Question: Respected Sir, Namaskar.
I am K. Satyanarayana, aged 60 years and suffering from “Neurogenic Claudication” due to “Lumber Spinal Stenosis” for about 03 months. Because of this problem, my right leg is giving severe pain & numbness while in standing position and walking and hence, I could not walk or stand for more than 05 minutes. (Problem analysis is solely based on my understanding of the problem with the information available in the Google search in the internet. But could not get confirmed by required X-ray, MRI & CT scan reports, as I was hesitating to consult a doctor or undergo those tests in the present Pandemic situation).
Presently, as per the online advice of an Orthopedist, I am using “Chimoral Forte(daily once at morning), Pregaba- M75 (daily once at bed time) and Rockbonn kit (daily once after lunch).
But, so far, there was no improvement in the situation / pain.
Hence, Sir, my doubts are:
1.     Should I consult a Orthopedist or Neurologist for my problem.
2.     If, it is a Neurologist, please advise me, what to do.
3.     If, I have to consult you personally, should I have to undergo Covid test before visiting you. If, yes, covid test can be done in the hospital itself.
4.     Or I should continue with the same medication or changed medication for some more time.
Please advise me Sir.
With thanks & regards,
K. Satyanarayana, XXXXXXX No. 0000.

Respected Sir, Namaskar.
I am K. Satyanarayana, aged 60 years and suffering from “Neurogenic Claudication” due to “Lumber Spinal Stenosis” for about 03 months. Because of this problem, my right leg is giving severe pain & numbness while in standing position and walking and hence, I could not walk or stand for more than 05 minutes. (Problem analysis is solely based on my understanding of the problem with the information available in the Google search in the internet. But could not get confirmed by required X-ray, MRI & CT scan reports, as I was hesitating to consult a doctor or undergo those tests in the present Pandemic situation).
Presently, as per the online advice of an Orthopedist, I am using “Chimoral Forte(daily once at morning), Pregaba- M75 (daily once at bed time) and Rockbonn kit (daily once after lunch).
But, so far, there was no improvement in the situation / pain.
Hence, Sir, my doubts are:
1.     Should I consult a Orthopedist or Neurologist for my problem.
2.     If, it is a Neurologist, please advise me, what to do.
3.     If, I have to consult you personally, should I have to undergo Covid test before visiting you. If, yes, covid test can be done in the hospital itself.
4.     Or I should continue with the same medication or changed medication for some more time.
Please advise me Sir.
With thanks & regards,
K. Satyanarayana, XXXXXXX No. 0000.

Thank you very much Sir for your kind & valuable advice.
Sir, as I said in my previous mail, I want to delay any personal visit to Hospital and undergo medical tests for the time being, till this covid pandemic situation subsides or vaccine comes.
Sir, please tell me, whether my decision is very dangerous that any delay in proper diagnosing and treatment may aggravate my present situation, that may leads to permanent problem? or can be delayed for some more time with proper medication, suitable exercises etc?
Based on your advice, I will follow Sir. I am presently hesitating, due to my age (60+) and wife is suffering from “Auto Immune Disorder” for the last one year. Becoming Covid positive at this moment may be very costly for me, my wife and my family.
Sir, I request you to kindly advise me and assure me, whether I can delay for some more time.
1.     If yes, please advise me whether, your suggested medication is sufficient or supplementation of medicines required?
2.     Any precautions to be taken regarding physical movement like avoiding steps climbing, weights lifting, rest etc?
3.     Physical exercises to be followed if any (if yes, kindly share the link file of the video).
4.     Based on your most valuable & vast experience in neurology, please tell me Sir, whether my problem can be cured by medication or requires surgery? If, surgery is the final solution, any delay in surgery, aggravates & complicates the problem Sir? Sir, this problem has already paralyzed my life after my superannuation from the services of NTPC Limited as AGM. Sorry Sir, if I am irritating you with my questions.

With thanks & regards,
K. Satyanarayana.

