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To Be Answered By Dr. Prof. XXXXXXX Saha, Hi Doctor

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Posted on Thu, 25 Apr 2019
Question: To be answered by Dr. Prof. XXXXXXX Saha,
Hi Doctor Saha, This is Rosemarie Raia again. I have the back herniations and disc bulge.. I told you about the numbness in my feet and calves an buttocks. My feet are very cold. Does that mean they are not getting enough blood?
The orthopedic doctor said to do the therapy for one month. I have almost completed two weeks now and very slight improvement in walking but not in the numbness. I am taking the B-12 as you suggested. I also am having tingling on the left side of my face which started last year about this time. I was diagnosed with occipital neuralgia for which I have been doing exercises every morning and the tingling was almost non-existant until recently. Only if I became upset did it happen. The orthopedic doctor said to call him if my leg became weak or my pain became worse. He did not make another appointment. Do you think I should get a second opinion? Also, his office said not to do the therapy and chiropractor at the same time, so I am just doing the therapy now. Please answer as soon as possible. Thank You. It also has been suggested to take gabapentin but I am afraid that it would mask some serious symptoms . and the suicide warning on the medicine.

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Follow up: Dr. Prof. Kunal Saha (0 minute later)
To be answered by Dr. Prof. XXXXXXX Saha,
Hi Doctor Saha, This is Rosemarie Raia again. I have the back herniations and disc bulge.. I told you about the numbness in my feet and calves an buttocks. My feet are very cold. Does that mean they are not getting enough blood?
The orthopedic doctor said to do the therapy for one month. I have almost completed two weeks now and very slight improvement in walking but not in the numbness. I am taking the B-12 as you suggested. I also am having tingling on the left side of my face which started last year about this time. I was diagnosed with occipital neuralgia for which I have been doing exercises every morning and the tingling was almost non-existant until recently. Only if I became upset did it happen. The orthopedic doctor said to call him if my leg became weak or my pain became worse. He did not make another appointment. Do you think I should get a second opinion? Also, his office said not to do the therapy and chiropractor at the same time, so I am just doing the therapy now. Please answer as soon as possible. Thank You. It also has been suggested to take gabapentin but I am afraid that it would mask some serious symptoms . and the suicide warning on the medicine.

doctor
Answered by Dr. Prof. Kunal Saha (3 hours later)
Brief Answer:
Continue the therapy

Detailed Answer:
Thanks for the update.

I do not think that the blood supply to your lower limbs is inadequate. Rather, the nerves to the lower limbs are getting compressed. The therapy is the main modality of treatment. Although the orthopedician has suggested it for one month, I would insist you to keep continuing. I do not think that you need a second opinion or a second appointment. You can skip the chiropractic consultation but not the therapy and exercises. Gabapentin can help in relieving your pain but it may also make you sleepy. You need to balance the advantages with this adverse effect. Otherwise I do not expect any other problems with Gabapentin.

Feel free to write back.

Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Prof. Kunal Saha (0 minute later)
Brief Answer:
Continue the therapy

Detailed Answer:
Thanks for the update.

I do not think that the blood supply to your lower limbs is inadequate. Rather, the nerves to the lower limbs are getting compressed. The therapy is the main modality of treatment. Although the orthopedician has suggested it for one month, I would insist you to keep continuing. I do not think that you need a second opinion or a second appointment. You can skip the chiropractic consultation but not the therapy and exercises. Gabapentin can help in relieving your pain but it may also make you sleepy. You need to balance the advantages with this adverse effect. Otherwise I do not expect any other problems with Gabapentin.

Feel free to write back.

Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Prof. Kunal Saha (15 hours later)
Thank you for your answer.

I had to get an injection of cortisone in my left knee today Wednesday, for pain. Several hours after the injection I have more pain. I have a tear in my knee which was seen last August.

I have therapy tomorrow. If the pain persists, should I cancel or still go to the therapy. Also, I am supposed to be doing the exercises at home. Should I skip them for tonight or do them?

I forgot to tell the doctor that it feels like there is a strap pulling around my ankle and under my instep or arch. What do you think that is?

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Follow up: Dr. Prof. Kunal Saha (0 minute later)
Thank you for your answer.

