Dr. Roach: Neurologist can offer second opinion on spinal stenosis plan
Dear Dr. Roach: I am a 77-year-old female with spinal stenosis and have been treated by a pain management doctor over the course of several years. My pain is from my neck down to my lower back and radiates to my legs. The pain is constantly moving from one place to another and sometimes everywhere at the same time. I have received numerous injections in different areas, and at most, it has helped for about a month or two. I use muscle relaxants periodically and Voltaren gel, which is a life saver. I have read that a neurologist can be helpful, but I am not interested in surgery. Would seeing a neurologist be a waste of time? Is there anything else available for my condition?
Dear V.D.: Spinal stenosis is when a major nerve structure, a nerve root or the spinal cord itself, is compressed by hard structures around the spinal column, such as the bones and ligaments. The hallmark of the condition is pain and numbness, but with more advanced compression, numbness and weakness can develop. Weakness is a major concern because unless the nerve is decompressed quickly, the weakness can become permanent.
Local injections, medications, implantable devices and surgery all are potential treatments. Pain management doctors are very skilled in proper use of these treatments and can refer to a surgeon if necessary. A neurologist comes from a different background but is also likely to have the skills and experience to help manage this condition. I would consider a neurologist visit as a way to get a second opinion or another perspective.
Dear Dr. Roach: I am a 70-year-old woman in good health. I started using a CPAP machine about 15 years ago. In the ensuing years I received five years of allergy shots and have lost 30 pounds. My CPAP machine recently started having problems, but due to insurance I won’t be able to replace it for a few weeks. So, I started sleeping without it. I use a Neti pot and a nasal strip before going to bed, and I take one Zyrtec every day. I have not experienced any daytime drowsiness that I had when I began using the machine. Is it possible I no longer need to use a CPAP machine?
Dear N.O.: Obstructive sleep apnea is a common but still often undiagnosed condition where people periodically stop breathing at night. When a person is asleep, the muscles around the back of the throat relax, and this can be enough to close the airway. Oxygen levels drop until finally an internal alarm system wakes the person up, which allows the muscles to regain tone and the person to breathe enough to return blood oxygen to normal. This may happen dozens or hundreds of times per night without the person being aware of it.
While being overweight is a major risk factor for OSA, there are people of average (or below-average) weight whose anatomy still causes them to obstruct. Snoring is a common finding in people predisposed to OSA — about 1/3 of people who snore will have obstruction during the night.
It is possible that your weight loss has lessened the degree of obstruction. However, it’s also possible that you haven’t been off the CPAP machine long enough to develop the daytime sleepiness associated with poor sleep that is another hallmark of this syndrome.
Another sleep study, where your oxygen levels are monitored overnight, would be necessary to tell for sure.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.