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Dear Dr. Corenman,

I am 30 years old male in good athlete shape. I was injured with herniated L5S1 disc April 16th this year during my bodybuilding training in the gym. I felt a little bit of pain in my backs at the same day and after two days I could not walk. What is interesting I felt only pain in my lower back. I went to the doctor and he told me it might be a result of overexercising. I was prescribed some non steroids drugs with advice of the bed rest for two weeks. After few days I was in much better condition nevertheless I was feeling some pain in my left leg (outside thigh and calf). The pain was not so big so I could easily work 8 hours at my desk at work. I was a little bit worried with this small pain and I did MRI after consulting my doctor. It was done 13th May this year [hide]The results you can find under following image link:
https://plus.google.com/u/0/photos/101016139523903621227/albums/5757881451772698465%5B/hide%5D
In the meantime I have started physical therapy (exercises plus ultrasounds, TENS, laser etc). I visited three surgeons and they were really surprised of my good physical shape in relation what they saw on MRI scans (negative leg test, no muscles weakness). One of them advised surgery. The other two were not sure if to do surgery. Currently I feel a little numbness in my foot but it is not constant. It appears at the end of the day mostly. I am still missing Achilles reflex in my left leg. I have no constant pain in my leg. It appears rarely during the whole week.
I focused now on conservative treatment but I do not think it is the right way for me. Till now I was a really active person (playing squash, horse riding, some bodybuilding, running, skiing etc.) I partially came back to swimming and biking at the moment.
I was doing some research of the topic and read that in some of the cases the body can absorb the herniated disc. Do you think it is possible in case of such huge herniation as mine? I have read some articles that professional athletes (NHL, NBA, soccer player, even weightlifters) came back with success to their sports after microdiscectomy. Is it possible to reach the same level with conservative treatment?

Thank you for your response in advance.

QUESTION

Dear Doctor, I have a peculiar problem.Kindly go through this letter patiently and advise me.I was in dialemma and very disturbing. Does this vertigo resulted because of the middle ear problem or from spondylosis?. Or from small syrynx in spinal canal.?

PROBLEM

I am 69 year old male .I have cervical spondylosis from 1995. In December last while i was in bed, i have stretched my hands over my head and stiffened my hands to ward of lethargy. immediately after that when i got up, i felt dizzy and lost balance for the first time in my life.. since i have spondylosis, i immediately taken stugeron 25 mg and then gone to see ortho. He asked me to undergo MRI for cervical spine, since i have spondylosis for many years. Accordingly I ve gone for MRI of the cervical spine.He diagnosed it as postural vertigo (bppv). He asked me to take stugeron twice a day for 10 days and aceproxivon twice for 3 days. Besides this , accidentally , in the MRI he has seen a small syrinx at c4 and c5 level.He said not to worry about this, since it is asymptomatic and as i have never experienced weakness in limbs or pain in head etc. He further told me some elderly people have some abnormality and there is nothing alarming. It takes a long time to expand.He further said that it is most likely a cyst.I took the stugeron and aceproxivon. After that the vertigo lasted for about 16 to 20 days and subsided. In this period I felt spinning of the room while getting up from the chair or bed and also while turning sideways in the bed and while moving . I lost balance while going to the bath room. Again in May this year, I have again in the same position in the bed as in December , resulted again dizziness. Again i took stugeron for about 3 days but it was not subsided. Then on somebodys suggestion i ve gone to an ENT surgeon. He asked me to take Audiometry. Accordingly i took it and it shown 60 % loss in the left ear and 25 % loss in right ear. and apart from this some fluid secretion resulted in the middle ear and i am told that this is preventing the air to pass freely and it is building up the pressure and creating vertigo as my eushtachian tube is somewhat narrow.As such, he suggested me to take vertin 16 mg twice daily , allegra 120 mg one a day and ambrodil syrup thrice daily for 20 days .He further suggested if we implant gromets, the loss of hearing may be improved to some extent and the vertigo may also subside.But he has not given any assurance. Now the vertigo has gone. But at times, when i woke up from sleep in the morning I feel reeling or dizzy ness, particularly when i bend my head to wash my face in sink. I never had any head ache.

MEDICAL HISTORY
My medical history is as under: Had IHD in the year 1977 (T wave inversion in V1 to V6) No complications since then .
Had mild Hypertension in the year 1980 (under control)
Had prediabetes in the year 2010 (IFG) (under control)
Had subclinical hypothyroidsm in 2011
Medicines now being used
Heart * (from the year 1977)

I have been taking Stamlo Beta 50 MG,(since 2006) Ismo 10 mg (since 1996), ASA 50 mg ,(since 191) TG tor 5 mg (since 2006) and glycomet 250 mg (since 2910)

.
mri report
. Early changes of cervical spondyilosis with multiple level changes of degenerative discs, marginal osteophytosis and mild disc bulge is seen at C3/4, C4/5,C5/6,C6/7 discs. No obvious thecal sac indentation/neural foraminal encroachment seen at any level

Mild flateening of contour with slight posterocentral disc bulge is seen at c3/4, c4/5,c5/6 ,c6/7 discs. No obvious thecal sac indentation/neural formainal encroachment seen at any level.
A mall syrinx is seen at c4 and c5 level.

