topic Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE in Wellness

FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Nonametoday — Mon, 16 Nov 2015 19:57:39 GMT

Spinal Stenosis

Spinal stenosis is like prostate hypertrophy or graying of the hair—it’s not a matter of if, but when: if one lives long enough, one will get it. Spinal stenosis is a favorite topic of mine because it epitomizes one my other favorite topics, the distinction between the medicine’s dichotomy of purpose: eradication of a disease and, a very different concept, the promotion of health. As much as surgery would appear to be the paradigm of eradication of disease, I will show you how, in spinal stenosis, it may be more properly conceived of a promotion of health.

Spinal stenosis is not actually a syndrome, but an anatomic finding. Nonetheless, it is often described as if it were a syndrome. It should be made clear that simply having spinal stenosis is not an issue. Many people have it and have no symptoms, and thus, need no treatment. The most commonly associated syndrome is called neurogenic claudication, which means pain in the legs when you are walking. This syndrome is what some people with spinal stenosis experience.

The word “stenosis” is derived from the Greek language and means “narrowing.” The narrowing is a result of the thickening of bones and ligaments in the spine that ultimately compromises the diameter of the canal through which the nerve roots descend when passing from the bottom of the spinal cord before they exit the spinal canal and form peripheral nerves. This thickening is an example of one of the many instances in which the body’s protective mechanisms end up having an unintentionally negative effect. In this case, the hypertrophic changes in the ligaments and bones of the lumbar spine that are teleologically programmed to counter wear and tear stresses, do so at the expense of the adjacent, traversing nerve roots. Put another way, the spine “thickens” with age to protect its structural integrity and in doing so compresses the nerves that run through it.

This nerve compression can manifest as pain, numbness, heaviness, and rarely, as weakness. What makes the spinal stenosis so unique is that the pain typically arises only when the patient is standing or walking. The pain is, moreover, typically relieved by sitting or lying down. Since the patient is able to get relief by changing position, the syndrome can be, and often is, tolerated for a long time.

These somewhat unique features of spinal stenosis lead to an insidious restriction of many of the activities of daily living. The patient is often focused on the pain and is unaware of how much of his or her life has been altered by avoidance of this pain. Many patients never seek surgical treatment, as they believe that they are too old or that the gradual erosion of their repertoire of activities is a normal consequence of aging.

What patients often fail to realize, however, is that when one stops walking, two things are sure to follow: first, the body, and the heart in particular, weakens from a lack of exercise and activity. Second, the brain begins to rot from a lack of variety and stimulation. By limiting walking the patient avoids pain but loses cardiovascular fitness and brain acuity. I am certain that the unrecognized or overlooked consequences of spinal stenosis are the deconditioning and dementia that slowly sets in. Dementia may seem like an exaggeration but when the brain is deprived of the stimulation and variety that being mobile provides, it will lose some of its vitality.

The effective treatment of spinal stenosis should thus be considered as more of an empowering process, or as a process that allows for the promotion of health than as a process that eliminates a disease. In fact, since spinal stenosis is a manifestation of chronic arthritis, it can never really be eliminated.

Although there are a variety of treatments employed in treating spinal stenosis, most of them are either ineffective or merely make the patient better temporarily. They often focus on reducing the pain rather than empowering the patient. I am all for starting off with conservative treatments, but if the treatments employed only serve to delay the inevitable need to make more room for the nerve roots surgically, the treatments may be counterproductive. Some of the patients subjected to prolonged conservative treatments ultimately opt for surgery after enduring a restricted or a painful lifestyle and have the surgery in a more deconditioned state, which makes recovery more difficult.

Oddly, this may be an instance where surgeons are not aggressive enough. Often the medical doctor or family member suggests to the patient that he or she is too old for surgery. This well-meant advice may paradoxically cause the patient to have a worse result.

The surgical treatment of spinal stenosis is often complicated as it has to be individualized to each patient in terms of levels of stenosis treated, amount of bone and ligament removed, and the need to fuse the decompressed levels. This is where the dialogue between doctor and patient is essential.

How does spinal stenosis cause pain? To answer this question we must separate how spinal stenosis may cause back pain and how it may cause leg pain.

The back pain in spinal stenosis is likely the result of the arthritis of the facet joints that caused the stenosis in the first place.

There may be associated multifidus muscle weakness that can be a cause of back pain.

The leg pain in spinal stenosis is not clearly understood. It may be a combination of the nerve roots being compressed and being inflamed, along with the nerve roots being deprived of oxygen or blood flow from the compression.

