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Suggest Treatment For Soreness In The Lower Back Area
Question: I HAVE 6 STENTS (2014), AM DIABETIC. AGE 71 WT 235# 5 '11"
AM ON TYPICAL HEART (CLOPIDEGREL, BABY ASPIRIN) AND INSULIN DIABETIC DRUGS
I SEE CARDIO AND DIABETIC DRS REGULALY AND HAVE HAD GOOD CHECKUPS IN AUG & SEPT
NO PAIN/HEART AND A1C WAS 6.7 ON 9/15/16.
2 WKS AGO 10/2/16 WAS PUT ON STEROID PAK & FLEXERIL 5 MG ONCE/DAY BY A REDI MED DR WHEN I WENT FOR SORE LWR BACK MUSCLES. ( XRAY SHOWED NO BACK BREAKS BUT LOTS OF ARTHRITIS IN LWR SPINE & KNEE HORROBLY DETERIORATED.)
I ALSO HAVE A DETERIORATED R KNEE THAT HAD GIVEN OUT AND I STUMBLE/FELL 3 DAYS PRIOR.
SINCE STARTING THE MEDS I BECAME WEAKER IN BOTH LEGS, HANDS, & HAVE PRONOUNCED GENERAL FATIGUE
NEED WALKER FOR STABILITY AND HAVE SLUMP/FALLEN 2X MORE. NO LEG STRENGTH TO GET MYSELF UP.
RETURNED TO REDIMED 1 WEEK LATER ON 10/9/16 WHEN MEDS WERENT HELPING. DIFFERENT DR..
.SHE RX'D 10 MG FLEXERIL 2X/DAY AND NO STEROIDS. FROM
SAT TO MONDAY SAW NO CHANGE, STILL VERY WEAK.
CALLED DIABETIC DR WHO HAD JUST SEEN ME 9/15 AND HAD BLO0D WORK AND A1C .
HE SAID ALL WAS PERFECT AND COME BACK IN 1 YR ! (THIS WAS PRIOR TO ABOVE PROBLEMS)
WHEN TOLD OF MY CURRENT SITUATION, HE STOPPED ALL FEXERIL AND STARTED ANOTHER STEROIDS PAK. THAT WAS MONDAY 10/10...NO CHANGE EXCEPT LESSENING LWR BACK SORENESS AS OF THIS MORNING 10/14.
HAVE I HAD A STROKE OR tia?
IS THIS A BAD MED INTERACTION?
I CANNOT GRIP A GLASS WITH ONE HAND OR A SPOON. WIFE FED ME LAST NIGHT DUE TO POOR GRIP...
I HAVE HAD NO HEART OR ANY REAL PAIN..NO FEVER/ URINALYSIS NEGATIVE/ SHARP MIND...
THANK YOU.... XXXX
AM ON TYPICAL HEART (CLOPIDEGREL, BABY ASPIRIN) AND INSULIN DIABETIC DRUGS
I SEE CARDIO AND DIABETIC DRS REGULALY AND HAVE HAD GOOD CHECKUPS IN AUG & SEPT
NO PAIN/HEART AND A1C WAS 6.7 ON 9/15/16.
2 WKS AGO 10/2/16 WAS PUT ON STEROID PAK & FLEXERIL 5 MG ONCE/DAY BY A REDI MED DR WHEN I WENT FOR SORE LWR BACK MUSCLES. ( XRAY SHOWED NO BACK BREAKS BUT LOTS OF ARTHRITIS IN LWR SPINE & KNEE HORROBLY DETERIORATED.)
I ALSO HAVE A DETERIORATED R KNEE THAT HAD GIVEN OUT AND I STUMBLE/FELL 3 DAYS PRIOR.
SINCE STARTING THE MEDS I BECAME WEAKER IN BOTH LEGS, HANDS, & HAVE PRONOUNCED GENERAL FATIGUE
NEED WALKER FOR STABILITY AND HAVE SLUMP/FALLEN 2X MORE. NO LEG STRENGTH TO GET MYSELF UP.
RETURNED TO REDIMED 1 WEEK LATER ON 10/9/16 WHEN MEDS WERENT HELPING. DIFFERENT DR..
.SHE RX'D 10 MG FLEXERIL 2X/DAY AND NO STEROIDS. FROM
SAT TO MONDAY SAW NO CHANGE, STILL VERY WEAK.
CALLED DIABETIC DR WHO HAD JUST SEEN ME 9/15 AND HAD BLO0D WORK AND A1C .
HE SAID ALL WAS PERFECT AND COME BACK IN 1 YR ! (THIS WAS PRIOR TO ABOVE PROBLEMS)
WHEN TOLD OF MY CURRENT SITUATION, HE STOPPED ALL FEXERIL AND STARTED ANOTHER STEROIDS PAK. THAT WAS MONDAY 10/10...NO CHANGE EXCEPT LESSENING LWR BACK SORENESS AS OF THIS MORNING 10/14.
HAVE I HAD A STROKE OR tia?
IS THIS A BAD MED INTERACTION?
I CANNOT GRIP A GLASS WITH ONE HAND OR A SPOON. WIFE FED ME LAST NIGHT DUE TO POOR GRIP...