Thank you very much Sir for your kind & valuable advice.
Sir, as I said in my previous mail, I want to delay any personal visit to Hospital and undergo medical tests for the time being, till this covid pandemic situation subsides or vaccine comes.
Sir, please tell me, whether my decision is very dangerous that any delay in proper diagnosing and treatment may aggravate my present situation, that may leads to permanent problem? or can be delayed for some more time with proper medication, suitable exercises etc?
Based on your advice, I will follow Sir. I am presently hesitating, due to my age (60+) and wife is suffering from “Auto Immune Disorder” for the last one year. Becoming Covid positive at this moment may be very costly for me, my wife and my family.
Sir, I request you to kindly advise me and assure me, whether I can delay for some more time.
1.     If yes, please advise me whether, your suggested medication is sufficient or supplementation of medicines required?
2.     Any precautions to be taken regarding physical movement like avoiding steps climbing, weights lifting, rest etc?
3.     Physical exercises to be followed if any (if yes, kindly share the link file of the video).
4.     Based on your most valuable & vast experience in neurology, please tell me Sir, whether my problem can be cured by medication or requires surgery? If, surgery is the final solution, any delay in surgery, aggravates & complicates the problem Sir? Sir, this problem has already paralyzed my life after my superannuation from the services of NTPC Limited as AGM. Sorry Sir, if I am irritating you with my questions.

With thanks & regards,
K. Satyanarayana.

Thank you very much Sir for your very kind & highly concerned suggestion, which I could not neglect any more. Hence, I have undergone MRI test for Lumbo Sacral Spine on 12.10.2020 (MRI Report attached for your kind information please. Sir, I am having MRI images (120 Nos) with me, which I can share with you, if required ).
Sir, kindly go through the report and advise me, whether my Neurogenic Claudication due to Lumber Spinal Stenosis can be treated with medication and suitable physiotherapy or requires surgery.
I will follow your advice Sir.
1.     If, it is cured with medication & physiotherapy, please suggest the medicines with dosage and video link file for suitable physiotherapy if any available with you Sir. Any particular precautions to be followed based on my MRI report Sir.
2.     If surgery is the permanent solution, please advise me Sir, whether I have to consult Neuro surgeon or Orthopedic Surgeon within what time period, so that situation does not become serious.
I am anxiously awaiting your kind suggestion Sir.
With Thanks & Regards,
K. Satyanarayana, XXXXXXX No. 0000.
Email : YYYY@YYYY

Sir, I could not attach the MRI report as attachment option is not available, I hereby copying the report as it is Sir.
Department of Radiology & Nuclear Medicine
Patient Name:Satyanarayana K Patient ID :CH0000 DOB / Sex :25/09/1960 / M Accession No : 488604 Ref. By : Date of Examination :12/10/2020 10:45

Dr XXXXXXX XXXXXXX B Consultant Radiologist & HOD Dr.Ruju Doshi Consultant Radiologist Dr XXXXXXX Kunkunuru Consultant Radiologist Dr. XXXXXXX XXXXXXX XXXXXXX Bittla Consultant Radiologist Dr.Khajindar XXXXXXX XXXXXXX Consultant Interventional Radiologist Dr.Jyothsna .M Consultant PET-CT Dr XXXXXXX Kollur Radiologist Dr XXXXXXX Pabbati Radiologist “ Where Advanced Technology Meets International Expertise”
Email: YYYY@YYYY Emergency +91 40 6700 0111 Tel: +0000 YYYY@YYYY www.continentalhospitals.com Plot No. -3, Road No-2, IT & Financial District, Nanakramguda, Gachibowli, XXXXXXX – 500 032

Page 1 of 1
MRI OF LUMBOSACRAL SPINE
TECHNIQUE: T1, T2 sagittal, T1 & T2 Axial, STIR coronals & Sagittal, MR Myelogram. Whole Spine T2 Sagittal.
FINDINGS:
Vertebral body alignment is normal. Marginal osteophytes noted in lumbar vertebrae Discogenic endplate changes noted at L5-S1 level.
Otherwise vertebral bodies are normal in height and signal intensity. Right paracentral and central disc extrusion noted at L5-S1 level causing root compression and thecal indentation
Mild left paracentral, foraminal and central disc protrusion noted at L4-L5 level causing mild root compression.
The spinal cord shows normal signal intensity. No intra spinal or extra spinal mass lesion. Pre and paraspinal soft tissues are normal.
Both sacro iliac joints are normal. Facet joints are normal. Screening of cervicodorsal spine shows mild cervical spondylosis.
CONCLUSION: 
LUMBAR SPONDYLOSIS.  RIGHT PARACENTRAL AND CENTRAL DISC EXTRUSION AT L5-S1 LEVEL CAUSING ROOT COMPRESSION AND THECAL INDENTATION 
MILD LEFT PARACENTRAL, FORAMINAL AND CENTRAL DISC PROTRUSION AT L4-L5 LEVEL CAUSING MILD ROOT COMPRESSION. FOR CLINICAL CORRELATION. Dr. XXXXXXX XXXXXXX B Consultant Radiologist Report Approved Date & Time : 13/10/2020 18:12

