Balance, high blood pressure medications, and …
I am seeing a neurologist about my worsening balance trouble. I am also dealing with high blood pressure, and currently take 50 mg of Losartan in the morning and, for the past two months, 5 mg of Amlodipine Bensylate at bedtime. Two nights ago, because of the hot temps, I added a 10 mg Melatonin. Might I be making my balance trouble worse with this mix of meds and Melatonin?
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Hey @ray666, you'll see that I moved your post to the previous discussion that you started just for continuity and so the members that already reached out can see any new information you have and are posting.
Something you might be interested in reading:
I am sorry to hear that since your previous post you have started to feel a bit dizzy at times. Have you considered talking to an otolaryngologist about inner ear problems that may cause balance issues?
Thank you, @amandaburnett, for moving my post to my original topic. And thank you, all, for your thoughts and suggestions! Since last week, I've had no further dizzy spells. My primary doc thinks it may be unrelated to my ongoing balance difficulties. Of course, we can't be sure. In any event, I'm keeping a detailed journal of all of my symptoms, related or unrelated, and will be meeting with my neurologist Wednesday-after-next. At that time, she and I will go over my journal, and also my recent cervical MRI. In the meantime, I wish you all a healthy, happy weekend! ––Ray
Thank you, all (@artscaping, @elizm, @njh, @jenniferhunter, @amandaburnett) for having replied to my posts! Your words have been immensely helpful. I met with my neurologist yesterday and now have what seems a clear diagnosis of my problem: cervical stenosis. Finally, I have a name to put to what has been troubling me––and getting slowly worse––for something like ten years. (Can any of you relate to this?) The immediate plan is twofold: neck PT, and a visit with a neurosurgeon––not necessarily to arrange surgery but to learn what if anything besides PT might be the wisest way to tackle this cervical stenosis. ––Ray
@ray666 Thank you. You are experiencing what I went through 5 years ago. It is reassuring to have an answer and be validated, but now with that information there are choices to be made.
I knew I would become disabled if I allowed my spine condition to worsen. My spinal cord compression was at C5/C6 with bone spurs (disc osteophyte complex) pressing into my spinal cord in the central canal. The critical factor is how fast the bone spurs are growing and if the compression is increasing. The herniated jelly like inner disc material causes inflammation when it spills out and that causes bone spur growth which can also happen at the nerve roots if it herniates that direction. I did not have that, just the spinal cord compression. On MRI,s I saw the bone spurs double in 9 months time while my symptoms got worse. PT can only go so far, and if you can maintain normal neck curvature, it helps. If muscle spasms start moving your vertebrae around with a compressed spinal cord, it just makes the central canal space smaller. I was having dizziness when muscle spasms twisted or tilted my vertebrae. I went through intermittent problems because my PT would realign my neck and the next muscles spasm brought on the symptoms from the compression again.
What I can tell you is find the very best surgeon that you can at a respected medical center. There are ratings for this on the US News and World Report website. Look up everything you can about a surgeon. Ask questions. Different surgeons have different choices for implants they use and it they do or don't do disc replacements. My surgery was at Mayo Rochester with Dr. Fogelson. Here is my story.
My experience was that this surgery was not as bad as I had imagined. On waking up from surgery, all the spine generated pain and leg weakness was gone, and I was left with the incision pain. After 6 weeks I felt pretty good and after 3 months, I could forget that I had had spine surgery. I also had a good physical therapist who also did myofascial release to treat the surgical scar tissue. Here is our discussion about MFR:
There are lots of factors that play into surgical success including things like age, smoker or nonsmoker, other health conditions, etc. Also know that permanent damage of the spinal cord or paralysis is possible if you were to be in a traffic accident in this condition. If you do choose to have surgery, it's best to do that before permanent damage happens. Make sure to ask your surgeon about that time frame, but listen to your body. It is also good to get several opinions before making your decision. I chose a bone graft fusion without hardware. If you need to discuss surgery experience further, please reach out to me.
