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Suggest Treatment For Severe Lower Back Pain While Having Cold And Flu

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Posted on Thu, 29 Jan 2015
Question: Dear Doctor,

I am a 26 year old male.

I started having the common cold/flu at around december 10,2014 (I currently have til now but it seems to be at the end of its course).

Here is my MAIN CONCERN:

While having the cold/flu on the morning of december 15,2014 I started to develope a quite severe lower back pain and I also had pain shooting up on both of my legs.It would really hurt whenever I coughed on that day.I was not able to sleep whatsoever and had to lie down facing on my left side.

On december 16,2014 the pain on my lower back went away,but to date that was the worst day because I had a sciatica attack,I was not able to stand straight the whole day and I was basically immobile and the sciatic nerve pain was only manifesting on my right leg (severe stabbing pain behind the thigh).I had to sleep on my left side again (still had the flu).

On december 17,2014 things seemed to have greatly improved,my sciatice nerve pain on my right leg has dissapeared,I am able to stand almost normally again and walk (but not run).But a new problem has arised,on the LEFT side of my buttocks and on my genital area,numbness has taken over! I am unable to feel my penis and buttocks (left side) and very mild on my LEFT leg til now.I am able to stand and walk without any lower back or leg pain.

What could this numbness be doctor? I would not want to think that this could be an indication of early CES (Cauda Equina Syndrome).

Could this numbness developed because I was sleeping on my left side the previous nights? What could have caused all of this symptoms to have appeared? Is it because of the flu virus? My main concern as of now is this numbness.

I had a CT scan done on november 29,2014 because of constipation issues after a course of meds. The only relevant findings were on my spine; L4-L5 has a disk bulge (not hernia),and also noted was that there's a POSSIBLE (no definite answer) disk protrusion on L5-S1.

I am currently able to walk and stand,my only problem now is this numbness in my genital and buttocks (left side).

No sciatic or lower back pain as of now,although my back is a bit stiff.
Is it because of the flu virus which triggered all of this happen?
doctor
Answered by Dr. Ajay Panwar (1 hour later)
Brief Answer:
These may be manifestations of L4-L5 and L5-S1 radicular inflammation.

Detailed Answer:
Hi XXXX,
Thanks for being here on HCM.
I am Dr.Ajay Panwar, a neurologist and I''d like to help you with your query.

Your main symptoms of radiating pain on both sides but more on right side,which started in the low back and went upto the right thigh and legs(though on both legs,but more on right),increased on coughing and standing straight,which is very characteristic of radicular pain.Also the main symptoms on left side, which are numbness on left buttock and penis is just another manifestation of L5-S1 radiculopathy(pain is a more common manifestation).

Your flu started on 15th December and it had the symptom of cough,which increased the pressure on nerve roots emerging out of spine(while coughing) along with the immunogenic reaction of the body against the flu virus,which increased the inflammation around the radicles of the sciatic nerve and the L5-S1 radicles.

Though,sciatic nerve symptoms improved on 17th december as the cough improved, but just another manifestation of viral inflammation around L5-S1 persisted as numbness around the buttock and the penis.Sleeping on left side may have played its role as well.Another possibility is that due to flu symptoms,your postures may have changed a bit like keep lying for long time,or sitting in different positions,which may have contributed to the radicular inflammation.

Please take some anti-inflammatory medicines like non steroidal anti-inflammatory drugs(NSAID) so as to decrease inflammatory effects.It will probably help in the symptoms.As your flu symptoms improve,your radicular symptoms should get better.In addition,please visit a physiotherapist as spinal exercises will help in this regard.

I have gone through your CT report and suggest you to get a Magnetic resonance imaging(MRI) of lumbosacral spine done for better disc and roots status.

Bottom line-Take anti-inflammatory medicines,proper physiotherapy and observe till your flu symptoms improve.It will probably get better.

Hope I have answered your query.If you have some follow up questions,I shall be glad to answer them,else please close the thread and rate it.

Dr.Ajay Panwar
MD,DM(Neurology)


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Ajay Panwar (2 days later)
Dear Doctor,

I have attached the test results of my MRI scan for your review.

I still have a bit of flu left with very mild coughing and whitish phlegm (not green anymore).

I do not have any back pain or lower back pain whatsoever,but when I cough I could feel some pain on my tail bone.

When I walk I could still feel some pain on my legs my the pain is more intense on my left leg.

I still have the numbness on my left buttock and genitalia (more on thr left side).

Doctor,so is cauda equina syndrome ruled out?

How much time would you think it would take for the numbness to go away?