How does spinal stenosis improve? It doesn’t, on its own. The symptoms associated with the narrowing may wax and wane, particularly early on in the course of the disease. The overall trend is to typically worsen slowly. Physical therapy may help temporarily. Epidural steroid injections are often particularly helpful in the early stages, but these, too, offer only temporary relief. Most of the time, surgery will be needed to provide more room for the traversing nerve roots when the stenosis is severe.

Perhaps, more common than neurogenic claudication, spinal stenosis manifests clinically as back pain without leg pain related to standing and walking. This leads to the often frustrating diagnosis of “arthritis” as the cause of pain The diagnosis of arthritis certainly helps the patient understand that there is no “fix,” but is often perceived by the patient as vague. As discussed previously, this diagnosis is ideal for the healthcare provider for it is a definitive diagnosis that avoids the real question, “Why does my back hurt?” It is one of the many “answers” we use that doesn’t exactly answer the question being asked.

Although, back pain caused by spinal stenosis is often treated with surgery, the results are much less predictable than are the results for leg pain caused by spinal stenosis. In the setting of back pain, the patient is better served to pursue physical therapy and pain management (see Chapter 9).

What Is the Shopping Cart Sign?

This phenomenon is so common that it has been attributed its own “sign.” The idea is that some of you will find that you can “miraculously” walk longer, without pain, while in the supermarket pushing the shopping cart around. The shopping cart is not really supplying support, but allowing you to walk with your spine in a slightly flexed position. Flexing the spine makes the spinal canal larger so that areas that are stenotic become less stenotic. The nerve roots are less compressed in this position and you have less pain when walking.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

newziesuzie — Mon, 16 Nov 2015 20:09:35 GMT

I looked up the source of article fwiw:

"Spinal Stenosis" - Dr. Patrick Roth, MD

http://www.patrickrothmd.com/spinal-stenosis/

😊

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Chrystaltree2 — Mon, 16 Nov 2015 20:16:22 GMT

....I've been in healthcare for 30 plus years; I am a certfied Health Information Management Specialist. So, I do think I know a little something.....lol I also have spinal stenosis, so speaking as a professional and as a patient, I didn't disagree with anything in the article you found and posted. It was general, no two of us have the same bodies and we feel and react to pain as individuals. What works to alleviate pain for some does nothing for others. So, I would never advise that someone rule out surgery if nothing else works. No wants to exist with chronic pain. Walking, pt, stretching, ibuprofen....none of that helped me at all. Not one bit. So, every 4 or 5 months, I get spinal injections. I'm pain free for 3 months after the injections but it gradually comes back. When it does, I get relief from 500mg of naproxen and 300 mg of gabapentn twice a day. I understand the yada yada yada if it all. To be honest, I don't are. I just don't want the pain.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Lipstickdiva — Mon, 16 Nov 2015 20:23:52 GMT

@newziesuzie wrote:

I looked up the source of article fwiw:

"Spinal Stenosis" - Dr. Patrick Roth, MD

http://www.patrickrothmd.com/spinal-stenosis/

😊

Wow. It would have been nice if the OP had given her source instead of trying to come off as an informed medical person. In the other thread she started about this issue, I see she resorted to name calling in 3 responses. SMH

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

millieshops — Mon, 16 Nov 2015 20:47:17 GMT

@LipstickdivaYou are so right. No where did I see that she was the expert!

Although her expertise was lost on me because if I had wanted to know so much about a serious health issue, I wouldn't take that much info from an unknown source. It would have been enough to suggest we check trhe Internet for info with a name if she wanted and it were okay with the mods.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

sophiamarie — Mon, 16 Nov 2015 20:53:28 GMT

In no way did I think the OP was an "informed medical person". She really should have just posted the link instead of c&p it.

Anyone can google.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

151949 — Mon, 16 Nov 2015 22:21:11 GMT

And when one does google they can get both correct and incorrect information.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

151949 — Mon, 16 Nov 2015 22:30:21 GMT

I don't see anywhere here that it says you should drag yourself around costco for an hour draped over a shopping cart while carrying a heavy purse. Just saying.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

sophiamarie — Tue, 17 Nov 2015 00:09:58 GMT

@151949 wrote:
And when one does google they can get both correct and incorrect information.

****************************************************************************************************

This is true. It depends on what link you click. I trust WebMd....... MayoClinic is another trustworthy link.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

hckynutjohn — Tue, 17 Nov 2015 00:50:32 GMT

Appears to be a copy/paste and way too long for me to want to read. I have never been a copy/paste person, neither posting them or reading them.

