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Dear Folks on Steadyhealth,

I saw so many entries about spinal problems I thought I would set a "bunch of people straight" with one note.

First of all I was a general practitioner for three decades and was taught that herniated discs cause low back/buttock pain, shoulder/cervical pain with neuropathic feelings to the extremity: numbness, tingling, etc. The lower extremity syndrome is termed sciatica, usually.

After many,many patients failed to improved after surgery (they should improve in days or a few weeks!!!) I gave up one the whole idea of herniated discs. I did a research project that took three years! of 12 to 14 hour days and attracted 700 of the most miserable, painful patients.

I learned that 95% of the nerological pain was caused by a "disease" and not herniated discs. My research is original and I am writing a book about it so in just a few months the information will be out in a book titled, Rheumatism, Enigma Unraveled. Yes, the disease is rheumatism, a systemic disease that often shows up as neuropathies and arthritis.

So, in about 1890 or so Palmer of Chiropractic fame developed the "out of place spinal disc theory" and it has held on for a long period. Chiropractes bang on peoples necks and backs and surgeons do surgery!! Well, is there a "rat" here someplace.

The reality is that MRI's that we all think are so great do NOT have the resolution to see nerve roots clearly. They can see arthritis and usually it is kind of nasty because the same disease causes it!! We all know that rheumatoid arthritis is an inflammatory autoimmune disease and it also causes vasculitis and neuropathy: that is what causes the pain you foks are feeling!, but the primary lesion is "inflammed blood vessels" and that is termed rheumatoid vasculitis. So, compression and abrassion causes the blood vessels to become inflammed: well hands and feet are used that way 12 plus hrs a day so they show rheumatoid arthritis first. Knees too; lots of people will need arthroscopy of the knee. TMJ syndrome and headaches from that are caused by the same disease; the cartilage in the temporomandibular joint is compressed and abraded by chewing!

Those who have sciatica usually have more symptoms with straight leg raising, you know, lay on the back and have someone raise the leg by the heel as it is straight. Often neruological pain is felt from the buttock down the leg with just a bit of lift. Well, that is not enough to cause "nerve roots to be stressed" and the problem is in the buttock. Look up Aaron Filler, MD. He has a neurological institute wherein he does surgery to make the opening for the sacral plexus larger and this decreases the compression and abrasion on the sacral plexus and that is: where the problem is really at in 90% of cases. There are a few herniated discs, but not many.

What causes the autoimmune inflammation: Streptococcal pyogenes infections during a person's lifetime. Yup, that is why many family members often have it through the years: it is a catchy disease!! Strep throat, rheumatic fever (that can seem like a severe flU), scalet fever, ear infections, bronchitis, peridontal disease, and a pneunomia type disease. The autoimmune disease can cause many more problems and they will be in the book I am writing.

With sholder/neck problems do this: lift the arm out from the body as high as it can go; up alongside he ear is best. Hold it. If the fingers get tingly, well that proves the problem is in the brachial plexus and not the neck, no matter if MRI shows arthritis. If the leg is lifted by someone as the patient is lying down on their back and if sciatic pain comes on with a more or less gentle lift of about 30 to 40 degrees and there is no tugging, well that pretty much indicates that the problem is in the sacral plexus where it goes over a bone, the ischial spine, and between the piriformis muscle and the superior gemmelus muscle. It is a tight passageway I call the piriformis canal. In the shoulder it is the axillary canal. The tight passageway, the motion of the shoulder and hip, the inflammatory vascular disease, causes the problem to exist.

If a person has a "rear ender" and their neck goes back and the arms to up rapidly, well the whip lash syndrome is "in the shoulders" and not the neck. It feels like the neck because the suprascapular nerve and the dorsal scapular nerve, that originates from the brachial plexus goes over the shoulder and innervates most of the muscles of the shoulder blades and the skin of the upper back down to the lower end of the shoulder blades, just at the bottom of the arm pits. This phenomenon of decreased sensitivity is on the upper chest and the upper back, because the brachial plexus innervates all that area, including the arm. People have radiated pain into the neck; often pain in the shoulder blade area, and aching in the shoulder, at times and numbness, tingling and weakness of muscles that "run the arm".

