#bilateral sciatica

[gleditsia-triacanthos]

hey so if you get sciatica in both legs overnight and become suddenly incontient— that could be cauda equina syndrome! that’s incredibly serious!see a doctor!

- sincerely, someone who had full lower body function this saturday

[semiotomatics]

researching the anatomy of the lower back/pelvis/legs/feet to try to figure out what the FUCK is causing my sciatica bc dear GOD am i in agony rn

[cripplepunked]

One thing I WILL say, having had lumbar surgery yesterday, is that there's a very weird experience where new medical information can be simultaneously extremely frustrating while also relieving and freeing?

So I had the sciatica for 7 years, which progressed and became bilateral and I had intermittent but regular symptoms of gradual onset cauda equina.

But it took 5 years for anyone to even give me an MRI, and after that a lot of delays with getting things sorted, because on my MRI there WAS a herniated disc but the herniation was small.

Like really small, couldn't account for the symptoms I was describing. So the general thought was that I had a very minor disc herniation and a very low pain tolerance, because even repeated MRIs didn't show the bulge getting bigger, even though I was complaining of worsening symptoms.

Turns out that's because the disc herniation was super small! And not causing my symptoms! The cause of my symptoms was that my vertebrae had grown incorrectly and there physically wasn't enough room for the nerve to pass through, causing extensive visual nerve compression. And the reason that it was getting worse was that my body was trying to compensate by shifting my weight backwards, which caused the disc herniation, which was pressing the nerve further into the bones.

So if they hadn't done the surgery and physically followed the nerve down, having seen the herniation was pretty small, they wouldn't have known that my nerve was being increasingly compressed. And that I DID have gradual onset cauda equina. And if I wasn't so extremely lucky to have an extremely good surgeon they wouldn't have checked, he went out of his way to look for the cause of my symptoms while he was in there.

So like, on one hand, it is very frustrating that I've been suffering progressive nerve damage for years that was minimised and not taken seriously. But on the other hand it is such a relief to know that... like... I am NOT a hypochondriac and I'm not being dramatic and that I do have an appropriate assessment and understanding of my body?

Because when you're constantly told you must be exaggerating or misunderstanding your own symptoms it becomes really easy to think that you must be making everything up. So there is something weirdly relieving at having a man walk into your room and say "oh yeah, your nerve was very compressed, it is amazing you were walking at all I would have expected someone with that much compression to be rolling around in pain at all times. The MRI didn't show the extent of the issue, you had bones crushing your nerves." And also knowing that he was able to remove those bones and that hopefully, depending on how I scar, I might get a very positive recovery out of it.

[taylors-a-goblin]

Just started exercising again recently, and let me just give a little example of how real this is.

Years ago, I paid for a gym membership and a personal trainer. I've got bilateral bursitis in my shoulders, a janky knee, and sciatica. Trying to explain all the ranges of movement or positions I can't achieve without triggering any of these painful issues was exhausting. Going through a workout and repeating this to the PT every time I was asked to do an exercise that hurt was exhausting. Trying to work out a workout routine I can do reliably with the PTs advice was exhausting. And that's without even getting through the workout. I'm also audhd, so it was really difficult to maintain those appointments or even make myself go to the gym, with all those people around it was fucking difficult. And it was expensive. And I wasn't enjoying myself. It sucked. All of this without even mentioning my history with disordered eating, which makes things like counting calories a huuuuuge no-no for me.

That was then. I stopped trying after only a couple months because it was making me miserable. Now? Now I have a few basic weights and a loose barbell in my garage. I've been watching a YouTube series (Celtic Warrior Workouts) with wrestlers who are all different body types and are all incredibly fit in different ways, and I'm taking advice from their work outs. I adjust for my body, for my various chronic conditions, and only do as much as feels right for me (which is exactly the advice a lot of these really fit wrestlers give). I've only been doing it a few days, but I'm ACTUALLY FUCKING ENJOYING MYSELF. I'm in my own home, in my comfort zone, taking inspo and motivation from people whose athleticism and mindsets I admire. And I feel far more happy and motivated to continue under these conditions than I ever did at the gym. And my body feels good, and my mind feels good, and that's exactly what I was trying to achieve.

So find a way to feel healthy that works for you. Maybe it's just going for walks, or improving your diet, or doing yoga, or going for a bike ride. Whatever. Just start small and simple and start somewhere you feel safe and confident. You won't enjoy yourself if you're feeling self-conscious the whole time. Find inspo and motivation that works for you. Do it to feel a little happier, not to look like someone else.