As far as thinking I am an "informed medical person"? When it comes to "my" ton of medical issues, I feel I am very well informed, from diagnosis/prognosis and any and all therapy/recovery necessary.

I am not one to speculate on others medical issues. Should someone ask me a question directly, I can offer them my opinion from my own experiences while suggesting they see their doctor.

Not really sure what precipitated this thread, maybe I missed something.

hckynut(john)

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

151949 — Tue, 17 Nov 2015 01:47:42 GMT

@hckynutjohn wrote:

Appears to be a copy/paste and way too long for me to want to read. I have never been a copy/paste person, neither posting them or reading them.

As far as thinking I am an "informed medical person"? When it comes to "my" ton of medical issues, I feel I am very well informed, from diagnosis/prognosis and any and all therapy/recovery necessary.

I am not one to speculate on others medical issues. Should someone ask me a question directly, I can offer them my opinion from my own experiences while suggesting they see their doctor.

Not really sure what precipitated this thread, maybe I missed something.

hckynut(john)

John, what started it was another thread where the OP (of both threads) said that she has spinal stenosis and her way of dealing with it was to walk around Costco for an hour every day hanging over a shopping cart and she carries a uber heavy handbag which she shifts from arm to arm for some reason. I said that no doctor would ever advise a patient to carry a heavy handbag as a form of therapy nor to walk around for an hour draped over a shopping cart and that people should go to PT and learn the proper way to exercise so they help , not further hurt themselves.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Kachina624 — Tue, 17 Nov 2015 01:58:25 GMT

@jobran wrote:
In no way did I think the OP was an "informed medical person". She really should have just posted the link instead of c&p it.

Anyone can google.

Apparently she thinks she's getting points for being "wordy". I'm not in the mood to read all that. All I know is that I've had it for over 10 years, I've tried everything, nothing has helped, I've been told but three neurosurgeons that surgery won't help. So I sit.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Reba055 — Tue, 17 Nov 2015 04:58:22 GMT

@Kachina624 Yeah, and I also have cervical stenosis. That's a treat 😡

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Desertdi — Tue, 17 Nov 2015 18:33:59 GMT

Here's how it works: When you drop the heavy purse, and quit bending over the cart......you feel much better. It's like hitting yourself in the head with a hammer when you have a headache.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

151949 — Tue, 17 Nov 2015 21:18:39 GMT

@Desertdi wrote:
Here's how it works: When you drop the heavy purse, and quit bending over the cart......you feel much better. It's like hitting yourself in the head with a hammer when you have a headache.

Oh OK , now I get it.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

CatsyCline — Wed, 18 Nov 2015 00:15:11 GMT

videos are worth 100,000 words:

quick snapshot:

What is Spinal Stenosis? - Lumbar Spinal Stenosis - DePuy Videos

https://www.youtube.com/watch?v=31RuBxzXhr0

30 minute web presentation:

Lumbar Spinal Stenosis : Diagnosis and Treatment Options

https://www.youtube.com/watch?v=rMEkjGHZ7o0

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

151949 — Wed, 18 Nov 2015 00:55:29 GMT

yes, and on the video having to lean over a shopping cart is presented as a SYMPTOM - not as a treatment.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

sfnative — Wed, 18 Nov 2015 05:57:08 GMT

@151949 wrote:
And when one does google they can get both correct and incorrect information.

@151949

1. If you are an informed individual with experience in the healthcare industry; have had "some" clinical vocabulary education; have on board what you might term a wealth of knowledge per your experience or that of someone close to you; and/or, have someone close to you with that knowledge, then if you have clinical questions and desire more information, I'd recommend the Mayo Clinic's website. It can address disorders and diseases for you and breaks down the information into appropriate sections.

2. If you don't have any of the above, it would honestly be best for you to take questions to your physician or nurse practitioner.

(3.) Some physicians will advise their patients not to seek information on the internet and many times that's good advice. However, if you have a grounding as above and can read with understanding and without panicking, go to it.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Big Sister — Wed, 18 Nov 2015 08:20:26 GMT

OP, you may have meant well, but there is no way I am going to read your entire post. It's just too long and doesn't have paragraphs. It's torture to read it.

Re: FOR THOSE WHO THINK THEY ARE INFORMED MEDICAL PEOPLE

Suziepeach — Wed, 18 Nov 2015 12:13:36 GMT

I gave up responding to any post about mammography, as I am a former radiologic technologist and certified mammographer.. because so many non medical people know more than I.. I got jumped on for suggesting see your physcian... It's like some can and us professionals can't.. Go figure!