Well, some people write back and give me some comments. If people are interested I will write more about infection and treatment. I am now retired; no license anymore so I am not treating anyone, but just giving out some information on a difficult subject in medicine and one wherein the treatment is "rotten".

Yours, Norsk10

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My father was in a car accident 10 years ago. He walked away from the crash not needing to go the hospital. The next day he could not get out of bed and was taken to hospital via ambulance. From that day on his life has never been the same. Severe back pain, leg pain, swollen feet and ankles just to name a few. He has been back and forth to many Drs. and given a treasure trove of drugs, nothing really helps for long. One ex-ray after the other says 2 herniated discs and this is how they have been treating him for all these years. He has refused surgery, as his neighbor had the same problem, agreed to have operation, and is now living the rest of his life in a wheelchair.
My mom suggested that he go to her cancer Dr. just to talk to him to see what he may say. Her Dr. did a few tests on him, 3 days later he tells my dad that he has bone cancer.
My dad has lost so much weight, and he looks like he has aged 30 years since the car accident, and his regular Drs. just thought it was all the medication altering his appetite and making him depressed. Not a single Dr. ever thought about cancer. My dads brother died from bone cancer in his early 30,s, his sister died from brain cancer in her early 30,s as well.
My mom has has 3 bouts of cancer, the last one being lung cancer. She is still with us and has beat each one.
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Dear bbfeet9,



Well, your family is involved with what old time docs called "familial rheumatism". Modern texts indicate that neuropahthies often show up with cancer or before it. That word is paraneoplastic neruopathies. No one knows what that exists.



Ido. Your family has lived with a common germ and they have been stimulated to have an autoimmune disease. It causes all the rheumatoid diseases, cancer, neuropathies, and all in all it causes what we call the changes of aging. Naturally, this information is not in medical books, but I am writing one. The title will be, Rheumatism, Enigma Unraveled. I was one of the last general practitioners and saw 230,000 patient visits and eventually put the "puzzle of systemic disease" together in a world of specialists. They specialize in doing procedures to alter diseases and not find the cause and cure them.



If you want more information contact me on ****** and title it rheumatism.



Yours, L. Kristiansen, DO



**edited by moderator**emails not allowed**
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My husband was diagnosed several years ago with Restless leg syndrome, in the past several months the tremors are severe, legs arms, jumping around excessively while asleep. As a child he had rheumatic fever. His sleep is very poor and he does not want to take sleeping pills he is 63. He has also had skin problems around his eye diagnosed as ocular roeasia.
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Dear ballassoc,



Once a person has had rheumatic fever they are much more likely to contract it again. The "not so well known fact" is, however, rheumatic fever does not usually appear as a high-grade disease, but a subacute or less than subacute disease process and so it takes place with few or no symptoms until a person starts having pain, neurological symptoms/signs, etc. A person gets an exacerbation of the symptoms in areas innervated by large plexus's of nerves, that is the brachial plexus innervating the arms, chest,s and upper back and the buttocks and the buttock, lateral-posterior thigh and most of the lower leg and foot. The feeling of "restless leg syndrome is: for sure, a manifestation of rheumatic autoimmunity. You see, rheumatic fever is a systemic autoimmune disease process., but manifests signs and symptoms more commonly in certain anatomical locations.



You can have ASO titer done; Anti-DNase titer done, C-reactive protein , sedimentation rate, and RA factor done. It will be most likely that Anti-DNase B and C-reactive protein will be positive. if either or both of the first two are positive, or somewhat elevated above zero, it means he has had or has rheumatic fever at the moment.



