Low Back

[Sharon]

Hi,
I was injured in Dec98 Lower Back lifting a heavy bin.I felt the pain at once. Leg went numb, toes and I was in a lot of pain.
I had an MRI results: Compressed SI nerve, bulging L4-L5. I am getting worse, I keep telling this to the Dr's. The treatment was to put a bandade on the problem and it will go away. I might add this is a W/C case. The symptoms are --- Leg tingling, Toes numb
was three now all five stricking, on the bottom of my foot when I walk, lots and lots of back pain now terriable pain in the groin.
I sit for over 5 mins. I get dizzy and fall to sleep. I am retaining lot of fluid all on the my left side (the injured side)
me leg swells and I can't lift my leg off of the ground to put my clothes on. I have had all of these symptoms, and told the Drs about them. They told me "that they have nothen to do with my back injure." I want to add I don't take pain pills. I just try to breath when the pain gets so bad. I need  help!!! This has gone on for too long. I have ended up in the ER Twice for pain and swelling of the leg. Checked for a blood clot. never had one Thank God.  Please if any one can inlighten me about this. HELP
Thank You Sharon

[Jan Bailey]

Thanks for replying to my "illegal" post.  I had a muscle biopsy due to weakness in all extremities for approximately 4 months.  Prior to this I had had widespread Fascics, lots of wierd symptoms like goosebumps in wierd patterns on my arms, tingling in my face, pins and needles.  I've been worked up for MS at least twice, with MRI's, spinal taps, etc....had a slightly abnormal SEP (evidence of either central or peripheral nervous system disease).  Have a wierd sleep disorder which began with an electric jolt from the base of my skull to my feet EVERY SINGLE TIME I SLEPT, lasting for about 2 weeks.  Eventually this changed to a seizure like activity, and now I only feel a quivering in my chest when I awake naturally.  I am on Sinequin 100mg and Klonopin 2mg h.s., and I must take this or I just don't sleep.  My sleep study consisted of no deep sleep, 3 hours of REM sleep, with 59 episodes of apnea (but my 02 sat never went below 90%).  My EEG at the junction of muscle showed wide spread myopathy (despite the fact that I was an active person who exercises on a regular basis).  The biopsy report showed Type II muscle fiber myopathy, but no red ragged fiber.  My neuro was convinced I have mitochondrial disease, and sat with the neuropathologist and went through 3000 cells looking for signs of red ragged fiber, which they found.  He told me that fresh biopsies aren't very accurate, and that he had no idea which mito disorder I have.  I had a pulmonary test which seems to verify the myopathy....my cell metabolism during the bicycle stress test was very low (4.7 - 5) and on the panting, they could tell I have some muscles in my diaphragm involved.  I am concerned because the cocktail my doctor has put me on contains no alpha-lipoid, and only l GM Carnitine, and I am 5'9 and weigh 160lb.  I am being pressured by my family and my oncologist friend to get a second opinion...just wondering if I need it, and if the treatment would be any different regardless of the problem (if it is mito myopathy).  My sister is also having similar problems now...she is approximately 5 years younger and having similar symptoms that I had 3 years ago.  I am sorry to ramble....just wondering what I should do.  Thank-you for your time...JanB

[CCF Neuro[P] MD, RPS]

Dear Jan B:

Sorry to hear about your myopathy.  Why do you think you have a mitochondrial myopathy when you have been diagnosed with type II myopathy?  I am not sure what you mean by type II, do you mean acid maltase deficiency, or type II fibers are abnormal?  The red ragged fiber is associated with mitochondrial cytopathies but not all mitochondrial cytopathies have red ragged fibers and red ragged fibers have been found in other entities.  Having a frozen biopsy does not prevent you from having ETC studies.  The only studies that one can not do on frozen muscle is polarography.  Yes, we see many mitochondrial patients.  Most of the time they are seen by Dr. Bruce Cohen.

I hope that I have helped you alittle.

Sincerely,

CCF Neuro MD

[RW Chiro Doc]

Sharon,
You state well symptoms associated with low back disc problems.
My suggestion to you is to seek out conservative care from a chiropractic physician, preferably one who has rehab training, uses manipulation and may have the traction device called a Vertetrac. If your not getting the care you need, it may be in your own best interests to look elsewhere.

[Jan Bailey]

I am hoping I am lucky and will receive an answer to a new question here...Have been trying to post for weeks. How important is it to know exactly which mitochondrial disorder you have? I have had two biopsies, the last was a month ago.  It was a frozen specimen, initially read as type II myopathy, and later, when my neuro and the neuropathologist went over 3000 cells, they found red ragged fiber.  I read in forums how everyone knows which fatty acid link is affected, or what part of the chain is affected.  I have and will know none of that information from my biopsy which was frozen.  Also, who do you have at Cleveland Clinic who sees mito patients, and must I have a fresh biospy with a second opinion?  Thanks...Jan

[CCF Neuro[P] MD, RPS]

Dear Sharon:

Sorry to hear about your pain.  Unfortunately it is common and especially with lower back problems.  Without seeing the MRI or doing the neurological exam it is difficult to precisely tell you what to do and the prognosis (even with both, it is a difficult task).  We usually recommend to seek out rehab from a rehab specialist and PT.  Surgical intervention is the last resort and has mixed results.  

Your symptoms have a real SI irritation flavor.  There have been studies (one recently published in the New England Journal looking a osteopathic treatment vs medication) and found that osteopathic type of rehab is helpful.  Rehab has also been found to be helpful.  Usually there are exercises to strengthen the muscle surrounding the spine, pain medications or manipulation to help the patient do the exercises and relieve the imbalanced muscle contractions.  Anti-inflammatory medications to reduce swelling and inflammation around the site, especially the boney inflammation.  Proper lifting techniques and posture are taught.  Together, it is hoped that these will stop progression and help the healing process.

I hope that things can be worked out.  Seek out a good rehab specialist team.

Sincerely,

CCF Neuro MD