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Health Screen

age:                   30
gender:               f
occupation:        nurse
height:                 5 feet  8
weight:                12 stone
sleep:                  No
energy:                No
exercise:             No
alchohol:              6
Diet:                     Yes
climbing:              No
chestpain:            No
stiffness:               Yes
headache:            Yes
weak-or-numb:    Yes

current prob:         back pain and numbness in L arm and patch on L leg following pregnancy and childbirth
pastprob:              hospitalised 2 years ago with oral/genital ulceration, possibly Behcet's Disease
stiff-explain:           at night... severe pain like my back has 'seized up' wakens me. During the day, numb, heavy 'stretching' feeling in Left Arm and Numb Left Leg  

Thank you for visiting www.med4u.co.uk and for using the healthscreen.

    You are describing problems with both your cervical and lumbar spine. There are two aspects to these problems, first the immediate management and second, the longterm care of your spine.
    The heavy stretching feeling in your left arm and leg and the patches of numbness in your arm and leg suggest that you have at least two intervertebral discs that are bulging and pressing on nerves to your limbs.
    The pain that wakes you up at night, may be due to the back muscles relaxing while you are asleep and then allowing a nerve or ligament to get compressed once the muscles have stopped protecting it.
    In the first instance, physiotherapy can be quite helpful. I do not recommend a chiropractor or osteopath because you have evidence of disc prolapse and these can be worsened by manipulation. Osteopaths and chiropractors are good at mobilising joints and relieving muscle spasm, but it is important when discs are involved that the spine is looked at overall. 
   Besides physiotherapy to help your movement, it is important at this stage to get rid of the pain, with ibuprofen (nurofen) or other non-steroidal anti-inflammatory drug) and paracetomol as required. Your own GP can prescribe stronger painkillers. If pain is not treated properly, then it is more likely to become chronic - so dont feel that you are giving in by taking sufficient painkillers.
   The question is then whether you an MRI scan would be helpful. On the one hand it is really only necessary if you are thinking about an operation. The problem you are describing is probably too extensive to be suitable for an operation. Removing more than one intervertebral disc rarely produces good results and almost certainly in your case more than one level is involved. On the other hand a scan will show the extent of damage to the spine and help plan physiotherapy and future management. It is likely that you would have to wait some time (several months) for a scan and I am not sure how widely they are available outside London.
     With regard to the longterm management of your spine. Almost every nurse I know has had some type of back problem. There is, by necessity, a considerable amount of lifting at awkward angles and this does damage the back over time. I don't know what type of nursing you are involved in but I think you need to look for nursing in an area away from the wards - your spine and physical health are more important!
    Pregnancy and childbirth stretch the ligaments of the spine and will again worsen your back problem. However bending over and lifting small children and carrying the inevitably heavy shopping is probably a worse strain and does more damage.  Here a good physiotherapist can help you find better ways of lifting and carrying. For example, where you have to lift or carrry something, it puts far less strain on the back if you hold the item close to your body rather than at an angle or away from you.
    In the long term, only your muscles will protect your spine. Exercises, either a programme from a physiotherapist or something like swimming,  will strengthen your back muscles. The Alexander technique has good results but be careful of anything to strenuous and if you are at all hypermobile, avoid yoga which will stretch your ligaments further.
    You are slightly overweight. Your BMI (Body mass index = Weight (kg) divided by your height in meters squared) is in the region of 26, whereas between 19 and 24 is recommended. It would be advisable to think about reducing your weight by 1 stone. This will make a large difference to the amount of strain your back is put under every time you bend over.
    Finally, this episode will almost certainly settle with time. It is worthwhile consulting your GP, for her/him to examine you and make sure there is no other evidence of nerve damage than nerve root compression that is causing your numbness. In addition you could ask about physiotherapy and the possiblity of a scan and make sure that you have good painkillers.
    From now on it is most important to actively  take care of your neck and back. This includes exercises, losing weight and avoiding heavy and awkward lifting. If you have hypermobile joints, then avoid stretching exercises and yoga.  

 

Ask the doc

Subject:         Physical Health

Is there a treatment for shingles?  What can be done to hasten recovery?    

 Shingles is caused by the same virus as chicken pox, but the virus is found within the nerves rather than on the skin generally (as in chicken pox). This is why it is so painful and why it only appears in the area of skin supplied by that nerve.
    Painkillers are important, both to relieve pain in the first instance and also to stop the pain becoming chronic.
     There are several antiviral drugs that are effective against shingles and these will reduce the length of time that the rash is present. Ideally they should be started at the very first sign of an attack. They include Valaciclovir (Valtrex) Famiciclovir (Famvir) Aciclovir (Zovirax). They all cost around £100 for a five day course and should be available from your GP on the NHS although s/he may be reluctant to prescribe it for a self-limiting condition.

    Thank you for visiting med4u. Please note I am not your GP and I have not examined you, so the advice included below is for your information only.

 

   

Many thanks for your info.  I'd be interested to know what reactivates the virus and also whether or not it is likely that attacks might recur?

 Shingles can recurr but may not necessarily. It is surprisingly common - up to 50% of people will eventually get shingles. It seems to strike when peoples' immunity is low. Either because of other illnesses, general stresses or being run down. It may recur after a course of steroids.
    Other people can catch chicken pox if they have not already had it, but by the time you have shingles you already have had the chicken pox virus. It was lying dormant until it was reactivated for whatever reason.