By
- Dr. Keith Roach
Dear Doctor Roach: I’m a 70-year-old man. About eight weeks ago, I began having sweats, chills, severe headaches, body aches, a low fever, a lack of appetite, a lack of energy, and numbness around my waist. As this progressed, I began having severe pain in my lower back and left shoulder blade. I lost 24 pounds
I went to the hospital twice and had many tests (MRIs, EKGs and CT scans) done of my belly, head, spine, etc., as well as many blood and urine tests. I was also checked for viruses, tick- and mosquito-borne diseases, and many other possibilities that all came back negative. The myriad of symptoms didn’t correlate to a specific cause. Fortunately, after eight weeks, I started feeling better
I have Crohn’s disease and a permanent ileostomy, but doctors didn’t see this as a
Answer: Crohn’s disease is a consideration, but the fact that the CT scan was negative makes this less likely. I suspect that your doctors ordered a stool test called fecal calprotectin, which is very good at detecting active Crohn’s disease. If they had a high degree of suspicion, they would’ve done an endoscopy
The combination of symptoms that you had isn’t specific, and it sounds like your doctors thought about and tested you for most of the common possibilities. I’ve had more than a few patients with similar symptoms as yours where an exhaustive evaluation failed to turn up a cause, and they got better without treatment
In such cases, we suspect an infection (a viral one most commonly) that your body finally fought off. Viral infections can sometimes trigger a condition called transverse myelitis, which might explain your most unusual feature — the waist numbness. This can also go away spontaneously
A return visit to your general doctor is still a good idea, as some conditions wax and wane before getting diagnosed. Some cancers are good at hiding, especially lymphoma and myeloma, so follow-up blood testing is a smart idea to be sure, even if it’s unlikely
Dear Doctor Roach: I’m a 77-year-old woman with degenerative disc disease. I had an L4 microdiscectomy surgery in 2020, but I still have chronic pain in my lower back. Although I do core strengthening exercises with physical therapy (which helps), I’m still in daily pain. I’ve been seeing advertisements for multifidus muscle-strengthening devices, such as NeuroMD and ReliveX. What’s your opinion on this type of exercise device? — C.K
Answer: I think that better non-pharmacologic therapies are needed for back pain, and the theory of electrical stimulation to strengthen the back muscles makes sense. (The multifidus muscles run on either side of the spine, stabilizing the joints between the vertebral bodies. Weakness and atrophy of these muscles are strongly associated with back pain.) The devices that you mentioned are called neuromuscular electrical stimulation devices, and they have a complementary action with exercise
Unfortunately, the published data supporting their use aren’t strong. Some studies do show an improvement in muscle strength, and one study did show a reduction in back pain. But other studies didn’t show a benefit when compared to a control group. Some of the expert groups issued guidelines that haven’t yet recommended the treatment for chronic back pain, citing a lack of proof. A well-designed study is apparently underway
I did read a handful of reports of adverse events (mostly around unpleasant electric shock sensations), but the studies found a low incidence of side effects. I can’t recommend it based on the lack of strong evidence of its effectiveness at this time, but this may change with further studies
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
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