I HAVE HAD NO HEART OR ANY REAL PAIN..NO FEVER/ URINALYSIS NEGATIVE/ SHARP MIND...
THANK YOU.... XXXX
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Just to make sure I got the sequence of events right....your last check up was on 15 Sep while the weakness you describe started after the start of the therapy with Flexeril and steroids....is that correct?
I do not think that your symptoms represent a stroke, certainly not a TIA (which is a stroke with transitory episodes, less than 24h - your symptoms are not transitory).
I think that medication side effects should be considered though. Corticosteroid use can cause many side effects. It can cause a raise in blood sugar to which you are more prone being a diabetic. It can also cause muscle damage. Muscle damage is related to length of use the longer the more likely, still at times it can manifest early, so since symptoms started with the use of steroids I would consider interrupting them. I would also have a repeat of blood tests, not only blood sugar but also electrolyte panel as well as creatine kinase which elevation indicates muscle damage.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Just to make sure I got the sequence of events right....your last check up was on 15 Sep while the weakness you describe started after the start of the therapy with Flexeril and steroids....is that correct?
I do not think that your symptoms represent a stroke, certainly not a TIA (which is a stroke with transitory episodes, less than 24h - your symptoms are not transitory).
I think that medication side effects should be considered though. Corticosteroid use can cause many side effects. It can cause a raise in blood sugar to which you are more prone being a diabetic. It can also cause muscle damage. Muscle damage is related to length of use the longer the more likely, still at times it can manifest early, so since symptoms started with the use of steroids I would consider interrupting them. I would also have a repeat of blood tests, not only blood sugar but also electrolyte panel as well as creatine kinase which elevation indicates muscle damage.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you.
Yes the muscle weakness began after steroid + flexeril started.
Patient saw his PCP yesterday 10/14. Dr ordered several blood tests after reviewing recent Sept 15 dr note & blood work. PCP was also puzzled, as symptoms don't add up. Also Said no stroke occurred.
He asked did pt have a rash/ fever recently?
No. But in early timing of weakness (5-8 days ago) pt did have a crescent shaped groin redness at top of inner thigh. first one side, then couple days later on other side. no itching. Used Tinactin powder kept it dry and it faded in 2-3 days. We thought it was irritation from elastic lining of exercise type shorts.
We mentioned this to PCP but he meant a body rash.
You are a neurologist. Could this be a brain/nerve link? Pt hands will only close partwayt. cannot make a fist/ grip a glass tightly, hold a spoon to eat.
very great effort to stand from a sit with help of walker. Can raise legs to get into a car. remember right knee is very bad with arthritis/no cartilage/ bone spurs/ etc. NO PAIN ANYWHERE AT ALL FOR PT>
Blood work results expected on Monday 10/17.
Can we come back to you then to follow up/ or not?
Yes the muscle weakness began after steroid + flexeril started.
Patient saw his PCP yesterday 10/14. Dr ordered several blood tests after reviewing recent Sept 15 dr note & blood work. PCP was also puzzled, as symptoms don't add up. Also Said no stroke occurred.
He asked did pt have a rash/ fever recently?
No. But in early timing of weakness (5-8 days ago) pt did have a crescent shaped groin redness at top of inner thigh. first one side, then couple days later on other side. no itching. Used Tinactin powder kept it dry and it faded in 2-3 days. We thought it was irritation from elastic lining of exercise type shorts.
We mentioned this to PCP but he meant a body rash.
You are a neurologist. Could this be a brain/nerve link? Pt hands will only close partwayt. cannot make a fist/ grip a glass tightly, hold a spoon to eat.
very great effort to stand from a sit with help of walker. Can raise legs to get into a car. remember right knee is very bad with arthritis/no cartilage/ bone spurs/ etc. NO PAIN ANYWHERE AT ALL FOR PT>
Blood work results expected on Monday 10/17.
Can we come back to you then to follow up/ or not?
Brief Answer:
Read below
Detailed Answer:
Thank you for the update.
As a neurologist I do not think that it is a brain related issue. When due to brain lesions such as stroke, symptoms usually are only on one side that is why this generalized weakness you describe goes against that.
If it is a neurological condition it is more likely to be a suffering of the peripheral nervous system, the nerves and the muscles. Nerves and muscles can be affected by any metabolic change, that is why the blood tests repeat was needed. Furthermore they can be affected by medication at times such as steroids as I already mentioned in my previous answer.
Of course I would gladly look at your blood tests results when you have them, you have one more free follow-up question you can use for that.
Read below
Detailed Answer:
Thank you for the update.
As a neurologist I do not think that it is a brain related issue. When due to brain lesions such as stroke, symptoms usually are only on one side that is why this generalized weakness you describe goes against that.
If it is a neurological condition it is more likely to be a suffering of the peripheral nervous system, the nerves and the muscles. Nerves and muscles can be affected by any metabolic change, that is why the blood tests repeat was needed. Furthermore they can be affected by medication at times such as steroids as I already mentioned in my previous answer.
Of course I would gladly look at your blood tests results when you have them, you have one more free follow-up question you can use for that.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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