Most docs do not know much about rheumatic fever any more and most texts do not have much knowledge about it except certain knowledge that is "most basic'" and does not provide complete knowledge of the condition.
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I had acdf 2010 c5 thru c7 ---did ok for 18 months now shoulder issue on right. Mri stated c5 mild indentation shows some never compression. 100% fused I have pain in neck and shoulder. Never goes aways sometimes predisone helps lessen pain. Docs wont keep putting me on predisone do to nasty side effects. I did previously have melanoma a few yrs before surgery...almost lost my leg. I would really like to hear more about your research or suggested treatments? Is there anything to help us ??? Thanks for any assistance in advance.
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Dear writer, Well, look up paraneoplastic neuropathy as a subject and realize that you are one of those people who have had both due to an underlying, inflammatory, autoimmune process that causes both peripheral neuropathy, cancer, and arthritis. The arthritis, in your case "showed up" on cervical x-rays and MRI/CAT scans and the neuropathic condition was "blamed" on the arthritic findings and so you went on to have surgery on your cervical spine with plus-minus results. The reality is, however, that the imaging does not "see" nerve tissue well enough to make an accurate analysis about nerve-root pathology, so since it is the dogma that herniated discs and osteophytes, both being rheumatic, and therefore autoimmune in nature, the "cause" the neurological lumbar/buttock and cervical/shoulder pain is thought, commonly, to be a result of the arthritic changes in the spine in those two anatomical areas. Since steroids improve the condition you have that, basically, proves that the problem is inflammatory in nature and the type of inflammation is autoimmune in nature. If steroids help, non-steroidal anti-inflammatory medications will help, too, if the dose is large enough and the treatment is continuous for some time. Since I have determined that generalized autoimmunity is caused, and triggered by infections by a certain common microorganism I know that, simply, the use of penicillin, one of the first antibiotics developed in the late 1930's to 1950's is all that is needed to control the infections. Now, most of the infectious episodes are sub-clinical. That means that patients are not very sick: like a stuffy nose; like a minor cough, like minor sinus drainage, like minor vaginitis, like periodontal disease at some, even a minor, level, an impitigo when a person was a child, for instance. The infections can be higher grade like ear infections, bronchitis, a flu-like disease with lethargy, tiredness, body pains, dilirium (subtle, or not so subtle mental changes)l, sometimes severe, protracted cough, sometimes a rash development that looks like hives or chicken pox and often a person undergoes a mistaken diagnosis by mom or by the local physician. Well, most of us have these type of infections in our lifetimes and so that is why neurological low-back pain is common and that is why its treatment is controversial: chiropractors manipulate; massage therapists massage, various docs use steroids and NSAIDS, naturopaths give their types of treatment, and spinal surgeons do spinal surgery: well, it is all very unscientific and so all medical practitioners make a buck doing what they do without, really, definatively, knowing what is causing a patient's problems. My personal e-mail is: _[removed]_ if you want to communicate. I did not get your "handle" on this system so in the subject space put "steadyhealth" so I do not delete your message.

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Dear ballassoc,

See my note under Norsk10, my handle.

I have provided an explanation of what your husband, probably, has.

Yours,

Norsk10
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Thank you very much ....find this very intresting. My ? is my acdf was all the disc c-5 thru c7 were pressing on spinal cord. The pain I was in prior to surgery was a nightmare. My spinal surgeon is blaming continued pain of neck and shoulder from post surgery follow up mri still shows c5 area mild indentation of spinal cord and neural formian is opened but barley --where the nerve passes thru? Just curious what you think.....I will email you in near future. Thanks Again!!
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Dear bbfeet9,

Look up paraneoplastic neuropathy. That means that people who have neuropathy: like neurological back pain, often develop cancer. The reason, I think, is that the same autoimmune condition that causes neuropathy also causes cancer.