I gave my soapbox speech about how weight loss is mostly bullshit to two different patients in a row yesterday and so help me I’m pretty sure one of these days someone is going to say “but SURELY you agree I’d be HEALTHIER if I lost weight!” bc you can see the disbelief in their eyes. And like. Sure, maybe! You might see some improvement in biomarkers like LDL and A1c, and your knees would probably feel better. But you would be amazed at how much more good you can do for yourself by focusing on things you can actually meaningfully change without resorting to making yourself miserable. Eat more fresh fruits and vegetables—it’s hard bc they’re more difficult to prepare and more expensive per calorie and go bad faster than other foods, but they’re what we evolved eating the most of so they’re what our bodies need the most of. And walk around more; sure, cardio is great for you, but if it sucks so bad you don’t do it, it isn’t doing shit for you. And we evolved to walk very very long distances, a little bit at a time, so our bodies respond actually very well to adding walks into our schedules, which is vastly easier than adding workouts that are frankly designed to be punishing when the definition of punishing is “makes you less likely to do it again in the future.”

You get one life. It is shorter than you can begin to imagine. Don’t waste it hating yourself because somebody is going to make money off that self-hatred. You deserve better than to be a cash cow for billionaires who pay aestheticians and dermatologists to make them (or at least their trophy wives) look thin and beautiful no matter what they actually do.

[dissociacrip]

gynecological stuff/health updates

1. bilateral hydrosalpinx still there after course of antibiotics but didn't have same bad pain as last time (possibly bc i've been taking the BC pills straight through, no sugar pills.) i still got pelvic pain and the weird aches and pains in my left leg but not the sciatica-like pain i was getting that made it hurt to walk. doc said continue taking the BC pills continuously and see if the hormone regulation continues to improve the pain and other symptoms (like the migraines) but if the hydrosalpinx still doesn't go away at all at 3-month follow up we'll still need to find what's causing it which this time prob requires surgical intervention.

2. gyn also said the pre-menstrual(?) hypoglycemia stuff doesn't sound normal so if it continues i prob will try to get PCP to investigate. zero clue what the cause could be.

3. i get anemic once bleeding is over or something even though i don't bleed nearly as bad as i used to (i would get anemic during menstrual phase and have really bad constant PVCs along with it, barely able to get out of bed) thinking it's anemia and not POTS flaring because i'm also getting mouth sores. have iron gummies at home with vitamin C tablets but dunno if those are working (yet.) messaged gyn about it. this is why i feel so fucking ill after my period and also it happened to coincide with finals week in this semester and last semester :/

[ayurvedicvitality]

Effective Ayurvedic Solutions for Bilateral Sciatica and Shoulder, Neck, and Arm Pain

Discover Ayurveda's holistic approach to alleviating bilateral sciatica and soothing shoulder, neck, and arm pain. Explore natural remedies and treatments for lasting relief.

Are you suffering from the double whammy of bilateral sciatica and persistent shoulder, neck, and arm pain? If so, you're likely seeking effective solutions to alleviate your discomfort and regain your quality of life. In this article, we will explore the world of Ayurveda and discover how this ancient holistic system of medicine offers natural remedies and treatments for lasting relief from these debilitating conditions.

Understanding Bilateral Sciatica

Before delving into Ayurvedic solutions, it's essential to understand what bilateral sciatica is and what causes it. Sciatica refers to pain that radiates along the path of the sciatic nerve, which extends from the lower back down to the legs. When this condition affects both sides of the body, it's referred to as bilateral sciatica.

The common causes of bilateral sciatica include herniated discs, spinal stenosis, or even pregnancy-related pressure on the sciatic nerve. The symptoms can be excruciating, often characterized by sharp, shooting pain, tingling, or numbness in both legs.

Ayurvedic Approach to Sciatica

Ayurveda, an ancient Indian system of medicine that dates back thousands of years, offers a holistic approach to managing sciatica. In Ayurveda, the focus is not just on alleviating symptoms but on identifying and addressing the root causes of the condition. Here's how Ayurveda can help:

1. Dosha Analysis and Sciatica Management: Ayurveda identifies three doshas - Vata, Pitta, and Kapha - which represent different energies in the body. Sciatica is often associated with an aggravated Vata dosha. Ayurvedic practitioners will assess your dosha balance and develop a personalized treatment plan to restore harmony.

2. Herbal Remedies and Dietary Recommendations: Ayurveda relies heavily on natural remedies, including herbs and dietary adjustments. Commonly used herbs for sciatica include turmeric, ginger, and ashwagandha, known for their anti-inflammatory and pain-relieving properties. A balanced diet tailored to your dosha can also aid in reducing inflammation and improving nerve health.