One thing that surgeons sometimes do is spinal injections of steroids to calm inflammation (which are not FDA approved for this use). That didn't help me much when I had one as a diagnostic test. It can indicate what would be resolved by surgery. I also had a new sharp electric stabbing pain in my hand for several weeks because of the epidural injection. Also know that surgeons do this to put off surgery, and that might be because they don't want to take on the risk of your case, so instead of offering a fix, they offer injections. Surgeons have ratings for the success of their procedures and they don't want to lower their statistics if a procedure doesn't go well. It's easier to have great ratings if you can cherry pick your cases. I ran into that myself before I came to Mayo and was refused by 5 local surgeons. At Mayo, the conversation was about fixing the problem and I was offered surgery right away. The other surgeons had not understood the connection of my symptoms to the imaging, and because it generated pain all over my body, they were afraid to touch it.
It's a big decision. Is there anything I can do to help you?
Dear Jennifer (@jenniferhunter),
Thank you a millionfold for your letter! Earlier, I started a 3-ring binder in which I’m saving everything related to my stenosis. Your letter is now in my binder. I’m also heading over in a few minutes to my partner’s house. She’s much concerned about my stenosis. I’ve made a second hardcopy of your letter to give to her.
I appreciate your willingness to help with this. I’ll let you know more as I learn more. This business is so new to me––less than 24 hours, although I’ve been trying (with so-so success) for almost a decade to assign a name to what’s been troubling me. As I believe I mentioned in my post, today, rather than feeling defeated by my diagnosis, I’m feeling somewhat triumphant: at last I’m able to ask the right questions of the right people. It’s a heady feeling!
Briefly (as I need to get over to my partner’s house): the report of my neck MRI concludes with “Impressions: (1) There are spondyloses, protrusions, and osteophytes in the cervical spine at the C3-4 through T1-2 level, (2) There is severe right foraminal stenosis at C4-5, (3) There is moderate canal and severe foraminal stenosis at C5-6, (4) There is severe bilateral foraminal and moderate canal stenosis at C6-7, (5) There is no cord lesion or compression, (6) There is moderate cerebellar atrophy.
I would imagine you can guess––this being so new to me––I barely know what any of this means!
And now I’d best get over to my partner’s house. Again, Jennifer, thank you for being there!
I had a similar experience. I staggered when I walked and my legs were weak from Myelopathy. I had neck and shoulder pain and radiculopathy in both arms and hands. I had Ossification of the Longitudinal Ligament that was flattening my Spinal Cord at C5/6 and C6/7. I had an Anterior Discectomy and Fusion with Cadaver Bone and Titanium Plates and Screws in 2006. I had a difficult recovery with a lot of pain and ended up with a Paralyzed Vocal Cord. I could barely whisper. The Surgeon said there was a possibility I would never get my voice back, but fortunately it suddenly returned 3 1/2 months later. I had severe pain in my shoulders and arms for 3 months and numbness and tingling in my right arm and hand that lasted for a few years. The reason I had so much pain is because I can’t take Opioids. I took Darvocet (no longer on the market) Robaxin, and Gabapentin. After 4 months I was able to resume most activities but I had Tricep weakness for a few years where I had difficulty raising my arms above my shoulders. I had PT for about 8 visits to help with the shoulder pain and release the arm nerves with nerve glides. It did not resolve all of my issues, but improved them. It was a difficult surgery for me. But one Surgeon I saw told me if I were to be in a car accident and hit my head on the dashboard I would be paralyzed. I had a well trained Neurosurgeon who did his Fellowship at Cleveland Clinic, and the Hospital built a new Neurosurgery Wing for him. It’s not an easy surgery for everyone.
Hi, @njh. Thank you for sharing your story. As I believe I mentioned in my earlier post, I'm just beginning to learn about cervical stenosis. Until yesterday, I had no idea in what direction I should go to find answers. Stories like yours are an immense help. From what I have learned so far, my difficulties may still be somewhat limited––which I find amazing, considering the onset of symptoms was a decade ago. To rank my "complaints," my No. 1 difficulty is walking: I fell as though I'm walking on the deck of a ship rolling about in a moderate sea, not a stormy sea, only a lightly heaving sea. Otherwise, my issues are minimal, comparatively so: some neck and shoulder tightness (not pain(, and (if it is related, and some of what I've read says it may be) some deterioration of my handwriting (no hand pain, however, nor numbness, really). I look forward to learning more about this condition. Posts like yours, and this forum in general, are most welcome! ––Ray
@njh Thanks for sharing your experience. I have wondered if plates and screws make a difference in the pain after surgery and I did not have any hardware placed in my ACDF, so was it easier for me? I also had a lot of hands on physical therapy with myofascial release before and after surgery (when I was healed enough). This let my tissues be looser and easier to retract during surgery, so less pulling on my neck to get to the spine. I think that probably helped a lot. I did have to be very careful not to swallow wrong in the beginning.
