Expert: Dr. Timothy K. Durnin - 5/31/2007

Question
QUESTION: I have lower (cramping)back pain which goes around and causes cramping in the front. The doctor and chiropractor say it is my back causing this. I had an X-ray of the back  and also a lower and upper ultra sound of the abdomen. Nothing showed up. If it's my back why am I getting cramping in the front?
ANSWER: Hi Evelyn,

Your doctor should have explained this to you. When you hit your funny bone it refers pain into the little finger, right? Well its the same everywhere else, its called referred pain. All the nerves exit the spine and travel to the corresponding muscle, cell, tissue or organ and will precipitate an adverse reaction if it's being pinched. So if you have a pinched nerve in your back, it can cause slow bowel movements or constipation, pain and numbness down the arms or legs plus a whole host of other issues like weakness. When you go back to the doctor, have him explain this to you using a dermatomal graph, than it will all make sense.

Hope this helps!

Dr. Timothy K. Durnin
drs.chiroweb.com

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

QUESTION: When should I consider getting further testing like a MRI. ti see if there is a disc or nerve. Also what is good for the discomfort. The doctor gave me Celebrex - that does not help. I can't take my hot water bottle to work.
ANSWER: Hello again Evelyn,

It sounds like you are using the wrong tool for the job. You are not seeing a D.C. if you are getting pushed through the system with a prescription that does nothing to address the cause of your problem while putting heat on something that should be iced.

It sounds like you have more sense than your doctor, an MRI would definitely be indicated with lower extremity radiculopathy, pain traveling down your leg.

You are a candidate for spinal decompression or flexion/distraction therapy. It certainly sounds like a disc problem pinching the L5/S1 nerve root. Surgery is unnecessary since for the last two decades we have been able to decompress 95% of herniations manually with F/D equipment.

If you need a referral to someone in your area, I will be happy to accommodate you, just ask.

Hope you make the right choice,
Dr. Timothy K. Durnin
drs.chiroweb.com

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

QUESTION: I am not having any pain down my leg - it's in the bottom of the abdomen sort of like menstrual cramps.
Actually I'm seeing 2 doctors. My primary physician - he gave me the celebrex. i stopped taking it - it doesn't help. My Chiropractor is the one who sent me for the X-rays and ultra sound.
I will mention the spinal decompression.
So who would you suggest.?
ANSWER: Evelyn,
I was under the impression that you did have a radiculopathy from your previos staement, "I have lower (cramping)back pain which goes around and causes cramping in the front. The doctor and chiropractor say it is my back causing this".

This is a classic finding of referred pain, especially when it, "goes around to the leg". I assume it is going around your leg to get to the foot.

Please be clear on the exact nature and location of your pain.

Ultrsound may or may not visualize ovarian cysts, Celebrex can cause abdominal discomfort as well. Diverticulitis is another possibility, Only an endoscope performed by a gastrointestinal specialist can rule this in or out. If all the tests are negative, it may be IBS or irritable bowl syndrome usually brought on by stress. Pro-biotic therapy is very useful, without examining you, all I can do is guess. One other thing, if the pain is just in your foot, it may be plantar fascitis which is corrected with orthotics in your shoes. I need more info to help.

As far as who I would reccomend, I will need your location.

Sincerely,
Dr, Timothy K. Durnin
drs.chiroweb.com

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

QUESTION: Yes i had an ultra sound and x-rays for this situation. I've been to the gynecologist. Nothing showed up.
In december I had a routine Colonoscopy and last July I had an endoscopy.
This problem with my back begam early March. I had passed out and fell.  
I live in NJ
ANSWER: Evelyn,

It looks like most of the systemic problem have been ruled out, so flexion/distraction is the course I would recommend. I need to know the D.C.'s in your town so I can screen them to find a competent one. Send me a list of D.C's within a 10-20 mile radius and I will call each one and find the best for your condition.

Sincerely,
Dr T

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

QUESTION: Here are some DC in my area
Robert Wise 332 North Ave  Garwood, NJ
Mark Adona    June Shell    767 Central Ave. Westfield,NJ
Willam Bonsall  Jeffrey Kavalin  Antonio Pugliese
425 North Ave  Westfield, NJ
Douglas Young  45 South Ave. W Cranford
Jeffrey Kavalin 501 Parkview Ave, Westfield, NJ
Frank Caldwell  20 North 20th St  Kenilworth, NJ
Robert Ryan 67 Westfield Ave  Clark, NJ
ANSWER: Thanks for the list but I need their phones numbers. I plan on calling each one of them, I need to ask them several questions to make sure they can handle your problem.

I know it's a pain but on my end, it would take hours tracking each down since I don't have a phone book for your area and half don't have websites.

I will get on this immediately upon receiving this info,

Thanks,

Dr. T

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

QUESTION: Dr. Robert Wise is the DC I am seeing now and I've mentioned a lot of what you said.  Anything else I should ask?
Here's the list
Mark Adona & June Shell 908-232-4448

Thank you so much for your help
William Bonsall   908-654-9228  Jeffrey Kavalan 908-789-3400
Antonio Pugliese 908-654-3040  Douglas Young 908-272-2992
Frank Caldwell 908-276-4255  Robert Ryan 732-827-0800
ANSWER: I will be with patients all day and I suspect I won't be able to call anyone late tonight or over the weekend. Monday I will find you who you need.

td



FOLLOW UP,

I called all the doctors and Frank Caldwell 908-276-4255 does flexion/distraction. I told him about your case and he is expecting your phone call, just tell him I sent you through allexperts. He will be happy to try the correct approach to your problem.