I had to get an injection of cortisone in my left knee today Wednesday, for pain. Several hours after the injection I have more pain. I have a tear in my knee which was seen last August.

I have therapy tomorrow. If the pain persists, should I cancel or still go to the therapy. Also, I am supposed to be doing the exercises at home. Should I skip them for tonight or do them?

I forgot to tell the doctor that it feels like there is a strap pulling around my ankle and under my instep or arch. What do you think that is?

doctor
Answered by Dr. Prof. Kunal Saha (20 hours later)
Brief Answer:
Vitamin D supplementation can help

Detailed Answer:
Sorry for the inadvertent delay in responding.

If you have pain, perhaps it would be a good idea to skin the therapy for the day. You are definitely supposed to be doing the exercises at home as many times as you can. However, if you have pain, you can skip for a day or two.

The strap-like sensation seems to be due to a muscle pull. Taking vitamin D3 supplement 60,000 International Units once weekly for 6-8 weeks should help.

Regards



Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Prof. Kunal Saha (0 minute later)
Brief Answer:
Vitamin D supplementation can help

Detailed Answer:
Sorry for the inadvertent delay in responding.

If you have pain, perhaps it would be a good idea to skin the therapy for the day. You are definitely supposed to be doing the exercises at home as many times as you can. However, if you have pain, you can skip for a day or two.

The strap-like sensation seems to be due to a muscle pull. Taking vitamin D3 supplement 60,000 International Units once weekly for 6-8 weeks should help.

Regards



Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Prof. Kunal Saha (4 days later)
Dr. Saha,
The numbness in my feet and legs continue. I am still going to therapy 2x a week. I can walk slightly better. However, I am having numbness in the saddle area which is making me concerned. I saw the orthopedic doctor again today.

He said he did not think I needed an injection in my back or an operation unless I loose my bladder or bowels.

I feel very uneasy. I do not know if this is the right treatment. I am uncomfortable in the area and have fear that if I loose control of my bowel or bladder I would need emergency care.

Did you get a chance to look at the mri report which I uploaded?
If i review you, and I want to ask another question, I have to enter my medications and allergies and everything else again.

Please write back and let me know what you think about what the orthopedic doctor said, and if I should do anything else. Thank you Doctor.
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Follow up: Dr. Prof. Kunal Saha (0 minute later)
Dr. Saha,
The numbness in my feet and legs continue. I am still going to therapy 2x a week. I can walk slightly better. However, I am having numbness in the saddle area which is making me concerned. I saw the orthopedic doctor again today.

He said he did not think I needed an injection in my back or an operation unless I loose my bladder or bowels.

I feel very uneasy. I do not know if this is the right treatment. I am uncomfortable in the area and have fear that if I loose control of my bowel or bladder I would need emergency care.

Did you get a chance to look at the mri report which I uploaded?
If i review you, and I want to ask another question, I have to enter my medications and allergies and everything else again.

Please write back and let me know what you think about what the orthopedic doctor said, and if I should do anything else. Thank you Doctor.
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Follow up: Dr. Prof. Kunal Saha (2 minutes later)
Also, I am embarassed to say this, but the vaginal area feels sore.
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Follow up: Dr. Prof. Kunal Saha (0 minute later)
Also, I am embarassed to say this, but the vaginal area feels sore.
doctor
Answered by Dr. Prof. Kunal Saha (31 hours later)
Brief Answer:
Sorry for the delayed response

Detailed Answer:
I am really sorry that I was unavailable and could not respond earlier. You need not fill all the boxes unless you feel that the information is relevant to the current question.

Although you are going for therapy twice a week I would insist you to practice the exercises at home as many times as you can. They are going to help. Your orthopedician is right that you do not need injections or surgery at the moment. As of now you need not worry about the MRI findings. Nothing else needs to be done at the moment.

Going by the mentioned symptoms of feeling of vaginal soreness, it seems that you are suffering from hormone deprivation. Such a thing is commonly encountered in perimenopausal or post-menopausal women. If that is the case, hormone replacement therapy (HRT) could provide relief. You need to visit a gynecologist to get evaluated and tested. He would be able to set up the right regimen for you.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Prof. Kunal Saha (0 minute later)
Brief Answer:
Sorry for the delayed response

Detailed Answer:
I am really sorry that I was unavailable and could not respond earlier. You need not fill all the boxes unless you feel that the information is relevant to the current question.

