Question
QUESTION: Hello Dr. Ornstein,

Its Sarah here, again.
Guess you shouldn't have made the offer that I can get back to you with questions any time...;-)
Well, I am still waiting fir the MRI study. Meanwhile, it suddenly came to my mind where i recall this pressure feeling/pain/paresthesia in my thoracic spine from: in the past, i had several bowel surgeries, and each time, they placed an epidural catheter for better pstoperative ain management . In the few seconds the anesthesist needed to place the catheter  in the epidural space i felt a very similar pressure/discomfort. Also, one year ago, i had a lumbal puncture (in which - i think - the canule is placed deeper, beyond the epidural space) and it felt very similar, except that it was associated with more pain rather than discomfort.

So could this be a sign that something is pushing on the external dura (either from inside or outside)?
Would this be suspicious of a tumor?
The pain and paresthesia are still increasing day by day. Now, sometimes the affected area feels numb (though actually, it isnt (yet)).
Thanks so much.

ANSWER: Hi Sarah!

No problem, I meant what I said and you can contact me anytime and I am happy to do anything I can to help.

Well, if the catheter was in the area of your current thoracic pain, it is certainly possible and would provide some kind of alternative causation regarding your pain, considering that tumors in that area are not very common.  Only thing is, you said in the past, and I would be somewhat curious for a delayed reaction if it was some time ago. My experience regarding epidurals in people is that there can be some delay, usually within weeks, but they can be problematic. Pain can take up to a year to abate and there is really not much that can be done, so it is very frustrating, not only for the person that suffers, but to try and find some relief in treating it.

So, if that is the case, and I hope it is, there is not much that can be done but to wait and, with time, it should clear up. Sometimes a TENS Unit can help with the nerve pain, but you would have to check with your doctor because of the area and pending results of your diagnostic tests. It is also possible a local steroid or analgesic injection would provide relief.

In your case, we are waiting for diagnostic results and yes, this could be a tumor - not sure if it would be that deep, perhaps pushing from the outside, however, it must be suspect until ruled out. Pressing on the Dura, if it is a tumor and growing in size would tend to produce more long track symptoms.......... other symptoms than localized pain and numbness as it places more pressure on the cord itself.

So, again, we are just theorizing at this point, but it is interesting that you picked that up. You sure have been through a lot.

Take care and hope to hear from you again soon.

Dr. Steve



---------- FOLLOW-UP ----------

QUESTION: Thanks...
No, the catheter as well as the needle for the puncture were placed much deeper, in the lumbar region i think. I just meant that the kind of pressure pain during insertion was similiar to the pain in the thoracic region now. Moreover, the surgeries were 5 years ago. I never had any neurological issues with them back then.
It concerns me somewhat that the pain and paresthesia are getting worse so fast, and that they are worse in the mornng.
As for other potential symptoms: well thats pretty hard to say in someone with so many issues/diseases what is causing what.
But i have been experiencing altered sensation of the upper thighs since some time, too.

ANSWER: Hi Sarah,

Well, that is not great to hear. It is just to difficult to guess what is going on without results from the MRI. I don't like the symptoms in your upper thighs. Hopefully, the results will be in soon and a treatment plan can be formulated. A neurologist might be able to assess what is going on best at this point, however, being that the results from the MRI should be definitive, I'm sure one will be involved. I hope you are doing ok, waiting for the results must be very difficult.

Keep me posted and all the best.

Dr. Steve

---------- FOLLOW-UP ----------

QUESTION: Thanks so much. I havent often seen such empathetic docs in my whole "patient career" (which is very long despite my young age)
Could you explain more precisely how the altered sensation/paresthesia in my upper thighs could relate to a spinal problem?

Answer
Hi Sarah,

OK,

It depends on the type of sensation. It could be related to a lumbar problem and that would cause altered sensation in a dermatome pattern. Have you experienced this before? Is it just since you have noticed the thoracic problem? It is possible, if there is pressure on the spinal cord in the thoracic area, it could cause some of these symptoms further down. What to be concerned about is any loss of bladder or bowel control or what they call saddle anesthesia, which would be loss of sensation around where you sit, like on a saddle of a horse. If it is a lumbar problem, it would tend to be in the lower back and around the side of the thigh, going across and down the upper thigh.

Dr. Steve

And thanks for the kind words!