Hope this does it!
Dr. Tim Durnin

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

QUESTION: Thank you for oyur help. Just an update I am going for a MRI tomorrow and after we see results I will call Dr. Caldwell.
Thank you.
Evelyn
ANSWER: Ok Evelyn,
Keep me informed!
Dr. T. Durnin

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

QUESTION: Hi Dr. Durnin
I got a preliminary result fro the MTI - I have some discs that are slightly bulging. Nothing more. I still find it difficult that it can cause cramping in the front. But nothing showed up on the lower and upper abdomen ultra sound and my gynocologist doesn't seem to worry. So i guess a problem in the back can cause anything. I wonder if it is gastro.

Knowing what you know about the MRI should I still call Dr. Caldwell as you suggested?

Thanks for your help.

Evelyn
ANSWER: Hi Evelyn,

Unless you have bowel disturbances that cause it to be bloody, loose, urgent, black or painful, your upper lumbar vertebra can and does cause pain in the abdomen. The nerves that exit the spine keep going until they innervate the muscle, cell, tissue or organ that it supplies. If this nerve is being compressed with fluid secondary to inflammation or mechanically (disc bulge), then it certainly makes sense to see the doctor I recommended.

Good luck,

Dr. Durnin

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

QUESTION: Hi Dr, Durnin
I went to see Dr. Caldwell on Friday and I will be going tonight. After the first treatment I could feel a difference. So hopefully after a few more things will be a lot better.
I have one more question - are you familiar with IC (Interstitial Cystitis?)  If so do you have any recommendations. If not that's oK - I am having a flare and looking for something.
I just want to say thanks for your help in getting me to Dr. Caldwell. No too many doctors will help the way you did.
I jjust wish you were closer
ANSWER: Hi Evelyn,

My pleasure and thank you for your kind words.

Of course I am familiar with interstitial cystitis, it's a bladder infection. Unless you have an urgency to pee all the time and then go just a little, that diagnosis is ruled out. If you are asking me about how to treat it for someone else, I would tell you to take Septra DS, it is a sulfa compound available by presciption only. If this person is allergic to sulfa, very common, then Cipro would do fine. That is until you aquire a yeast infection from the antibiotic, them I would grab myconozole which is OTC to fix that.

I think you will be quit pleased with the results of F/D therapy, give it a week.

Take Care!

Dr.T

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

QUESTION: Hi Dr. T.
IC (interestital cystitis) isn't an infection - it's a chronic bladder inflamation. I was diagnossed in 2001. From time to time I get flare ups that are just horrible. There is a lot of different opinions on treatment and one thing that works for one person does not work for another. Actually you learn to deal with it.
I also have a hiatial hernia that sometimes acts up and gives me heart burn (my DC does adjustments on it and that helps but there are times it doesn''t help). My question was dpes the IC and gastro propblems go hand in hand because when one thing gets up in a flare the other is right there.
I spoke to my urologist and she feels that with my back that could be causing my flare up. Wonderdful.
Thank you again for your help

Answer
Hi Evelyn,

You are correct,IC is a result of a bladder infection in 99% of the cases, so technically, IC is not a bladder infection, but a result of one. Chronic IC is usually autoimmune or caused by some type of allergy or pH imbalance. When you get a bladder infection, IC always results, the infection inflames the lining of the bladder. Most patients with chronic IC are mis-diagnosed and dismissed with a bogus Dx, then they are given a NSAID for the inflammation without addressing the cause. I do believe the GI problems are related to the IC, food allergies will cause this, Ulcerative Colitis, Tropic Sprue, Crohn's disease, IBS and a whole host of things need to be ruled out. Get a lower GI with biopsy if needed and see if there is any pathology in the intestinal wall, if there is, Pregnisone and Pentasa are in your future.

I sure hope it's not an autoimmune thing, there are no cures, just bad treatments.
If it is just a pH imbalance, then that's easy enough to cure. I really need your U/A results to comment further. As far as your back causing this, slim but possible, you'll know in a week after F/D anyway. If it persists, get the GI study and a second opinion with my comments to another urologist.

One way or another, you'll get to the bottom of everything as long as you persist. I will always be here to assist you if you get weird advice or solutions that don't work. I have quite a few tricks up my sleeve dealing with odd conditions, never hurts to ask.

Before I can give you treatment options, I'll need a definitive diagnosis or it ends up being trial and error and I don't practice that way.

I need to know what I'm treating before I treat. Some docs throw whatever at you until they find something that works instead of doing the ground work with thorough history taking. This to me is unacceptable and it should be for you too.
Get a firm Dx from another uro and get back with me. IC isn't a diagnosis per se, it's a general symptom which means literally, "inflamed bladder". Your question should be, "inflamed from what?" That will necessitate a diagnosis.

Good luck and keep in touch!
Dr.T