Question :

Possible Lumbar radiculopathy and overweight

Dear Ask The Doctor:
Hello, I am 46 and started having numbness in lower outer thigh areas about 7 years ago, and I think it is from my weight which I am losing now (a doctor told me that back then, meralgia paraesthetica)). I later developed numbness in the balls of both feet and big toes, with the right side being very minor and the left side being the real big problem and 1000 times worse. Lately in the last 4 months, I started working out while losing weight (3 mile fast uphill walks and lost 35 pounds so far), and it seems like the left thigh and left foot are getting much worse. The right side has not changed at all. I am still overweight at 310 pounds now, and my weight in Army basic training was 245 (my goal). Nobody believes my weight when they see me, and I have real heavy bones at 6'3". I am in pretty good shape I think for my age and weight. I do take toprol and nephedipine for high blood pressure, but it is getting so low now since working out that I may have to stop taking what is considered small doses. I have been on the Internet for hours and can't find anything with my most recent development of numbness in outer thighs and feet (again, much worse in left side). When I barely touch or rub the outer left thigh just above the knee, I feel the bottom of my left foot along the arch area to big toe buzzing strongly, or tingling. It is strange to touch my left outer thigh and feel this strong buzzing, or an electrical shock feeling, in the bottom of my left foot. I am also starting to feel some slight numbness in the outer left shin area, I do not ever recall that as an issue before either. I don't have the same problems in right thigh and right foot. I just have some very minor numbness in right outer thigh and ball of foot, and it is not getting any worse. I have no backpain unless I stand in the same position longer than 10 minutes, and it really aches and sore in the middle of lower back (just above the vertebrae where I think the lower leg nerves come from, just above L4-L5?). I have to sit down and it feels much better right away. Walking is never a problem, just when I stand for awhile int he same position. One thing that I think is really important to mention, I do have more severe numbness and burning sensation when laying in bed or sitting in chair too long, my feet get really numb and sometimes left foot cramps up (again, 90% is in left foot), but there is immediate relief when I get up and start walking. It is almost as if I have no problems when I am walking, but it comes back soon after laying down or sitting back down for a period of time. It is really bad when laying on my back, and things get really numb, but there is immediate relief and not really a big problem when I turn on my side. I try to stay on side as much as possible. My thighs are completely dead and even hurt when I lay on back too long. I also wake up in the morning feeling pretty good, and I really don't feel nearly as much numbness when I get up. I wish I could feel the way I do in the morning getting out of bed all day and night. It seems to get worse as the day progresses. The numbness in feet really bothers me after my long walks. I had some brief history with alcohol because of depression (for about 2.5 years, and I drank way too much everyday after death of family member), but I quit a year ago completely. I have done a great deal of research on alcoholic peripheral neuropathy, but does it get worse after not drinking for a year? Thought you should know that, but I have been feeling good since quitting and thought a lot of my problems would go away or at least not get worst. I do not have really high blood sugar although my glucose level can be improved. My fasting glucose is about 95, and it never goes higher than 160 after eating (my Mom gave me test kit). I know it can be a lot of things, but I am unemployed now and can't see a doctor because I have a family to support with almost nothing to even buy groceries. Lots of info out there on some of my symptoms, but I could never find anything on why I feel these strong shocks in foot when touching my outer left thigh. Any feedback would be greatly appreciate. I also started taking B12, the type with methylcobalamin, and hope that was a good move (watching levels of B6 carefully). Thank you very much, Clay S.


Answer :

Dear Patient: 
 I agree with your doctor that according to your symptoms you might had Meralgia Paresthetica at that time, but in the view that you are overweight and you have new symptoms since then that apparently are getting worse, maybe this might be due to a nerve compression, caused by a degenerative process or a bulging disk at lumbar spine level, and you can feel it worst in some positions because in certain positions the intervertebral space gets smaller and compress the correspondent nerve. The pain can radiate to the upper thigh, leg or even to the foot depending of the lumbar segment involved. In order to confirm this diagnostic impression, the best imaging study is the MRI. Basically the conservative treatment is Physical Therapy aimed to recondition and stabilize the lumbar spine by re-educating you , teaching you a daily stretching routine for the lumbar area, strengthening of abdominal muscles, and other important general recommendations as follows: lose weight, sleeping with a pillow between the knees lying on the side, avoid activities that place additional strain on the lumbar spine (example: weight lifting). All of the above, with the objective to keep you as far as possible from episodes of acute low back pain, and also to preserve your quality of life. If the conservative measures do not seem to work, the local corticosteroid injection may be considered.


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