Can be painful in a good sort of way, but when it is in the lower back, fear takes over. This is common with 24 hours of therapy or even walking a lot, so I try to not overdue walking. A bit confusing.
Pain is not severe, but fear of recurrence (being unable to move or walk) comes whenever I have any. It can be a twinge after sitting on a too low stool, or especially within 24 hours of a therapy session. I was able to start a Part time teaching position that involves a 3hour train ride both ways..overnight at the sight. But anxiety and some depression comes at times..fear of recurrence and fear I won't be able to finish the semester, though objectively, it has been overall a healing situation. A month ago I could not walk for long, now I can, albeit with stiffness and occasional pain....I will make an appointment with a psychiatrist soon about the anxiety but was wondering--if this was developing over time and the heavy lifting triggered the severe first few days prior to hospitalization, why does it not get better to the state it was before lifting my cat?
Meds I am taking, all related to pain symptoms:
1 Neurotropin 4 NU tabs x2 am and pm. Presumably for burning sensation in leg.
2 celcoxib 100 mg am and pm
3 Alfadex 5ug tabs x 1 3 times a day --Japanese name is purorenaru. In hospital had IV drip of alprostadil, similar effect. Presumably to get more blood into the narrowed canal.
The dr also gave me antizolam for when I have the most anxiety...work days. I start my 3rd week tomorrow. Knock on wood.
Rehabilitation hospital doctor suggests gradually discontinuing all or most pain meds, says all 3 not needed. Dr affiliated with first hospital said since I am so nervous about my condition I could keep taking all 3 at least until the weather warms up.Then stop until the winter.
I am worried about taking unnecessary drugs but more worried that I will have a relapse if I stop. I wonder if this is a misunderstanding on my part on what the drugs do. All agree that rehab and not resting too much are useful, but I do fear any little pain that comes. ( I also take a blood pressure med blopress, Lipitor and Bayaspirin, plus singular and Flotide.)
Would love to hear your perspective on the PT and pain meds mentioned.
In hospital 2 weeks....too much bed rest, but I was scared and the MRI room was booked until the 6th day. Diagnosis was moderate lumbar spine stenosis...no mention of herniated disk...just Inteverterbral disk generation. 8 years ago i fell backward...leaving a dent in my posterior..and after walking on one side to avoid pain, I developed a herniated disk. PT then --extension stuff-- helped. Not sure if relatedto the canal stenosis. I also have mild numbness at times from cervical spine spondylosis, but usually a symptomatic. Especially with moderate exercise.
Hospital this time judged stenosis not severe, and the rehabilitation of assisted walking in hospital was not continued as my case did not warrant it. I felt it very useful, maybe essential, and I had to find another hospital doing PT at its sports rehab center on my own. Lots of massage and manipulation, flexing stuff. I can walk fairly well now, though there is a burning sensation between right knee and thigh. PT says I also have lots of muscle tightness, and also right leg muscles have shrunk, contributing to tightness in the right leg. He does therapy every two days 3 times a week since sometimes therapy induces a bit of pain, and the muscles need to rest. He says the pulling of the muscles on the lumbar spine should decrease over time with strength and endurance. Some of the stretching of the hamstrings, ETS. Can be painful in a good sort of way, but when it is in the lower back, fear takes over. This is common with 24 hours of therapy or even walking a lot, so I try to not overdue walking. A bit confusing.
Pain is not severe, but fear of recurrence (being unable to move or walk) comes whenever I have any. It can be a twinge after sitting on a too low stool, or especially within 24 hours of a therapy session. I was able to start a Part time teaching position that involves a 3hour train ride both ways..overnight at the sight. But anxiety and some depression comes at times..fear of recurrence and fear I won't be able to finish the semester, though objectively, it has been overall a healing situation. A month ago I could not walk for long, now I can, albeit with stiffness and occasional pain....I will make an appointment with a psychiatrist soon about the anxiety but was wondering--if this was developing over time and the heavy lifting triggered the severe first few days prior to hospitalization, why does it not get better to the state it was before lifting my cat?