What do you overall think of my results?



doctor
Answered by Dr. Ajay Panwar (1 hour later)
Brief Answer:
Dedicated physiotherapy and anti-inflammatory drugs

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
I Dr.Ajay Panwar,welcome you for the day.

I have gone through your MRI reports and as they say(and as clinically impressed in the above discussion) you have L4-L5 and L5-S1 disc bulges with secondary spinal canal stenosis and neural foraminal stenosis(bilateral at L4-L5 and right side at L5-S1).It means that the disc bulges are compressing your emerging nerve roots at the said levels, which is resulting in your symptoms of leg pain and gluteal numbness.

You are not having a Cauda equina syndrome as cauda equina syndrome is a very severe form of asymmetric compression of nerve roots which causes asymmetric leg paralysis, with sensory loss in lower limbs and loss of reflexes. Along with patient may have difficulty in passing urine and stool.So,it is not cauda equina syndrome.
Still, you need to be careful for what it is-a milder form of nerve roots compression. Please meet a good physiotherapist so that he teaches you well spinal stabilization exercises and make it sure that you do them in a dedicated manner. Some non- steroidal anti-inflammatory drugs (NSAIDS) like naproxen may be taken (please make it sure that you get properly examined by a neurologist and your treatment is supervised by him). Also, if sometimes you start having severe symptoms; please refer a neurosurgeon or spinal surgeon. Present symptoms will probably improve with regular physiotherapy, NSAIDS and improvement of flu symptoms.

Hope, I have answered your query. If still you have follow-up questions, I shall be glad to answer them, else close the thread-rate it and please write a review.
Dr.Ajay Panwar
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Ajay Panwar (2 days later)
Dear Doctor,

I have attached images of the MRI scan for your visual inspection and review.

What do you overall think of my condition?

It's already the 6th day into this condition (numbness and stiffness).

I could probably say that leg pain is slowly subsiding.

Leg pain does not bother me anymore,but whenever I walk legs are still STIFF (but no noticeable pain).

My genital (more on the left) and left buttock are still numb (symptoms are probably slowly improving).

I have not started any physical therapy at the moment as another doctor said bed rest (initially) is important for the recovery (numbness).

My sleep is seems to be improving as well as pain is subsiding on the legs.

How long do you think this numbness would last doctor?

I am still able to get an erection and have ejaculation (slowly improving).

Can still urinate (slowly passing out) and have bowel movements everyday.

I am taking lots of vitamin C,B complex,B12 and mecobalamin for nerve regeneration.

Tomorrow I will be revisiting my chiropractor.

Please let me know what you conservatively think doctor,and please do not hesitate at all to let me know.

Kindest Regards

doctor
Answered by Dr. Ajay Panwar (1 hour later)
Brief Answer:
Selective exercises, NSAIDS and a short course of oral steroids.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
You are welcome for the day.

You have put some nice MRI images here.I have been through them.You actually have a mild L4-L5 disc bulge with a mild compressive effect.But the cause of concern is your L5-S1 disc herniation,which is significantly causing the neural compressive effect at S1 root level,hence resulting in your symptoms.

Various studies about this disc disease have shown that bed rest of initial 2-3 days after the onset of disc disease is good for recovery(In your case,that time is over)Thereafter,it is selective exercises mainly ' XXXXXXX back stretches',sit-ups and some others(which a good physiotherapist will guide you well),which must be done rather than the absolute bed rest(while avoiding other exercises like weightbearing or weightlifting,games like cricket or hockey),if you want to have recovery at its best with non-surgical management.Along with, chiropractic manipulation helps.Regarding medicines as I already told anti-inflammatory drugs mainly NSAIDS(as told in the previous discussion) must be taken to counteract the inflammatory effects caused by the disc herniation.I would rather suggest you to take a short course of oral steroids(Prednisolone) for about 1 week along with NSAIDS.Meanwhile you can continue taking Vitamins and methylcobalamin,you are taking as they will help in nerve vitality and regeneration(Please take the medicines I prescribed under the supervision of your physician only).
Even on this all, if your symptoms(including numbness) does not improve at least partially or worsens, within 6 weeks,then you should take a spinal surgeon consultation.Many of the patients will improve on this therapy however.

Hope I have answered your query.If still you have follow-up questions, I shall be glad to answer them, else close the thread-rate it.

Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ajay Panwar (7 days later)
Dear Doctor,

My bladder and bowel movements seem to be improving so far.

The flow of my urine is stronger now compared to the previous days.

About two days ago,I noticed a strong ITCHING sensation on my left buttock (where most of the numbness is).Is the itching sensation a good sign doctor?I guess it's safe to say that the sensations now feel a bit better too.

