Q: I have lower back ache which makes walking upright difficult, so I tend to lean forwards for relief. I’m 81 but I still go the gym three times a week and don’t want to end up with a stoop. What could be the cause?
David Pollendine, Biggleswade, Bedfordshire.
A: Lower back pain is extremely common, with a range of different causes, including a slipped disc.
But I wonder if, in your case, the problem is possibly related to the medication you’ve been prescribed.
In your longer letter, you mention taking 4mg a day of a steroid – probably prednisolone – for polymyalgia rheumatica (PMR). This is a type of inflammatory arthritis, which causes often crippling pain and stiffness in the muscles and joints, particularly in the shoulders, neck and hips.
It’s important to stay on the medication – it’s usually given for up to two years – but a known risk of the long-term use of steroids is osteoporosis, where bones lose density and become fragile, and prone to breaking.
This can occur almost silently, until, for instance, the bones in the lower back, which support most of the body’s weight, collapse. This will cause pain, loss of height and a stoop.
Another possibility is changes due to osteoarthritis.
Persistent back problems should be checked out. Ask your GP to refer you for an X-ray or MRI scan, says Dr Scurr (picture posed by model)
You also mention that you’ve had both knee joints replaced due to severe osteoarthritis, and it’s highly likely you also have it in the spine.
This can lead to spinal stenosis – or an abnormal narrowing of the spinal canal. This occurs as the body responds to the inflammation caused by osteoarthritis by producing more bone. In turn, this narrows this canal, possibly explaining the stooping you describe.
I would suggest asking your GP to refer you for an X-ray or, better still, an MRI scan.
You may also need a DEXA scan to assess your bone density, but while you await the results of any investigations, you should be taking a calcium supplement and a daily dose of vitamin D, given what we know about the effects of long-term steroid use on bone health.
Q: My doctor has diagnosed me with benign thyroid nodules and I have a visible lump in my lower neck. Do I need any treatment to remove them?
Samantha Roberts, Newmarket, Suffolk.
A: Thyroid nodules are round or oval lumps within the thyroid, which is a butterfly-shaped gland in the front of the neck.
We don’t know what causes them but they are very common: up to 70 per cent of women have at least one, while more than 50 per cent of men and women in their 50s have multiple nodules (a ‘goitre’).
The first step is to have an ultrasound scan, along with a blood test to measure the level of thyroid stimulating hormone, or TSH. A high level of TSH is a marker for cancerous change, while a low TSH indicates the nodule is benign. If cancer is suspected, the next step is a biopsy (using a long needle to remove bits of thyroid tissue).
It is reassuring that your nodules are benign: these should be monitored with regular ultrasound checks, initially after 12 months, then 24 months, and then every three years.
If the nodules grow and exceed 4cm in size, it may be necessary to have surgery to remove them. Most benign nodules do not shrink over time.
IN MY VIEW: Tech is ruining care of older patients
Technology – and online consulting in particular – was meant to provide patients with easier and faster access to medical care and bolster their confidence in the system.
But has it? In newly published research, leading doctors spent two years embedded in 12 GP practices to gauge the reality of delivering NHS care in a digital age. Sadly it only confirmed what many of us on the primary care frontline feared: that the human elements of care are under attack.
For example, the study revealed that elderly, infirm patients who once would sometimes be seen by their GP in their homes are now expected to get to the practice – the only alternative being a phone consultation.
And those who find that, due to deafness or vision problems, ‘seeing’ their doctor in this way offers little comfort, tend to just do without.
But the research also revealed that GPs remain committed to delivering the traditional values of general practice, including a relationship with patients, continuity of care and compassion.
I hope young doctors are taught to prioritise these principles and take technology for what it really is: a useful tool.
Write to Dr Scurr at Good Health, Daily Mail, 9 Derry Street, London W8 5HY or email drmartin@dailymail.co.uk – include your contact details. Dr Scurr cannot enter into personal correspondence. Replies should be taken in a general context and always consult your own GP with any health worries.