Meds I am taking, all related to pain symptoms:
1 Neurotropin 4 NU tabs x2 am and pm. Presumably for burning sensation in leg.
2 celcoxib 100 mg am and pm
3 Alfadex 5ug tabs x 1 3 times a day --Japanese name is purorenaru. In hospital had IV drip of alprostadil, similar effect. Presumably to get more blood into the narrowed canal.
The dr also gave me antizolam for when I have the most anxiety...work days. I start my 3rd week tomorrow. Knock on wood.
Rehabilitation hospital doctor suggests gradually discontinuing all or most pain meds, says all 3 not needed. Dr affiliated with first hospital said since I am so nervous about my condition I could keep taking all 3 at least until the weather warms up.Then stop until the winter.
I am worried about taking unnecessary drugs but more worried that I will have a relapse if I stop. I wonder if this is a misunderstanding on my part on what the drugs do. All agree that rehab and not resting too much are useful, but I do fear any little pain that comes. ( I also take a blood pressure med blopress, Lipitor and Bayaspirin, plus singular and Flotide.)
Would love to hear your perspective on the PT and pain meds mentioned.
Thank you. The doctor is an orthopedist by the way. Walking has steadily imporved (I can walk 1 kilo, rest and another kilo without a cane. Climb steps well. Etc. When you say knee or hip level, could you explain? They said the feeling of pulling at the knee is related to muscle tension. Even now it fe very tight around the knee, but the physical therapist thinks it is due to lack of use during two weeks in the hospital.
I distinctly recall waking up each morning before the symptoms became worse and feeling a pulling between the back and the knee, as mentioned. One other question, I hope not odd. The symtoms were gradual, arthritic like for the months prior to the incident where I picked up the cat carrier. Then after that, after a few days, I could not move. I wonder why it does not return to the pre-cat carrier state if I had spinal stenosis all along? In other words, while the pain is not severe 6 weeks after the two week hospitalization, it is definitely harder to walk with my right knee feeling tight (and burning in the thigh) Or is this not unsual? Thank you.
I distinctly recall waking up each morning before the symptoms became worse and feeling a pulling between the back and the knee, as mentioned. One other question, I hope not odd. The symtoms were gradual, arthritic like for the months prior to the incident where I picked up the cat carrier. Then after that, after a few days, I could not move. I wonder why it does not return to the pre-cat carrier state if I had spinal stenosis all along? In other words, while the pain is not severe 6 weeks after the two week hospitalization, it is definitely harder to walk with my right knee feeling tight (and burning in the thigh) Or is this not unsual? Thank you.
MEDICAL PROFESSIONAL
Hi there!
Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation. If the stenosis is not severe and there is no compression of the neural structures, conservative management as suggested by your treating neurologist is preferred. If conservative management is not effective in 6-8 months of management surgical/ interventional management may be considered. Also an active search for causes other than spinal stenosis such as causes located at the knee or hip level should be done. The medications are largely anti-inflammatory medications and pain killers and just provide symptomatic relief without affecting the primary cause. I would suggest discussing the situation and the suggested management plan in detail with your treating orthopedician
Hope this is helpful.
Take care!
Well, without knowing the relevant clinical details or a detailed clinical evaluation it would be difficult to comment specifically on the situation. If the stenosis is not severe and there is no compression of the neural structures, conservative management as suggested by your treating neurologist is preferred. If conservative management is not effective in 6-8 months of management surgical/ interventional management may be considered. Also an active search for causes other than spinal stenosis such as causes located at the knee or hip level should be done. The medications are largely anti-inflammatory medications and pain killers and just provide symptomatic relief without affecting the primary cause. I would suggest discussing the situation and the suggested management plan in detail with your treating orthopedician
Hope this is helpful.
Take care!
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