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Question
"Hello Dr. Michael , I am 48 years old, my weight is 74 kg and my height is 159 cm. I am a mother of 6 beautiful kids and recently I started having pain in my right thigh ( inner side) and these are results of my MRI done for lumbar spine and right hip. I wonder if you can kindly explain for me what is the problem with my back and if you can explain what this means:(

High signal intensity focus ~ 1 cm is seen in the left iliac bone (T2 axial Im: 23)


=========== TEXT REPORT ===========
INDICATION:
Sever pain in the right hip joint radiate to the right thigh.
TECHNIQUE:
Multi planar, multi sequence images of the hips were performed.
Findings:
" No previous images available for comparison.
" Normal appearance of both hip joints with no evidence of effusion.
" The left iliac bone shows well defined focal fatty change , otherwise rest of the visualized bone marrow appears within normal.
" The visualized soft tissue is unremarkable.

Conclusion:
Normal study.



NB: Pelvic congestion is noted gynecological correlation is advised.


and the second report about lumbar

=========== TEXT REPORT ===========
INDICATION:
Server pain in the right hip joint radiate to the right thigh.
SEQUENCES:
Non-enhanced multi-planar multi-sequences MR of the lumbar spines were obtained.
OBSERVATIONS:

" No earlier films available for comparison of lumbar spine.
" Exaggerated lumbar lordosis suggestive of back muscle spasm.
" Desiccation of L2-3 and L3-4 levels.
" L2-3 level shows mild disc bulge abutting the thecal sac with narrowing of the inferior
aspects both neural foramina.
" L3-4 level shows diffuse disc bulge abutting the thecal sac with narrowing of the inferior
aspects both neural foramina.
" L4-5 level shows diffuse disc bulge abutting the thecal sac with narrowing of both neural
foramina (LT>RT).
" Rest of the lumbar discs shows no significant disc bulge or protrusion.
" The facet joints are normal.
" RVF uterus is noted.
" High signal intensity focus ~ 1 cm is seen in the left iliac bone (T2 axial Im: 23)

IMPRESSION: -
Multi-level degenerative disc changes with neural foraminal stenosis.

Thank you very much"

Answer
Dear Om Ali -

My heart goes to you because I believe that you are having some significant pain and muscle spasm in your lower back.

In general terms, the MRI shows that the discs between your lumbar vertebrae have bulged out of the area where they are supposed to be.  The bulging areas are pushing against nerves.  Also, when discs bulge they often collapse, and this makes the opening where the nerves come out from your spinal cord smaller, and this smaller opening also pushes on the nerves.  This will cause referred pain, and most likely explains why you feel pain in your hip.  The MRI indicates that your hip is normal but that there are problems in your lower back.

This type of condition is relatively common, and one that I see in various forms in my clinic.

Sometimes, this can be well treated with acupuncture, and sometimes not.  Since you are not in front of me right now, and I cannot tell to what degree you are experiencing muscle spasm in your back, I can only speak in generalities.

I hope that this brief response gives you some understanding of what is going on.  Pain can create fear because you worry that this will go on forever.  Have hope that you will be able to find relief.  The typical treatment process is muscle relaxant and pain control medication, with physical therapy.  Surgery is an option, but is normally not considered until other non-invasive methods are tried first.

Also, the MRI indicates that you have a retroverted uterus.  This is seen in about 20-30% of women and usually means nothing.  Since you have several children it obviously had no effect on fertility.  Since it can create back pain, however, you should see a gynecologist just to make certain it is not contributing to the overall pain that you have.

I wish you well in all things in your life, and wish good health for your children and family.

Mike Zanoni
Hawaii  

Acupuncture

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Michael M. Zanoni, MS, LAc

Expertise

I am knowledgeable about severe and chronic pain from musculoskeletal or neurological conditions, especially trauma, headache, and fibromyalgia. I can provide guidance that will assist healing and recovery after illness or surgery. I have a particular interest in long-term chronic conditions that are becoming progressively worse or intermittently severe (such as viral hepatitis, Crohn's, or Takayasu syndrome.) I have extensive experience treating endocrine disorders, such as diabetes or thyroid problems, where the primary condition is being monitored by a Western-trained physician, and cancer where there are specific treatment goals other than cure (e.g., decrease of pain; reduction of side effects of radiation and chemotherapy; lessening of edema; palliative treatment of associated conditions.) I do not treat or answer questions about infertility, ALS, or senile dementia.

Experience

I have practiced Oriental medicine for over sixteen years in a variety of settings. Much of my practice has centered around a busy clinic specializing in severe long-term chronic pain conditions and palliative care. For several years I worked in a hospice program. I also established a non-profit community clinic providing care to under-served and homeless patients. My work has found me in an HIV clinic in San Francisco, a busy private practice in Oregon, to traveling on muddy 4-wheel drive roads to see dying patients. I now teach acupuncture and Oriental medicine at a school in Hawaii.

Education/Credentials
My training was at the American College of Traditional Chinese Medicine in San Francisco where I received a masterís degree in Chinese Medicine. I have current board certifications in Oriental Medicine, Acupuncture, and Chinese Herbology from the National Certification Commission for Acupuncture and Oriental Medicine. I also have certifications in Chinese tui na bodywork, Physical Rehabilitation Training, and biofeedback. I am licensed to practice acupuncture and Oriental medicine in Hawaii, Oregon, and Washington. I also have BA, MS, and PhD degrees in subjects not directly related to Oriental medicine.

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