Although you are going for therapy twice a week I would insist you to practice the exercises at home as many times as you can. They are going to help. Your orthopedician is right that you do not need injections or surgery at the moment. As of now you need not worry about the MRI findings. Nothing else needs to be done at the moment.

Going by the mentioned symptoms of feeling of vaginal soreness, it seems that you are suffering from hormone deprivation. Such a thing is commonly encountered in perimenopausal or post-menopausal women. If that is the case, hormone replacement therapy (HRT) could provide relief. You need to visit a gynecologist to get evaluated and tested. He would be able to set up the right regimen for you.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Prof. Kunal Saha (3 days later)
The orthopedic doctor is referring me to my neurologist. When I was at the neurologist last week to ask him about the numbness on the left side of my face and neck tightening when I get nervous, he told me to ask the orthopedic doctor about doing an emg test for the numbness in my feet and calves and buttocks.

The orthopedic doctor said to do them and told me, via his nurse, to stop the therapy until after the emg's are done. I was feeling better doing the therapy. The physical therapist said that as I do the exercises, centralization, hopefully would take place. That is, the numbness in my feet would turn to tingling then to pain then nothing. That has not happened yet.

What can the emgs show? And how can they help me. I feel that the numbness in my feet is getting worse.

Also, on 2/22/19 I went to my cardiologist because my left foot was swollen and a little numb. He said something about valves in the legs an d to take the diuretic every day for 7 days instead of every other day and to wear support stockings which i did and the swelling went down.
Is it possible that there is something wrong with the valves in my legs and that is causing the numbness.?
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Follow up: Dr. Prof. Kunal Saha (0 minute later)
The orthopedic doctor is referring me to my neurologist. When I was at the neurologist last week to ask him about the numbness on the left side of my face and neck tightening when I get nervous, he told me to ask the orthopedic doctor about doing an emg test for the numbness in my feet and calves and buttocks.

The orthopedic doctor said to do them and told me, via his nurse, to stop the therapy until after the emg's are done. I was feeling better doing the therapy. The physical therapist said that as I do the exercises, centralization, hopefully would take place. That is, the numbness in my feet would turn to tingling then to pain then nothing. That has not happened yet.

What can the emgs show? And how can they help me. I feel that the numbness in my feet is getting worse.

Also, on 2/22/19 I went to my cardiologist because my left foot was swollen and a little numb. He said something about valves in the legs an d to take the diuretic every day for 7 days instead of every other day and to wear support stockings which i did and the swelling went down.
Is it possible that there is something wrong with the valves in my legs and that is causing the numbness.?
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Follow up: Dr. Prof. Kunal Saha (2 hours later)
When I stopped wearing the stockings and went to a diuretic every other day the swelling in my legs went up.
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Follow up: Dr. Prof. Kunal Saha (0 minute later)
When I stopped wearing the stockings and went to a diuretic every other day the swelling in my legs went up.
doctor
Answered by Dr. Prof. Kunal Saha (4 hours later)
Brief Answer:
Also get an NCV done

Detailed Answer:
Thanks for the update. I find no reason for the physical therapy to stop, especially when you seem to be responding. I do not think that the transition to tingling and pain is mandatory. Rather than only EMG, I would suggest getting an NCV and EMG of both lower limbs done. EMG stands for electromyogram and checks the functional capacity of the muscles. NCV stands for nerve conduction velocity and checks the nerve conduction to indicate whether some compression is the likely cause. Edema could lead to some compression and since diuretics help in decreasing edema, they can help in reducing nerve compression, at least to some extent.

Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Prof. Kunal Saha (0 minute later)
Brief Answer:
Also get an NCV done

Detailed Answer:
Thanks for the update. I find no reason for the physical therapy to stop, especially when you seem to be responding. I do not think that the transition to tingling and pain is mandatory. Rather than only EMG, I would suggest getting an NCV and EMG of both lower limbs done. EMG stands for electromyogram and checks the functional capacity of the muscles. NCV stands for nerve conduction velocity and checks the nerve conduction to indicate whether some compression is the likely cause. Edema could lead to some compression and since diuretics help in decreasing edema, they can help in reducing nerve compression, at least to some extent.

Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Prof. Kunal Saha (12 hours later)
If it is nerve compression, could an injection in the back help?
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Follow up: Dr. Prof. Kunal Saha (0 minute later)
If it is nerve compression, could an injection in the back help?
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Follow up: Dr. Prof. Kunal Saha (2 minutes later)
What about the valves in the legs, if they are not working properly could that cause numbness?
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Follow up: Dr. Prof. Kunal Saha (0 minute later)
What about the valves in the legs, if they are not working properly could that cause numbness?
doctor
Answered by Dr. Prof. Kunal Saha (20 hours later)
Brief Answer:
I do not suppose that the valves in the legs are contributory.

Detailed Answer:
I need more details about what sort of injection your are talking about. It could be a pain killer injection or a steroid around the spine. The purpose is different. Your treating physician would be able to judge whether that can help you.

I do not suppose that the valves in the legs are contributory.

Regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Prof. Kunal Saha (0 minute later)
Brief Answer:
I do not suppose that the valves in the legs are contributory.

Detailed Answer:
I need more details about what sort of injection your are talking about. It could be a pain killer injection or a steroid around the spine. The purpose is different. Your treating physician would be able to judge whether that can help you.

I do not suppose that the valves in the legs are contributory.

Regards
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Prof. Kunal Saha (9 hours later)
Dr. Saha, thank you for your reply.

I went to the neurologist today and had the emg done. I asked about the velocity nerve conduction. He said everything was good. He thinks the numbness in my calves and feet and buttocks are coming from my back. He ordered six more weeks of therapy. He said if that does not help I have to see the spine doctor. He would know whether an injection or surgery would help. I am not certain what is in the injection. I know some are pain killers such as lidocaine and some are steroids. I guess I might find out. Thank you again for being there. I feel confident you will tell me the information I need.
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Follow up: Dr. Prof. Kunal Saha (0 minute later)
Dr. Saha, thank you for your reply.

I went to the neurologist today and had the emg done. I asked about the velocity nerve conduction. He said everything was good. He thinks the numbness in my calves and feet and buttocks are coming from my back. He ordered six more weeks of therapy. He said if that does not help I have to see the spine doctor. He would know whether an injection or surgery would help. I am not certain what is in the injection. I know some are pain killers such as lidocaine and some are steroids. I guess I might find out. Thank you again for being there. I feel confident you will tell me the information I need.
doctor
Answered by Dr. Prof. Kunal Saha (6 hours later)
Brief Answer:
Makes sense

Detailed Answer:
Your doctor is right. Continue the therapy. I do not think that anything else would be needed. Thereafter you can consult an orthopaedician or a neurosurgeon and he will be able to suggest if anything else is needed.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Prof. Kunal Saha (0 minute later)
Brief Answer:
Makes sense

Detailed Answer:
Your doctor is right. Continue the therapy. I do not think that anything else would be needed. Thereafter you can consult an orthopaedician or a neurosurgeon and he will be able to suggest if anything else is needed.

Regards
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4467 Questions

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To Be Answered By Dr. Prof. XXXXXXX Saha, Hi Doctor

To be answered by Dr. Prof. XXXXXXX Saha, Hi Doctor Saha, This is Rosemarie Raia again. I have the back herniations and disc bulge.. I told you about the numbness in my feet and calves an buttocks. My feet are very cold. Does that mean they are not getting enough blood? The orthopedic doctor said to do the therapy for one month. I have almost completed two weeks now and very slight improvement in walking but not in the numbness. I am taking the B-12 as you suggested. I also am having tingling on the left side of my face which started last year about this time. I was diagnosed with occipital neuralgia for which I have been doing exercises every morning and the tingling was almost non-existant until recently. Only if I became upset did it happen. The orthopedic doctor said to call him if my leg became weak or my pain became worse. He did not make another appointment. Do you think I should get a second opinion? Also, his office said not to do the therapy and chiropractor at the same time, so I am just doing the therapy now. Please answer as soon as possible. Thank You. It also has been suggested to take gabapentin but I am afraid that it would mask some serious symptoms . and the suicide warning on the medicine.