I also noticed on the left side (where the numbness is) of my genital area some sharp/shooting pain.

The itchiness and sharp pains have somehow subsided as of now.

When I walk up the stairs,the pain on my tail bone while using the left leg has also subsided.

Please let me know what you honestly think doctor.

BUT,whenever I wake up in the morning I could feel my tail bone area to be quite painful/stiff.Goes away once I stand and walk.

Kindest Regards
doctor
Answered by Dr. Ajay Panwar (36 minutes later)
Brief Answer:
Your disease seems to be improving.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
I,Dr.Ajay Panwar,welcome you for the day.

It feels good to hear from you that your symptoms appear to be improving now.The best point indicating good prognosis here is that 'your pain, bladder and bowel symptoms are improving'.

'Itching' has no neurological correlation here and does not indicate good or bad prognosis.It may be incidental due to some non-specific reason such as dryness of skin over that area or something else.If it persists,please refer to a skin specialist.

As other symptoms have started improving,please continue the management as we have already discussed previously and your morning stiffness in the tail bone area will also improve subsequently.

I honestly feel that if you sincerely follow the management plan as discussed,you will probably get significant improvement in symptoms.

Hope,I have answered your query.If you have some follow-up questions,I shall be glad to answer them else,please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Ajay Panwar (2 days later)
Dear Doctor,

Just to follow up with my current condition,I am having bowel movements everyday (no straining). I am also urinating (improving since urine flow now is now stronger compared to the previous days).

I have started doing the treadmill (light walking 600m 20 min a day).

Stiffness and pain on the tail bone still persists (much less now when waking up compared to before).

I can walk longer distances now with less leg pain,but stiffness is still there.

It has been 17 days already since I'm having this numbness and stiffness and leg pain (my leg pain is now on my right leg).

Will start therapy around next week.

What do you think of my condition doctor? Am I improving?please do not hesitate to let me know.

I have been feeling quite depressed lately because of my condition.

Kindest Regards
doctor
Answered by Dr. Ajay Panwar (24 minutes later)
Brief Answer:
You definitely appear to be improving.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
I,Dr.Ajay Panwar,welcome you for the day.

I always tell you frankly about your clinical condition. It definitely appears to be improving. No matter, You have some pain in right leg and your stiffness is still persisting, but overall your symptoms are improving. You are putting dedicated efforts regarding medicines and physical therapy, and these efforts are working.

Your stiffness in legs along with pain and stiffness in tailbone will improve gradually. Please do not get depressed as you are gradually improving day by day.

Hope I answered your query. If you have follow-up queries, I shall be glad to answer, else please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Ajay Panwar (3 days later)
Dear Doctor,

I would also like to share with you some concerns that I am currently experiencing.I will explain to you the brief history when they have started/intensified.

I have always been suffering panic attacks and anxiety for most of my life.They have somehow greatly improved after learning that I am allergic to certain foods (attached the report).

My MAIN CONCERN:

About 3 years ago,I took a course of antibiotics for 2 weeks (doxycycline),while on the course I started to develop severe mental reaction (DEREALIZATION & BRAIN FOG).

After the course of the antibiotics,I developed a yeast infection (causing further brain fog and derealization).

They have subsided after stopping the antibiotic and treating the yeast infection.

After all that,I have been experiencing some brain fog time to time (much less,no more derealizaton).

Now XXXXXXX last year (2014),I started again another course of antibiotics (clindamycin,1000mg for only 1 day) for a nose infection.After that I started another course fluconazole to avoid a yeast infection from coming back.Once I took the antifungal,I started to have the derealization and brain fog again.

After all that,the derealization has subsided,but now time to time I still have this brain fog.It manifests especially after eating some foods that could be contaminated with allergens or with other carbohydrates such as rice.

Can you please advice what I need to do doctor? All of these symptoms have started/intensified after taking those medications.

What should I do exactly?

I've also attached other reports for your review just to have a better idea of the current situation that I have.

Kindest Regards

P.S. My flow of urine is almost normal (85%),but numbness and leg pain is still persistent.Bowel movements are fine.

doctor
Answered by Dr. Ajay Panwar (9 hours later)
Brief Answer:
Anxiety/Panic attack-common cause of Derealisation.Doxycycline can cause.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
You are welcome for the day.

It's good that you are recovering well from your disc herniation.
Some of the common causes of Derealisation and Brain fog are-
1)Anxiety/Panic attack
2)Vestibular disorders
3)Addictions-Smoking(nicotine),alcohol,Addictive drugs
4)Temporal lobe epilepsy

In your case,Anxiety/Panic attack can be the likely cause.Please do lifestyle modification if you smoke,take alcohol or excess of caffeine.