Yours,

Norsk1-
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Dear mg neck,



I think, after dealing with MRI interpretations, spinal surgeons opinions of them, and with a high percentage of failed spinal surgeries based on MRI images, that the MRI images are not detailed enough, they do not have the resolution, to exactly determine if the spinal cord or nerve roots are meaningfully harmed. Just because there is a small indentation is meaningless, because many people have them who are walking around with no apparent problem. Same thing for herniated discs of the cervical and lumbar spine. How come, for instance, no one has nerve root problems of the thoracic spine? Well, the reason is that most peoples problems are really located deep in the shoulder or deep in the buttocks and the movement of the arm on the shoulder and the leg at the hip, the large nerves that pass through those areas and the snug passageways through which the nerves pass experience an exacerbation of autoimmune vasculitis (nerves are half composed of blood vessels!) due to the compression and abrasion on them if a person has a accident that flails the arm or leg, has a contusion of the shoulder or buttock or if a person experiences a flail arm or leg injury due to a fall or some other episode. The pain into the lumbar area or the neck/shoulder/back/chest is referred pain through the nerve fibers, for instance. Any body with this kind of pain symptoms should have an intramuscular injection with 80 mg of triamcinolone. If it causes and improvement over a few days the problem is, more or less, proven to be due to inflammation of the nerves and not a fixed, physical, compressive lesion due to a herniated spinal disc or a bony osteophyte. Simple, really. Of course individuals will have classic findings if they have an analytic neurological examination, but modern docs rely on this or that test such as nerve conduction and MRI, but such tests do not really tell what is wrong because they are not specific enough. They are showy, impressive, etc., and expensive, but the neurologist or spinal surgeon involved does not have to do the work of performing an analytic neurological exam. Most modern docs do not know enough neuroanatomy to do one: they do not possess the art needed.



Yours,



Norsk10
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Norsk10 wrote:

mg neck wrote:

Thank you very much ....find this very intresting. My ? is my acdf was all the disc c-5 thru c7 were pressing on spinal cord. The pain I was in prior to surgery was a nightmare. My spinal surgeon is blaming continued pain of neck and shoulder from post surgery follow up mri still shows c5 area mild indentation of spinal cord and neural formian is opened but barley --where the nerve passes thru? Just curious what you think.....I will email you in near future. Thanks Again!!


Dear mg neck,

I think, after dealing with MRI interpretations, spinal surgeons opinions of them, and with a high percentage of failed spinal surgeries based on MRI images, that the MRI images are not detailed enough, they do not have the resolution, to exactly determine if the spinal cord or nerve roots are meaningfully harmed. Just because there is a small indentation is meaningless, because many people have them who are walking around with no apparent problem. Same thing for herniated discs of the cervical and lumbar spine. How come, for instance, no one has nerve root problems of the thoracic spine? Well, the reason is that most peoples problems are really located deep in the shoulder or deep in the buttocks and the movement of the arm on the shoulder and the leg at the hip, the large nerves that pass through those areas and the snug passageways through which the nerves pass experience an exacerbation of autoimmune vasculitis (nerves are half composed of blood vessels!) due to the compression and abrasion on them if a person has a accident that flails the arm or leg, has a contusion of the shoulder or buttock or if a person experiences a flail arm or leg injury due to a fall or some other episode. The pain into the lumbar area or the neck/shoulder/back/chest is referred pain through the nerve fibers, for instance. Any body with this kind of pain symptoms should have an intramuscular injection with 80 mg of triamcinolone. If it causes and improvement over a few days the problem is, more or less, proven to be due to inflammation of the nerves and not a fixed, physical, compressive lesion due to a herniated spinal disc or a bony osteophyte. Simple, really. Of course individuals will have classic findings if they have an analytic neurological examination, but modern docs rely on this or that test such as nerve conduction and MRI, but such tests do not really tell what is wrong because they are not specific enough. They are showy, impressive, etc., and expensive, but the neurologist or spinal surgeon involved does not have to do the work of performing an analytic neurological exam. Most modern docs do not know enough neuroanatomy to do one: they do not possess the art needed.

