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Ask Dr. Gott 1/23
Surgery last, best hope for pain relief
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    DEAR DR. GOTT: I am a 68-year-old female who has had back problems (spinal stenosis) for the past 10 years. Over this period, I have had eight cortisone shots and several physical-therapy sessions — anything to avoid surgery.
    Now I suffer muscular pain in one leg and even limp when I try to walk any distance. I also have difficulty climbing stairs. I'm wondering if I can put off the surgery any longer and what the success rate is with the procedure.
    DEAR READER: You appear to be the victim of a progressive neurological disorder: pressure on the nerves as they pass through or around the spinal discs, with resulting compression of the nerves leading to chronic pain.
    You have put off repair as best you can, but it is surgery alone that will "fix" your back and nerves. My conclusion is based on the limited information in your letter. Your best bet is to be examined and tested by an orthopedic surgeon specializing in discogenic disease. Speak with your primary care physician for his or her referral.
    On the negative side, no surgery can be guaranteed free from side effects. Everyone who undergoes surgery responds differently. Some fare extremely well, while others having the identical procedure have a more difficult recuperation period. Age, physical condition, related or unrelated medical problems and a host of other issues all come into play. I cannot begin to guess which category you might fall into. Therefore, I'll have to pass on projecting the success rate. Quality of life is an important issue, and the risks of surgery must be weighed against the pain you are suffering. I recommend selecting a specialist you have confidence in and who is highly recommended by your doctor. This is often the foundation on which to build success.
    While you are awaiting your appointment, you might try acupuncture, massage, physical therapy, chiropractic manipulation and other modalities. Then, should you not be a candidate for a procedure, the specialist can advise which alternative therapy is most appropriate.
    To give you related information, I am sending you a copy of my Health Report "Managing Chronic Pain."

    DEAR DR. GOTT: I have severe renal artery stenosis on my right side. I'm a 73-year-old male and have a history of heart bypass surgery. Would acupuncture be an effective treatment or at least worth a try, or are my thoughts misdirected?
    DEAR READER: If you are in pain, this alternative form of therapy might help, but acupuncture is not ordinarily a consideration for treatment of arterial blockage (stenosis) or heart disease. Without knowing more about you, I can only recommend you speak with your primary care physician or cardiologist. They both should have your complete medical history and can better direct you.
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