Managing Shoulder, Neck, and Arm Pain with Ayurveda

In addition to bilateral sciatica, many individuals also struggle with persistent shoulder, neck, and arm pain. These issues can stem from various causes, such as poor posture, muscle tension, or underlying medical conditions. Ayurveda provides effective solutions for managing this discomfort:

1. Ayurvedic Approaches to Upper Body Pain: Ayurvedic treatments for shoulder, neck, and arm pain often involve the application of herbal oils through gentle massages. This therapy, known as Abhyanga, not only relieves pain but also promotes relaxation and reduces stress.

2. Specific Herbs and Therapies: Ayurveda offers specific herbs and therapies tailored to upper body pain relief. For instance, eucalyptus oil is known for its muscle-relaxing properties and is often used in Ayurvedic massages to alleviate tension in the shoulder and neck areas.

Ayurvedic Treatments and Therapies

Ayurveda boasts a rich array of treatments and therapies that can provide immense relief for both bilateral sciatica and upper body pain. Here are some of the most effective ones:

1. Panchakarma Therapies: Panchakarma is a detoxification and rejuvenation process in Ayurveda. It can help eliminate toxins from the body, reduce inflammation, and promote overall healing. These therapies are particularly beneficial for chronic pain conditions.

2. Abhyanga (Ayurvedic Massage): Abhyanga is a therapeutic massage that uses warm herbal oils to relax muscles, improve circulation, and reduce pain. Regular Abhyanga sessions can be highly effective in managing both sciatica and upper body pain.

3. Yoga and Stretching Exercises: Ayurveda emphasizes the importance of physical activity to maintain balance in the body. Practicing yoga and specific stretching exercises can help strengthen muscles, improve flexibility, and alleviate pain in the affected areas.

Dietary and Lifestyle Changes

In Ayurveda, the role of diet and lifestyle in maintaining health and alleviating pain is significant. Consider these tips for making positive changes:

1. Importance of Diet: Ayurveda recommends a diet that aligns with your dosha type. For example, Vata types should focus on warm, nourishing foods, while Pitta types benefit from cooling, soothing options. A balanced diet can help reduce inflammation and promote healing.

2. Lifestyle Modifications: Lifestyle adjustments, such as maintaining good posture, practicing mindfulness, and managing stress, play a crucial role in managing pain. Ayurveda encourages these changes as part of a holistic approach to well-being.

Case Studies and Professional Guidance

To gain a deeper understanding of Ayurvedic solutions, consider exploring real-life case studies and testimonials of individuals who have found relief through Ayurvedic treatments. Additionally, when seeking Ayurvedic care, it's essential to consult a qualified practitioner who can assess your condition and provide personalized guidance.

Safety and Precautions

While Ayurveda offers valuable solutions for pain management, it's essential to approach these treatments with caution. Some herbs or therapies may not be suitable for everyone, and it's crucial to consult with a qualified Ayurvedic practitioner to ensure safety and efficacy.

Conclusion

In the quest for relief from bilateral sciatica and persistent shoulder, neck, and arm pain, Ayurveda stands as a time-tested and holistic approach. By addressing the root causes of these conditions and offering natural remedies and treatments, Ayurveda empowers individuals to regain their quality of life and experience lasting relief from pain. Explore this ancient system of medicine, consult with a qualified Ayurvedic practitioner, and embark on a journey towards holistic healing.

[codymonroediabetesdiary]

New Developments Regarding Chronic Pain…

I’ve been seeking treatment at APEX Neuropathy & Pain Center. I’ve recently undergone nerve studies, sonograms, cognitive assessments, balance assessments, and other testing.

My initial results have come back:

-Moderate carpal tunnel in both wrists

-Mild/Early Neuropathy in both upper & lower extremities

-Moderate/Severe Spinal Ridiculopathy in both upper & lower extremities resulting in Cervical & Lumbar compressed nerves in C7 (base of neck), L5 Left (back), L3 Right (back), and S1 bilaterally (Sciatica).

-There is suspected masses from testing causing the compressed nerves. The doctor believes it to be spinal rheumatoid arthritis.

Next steps:

I just completed a lower extremity MRI for them to confirm and gain Intel on the compressed nerves. They want to confirm rheumatoid arthritis. They want to rule out disk degeneration, herniated disks, and tumors/cancer.

I will need to go back to complete an upper extremity MRI as well.

Initial Treatment & Options:

-Continue physical therapy

-Chemical electro stimulation therapy

-as needed pain 💊

-steroid injections

-spinal decompression surgery

-carpal tunnel release surgery

Stay Tuned as this all unfolds…

[butterfly-casket]

YES SAME. My first time seeing a pain specialist, despite being diagnosed w bilateral sciatica TWICE already, pulled up on my leg making me overextend my knee and I kept telling her it hurt but she wouldn't listen to me. She kept saying "I need to know if it hurts your back." At that exact moment I couldn't give a straight answer, 3-5 mins later I was in tears, my back was on fire, and I ended up having a full body flare up. She held my leg in a position that hurt for like 10 whole seconds because she refused to put it down until I gave her an exact answer.