Thank you very much Sir for your very kind & highly concerned suggestion, which I could not neglect any more. Hence, I have undergone MRI test for Lumbo Sacral Spine on 12.10.2020 (MRI Report attached for your kind information please. Sir, I am having MRI images (120 Nos) with me, which I can share with you, if required ).
Sir, kindly go through the report and advise me, whether my Neurogenic Claudication due to Lumber Spinal Stenosis can be treated with medication and suitable physiotherapy or requires surgery.
I will follow your advice Sir.
1.     If, it is cured with medication & physiotherapy, please suggest the medicines with dosage and video link file for suitable physiotherapy if any available with you Sir. Any particular precautions to be followed based on my MRI report Sir.
2.     If surgery is the permanent solution, please advise me Sir, whether I have to consult Neuro surgeon or Orthopedic Surgeon within what time period, so that situation does not become serious.
I am anxiously awaiting your kind suggestion Sir.
With Thanks & Regards,
K. Satyanarayana, XXXXXXX No. 0000.
Email : YYYY@YYYY

Sir, I could not attach the MRI report as attachment option is not available, I hereby copying the report as it is Sir.
Department of Radiology & Nuclear Medicine
Patient Name:Satyanarayana K Patient ID :CH0000 DOB / Sex :25/09/1960 / M Accession No : 488604 Ref. By : Date of Examination :12/10/2020 10:45

Dr XXXXXXX XXXXXXX B Consultant Radiologist & HOD Dr.Ruju Doshi Consultant Radiologist Dr XXXXXXX Kunkunuru Consultant Radiologist Dr. XXXXXXX XXXXXXX XXXXXXX Bittla Consultant Radiologist Dr.Khajindar XXXXXXX XXXXXXX Consultant Interventional Radiologist Dr.Jyothsna .M Consultant PET-CT Dr XXXXXXX Kollur Radiologist Dr XXXXXXX Pabbati Radiologist “ Where Advanced Technology Meets International Expertise”
Email: YYYY@YYYY Emergency +91 40 6700 0111 Tel: +0000 YYYY@YYYY www.continentalhospitals.com Plot No. -3, Road No-2, IT & Financial District, Nanakramguda, Gachibowli, XXXXXXX – 500 032

Page 1 of 1
MRI OF LUMBOSACRAL SPINE
TECHNIQUE: T1, T2 sagittal, T1 & T2 Axial, STIR coronals & Sagittal, MR Myelogram. Whole Spine T2 Sagittal.
FINDINGS:
Vertebral body alignment is normal. Marginal osteophytes noted in lumbar vertebrae Discogenic endplate changes noted at L5-S1 level.
Otherwise vertebral bodies are normal in height and signal intensity. Right paracentral and central disc extrusion noted at L5-S1 level causing root compression and thecal indentation
Mild left paracentral, foraminal and central disc protrusion noted at L4-L5 level causing mild root compression.
The spinal cord shows normal signal intensity. No intra spinal or extra spinal mass lesion. Pre and paraspinal soft tissues are normal.
Both sacro iliac joints are normal. Facet joints are normal. Screening of cervicodorsal spine shows mild cervical spondylosis.
CONCLUSION: 
LUMBAR SPONDYLOSIS.  RIGHT PARACENTRAL AND CENTRAL DISC EXTRUSION AT L5-S1 LEVEL CAUSING ROOT COMPRESSION AND THECAL INDENTATION 
MILD LEFT PARACENTRAL, FORAMINAL AND CENTRAL DISC PROTRUSION AT L4-L5 LEVEL CAUSING MILD ROOT COMPRESSION. FOR CLINICAL CORRELATION. Dr. XXXXXXX XXXXXXX B Consultant Radiologist Report Approved Date & Time : 13/10/2020 18:12

Thank you very much Sir for your very kind, valuable and prompt advice, which has given me a big relief for the time being.
I am very much grateful to you Sir.
Sir, I will follow your prescription for one month and report back to you Sir.
With Thanks & Regards,
K. Satyanarayana, XXXXXXX No. 0000.
Email : YYYY@YYYY

Thank you very much Sir for your very kind, valuable and prompt advice, which has given me a big relief for the time being.
I am very much grateful to you Sir.
Sir, I will follow your prescription for one month and report back to you Sir.
With Thanks & Regards,
K. Satyanarayana, XXXXXXX No. 0000.
Email : YYYY@YYYY