Yours,

Norsk10


Thanks again ----it makes sense why so many people have surgery and still have nerve pain even though test show fully fused etc.....its sad to me that so many of us feel dropped by care and left in pain everyday. Wouldnt be something just to get a injection and feel better. Something should be alarming years after these surgerys patients are left on strong narcotics and become disbaled dur to pain. Thank you Doctor I will be following your research with great intrest.
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mg neck wrote:

Norsk10 wrote:

mg neck wrote:

Thank you very much ....find this very intresting. My ? is my acdf was all the disc c-5 thru c7 were pressing on spinal cord. The pain I was in prior to surgery was a nightmare. My spinal surgeon is blaming continued pain of neck and shoulder from post surgery follow up mri still shows c5 area mild indentation of spinal cord and neural formian is opened but barley --where the nerve passes thru? Just curious what you think.....I will email you in near future. Thanks Again!!


Dear mg neck,

I think, after dealing with MRI interpretations, spinal surgeons opinions of them, and with a high percentage of failed spinal surgeries based on MRI images, that the MRI images are not detailed enough, they do not have the resolution, to exactly determine if the spinal cord or nerve roots are meaningfully harmed. Just because there is a small indentation is meaningless, because many people have them who are walking around with no apparent problem. Same thing for herniated discs of the cervical and lumbar spine. How come, for instance, no one has nerve root problems of the thoracic spine? Well, the reason is that most peoples problems are really located deep in the shoulder or deep in the buttocks and the movement of the arm on the shoulder and the leg at the hip, the large nerves that pass through those areas and the snug passageways through which the nerves pass experience an exacerbation of autoimmune vasculitis (nerves are half composed of blood vessels!) due to the compression and abrasion on them if a person has a accident that flails the arm or leg, has a contusion of the shoulder or buttock or if a person experiences a flail arm or leg injury due to a fall or some other episode. The pain into the lumbar area or the neck/shoulder/back/chest is referred pain through the nerve fibers, for instance. Any body with this kind of pain symptoms should have an intramuscular injection with 80 mg of triamcinolone. If it causes and improvement over a few days the problem is, more or less, proven to be due to inflammation of the nerves and not a fixed, physical, compressive lesion due to a herniated spinal disc or a bony osteophyte. Simple, really. Of course individuals will have classic findings if they have an analytic neurological examination, but modern docs rely on this or that test such as nerve conduction and MRI, but such tests do not really tell what is wrong because they are not specific enough. They are showy, impressive, etc., and expensive, but the neurologist or spinal surgeon involved does not have to do the work of performing an analytic neurological exam. Most modern docs do not know enough neuroanatomy to do one: they do not possess the art needed.

Yours,

Norsk10


Thanks again ----it makes sense why so many people have surgery and still have nerve pain even though test show fully fused etc.....its sad to me that so many of us feel dropped by care and left in pain everyday. Wouldnt be something just to get a injection and feel better. Something should be alarming years after these surgerys patients are left on strong narcotics and become disbaled dur to pain. Thank you Doctor I will be following your research with great intrest.