Doxycycline is reported to cause derealisation but not fluconazole.

I have gone through your reports and saw the food items you are allergic to.Any particular allergen for some particular individual can cause derealisation. So,better to avoid those food items.

Please do some mental relaxation exercises,Yoga and get an ENT evaluation done if you have any vestibular symptoms like vertigo,dizziness or balance problems.

Hope I answered your query. If you have follow-up queries, I shall be glad to answer, else please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Ajay Panwar (2 days later)
Dear Doctor,

Disc bulge follow up:

I can now enjoy longer walks when going out,as opposed to the previous days when I would develop leg pain after walking short distances.

I am still having bladder and bowel movements everyday.

Leg pain seems to have greatly decreased while sleeping.

Numbness in my left buttock and genital (left side) area seems to improve very slowly.

Walking up the stairs I would not feel any noticeable pain on my legs or buttocks.

Doctor,I'd would like to know,would this numbness go completely away? And would my nerves RECOVER 100%?

What is my overall condition as of now regarding this disc bulge?

ANOTHER CONCERN AS OF NOW:

I've attached additional reports for your review.It is regarding a sinus disease and brain cyst as shown on the CT scan.

What do you think of them doctor? Is the cyst on my brain affecting (brain fog) me? Do I need to treat it in any way? How bad is the overall condition?

Also seen on the CT scan result indicates that I have a sinus cyst with disease.Could this be also related to my brain fog? More than three (3) years ago I've made a CT scan indicating only a sinus cyst,but now the results which I've attached (dated November 2014) indicate that it now has mucous retention/disease.Can this be treated to?In what method?Can this be the one also causing me to have brain fog every night?

Kindest Regards
doctor
Answered by Dr. Ajay Panwar (10 hours later)
Brief Answer:
Arachnoid cyst or mucus retention cysts are not likely causing brain fog.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
You are welcome for the day.

It really feels good to know that your disc herniation symptoms are at significant improvement. Overall condition is definitely improving. It is a bit difficult to quantify the predictions of improvement in terms of percentage. Even I don’t know whether improvement will be 100%.What I can say is that with current trend-improvement is going to be significant and significant means functional XXXXXXX in everyday life with no or minimal symptoms.

Neither arachnoid cyst in this location nor the sinus/mucus retention cyst is causing brain fog. Please upload a CT head image, so that I comment better. Your arachnoid cyst is most likely asymptomatic, as if now and needs no surgery.

For better opinion on sinus/mucus retention cyst, please refer to an ENT surgeon.
Hope I answered your query. If you have follow-up queries, I shall be glad to answer, else please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Dr. Ajay Panwar

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Suggest Treatment For Severe Lower Back Pain While Having Cold And Flu

Brief Answer: These may be manifestations of L4-L5 and L5-S1 radicular inflammation. Detailed Answer: Hi XXXX, Thanks for being here on HCM. I am Dr.Ajay Panwar, a neurologist and I''d like to help you with your query. Your main symptoms of radiating pain on both sides but more on right side,which started in the low back and went upto the right thigh and legs(though on both legs,but more on right),increased on coughing and standing straight,which is very characteristic of radicular pain.Also the main symptoms on left side, which are numbness on left buttock and penis is just another manifestation of L5-S1 radiculopathy(pain is a more common manifestation). Your flu started on 15th December and it had the symptom of cough,which increased the pressure on nerve roots emerging out of spine(while coughing) along with the immunogenic reaction of the body against the flu virus,which increased the inflammation around the radicles of the sciatic nerve and the L5-S1 radicles. Though,sciatic nerve symptoms improved on 17th december as the cough improved, but just another manifestation of viral inflammation around L5-S1 persisted as numbness around the buttock and the penis.Sleeping on left side may have played its role as well.Another possibility is that due to flu symptoms,your postures may have changed a bit like keep lying for long time,or sitting in different positions,which may have contributed to the radicular inflammation. Please take some anti-inflammatory medicines like non steroidal anti-inflammatory drugs(NSAID) so as to decrease inflammatory effects.It will probably help in the symptoms.As your flu symptoms improve,your radicular symptoms should get better.In addition,please visit a physiotherapist as spinal exercises will help in this regard. I have gone through your CT report and suggest you to get a Magnetic resonance imaging(MRI) of lumbosacral spine done for better disc and roots status. Bottom line-Take anti-inflammatory medicines,proper physiotherapy and observe till your flu symptoms improve.It will probably get better. Hope I have answered your query.If you have some follow up questions,I shall be glad to answer them,else please close the thread and rate it. Dr.Ajay Panwar MD,DM(Neurology)