Questions about the two problems

Now i would like to know from you first regarding VERTIGO …1. what are the other effective medicines in curing vertigo? 2.Do i have to take vertin as maintanence dose say 8 mg or 16 mg once day for the rest of my life to prevent vertigo? 3. what are the precautions i have to take when i go into the cold weather and travelling in an a/c compartment. 4.does this vertigo is a combination of middle ear problem and also cervical spondylosis? 5. If so do i have to take stugeron along with the vertin . 6. If so what is the dosage. 7.. How to differentiate the vertigo from spondylosis or from the middle ear problem ?. 8. Can the vertigo be cured permanently or do i have to live with it for the rest of my life? 9.Do i have to keep Vertin always handy? 10. Do I have to wear a cervical collar whenver i have dizziness?11.Do i have a cervical pillow while lying in bed?
Then regarding Syrinx . .1. Whether this syrinx has any bearing over vertigo. 2. Does this syrinx give me any problem at this age of 69 years or will it be dormant. 3.How much time does it take to grow? Already 6 months have passed after taking MRI. I did never have any symptoms through out my life so far. . Kindly advise me, as I wish to hear from you as an expert.Thanking you in advance.

Dear Dr Corenman,
Thank you very much for your website. I have learnt a whole bunch from it, and also from your replies in the forum. I was hoping you were kind enough to help me make a good decision based on the results of my MRI.
Here is how it happened: About 6 weeks ago, I woke up with intense pain in my left arm (triceps). As I’ve played all kind of sports all my life (rugby, soccer, tennis, squash, bicycling), the first thought was that I had damage in the triceps. This was strange because I had had lasik surgery and was inactive for the about 2 months, so basically the pain came without physical activity, out of nowhere. The first week I iced it down every other hour for 20 minutes, used tiger balm, hot towels, Tylenol, etc without good results. The 2nd week I tried muscle relaxers, and the not good results got me worried. The pain was not excrutiating but severe (maybe a 7 or 8), exclusively in my upper arm, and the most intense while waking up in the morning. 3rd week I decided to go see a chiropractor, who took an X-ray, and told me the problem wasn’t my arm but it was my neck. He tried I believe ultrasound, and decompression twice that week. As the pain continued, he referred me to a clinic where I got an injection and some pain medication (hydrocone). This did not help much, so he sent me to get an MRI and referred me to a neurologist. I got the MRI done in the 4th week and immediately went to see the neurologist, he performed some tests (can’t remember the name but got quite a good number of electrical shocks), and also tested my strength, and sensitivity to the touch. I think the strength was there, and the sensitivity too, as it felt the same for both arms. After this, the doctor told me he would like to try cervical traction for 4 weeks and see how it goes. He said he could not guarantee it was going to work but he would like to proceed that way. At this time, the pain wasn’t so severe (maybe 3 or 4) but it was not limited to my triceps, I would also feel it in my biceps, and armpit.
Here is what the MRI report says:
There is desiccation of the discs of the cervical spine
At c4-c5, there is minimal bulge of the intervertebral disc effacing the thecal sac
At c5-c6, there is a bulge of the intervertebral disc effacing the thecal sac with mild left neural foraminal narrowing
At c6-c7 there is a bulge of the interverebral disc effacing the thethecal sac with mild left neural foraminal encroachment. There is a tear of the annulus at this level and this the most prominent bulge.

I just finished the 2nd week of cervical traction and pain has been limited to the mornings when waking up, but there is tingling and a little bit of numbness in my arm, armpit, back of the shoulder, wrists, coming on and off during the day. The pain is not as intense as it was but I feel a lot of discomfort and also noticed a little bit of stiffness in my neck, but I could not say that it is painful. It definitely feels odd, maybe like pin and needles, it’s hard for me to make a good description of how I feel it.

Now, I was seeing the non surgical treatment options in your website, and there is no mention to cervical traction, so I got concerned, and I called a friend of mine in Argentina who is an orthopedic surgeon. He told me cervical traction is not performed in Argentina now for a good number of years, and he recommended getting a 2nd opinion. I am not struggling with the physical pain now, as much as I am struggling with the mental and emotional aspects of it. I’d like to think that the quality of my life is proportionally direct to the amount of physical activity I do during the week. For several weeks now, I have not done anything so I’m going crazy. It has even affected my work lately, which I think (I sit in front of a computer for long hours), in conjunction with the nature of the high impact sports I have practiced, has brought me to where I am now.

I would highly appreciate if you can give me your opinion on whether I need surgery or not (I’m a 42 now, never had any physical problems up until now), and let me know what your recommendation is as far as treatment options.

Thank you so much and best regards,

Manuel