We do have different experiences and it is a big surgery. I wanted to let you know (or anyone else) that there are treatments for a paralyzed vocal cord after cervical spine surgery. Mayo does a procedure that places an implant that allows the vocal cords to meet again, and that restores the voice. My surgeon told me about that when he told me about the risks. Here is a Mayo page that describes treatment, scroll down for the information.
Good morning, Jennifer (@jenniferhunter). This is the first I've heard of a person's vocal cords being in harm's way. I'd like to learn more. I'm still waiting for approval of my neurologist's referral; I may be weeks away from meeting with a surgeon. And I can't even be sure that surgery is in the cards for me. It may be, however, and if so, I want to know as much as possible––especially have all of my questions lined up––before I meet the surgeon. Can you (or anyone who's had the experience) tell me more about vocal cords and cervical surgery? ––Ray
Good morning, Ray. Yes, a paralyzed vocal cord is a risk of anterior cervical spine surgery because of possible nerve damage due to the proximity of the nerves to the surgical path. If you damage a nerve it causes muscle atrophy, and the vocal cord goes slack. This would make the voice sound like a whisper because the vocal cords don't close together to control the sound. During anterior spine surgery, they will retract the esophagus and trachea to the side so they can access the spine right behind it, so that gets stretched a little bit. My voice was a little hoarse for 2 days after surgery, but I could speak fine. My throat was sore (2 weeks) and swallowing was tricky for a few more weeks after that. It does help to stretch the muscles and skin on the neck where the incision will be. I asked my surgeon that ahead of time and he showed me what to do that could make it easier for him. You can ask your surgeon what they would do differently if you were an opera singer and depended on your voice for a living. Sometimes there is a posterior approach to the cervical surgery which hurts more and has a longer recovery, but it all depends on where the surgeon needs to access the spine, and how to get there with the least amount of risk of damaging other areas. I knew a lady from another online group who did have a paralyzed vocal cord after spine surgery. She had multiple spine surgeries before that with out vocal cord issues. She did go to Mayo and get the implant which is a triangle shaped device that takes up some space and pushes the vocal cord to meet its mate. She had posted a video of her speaking after that and her voice was normal again. I don't think that happens to a high percentage of patients, but your surgeon needs to answer that. It is best to seek several opinions before you decide on surgery, and you could get a 2nd opinion from a surgeon who has operated on people who depend on their voice professionally.
I like that you are seeking information to make an informed choice and keeping an open mind. I did that too, and I even watched surgeons giving presentations to other surgeons online about spine surgery, and management of the issues that arise, and what make a good or poor candidate for a procedure. To have a great outcome, you need an excellent surgeon who you can trust with your life, and to get onboard and embrace the situation. Having a positive attitude really helps, and it helps you heal better and lowers your stress. Stress and worry over surgery will just increase fear and pain. I expected something much worse than it was for me. In the hospital, the day of surgery, the pain meds just nauseated me. They didn't take all the pain away anyway, and it wasn't horrible. After I left the hospital, I managed just fine without pain meds and just accepted some healing pain. The more you know about something, the less it will worry you. Do ask the surgeon to explain your MRI imaging to you and explain everything on the report. My opinion does not count since I am not a medical professional, but I think you will be offered surgery, but keep in mind, you may not be offered surgery if the surgeon is afraid to take your case if it looks too complicated. At that point, a deformity specialist might be a good consult. My surgeon was that, and also taught cervical procedures at spine conferences. You might look up the credentials of the surgeon you will see ahead of time and look for any videos or research papers they have written. I don't know if you can choose a surgeon yourself, but it helps to shop around and see what is out there. I had to do that until I found the right one.