Question: I previously received a response from neurologist Dr. XXXXXXX Panwar regarding symptoms of tingling in both feet, left calf tightness and cramping pain, occasional pinching sensations, and focal fasciculations in both legs, moreso on left. I had also developed a localized ache in my lumbosacral area. Dr. Panwar advised that he felt most likely explanation was lumbar radiculopathy and that a lumbar MRI was warranted promptly. (Secondary explanation, barring lumbar MRI explanation, was peripheral neuropathy.) My PCP performed a neurological exam, which was normal, and ordered a lumbar MRI, which I had performed today. I have not yet received the report from the radiologist who will interpret, but the tech did show me the scans and pointed to what he described as a very slight disc protrusion at L-2, and then two larger disc protrusions at L4-5 and L5-S1, although deferring to the radiologist who will interpret the scan. I asked about osteoarthritis - he said that usually MRI doesn't show that unless it's fairly severe and he did not see any indication of that on the films. I would like to know whether you think these findings explain my symptoms, including the constant very annoying fasciculations in my left thigh and calf, which seem to track with the lumbar MRI findings. Also, given the current state of medical knowledge and experience, what is the recommended treatment and prognosis for 2 lumbar disc bulges? Do you think a neurology evaluation is warranted? What do you recommend for the fasciculations? I am 56 years old and about 40 lbs. overweight. I have been on a diligent program of regular walking (my favorite form of exercise) 5-6 times per week, 35-45 minutes, and eating a low carb, low sugar diet. I have lost 8 lbs over the past 3 weeks and plan to continue with my program as I know I need to do that for my general health as well as spine health.

Dr. Panwar: I don't yet have the MRI report, but my internist called me to advise that he had seen the the MRI this am and he does not think the results are impressive and do not explain my symptoms. He said that the only significant finding is that there is a small L3-4 disc bulge that slightly impinges on the L3 nerve root, which may explain some of my leg pain. He has started me on a course of oral steroids. He said if that does not work, we can consider an epidural steroid injection. He said that the impingement is so slight, however, that he does not think it explains my leg fasciculations. Also, my symptoms started on the right (mild right foot tingling and I've also had some mild calf pain and occasional fasciculations on the right, although the vast majority of my pain and fasciculations are on the left) and he says there's nothing on the MRI to explain the right-sided symptoms. He said the fasciculations may be benign or not and he doesn't want to overlook anything. He has ordered a lower extremity EMG to be done next week. I asked him for the list of differential diagnoses and he wouldn't give me the list, only to say that they range from trivial to not so trivial. Just a short while ago today, I began to have some mild tingling symptoms in the palms of both hands. I realize that it's hard to comment without having examined me or seen the MRI results yourself, but I would still appreciate your thoughts on these developments and the proposed approach.