Having sensory differences and slow processing speeds is so frustrating sometimes. I'll be talking to a Dr or physio and they ask "does that hurt?" and... I don't know? Give me 5 minutes to think about it and I might be able to answer you. Why is my brain like this

[shreya11111]

Bilateral Sciatica will never be canon UWU Mileven will prevail and Mikhail will be their side hoe. Will doesn't get any Mik-anything. OWO.

Will can have Richie because Eddie is dead anyways so they can bond over being sad over not having their crushes (:

fr! bonsai tree will not be endgame! matieral girls will be endgame! willchie for life🙄😒🙄😤😤😤 baseball bat is dumb and obvi mockumentary is wayyyy better smh my head.😡😡🤬

[brightlotusmoon]

I need distraction from the bilateral sciatica and sacroiliitis.

But at least my knees are fine because of the genicular nerve block so uuuhhhh haaaahaa?

(It's really weird being teased for using medical terms in my everyday life. Because it's so... juvenile? Like, yes, I am a nerd? I am a geek? I might be 24 years out of high school but the minds of some of my age peers are stuck in that confusing emotional bullying part. I can't really dumb it down for you as much as you want and you don't want to learn new things because it won't stick in your brain, so we're at an impasse.)

[a-zebra-n-her-servicedog-toad]

As all of you know if you don’t know by now I have a connective tissue disorder called Ehlers Danlos syndrome. I myself have referred to it as the “junk drawer disorder” due to the long list of comorbidities or conditions you can have a long with the primary condition. The definition of Comorbidity noun or plural noun: comorbidities Is the simultaneous presence of two chronic diseases or conditions in a patient.

When I discuss my medical issues many times it’s actually these “comorbidities” I am talking about. Although the majority of my medical issues can be explained by my genetic disease called Ehlers Danlos Syndrome. The majority of the time when I discuss my medical issues I get the looks of disbelief or some have even asked “do you really have all these problems?” The answer to that is simple, it’s yes!

So I decided I’ll list only the comorbidities that I have confirmed diagnoses (dxd) of. During the next couple of months I will discuss these medical problems in more detail.

These are not in any specific order. The list is a Semi-common Comorbidities (Unofficial) list. It's how the article labels it and I think it’s smart to label it this way. Mainly because there currently isn’t any statistics, how common these comorbidities are among EDS patients. The original list can be found at the website at the bottom of this post.

FELLOW ZEBRAS I’d like your input on anything you see that you also experience or have been diagnosed with.

~ Chronic Pain * dxd neuropathy*, neuralgia Myofascial Pain Syndrome* ACNES

~Fibromyalgia*

~Mood disorders dxd Anxiety*, PTSD*, Major Depressive Disorder*

~ irritable bowel syndrome IBS*

~Incontinence* at any age (often from occult tethered cord and/or MCAD or allergy induced) only experienced not diagnosed

~Uterine or rectal prolapse, pelvic floor dysfunction*

~Frequent (seemingly idiopathic) nausea and vomiting (may be from impinged vagus nerve/MCAD/hiatal hernia/gastroparesis/Chiari)

~ Arthritis of all kinds, Osteoarthritis* in the spine, neck and hands, but RA common especially early onset

~ Insomnia* also referred to as “painsomnia”(trouble falling and staying asleep, multiple causes in the EDS patient including pain and hyperadrenergic)

~ Hypotonia (unusually weak muscles despite “training” or physical therapy)

~Dizziness* (with or without syncope)

~Thyroid issues (high and low, often auto-immune despite normal TSH “levels For me Hyperparathyroidism*

~Deviated septum

~Chronic and recurrent sinus infections and sinusitis* (allergy shots have helped this)

~Frequent joint dislocations and subluxations (partial dislocations) or being so-called “double-jointed“ bracing is helping

~ PCOS and menorrhagia (very heavy periods)

~Tendonitis* and bursitis* of all kinds (aka “soft tissue rheumatism”, alt. tendinitis)

~Varicose veins* and spider veins, often early onset, easy bruising*

~Migraines* and headaches of ALL kinds and durations, (often driven by hydrocephalus from MCAD)

~ Strokes* (I had a TIA 2012)

~Mitral valve prolapse* (mine is mild)

~Easy bruising* often from no apparent cause or injury

~GERD* (weak hiatal sphincters and MCAD can contribute here – the stomach produces acid in response to histamine from food reactions)

~Gastroparesis* (slow or no stomach emptying) and dysmotility (poor digestive movement) beyond just constipation and IBS, possibly from impinged nerves & vessels

~Sciatica* (VA lists this as SI Joint Dysfunction

~Bilateral hip dysplasia* (sometimes seen at birth, and later) ability to “pop” – aka sublux – hips out and back in easily, which should be avoided!)

