Q: My father is about 56-years of age. He is hypertensive and diabetic. He is on Insulin 70/30 and on anti-hypertensive treatment. He is overweight and has been having hip-joint pain and backache on walking short distances or on standing. He has also developed weakness and numbness of both legs. After sitting for few minutes, he feels no pain and weakness of the legs on walking. MRI reveals spinal stenosis. Can you please tell me the medical treatment and about the chances of success in case of surgery?

A: It is imperative that the correct diagnosis be established for your father’s symptoms. The question of optimum medical treatment and the prospect of benefit from surgical intervention will be issues to consider subsequently.

The foremost task therefore is to evaluate the history of symptoms and perform a physical examination and then assess if the symptoms and signs corroborate with the MRI evidence of spinal stenosis. Your father, from the description provided, appears to have neurogenic claudication secondary to central canal stenosis. However, an insulin dependent diabetic must be investigated for two alternative diagnoses, namely, diabetic neuropathy and vascular claudication.

The first line of therapeutic plan for spinal stenosis would be symptomatic measures and activity modification. If, however, the quality of life is seriously compromised due to claudication (leg and buttock pain), a neural decompressive procedure will have to be considered on an elective basis.

Urgent surgical decompression is required only for patients with a rapidly progressive neurological deficit and/or cauda equina syndrome (bladder and bowel dysfunction). The results of surgery are reported to be good to excellent in 80% of patients.

Dr Riaz Hussain
Lakadawala
Aga Khan University Hospital


QI sometimes have bad breath problem. I have never touched cigarettes, alcohol and I brush my teeth twice a day. I also notice a white paste (sort of layer or residue) on my tongue. The problem is a must while I am on a journey. I can’t stick to mints and mouth sprays all the time. This is affecting my confidence badly.

Besides, I also feel dizzy for a while when I suddenly get up from bed. And my tummy is at times filled with gas. Milk does not agree with my system and I have to go to the toilet soon afterwards. I usually feel heavy, please tell me what I should do.

ABad breath is a very common problem and the medical term for it is Halitosis. There are multiple reasons for this problem which need to be identified and treated. These include improper brushing, gum problems, calculus, plaque accumulation and the latest research points all gastric problems play an important role in producing halitosis.

As you have mentioned that you do have gastric problems, I will suggest for you to get it treated first by a physician. Also you should consult your dental surgeon who can pinpoint any oral cause and treat it accordingly. Normally a good scale/polish along with an anti-plaque mouthwashes containing Triclosan or Chlorhexidine should be beneficial. The maintenance of treatment will matter the most for a good prognosis.

The white paste/layer you see on your tongue is a probable oral Candidal infection. This is a fungus which is again a normal inhabitant of your oral cavity. Its increased production is indicative of decreased immunity and certain vitamin deficiencies. During fever or flu its deposition also increases.

The solution is to see an oral surgeon first who can find the cause of its increased production and prescribe proper regime for it. Do not try to brush it off, unless diagnosis is confirmed and professional advice sought.

As for you getting dizzy when you suddenly get up, this is probably postural hypertension which your physician can deal with. If you follow the instructions of both your physician and dentist, I see no reason for your bad breath to persist. Remember to see your dentist every six months.

Dr Abdul Basit Padhiar
Liaquat National Hospital


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