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Suggest treatment for sensory neuropathy in feet and calves

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Posted on Sat, 23 May 2015
Question: I'm 69 years old. Female. Relatively good health. I have sensory neuropathy in both feet and leg calves and I believe my sciatic nerve is pinched in my right piriformis muscle. I also have extreme pain in my right hip. Years ago, I had cortisone injections into the right hip bursa and it seemed to help. I just completed a series of 3 (a week apart) cortisone injections into my caudal spine; no help. Who should I go to or which specialist? Thank you for considering a response. XXXX
doctor
Answered by Dr. Mohammed Taher Ali (35 minutes later)
Brief Answer:
Features are suggestive of Sciatica.

Detailed Answer:

Dear Ma am, Hi

I really appreciate your concern for the painful neuropathy apparently due to Sciatica.

The most common cause being a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can produce the symptoms of sciatica.
The piriformis muscle in the buttock can sometimes lead to irritation of the sciatic nerve. This is referred to as piriformis syndrome.

Since you have been given Inj corticosteroids in to the cauda equina with not much relief, I have the feeling that you must consult a neurosurgeon for further management which may include the following tests:
X-rays spine, CT scan, MRI scan, and Electromyogram used to further define the exact causes of sciatica.

Before taking a decision on surgical treatment you might be treated with Antidepressants like Amitryptiline with muscle relaxants.
Sometimes pain management specialists help with chronic sciatica conditions.
Bed rest has been traditionally advocated for the treatment of acute sciatica.

It is hoped that the suggestions given above could be useful in getting the right treatment with less adverse effects or complications.

Wishing you best of your health.


Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Mohammed Taher Ali (1 hour later)
A neurologist gave me Gabapentin for a year. The dose was subclinical at 300mg b.i.d. I know dosage should have been 1800 - 3600mg/day given t.i.d. The low dosage I took did no good. I have taken amitrytiline in the past; no positive results. Flexeril did nothing. The neurologist I went to had to stop the EMG tests because it caused so much pain. I have decreased ankle jerk reflex in my right ankle. My neurosurgeon fused c5-6, then 7 years later in 2002, he fused C6-C7. I had an MRI of my lumbar spine 12/12. Some stenosis, slight degeneration, unremarkable for the most part. Should I another neurologist or go directly to my neurosurgeon? He is well respected here in Bethesda, MD, and I trust him.

I went to a Pain Specalist (Like most, he was an anesthesiologist by training) I became addicted to methadone, OxyContin, deilaud, valium, fentanyl patches. You name it; I took it. I wound up loosing my mind, my home, my possessions, and nearly my life. It had taken 3 years to gain back my mind. I now have trouble walking even 10 minutes because of the pain, and I am very weak. I had been a very active touring cyclist, and even chairman of a cycling club in 2001-2003. The club had 5,000 members at that time. All was lost.
doctor
Answered by Dr. Mohammed Taher Ali (2 hours later)
Brief Answer:
A neurosurgeon consultation is needed.

Detailed Answer:
Hi
Welcome back to HCM.

It is unfortunate that despite of taking the most powerful analgesics like Methadone, Oxycontin, Fentanyl Patches and the antidepressants like Amitryptiline you still have the troublesome pain.

So, you may please visit the well known neurosurgeon of Bethesda.
Once again, wishing you best of your health.
Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Mohammed Taher Ali

General & Family Physician

Practicing since :1988

Answered : 6133 Questions

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Suggest treatment for sensory neuropathy in feet and calves

Brief Answer: Features are suggestive of Sciatica. Detailed Answer: Dear Ma am, Hi I really appreciate your concern for the painful neuropathy apparently due to Sciatica. The most common cause being a lumbar disc herniation directly pressing on the nerve, any cause of irritation or inflammation of the sciatic nerve can produce the symptoms of sciatica. The piriformis muscle in the buttock can sometimes lead to irritation of the sciatic nerve. This is referred to as piriformis syndrome. Since you have been given Inj corticosteroids in to the cauda equina with not much relief, I have the feeling that you must consult a neurosurgeon for further management which may include the following tests: X-rays spine, CT scan, MRI scan, and Electromyogram used to further define the exact causes of sciatica. Before taking a decision on surgical treatment you might be treated with Antidepressants like Amitryptiline with muscle relaxants. Sometimes pain management specialists help with chronic sciatica conditions. Bed rest has been traditionally advocated for the treatment of acute sciatica. It is hoped that the suggestions given above could be useful in getting the right treatment with less adverse effects or complications. Wishing you best of your health.