~Malabsorption and malnutrition* and nutritional deficiencies despite diet and even supplementation sometimes. (Poor absorption).

~Electrolyte imbalances* (often low potassium)

~Osteopenia* (low bone density) and osteoporosis* (brittle bones), often early onset

~Hiatal hernia* (stomach to esophagus sphincter) and all other forms of hernias just about anywhere (inguinal, duodenal, abdominal, etc.)

~Costochondritis* (pain at front rib attachment point to sternum)

~Chondromalacia* (cartilage loss) of all kinds, especially patellae (loss of cartilage in the knees, but can occur elsewhere, e.g. hips)

~Frozen shoulder

~Striae* aka “stretch marks” even in males and young (prepubescent) females (i.e. not always associated with pregnancy!)

~Bruxism* (jaw clenching, tooth grinding)

~TMJ* pain and issues, subluxations and dislocations (Temporo-mandibular joint syndrome, jaw alignment trouble)

~Restless Leg Syndrome* (RLS) and leg cramps (often eased by increased magnesium)

~Plantar Fasciitis*

~Chronically low Vitamin D and B12 levels* (caution urged for those with MTHFR mutations with the latter, may need a different form of Vi

Weak or crowded teeth, many need early or partial dentures

~Receding gums*

~Hair loss early, and even in women, especially those with signs of MCAD or iron imbalances

~Deviated septum (misaligned nasal cartilage)

~Trouble swallowing & choking issues, often neuropathic in origin from CCI, sometimes due to floppy laryngeal tissues

~Esophageal spasms (can extend to anywhere along GI tract also)

~Skin tears or rips, trouble suturing, would dehiscence (trouble healing post surgery, especially soft inner tissues)

~Liver problems, including fatty liver and lesions, enlarged liver

~Enlarged gallbladder & spleen, appendicitis (may be MCAD driven)

~Breast Ptosis (sagging, droopy breasts) had surgery to lift and reduce

~Leaky gut syndrome

~Dry eyes and blepharitis (bacterial eyelid infections), as well as retinal tears and more

http://ohtwist.com/about-eds/comorbidities

Remember Stay Zebra Strong!!

[subluxation-nation]

Hello, everyone! I rarely post on here, but I wanted to see if anyone has had a bilateral SI-joint fusion or stabilization done (especially people who have carried or want to carry children)?

What was your experience? Would you recommend it? Did it seem to help in the long run? What was the recovery time like for you?

I’ve been faced with a pain management doctor that highly recommends it after giving me steroid shots in my SI-joints and seeing their laxity and instability firsthand. My SI-joints are a HUGE cause of my daily pain. I’m also concerned about potentially putting more pressure on the surrounding joints/tissues (specifically my lumbar spine and hips), because I already have many issues with them (bursitis/sciatica/arthritis/buldging discs/etc.).

I went to a spinal surgeon for a consultation, and he flat out refused to do it on me because it may interfere with childbirth later on. He also mentioned that he thinks I’m “too young” for that kind of surgery (I’m 21).

I’m very frustrated, and I wanted to hear some experiences from my fellow zebras before seeking out this surgery wholeheartedly.

All opinions are welcome.

Much love & gentle hugs. ♥️

[stefanduell]

