Tingling feet could be a sign of a back problem: Ask the GP DR MARTIN SCURR

By Liam On Oct 2, 2023

Q: I have had constant numbness in my lower legs, ankles, and feet for over three years.

When I walk I have pins and needles in my feet. Hospital tests confirmed I had a problem, but no one could identify the cause (it was suggested it could be a pinched nerve in my back) and I was discharged.

I’m 88 and used to play golf twice a week, but had to stop earlier this year due to a back problem. What do you suggest?

BD Clifton, Tunbridge Wells.

A: It appears you are halfway through the diagnosis, but the investigation has stalled for some reason.

DR MARTIN SCURR: Tingling feet could be a sign of a back problem (stock image)

In your longer letter you describe that you have undergone a neurological test, a so-called nerve conduction study (also known as EMG, electromyography).

This common diagnostic procedure is used to test the function of the muscles and the nerve cells that control them, for example to check for nerve damage related to carpal tunnel syndrome (a compressed nerve in the wrist) or as a complication of diabetes.

IN MY OPINION: Measles case highlights risk of doctors assuming ‘it’s just a virus’

The story in last week’s Good Health pages about the time it took for 64-year-old Josa Keyes to be diagnosed with measles is another reminder of the value of experience, training and physical examination.

Well-trained, observant general practitioners will recognize the combination of symptoms in measles: coughing, coryza (inflammation in the nose and throat) and conjunctivitis.

If the patient also has a high fever, check for Koplik spots, which occur in the oral mucosa, especially in the cheeks.

The rash looks like a scattering of grains of salt and is visible before the characteristic rash of measles develops.

Two of my patients – sisters – got it after spending a weekend at the Glastonbury Festival several years ago.

Neither had been vaccinated with the MMR (measles, mumps and rubella) vaccine and both were hospitalized because they were so sick; One of them is in intensive care.

Not all doctors will be old enough or have the experience to diagnose measles. But they have to get smarter.

The low level of MMR uptake, together with immigration from countries where immunization has been patchy, have contributed to an increase in the incidence of measles.

It needs to be something that doctors think about: they need to challenge their own thinking, and not just assume that a patient suffering from a high fever just ‘has a virus’.

As well as seeing this as part of our mandatory continuing professional development, this is a good reason why patients should be seen and examined in person and not over the phone or email.

Your EMG test confirmed that the nerve supply to your legs is disrupted in some way, medically described as bilateral peripheral neuropathy (it’s called bilateral because both legs are affected).

The next step should have been to investigate the cause further.

Since both legs are affected, this implies that the problem lies in the spine. I am convinced that the back problem that keeps you from playing golf is a symptom of the same condition.

The likely diagnosis is spinal stenosis, a narrowing of the spinal canal (the space in your spine that contains the spinal cord). This usually happens due to the formation of new bone, caused by the body’s repair system after age-related wear and tear of the intervertebral discs.

This narrowing can cause the nerves in the spinal cord to become ‘pinched’, causing symptoms such as back or neck pain, and further down the nerve branches, tingling in your arms or legs.

I suggest you go back to your GP and discuss your symptoms. Hopefully you will be referred for an MRI scan of your lower back, or directly to a back surgeon.

Regardless of your age, surgery (to shorten the bony prominences, if that is the cause) should be an option and can relieve many of your symptoms.

Assuming you have no other health problems, I would encourage you to proceed with surgery if the specialist deems it the best option.

Q: Can you explain how a blood clot can form in my lungs two years after I was given warfarin to thin my blood?

Anthony Hill, Wadhurst, East Sussex.

A: Warfarin is a proven anticoagulant (blood thinner) that is often prescribed to patients who have suffered from blood clots – which in turn can cause a range of problems, including stroke and heart attack.

Whatever the reason you are prescribed warfarin, you will have had regular blood tests to check your prothrombin time; this is the time it takes for your blood to clot. Your dose of the medicine will be adjusted accordingly.

Results can vary: for example, what you eat and drink may mean that the drug is either too effective (in which case there is a risk of potentially dangerous bleeding), or not effective enough, resulting in unwanted clotting.

This seems to have happened in your case, with a blood clot in the lung (also called pulmonary embolism).

It’s important to keep your diet stable when taking warfarin, and also watch your intake of foods high in vitamin K – green leafy vegetables such as broccoli, Brussels sprouts or spinach.

Warfarin is a long-standing anticoagulant drug (blood thinner) that is often prescribed to patients who have suffered from blood clots (stock image)

Vitamin K helps your body produce clotting factors and therefore may inhibit the effects of warfarin. Therefore, patients taking the drug should stick to a consistent intake or avoid these foods completely (consult your doctor about this).

I’m wondering if you were given proper nutritional advice when the drug was first prescribed?

Nowadays, warfarin is prescribed much less than before, because there are new anticoagulants (e.g. dabigatran, rivaroxaban, apixaban) that are just as effective and less complicated to use (no blood tests required) and that do not affect what you do. can consume.

Maybe it’s time for you to ask your doctor to switch you to one of these medications.

Write to Dr. Scurr from Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email: drmartin@dailymail.co.uk.

Answers should be taken in a general context. If you have health problems, consult your own doctor.