Dear mg neck, Its important to think, rationally, about the phenomenon of pain. Pain is sensed because of two reasons. The first, is that an individual experiences the sensation of pain when she/he is acutely injured. The injury could be a sprain, fracture, laceration, abrasion, contusion, chemical abnormality, or burn. An acute cramping of the bowel of a type of contusion, for instance; angina that occurs with effort (because of a short-term need for oxygen to part of the heart's tissues) is a type of chemical abnormality as is heartburn! Pain that is more chronic, and which lasts, for instance, especially, more than two days, is the pain of inflammation. Inflammation is not a bad phenomenon: inflammation is the process by which animals, try, at least, to heal themselves. If an individual experiences a laceration he/she will have a sudden sense of pain, but then, slowly, a person's pain will evolve to be somewhat chronic in nature until the laceration is healed. Inflammation entails chronic pain, redness, swelling, increased heat and disabilty in that a person cannot use that part of the body normally. So, you see, chronic pain, even if it originates deep within the body is really the pain of the body trying to heal itself. Unfortunately, the other signs of an inflammation (redness, swelling, increase warmth) cannot be "observed" if the source of pain is located deep within the body (like deep in the buttock with sciatica and deep within the shoulder with brachial plexitis (both commonly autoimmune in nature) so, often, other causes of pain that are more "mechanical" and that can be "viewed" with high-tech devices, are commonly entertained. If damage to the body is chronic and ongoing, as it is with an autoimmune condition, and since "other parts of the immune system (like various types of white cells) contest the attack managed by autoantibodies, a person will develop chronic pain. Often chronic pain is neurological in nature, because "nerves are very sensitive". Compressing and abrading the nerves (which contain about 50% blood vessels) causes a localized exacerbation of autoimmune inflammation in a local fashion and so one can exacerbate such pain by moving the part: like low-back or shoulder/neck pain being made worse by certain movements. The bottom line is that the question: "what causes chronic neurological pain?", is not being asked. Some physicians, psychiatrists, etc., say and publish that, for some reason, certain people's brain amplifies pain; other medical professionals say and publish that severe, chronic pain is itself a "disease". Well, those opinions exist because their makers do not analyze exactly how and why pain develops, and that chronic pain is usually, simply, the body trying to heal itself because a chronic disease is attacking the nerves (or tendons, ligaments, the heart itself, or other parts of the body). Since chronic neurological pain is often caused by autoimmune inflammation a person can treat themselves with: one 325 coated aspirin twice a day; one Aleve 220 mg. twice a day, and one indocin 25 mg. twice a day, one citirazine 10 mg in the AM, Benadryl 25 mg. one at bedtime; and one ranitadine, 150 mg., in the AM to reduce stomach acidity. The last two medications are antihistamines (OTC) and they are a type of anti-inflammatory. The indocin was one of the first non-steroidal anti-inflammatory medications and it first was prescribed in the '50's and most docs do not use it now. It is a great medication, I think. Most people with neurological pain have some kind of arthritis, subtle, obvious, or intermediate. Morning stiffness, of the fingers, is the first sign of rheumatoid arthritis. It is usually subtle, but can be more obvious such as knee or hip arthritis. The former is usually "blamed" on an accident or overuse syndrome. Anyway, if a person has morning stiffness of the fingers/hands, most docs know it is a symptom of rheumatoid arthritis and then, perhaps, a prescription of indocin will be prescribed. A smalll dose: 25 mg. two times a day is o.k. since the aspirin and Aleve are also taken: both in small doses! 150 mg is the top dose per/day and, obviously, 50 mg (25 mg two times a day) is one third of that . A patient came to me after previously experiencing three lumbar surgeries including a fusion and four cervical surgeries including a fusion. Well: the neurosurgeon was, probably, focusing on the 70,000 to 100,000 he was making and not that "perhaps" the patient was experiencing a systemic disease process. I had another patient who had had eight lumbar spinal surgeries with no great amount of improvement. They both were experiencing the symptom of neurological pain secondary to a chronic autoimmune Yours, Norsk10

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My husband has been fighting sciatica and back pain/nerve pain for several years. Recently he started losing control over his bowels and is numb from the wait down. We have been to several doctors and emergency rooms and no one can tell us what is wrong. he now has no relfexes in his legs and all his MRI is showing is 2 buldging discs. Who should be go to and what should we do or be looking for. HELP!!!!!

