My legs go numb after only 15 minutes of walking, due to spinal stenosis. Is there anything I can do to relieve the symptoms?
Peter Cloke, Ipswich.
Dr Martin Scurr replies: Spinal stenosis occurs when the space within the spinal canal – the tunnel in the centre of the spine that protects the spinal cord and nerves – becomes reduced, resulting in pressure on the cord or the nerves descending to the legs.
In older people – you’re 80 – the cause is usually degenerative, related to wear and tear on the discs, the spongy tissue between the vertebrae that stops them rubbing together.
Osteoarthritis of the facet joints – which connect vertebrae to each other – is also part of the degeneration that leads to spinal stenosis, as the arthritic joints contribute to the nerve pressure.
You appear to have the most typical symptoms – the numbness, heaviness and weakness of your legs after walking or standing upright for a period of time.
Relief comes from sitting or bending forwards, which opens up the space in the spinal canal, taking the pressure off the nerves.
Walking slightly flexed, or bent forwards, may be helpful – and short walks are better than one long one. I would suggest that first you ask for your GP to refer you for targeted physiotherapy, such as lumbar flexion exercises, which is proven to help. This consists of exercises designed to ‘round’ the lower back, creating space in the spinal canal.
The most common symptoms of spinal stenosis are numbness, heaviness and weakness of the legs after walking or standing upright for a period of time (picture posed by model)
Gait training, or learning to walk in such a way that it eases pressure on nerves in the spinal canal, can also ease symptoms.
Ideally, you would also be referred to a specialist for epidural steroid injections, to reduce inflammation around the nerves affected. This will provide temporary relief and allow any physiotherapy to produce better results.
A physiotherapist may also suggest a lumbar brace – a device that supports the lower back.
Surgery is only considered if symptoms are severe and your quality of life is limited – and even then only when all conservative measures have been trialled.
Over the past two years I’ve lost my sense of smell and taste, resulting in complete loss in the last nine months. I’ve seen an ENT consultant, who sent me for a brain scan – which showed inflammation of the sinuses, though at 81, I’ve never had sinus problems in my life.
I did take the recommended medication – fluticasone propionate nasal drops – for the last four months. Could you recommend any other treatment?
Maurice Suthers, Bournemouth.
Dr Martin Scurr replies: Our sense of smell is provided by specialist cells, the olfactory nerve cells, found at the top of the nasal cavity – these communicate directly into the brain, conveying signals derived from molecules you’ve inhaled.
Sinus problems are a common cause of temporary loss of smell, as inflammation can impede the molecules getting in.
But the fact that despite your nasal lining being inflamed, treatment with potent steroid nose drops didn’t help, suggests this is not the underlying cause.
Typically, loss of smell is caused by damage to the olfactory nerve cells following a viral infection (which you can have without any other symptoms), or in older people such as yourself, it can be age related.
With age, the number of specialist olfactory nerve cells can, with time, become so depleted that the sense of smell is impaired or disappears completely.
A third possibility is that loss of smell may be an early warning sign of a neurodegenerative disease. I’d suggest discussing this with your GP.
In my view… Brain zapper for depression works well
Several of my patients have recently been successfully treated for depression with transcranial magnetic stimulation (TMS) – which induces tiny electrical currents in the brain.
This technology, invented by medical physicists at the University of Sheffield in 1985, has been shown in multiple trials to be effective in treating depression that’s resistant to medication.
The treatment is administered via a magnetic coil that’s placed on the patient’s head. This generates highly intense pulses of magnetism, which, in turn, triggers electrical currents in the nerve cells of the cerebral cortex – the outermost layer of brain matter.
Treatment normally consists of weekly sessions for six to eight weeks – no anaesthetic is required and the side-effects are minimal, such as headache. My patients – who’d not responded to medication – made a good recovery following TMS. My hope is that the NHS will provide sufficient funding for this type of treatment to become widespread and more available.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London, W8 5HY or email drmartin@dailymail. co.uk. Replies should be taken in a general context. Always consult your own GP with any health concerns.