QUADRATUS LUMBORUM MUSCLE (QL) . [ANATOMY AND FUNCTION] . @StefanDuell vs. @AnatomyLinks . The QL is not a single plane muscle but rather a complex network of fibers and links to other tissues. It links the ilium (origin), 1st to 4th lumbar transverse processes and the lowest ribs (insertion). . It has three layers: Purple: Costo-Transverse (deepest) Green: Costo-Iliac (middle) Pink: Ilio-Transverse (superficial or most posterior) The blue represents the lateral arcuate ligament connecting the 12th rib to L1. The lowest fibers of the QL actually become ligament tissue in adults, the Iliolumbar ligaments (orange and yellow). These ligaments connect L4 and L5 to the ilium and are often involved in low back pain. . All of these structures have a role in function and need to be considered in back pain cases. The QL is a 🗝muscle that the average back pain sufferer needs to get checked out. It will bring you to your knees crawling on all 4 when acting up! . FUNCTION ▪️Essentially, the QL contributes to the stabilization and movement of the spine and the pelvis. ▪️A bilateral contraction leads to an extension of the lumbar spine. ▪️A unilateral contraction leads to the trunk is bent towards that direction (lateral flexion) and it can also hike up the same sided hip. ▪️A contralateral contraction rotates the spine. ▪️It can also cause functional scoliosis if the upper fibers bends one way and the opposite lower fibers bends the other way. ▪️The QL fixes the 12th rib during movements of the thoracic cage and this way supports expiration (accessory muscle of expiration). . HOW DO I KNOW MY QL IS TIGHT? ▪️Your lower back pain over time develops into what seems like a sciatica. ▪️When acting up coughing or sneezing it will bring sharp agonising pain. ▪️People constantly attempting to brace and stabilize their upper body with their hands while they stand or sit. ▪️Being in an upright or sitting posture makes the pain worse but most individuals will experience pain with any movement. ▪️Rolling from side to side after laying face up for some time is extremely painful. ▪️If you’re aware of one leg being genetically shorter than the other and you’re suffering from back pain. (hier: Miami, Florida) https://www.instagram.com/p/BvUE1DiAp9J/?utm_source=ig_tumblr_share&igshid=1tp80ctssol89

[scientia-rex]

Technique evolves with practice, for sure. Sorry, I'm going to soapbox, not at you, I swear!

I walk in and say, "Hi!" and then something about the weather/sporting event for smalltalk and allow them to answer, and then I say, "So I heard [from my MA] that you're dealing with X," and if they confirm, say, "Tell me more!" and then I don't say anything else until they slow down and stop. They almost always will within 1-2 minutes, often a lot faster than that, and they will usually tell me what I need to know. In medical training we learn to ask how long the problem has been going on, whether something specific started it, where the pain is, whether it radiates, whether it migrates, how bad it is, whether it wakes them up from sleep, the quality (stabbing, burning, dull, etc.), and whether there are associated symptoms (fevers, chills, shaking, nausea, vomiting, etc.). Most patients, most of the time, will give me most of that information if I just let them talk, and then I only have to ask a few follow-up questions before I can tell them the provisional diagnosis (or diagnoses) and my plan for diagnostic confirmation and/or treatment and/or symptom management.

A classic example is knee pain. I could walk in and say, "So you have knee pain. Left or right?"

"Well, it's usually--"

"Which side is it on?"

"It started on the left but--"

"Okay, so the left."

"No, it moved to the right--"

"Which side is worse?"

"It's changed--"

And slow myself to a CRAWL.

Or I can say, "Tell me more!" and get a response like this:

"It started a couple of months ago. I didn't do anything like fall down, but I was working a lot in the garden, and I noticed it was starting to really ache? Bad enough that I have trouble sleeping. I tried ibuprofen and it helps a little bit but it still hurts. It was just in my left knee at first but after a while it moved into my right now but sometimes the left knee still really hurts."

Diagnostic code for Epic: bilateral chronic knee pain. (Both sides, lasting more than 6 weeks.) Most likely diagnosis: osteoarthritis (assuming my typical patient, in their 60s) aggravated by activity. Next best step: rest, physical therapy, anti-inflammatories (don't knock the topicals!), and potentially a steroid injection in one or both knees, though I often get an X-ray first just to make sure I'm not missing something like a subtle tibial plateau fracture that would be made worse by the cortisone. Optional step, consumes medical resources, your mileage may vary. I now have a history, a diagnosis, and a plan, and I've said three words. I can ask a bit more to mop up, but I honestly don't have to in order to be an adequate doctor. If it was sciatica they wouldn't be telling me about aching in the front of their knees, it would be electric zingers down the back.

Will some patients just not stop talking ever? Yes. About 30% of primary care visits are actually mental health care visits, whether that's what's on the "chief complaint" line or not. And some people are mentally ill in ways that mean they either can't read or won't respond to social cues or norms. For them, I interrupt eventually. I'll say things like "This is a visit for you, let's make sure we talk about you!" if they're off topic. "This is your time!" Or "I need to make sure I understand about the knee pain, let's go back to that," with some targeted questions to get the information they left out.

I have a lot of aging patients with some degree of cognitive impairment, and in our culture we often fail to recognize that "dementia" isn't just a memory disorder, it's a cognitive disorder, a disorder of thought. People with Alzheimer's or Parkinson's or Lewy body dementia or frontotemporal dementia aren't just forgetting things, they are unable to interact with information and the world the way they used to, so visits where I am relying on them to report about their symptoms are not going to go smoothly. Those visits require special techniques. Sometimes they work, sometimes they don't. Sometimes I end up filing Adult Protective Services reports, none of which have ever resulted in a patient's life meaningfully changing, but at least I tried.

