OpenHealth Q&A

Navigating Medical Options for My Mother's Health Condition: Conflicting Advice from Physicians

**Patient Overview:** **Birth Year:** 1949 (Age: 76) **Sex:** Female **Medical Background and Current Treatments:** **Chronic Conditions and Medications:** 1. **Thyroid Issues:** - Underwent 70% thyroidectomy two and a half decades ago - Takes **Euthyrox 100 mcg** daily 2. **Anticoagulant Therapy:** - Prescribed **Covatex 5 mg** daily 3. **High Blood Pressure:** - Medications include: - **Sevikar HCT 40/5/12.5** daily - **Amlopin 5 mg** daily 4. **Atrial Fibrillation:** - Diagnosed 20 years ago 5. **Osteopenia:** - Increased risk for fractures 6. **Pain Control:** - Currently taking **Panadol** (4 tablets daily) and **Proxen 500** 7. **Digestive Medication:** - On **Anstigar 60** 8. **Muscle Relaxants:** - Receives **Tilax 2 mg** **Previous Medications for Back Pain:** - **Gabapentin 300 mg:** Initiated three years ago, used for only a month due to lack of relief. **Current Complaints (Reported by Patient/Family):** - Intense back pain radiating down the legs - Significant numbness and tingling in the feet - Limited mobility - only slight movements feasible - Difficulty walking because of leg heaviness - Severe insomnia attributed to persistent symptoms These issues have greatly hindered her overall quality of life and sleep. **Medical Documentation (Chronologically Listed):** **4.1. Bone Mineral Density (DXA Scan) - October 9, 2024:** - **Scan Type:** DXA scan of both hips - **Outcome:** Classified as osteopenic; heightened fracture risk - **Detailed Findings:** - **Right Hip:** - Neck: T-score: -1.6, Z-score: 0.2 - Total: T-score: -0.4, Z-score: 1.1 - **Left Hip:** - Neck: T-score: -1.2, Z-score: 0.7 - Total: T-score: 0.0, Z-score: 1.6 **4.2. MRI of Lumbar and Lumbosacral Spine - January 8, 2025:** - **Scan Description:** MRI without contrast - **Key Findings:** - Loss of normal lumbar curvature; first-degree spondylolisthesis at L5 over S1. - Significant degenerative changes in the lumbar region, alterations in T2W signals of various discs, and evidence of joint arthropathy. - Diffuse posterior disc protrusions at L1-L2 and L2-L3 causing compression of thecal sac and foramina, leading to spinal stenosis. - Similar abnormality noted at L3-L4 and L4-L5 levels. - No signs of masses or significant abnormalities in adjacent areas. **4.3. X-ray of Thoracolumbar Region - January 20, 2025:** - **Findings:** - Notable dorsal kyphosis, signs of spondylosis, normal intervertebral disc spaces, and alignment without fractures. **4.4. X-ray of the Lumbar/Lumbosacral Spine - July 2, 2025:** - **Observations:** - Maintained vertebral height; signs of degenerative changes with decreased disc heights. No indications of fractures or abnormal soft tissues. **4.5. X-ray of the Dorsal/Thoracic Spine - July 3, 2025:** - **Findings:** - Changes consistent with degeneration; slight narrowing of mid-dorsal disc spaces. **4.6. MRI of Lumbar Spine with Contrast - July 5, 2025:** - **Scan Overview:** Detailed imaging of lumbar spine before and after contrast - **Key Insights:** - Multiple degenerative changes detected, but alignment remains intact. - At L3-L4 and L4-L5 levels, significant disc protrusions compressing surrounding neural structures and foramina were noted. - No signs of abnormalities in the paraspinal soft tissues. Despite undergoing six months of physical therapy, shockwave treatments, and radiofrequency ablation, no improvement has been seen. I'm questioning whether the ineffectiveness is due to improper administration of the procedures or if they simply do not align with her specific condition. Although I would prefer to avoid surgery, I am prepared to consider it if all other avenues have been exhausted.

Answers (1)

7/19/2025, 10:40:59 PM

OpenHealth AI

It sounds like your mother is experiencing significant discomfort due to her back pain and related symptoms, despite various treatments. Given her complex medical history, the conflicting advice can indeed be overwhelming. Let's clarify her situation and outline actionable next steps for her management.

Summary of Key Points:

1. Current Condition: Your mother has degenerative spine changes leading to severe back pain and mobility issues, compounded by her existing health conditions.
2. Treatment History: Previous conservative treatments have not provided relief, and you are considering further options, including surgery if necessary.

Explanation:

Your mother’s condition involves structural changes in her spine, including degenerative disc disease, spinal stenosis, and other issues that could be causing her symptoms such as pain radiating down her legs and numbness. While physical therapy and non-invasive treatments like shockwave therapy and radiofrequency ablation are often first-line options, their effectiveness can vary based on individual responses and the specific spinal issues present.

Next Steps:

1. Re-evaluate Pain Management:

   • Discuss with her healthcare provider about optimizing her pain management regimen. This may involve adjusting the dosages of her current medications (e.g., Panadol, Proxen) or adding a newer non-opioid analgesic, especially given her existing anticoagulant therapy which complicates the use of certain pain medications.

2. Seek a Second Opinion:

   • Considering the complexity of her case and the lack of improvement, consulting a neurologist or a spine specialist may provide new insights. They might review her imaging results again and offer alternative diagnoses or treatments, including advanced imaging if necessary.

3. Assess Surgical Options:

   • If conservative treatments continue to fail, surgical options may need to be considered. Discuss with her healthcare team about whether procedures like a laminectomy (to relieve pressure on spinal nerves) or a discectomy (to remove protruding disc material) are appropriate for her condition.

4. Incorporate Physical Rehabilitation:

   • If she has not yet been evaluated by a specialized physical therapist with experience in spine conditions, this may be beneficial. They can provide targeted exercises focusing on improving flexibility, strength, and function, tailored for her specific spinal issues.

5. Monitor and Adjust Lifestyle Factors:

   • Encourage small, manageable changes like gentle stretching, use of heat for muscle relaxation, and ensuring proper ergonomics in daily activities. Pain management can also be supported with mindfulness or relaxation techniques, especially if insomnia is an issue.

6. Dietary Considerations for Bone Health:

   • Given her osteopenia, ensuring adequate intake of calcium and vitamin D is essential. Discuss dietary changes or supplements with her healthcare provider to support bone health.

Closing Thoughts:

It’s important to remain proactive in addressing her pain and mobility issues. Consistent follow-up with her healthcare provider and open communication about her symptoms and treatment efficacy will empower better decisions moving forward. If you have additional questions or need clarification on specific aspects, please feel free to ask.