Q: I have lower back pain that makes walking upright difficult, so I tend to lean forward for relief. I’m 81, but I still go to the gym three times a week and don’t want to end up with a stoop. What could be the cause?
David Pollendine, Biggleswade, Bedfordshire.
A: Lower back pain is very common, with various causes, including a herniated disc.
But I’m wondering if the problem in your case might be related to the medications you were prescribed.
In your longer letter you mention that you are taking 4 mg per day of a steroid – probably prednisolone – for polymyalgia rheumatica (PMR). This is a form of inflammatory arthritis, which often causes crippling pain and stiffness in the muscles and joints, especially in the shoulders, neck and hips.
It is important to continue taking the medication – it is usually given for up to two years – but a known risk with long-term steroid use is osteoporosis, where bones lose their density and become fragile and prone to fractures.
This can happen almost silently until, for example, the bones in the lower back, which support most of the body’s weight, collapse. This causes pain, loss of height and bending.
Another possibility is changes due to osteoarthritis.
Persistent back problems should be investigated. Ask your GP to refer you for an X-ray or MRI scan, says Dr Scurr (photo by model)
You also mention that you have had both knee joints replaced due to severe osteoarthritis, and that there is a good chance that you also have this in the spine.
This can lead to spinal stenosis – or an abnormal narrowing of the spinal canal. This happens because the body responds to the inflammation caused by osteoarthritis by producing more bone. This in turn narrows this canal, which may explain the bending you describe.
I would suggest asking your GP to refer you for an x-ray or, better yet, an MRI scan.
You may also need a DEXA scan to assess your bone density, but while you wait for the results of any tests, you should take a calcium supplement and a daily dose of vitamin D, given what we know about the effects of long-term steroids. use on bone health.
Q: My doctor has diagnosed me with benign thyroid nodules and I have a visible lump in my lower neck. Do I need treatment to remove them?
Samantha Roberts, Newmarket, Suffolk.
A: Thyroid nodules are round or oval nodules in the thyroid gland, a butterfly-shaped gland located in the front of the neck.
We don’t know what causes them, but they are very common: up to 70 percent of women have at least one, while more than 50 percent of men and women in their 50s have multiple lumps (a ‘goitre’).
The first step is to undergo an ultrasound, along with a blood test to measure the level of thyroid-stimulating hormone, or TSH. A high TSH level is a marker for cancerous change, while a low TSH level indicates that the lump is benign. If cancer is suspected, the next step is a biopsy (which uses a long needle to remove pieces of thyroid tissue).
Reassuringly, your lumps are benign: these should be monitored regularly with ultrasound, initially at 12 months, then 24 months and then every three years.
If the lumps grow and become larger than 4 cm, you may need to have surgery to remove them. Most benign lumps do not shrink over time.
IN MY OPINION: Technology is ruining care for older patients
Technology – and online consultation in particular – was intended to give patients easier and faster access to medical care and increase their confidence in the system.
But has it? Newly published research shows that leading doctors were embedded in twelve GP practices for two years to gauge the reality of delivering NHS care in a digital age. Unfortunately, it only confirmed what many of us in primary care feared: that the human elements of care are under attack.
The research shows, for example, that older, sick patients who were sometimes seen at home by their GP now have to come to the practice – the only alternative is a telephone consultation.
And those who find that “seeing” their doctor this way because of deafness or vision problems provides little comfort tend to simply do without.
But the research also shows that GPs remain committed to the traditional values of general practice, including a relationship with patients, continuity of care and compassion.
I hope that young physicians are taught to prioritize these principles and take technology for what it really is: a useful tool.
Write to Dr. Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email drmartin@dailymail.co.uk – include your contact details. Dr. Scurr cannot enter into personal correspondence. Answers should be taken in a general context and should always be consulted with your own GP any health problems.