But letting patients tell me about what's going on, when they can, reduces my workload. It's that simple.

(Teenagers often hesitate to talk to me because authority figures tend to be really shitty to teens, so instead of letting them talk I often have to pepper them with tiny questions, many of which are just a prior question in new words and with a consistently cheerful, pleasant voice, until they get so tired of me asking that they start answering. I have to pry information out of them with a crowbar but God help me I will. If it's medically relevant. I don't need to know what I don't need to know, and that's none of my business.)

You want to know the best thing I learned on my Psychiatry rotations? Silence. When you’re talking to someone and trying to get them to tell you uncomfortable things, like whether they’re planning to kill themselves, sometimes you just have to sit there in silence with the question hovering in the room like a palpable force. I do a lot of my best work in silence. People notoriously tell me things they don’t tell other clinicians; they’ll tell me about their depression or anxiety or fights with their husband or their gambling addiction or their fears about their parents. I always tell people the reason my MA stocks tissue boxes in the exam rooms is that I make so many people cry, so they feel better about crying. (It’s not true, it’s standard, but I do think she has to stay on top of the tissues more than for most other providers.)

Listening isn’t something you can do if you’re cutting off a patient who’s talking. It isn’t even something you can do if you’re filling empty airspace. Sometimes listening to the silence is the necessary prelude to listening to the person.

[drkarunaspine]

What is Sciatica

What is Sciatica?   Definition Sciatica nerve which originates from the buttock or gluteal area, is subjected to injury or irritation causing sciatica nerve pain. The finger width sciatica nerve which is also the longest nerve in the body comprises five nerve roots of which two originate from lower back or lumbar region and three from the sacrum.  Types Acute sciatica | Chronic sciatica | Alternating sciatica | Bilateral sciatica Causes Sciatica occurs due to disc herniation and may initiate suddenly or gradually. Injury in the lower back, ageing and gradual wearing down of bone tissues and discs, obesity, absence of strong core, jobs that require heavy lifting or prolonged sitting, nerve damage due to diabetes, osteoarthritis, lack of exercise and smoking may cause sciatica. Symptoms A patient observes mild or severe pain anywhere along the sciatica nerve path which also results in muscle weakness in leg or foot, numbness, pins and needles sensation in leg and foot regions. The description of pain varies while few terms it as sharp and jolts of pain, others find it as burning, electric or stabbing. The pain aggravates while standing and sitting for prolonged hours, while twisting the body and during sudden movements like coughing. Treatment Employing heat and ice therapy, sciatica could be treated. Inflammation is reduced through ice therapy while heat promotes blood flow and accelerates the healing process. Walking and stretches like reclined pigeon pose, supine twist, seated forward bend, cat-cow stretches and bird-dog poses also provide relief. While therapeutic massage and bracing, chiropractic care and decompression therapy treats sciatica, platelet-rich plasma therapy enhances healing and tissue regeneration. Proper body mechanics must be employed while lifting weights. Prevention   Few precautionary measures which can prevent the recurrence of sciatica are regular exercises, carefulness while lifting heavy objects, proper posture while sitting and standing, and reducing overweight. Avoiding smoking and intake of anti-inflammatory diet including turmeric and ginger, intake of fruits and vegetables, keep sciatica at bay.   FAQ sciatica Can physical therapy cure sciatica? Physical therapy strengthens and mobilizes tissues in the lower back, pelvis, abdomen, buttocks and thighs. As a result, pain free functional movement patterns are restored and muscle spasms are reduced. Physical therapy and exercises are first-line treatments to relieve and prevent sciatica symptoms. Can sciatica cause paresthesia and vice versa? Sciatica is a combination of pain and numbness radiating into the leg while paresthesia is a tingling sensation associated with numbness. While sciatica is caused by nerve root damage, paresthesia occurs due to diseases and disorders in the spinal cord. Paresthesia does not cause sciatica. Sciatica can cause paresthesia. Are sciatica and piriformis syndrome same or similar? Piriformis syndrome and sciatica are not the same. While both affect nerve function, their causes and treatment procedures are different. Buttocks and hip pain constitute piriformis syndrome while radiating leg pain displays sciatica. What is chronic sciatica? Chronic sciatica is long term sciatica pain which worsens with twisting, bending and coughing and lasts for more than eight weeks and does not subside with self management. It is treated through hot and cold therapy, over the counter medicines, physical therapy, epidural steroid injections under X-ray guidance and minimally invasive procedures. Is spine surgery ever necessary to treat sciatica? Sciatica is treated through spine surgery only if the pain is persistent and progressive and if non surgical treatment fails. If sciatica is caused by cyst, tumour or spinal cord compression, surgery is recommended. If the pain is due to lumbar spinal stenosis, lumbar laminectomy is performed. How do I treat sciatica at home? Sciatica can be treated at home through mild exercises, stretches, proper postures, over the counter medicines, ice and heat therapy, plank exercises and sciatic nerve mobilization. What are sciatica symptoms? Is it required to consult a doctor? Mild sciatica is short-lived and one must approach a doctor when the pain exceeds one week. Changes in bowel and bladder function and worsening neurological symptoms require immediate medical attention. Can B12 shots help with numbness from sciatica? Vitamin B12 deficiency can cause sciatica and patients must add vitamin B12 rich foods like turkey, salmon and eggs in their diet. Vitamin B12 injections are part of combination therapy and regenerate nerves and minimize pain in acute sciatica. How much downtime is there with sciatica? Acute sciatica lasts from 4 to 6 weeks and becomes chronic thereafter. Doctors try to treat sciatica without medical intervention until the pain exceeds 12 months. Sciatica subsides on its own through proper postures, mild exercises and stretches. Duration of sciatica depends on the underlying problem. Can a person with sciatica lie on the floor? Since sleeping on the floor can alleviate sciatic pain, patients can avoid direct contact with the floor by using a yoga mat or towel. Specific sleeping postures are comfortable and minimize stress on the sciatic nerve. Read the full article