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Dear amoon333, Thanks for standing by your husband as he is having such problems. I know it makes him feel very useless; the worst feeling a husband can have. Now, "there are a few herniated spinal discs "out there", but surgery for them is very common." The above conclusion is what I learned while seeing patients, in a logging and millwork area for over twenty years. The majority of patients who experienced spinal surgery did not improve in a reasonable time after surgery. If they improved after four months or five years that result did not mean that the surgery necessarily helped him, since many people improve without any professional treatment, whatsoever. There are five results of various treatments for lumbar/buttock pain with neuropathic abnormalities into the legs. 1. People take it easy for a various period of time and often they get better; some people become asymptomatic. 2. People do not have spinal surgery and stay chronically sick, often, in a waxing and waning fashion. Activity often makes their problem worse. (your husband, perhaps) They often have a medical history of experiencing various minor, or more than minor neurological problems to the upper extremity: shoulder/neck pain, they may have been diagnosed with carpal tunnel syndrome, they may frequently have an arm go to sleep if they lie in a certain position (especially around your sweet neck!), or drive with the arms in a certain position...or have some numbness in the hands while operating a computer. These problems can wax and wane. It is not unusual for people to have some pain in the "other" side, contralateral side, and a history of minor, more or less, low-back (lumbosacral/buttock) pain on that side. They often have neurological examination abnormalities in the good leg. Like not very sensitive as when a person is a child of the bottom of the foot. These patients often have herniated lumbar spinal discs (almost everyone does!), but not severe enough for the spinal surgeon to be aggressive in suggesting spinal surgery (unless they are greedy). 3. If people do have spinal surgery if they have highly prominent herniated spinal-discs affecting L-4, L-5 or S-1...on one side...the symptomatic side, and they improve within hours or days after surgery: these are fairly rare cases and they are the ones that have "symptomatic herniated spinal discs." They will have neurological losses (decreased sensitivity) in one dermatome, on the symptomatic side "only", and no symptoms on their contralateral side. Dermatomes are strips of skin innervated by nerve fibers from just one nerve root (look up dermatomes of the legs on Wikipedia or Google; you will see the strips of skin innervated by sensory nerves of L-4, L-5 and S-1: the only nerves which can suffer from compression by herniated discs.) 4. People have lumbosacral/ buttock pain and neurological abnormalities to the leg and have spinal surgery, but they have worse symtoms and signs after their surgical procedure. Surgery, rarely helps them, but they "may" improve after a variable period like months or years. These patients often have had upper extremity neurological symptoms of a minor or major fashion in the past. These patients often have symptoms in the "other" leg, too, but of a more minor nature...that usually isn't noticed by the physician involved. 5. A very, very few patients have very large herniated spinal discs that can compress many nerve roots as they are descending within the spinal cord before they exit the spine. This is termed spinal stenosis. I saw "one real case" in twenty years, but many improper diagnosis of it...surgery didn't help these cases since the broad-based herniated spinal discs were not "harming anything" just touching the nerves roots. If a patient has symptoms in any extremity...arms or legs currently or historically, or the contralateral leg...the one that doesn't hurt so bad, the are not likely to have a "symptomatic herniated spinal-disc". They may have bulging spinal discs on x-ray or MRI, but, there again, many people without symptoms or signs have them, also...probably most people over 40 or 50. So, except for those few percent of people who have sciatica-like symptoms, and who have "single dermatome neuropathy" on the side on which they have pain, and no history of other neurological symptoms or findings: just to one nerve root, and therefore its dermatome, that "matches" the MRI, and who therefore have a herniated spinal disc, the rest have something else, most likely, have a systemic autoimmune neuropathy, but one group of nerves is affected more than others! (A very few patients have cancer like multiple myeloma or a cancer of the tissue or bone of the spinal cord, but they can be seen on MRI easily) They will have many dermatomes involved often severely in the most symptomatic limb, and who often have had, or have, "some" minor neurological abnormalities to another limb or limbs, and often have less nasty sensory losses in the dermatomes of the other limbs. Some people who have the problem severely have meaningful problems in more than one limb, usually the lower limbs. Years ago, before he developed problems did he have a sickness: a flu-like sickness with lethargy, body pain (maybe), rash (maybe), respiratory symptoms: sore throat, tonsillitis, ear infection, bronchitis, pneumonia-like disease? Did he have tonsillitis when he was younger. Does he have siblings or parents with the same, or similar problems to the upper or lower limbs? Does he have chronic post-nasal drip? Does he have a "reddish face" or small blood vessels appearing under the skin of the cheeks or the "v" of the neck? Does he have meaningfully red palms and soles: like the heels and balls of the feet. Has he ever had plantar fasciitis? Does he have premature age marks or light patches on his forearms? Does he have vitilago? Does he have premature greying of the hair. Has he had gall bladder problems? Does he have hypothyroidism, diabetes or any other endocrine problem? Y


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