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Chiropractic Manipulation Compares With Surgery As an Effective Sciatica Treatment

New Post has been published on https://backtherapyhealth.com/chiropractic-manipulation-compares-with-surgery-as-an-effective-sciatica-treatment/

Chiropractic Manipulation Compares With Surgery As an Effective Sciatica Treatment

Sciatica refers to pain or dysfunction involving the sciatic nerve in the lower back and legs. Symptoms may include tingling or a burning sensation, weakness, numbness, and pain. The symptoms begin in the lower back and commonly travel down the back of the thighs, calf muscles, and even into the feet. People usually experience sciatica symptoms down one side but can experience it bilaterally. Symptoms are secondary and caused by other primary conditions such as a herniated disk in the lower back that is pressing on the sciatic nerve.

Sciatica pain is often caused by a temporary inflammation or overuse of the low back, which irritates the nerve. In these instances, pain will usually subside on its own as long as you take care of your back. Your doctor or chiropractor may recommend an over the counter anti-inflammatory, ice for the first 48 hours then heat, and gentle activity for a few weeks until the symptoms subside. Chiropractors recommend avoiding extremes-no bed rest and no heavy lifting.

Chronic sciatica is pain or dysfunction that lasts more than six months. Most often, chronic sciatica is due to a herniated or bulging disk in the lower back due to overuse or an injury. Other causes of sciatica may include tumors, Piriformis syndrome, or a trauma to the pelvis. If you experience fever, redness or swelling of the back, problems urinating, or severe pain, call your health care provider immediately.

When chronic sciatica is a result of a non-life threatening condition such as a herniated disk, doctors recommend the most conservative treatment first. Surgery can be effective but there are risks and higher costs associated with surgery as opposed to more conservative treatments such as injections, physical therapy, and chiropractic care.

A recent study on the effectiveness of chiropractic care for sciatica showed that chiropractic spinal manipulations were equally as effective as surgery (microdiskectomy) in treating sciatica. The study in “Journal of Manipulative and Physiological Therapeutics” reported “sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention.”1 Further, surgery for sciatica can cost up to $25,000 and involves the risks associated with invasive surgery. When compared to the average 21 chiropractic sessions at $100 ($2,100) to treat sciatica, this is a savings of $22,900.2

The researchers concluded that spinal manipulations performed by a chiropractor proved to be an effective and cost efficient treatment for sciatica. Patients with sciatica due to a herniated disk should consider treatment by a chiropractor before surgery. Chiropractic manipulations have proven to successfully relieve sciatica without the need for surgery in many instances. For patients that do need to proceed with surgery, the study found that patients who delayed surgical treatment and tried chiropractic care first experienced no negative effects.

Chiropractors are whole body practitioners and work within the body’s natural healing abilities. If treated by a chiropractor for sciatica or a herniated disk, your rehabilitation may include any combination of physiotherapy treatments including spinal manipulations, heat and ice therapy, electric stimulation, ultrasound, massage, and rehabilitative exercises.

References 1. McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. 2010 Oct;33(8):576-84. 2. Spinal Manipulation Proves Equally Beneficial as Surgery in Sciatica Treatment. Foundation for Chiropractic Progress. Press Release May 10, 2011.

Source by Brad Woodle