[39M] With severe numbness in feet and lower legs, difficulty urinating, and lower back pain

Patient Description

A 39-year-old male presents with severe numbness in his feet and lower legs, described as a 'pins and needles' sensation, along with severe pain. These symptoms have been ongoing for a few months. The patient also reports difficulty urinating, requiring significant effort using core muscles to produce a small, weak flow of urine, rated as 9 out of 10 in difficulty. Additionally, the patient experiences pain in the lower back, attributed to a cracked disc. Constipation and weakness in the legs are also noted, but there is no loss of bladder or bowel control and no saddle anesthesia. The patient consumes alcohol daily, typically 10-12 drinks per day, and has a history of alcoholism diagnosed 10 years ago. Family history includes stroke, autoimmune disease, diabetes, and psychiatric illness. Current medications include Gabapentin (400mg, 2 capsules 3 times a day), Tizanidine (4mg, 1 tablet every 8 hours), Metoprolol ER Succinate (25mg, 1 tablet daily), Folic Acid (1mg, 1 tablet daily), Vitamin D3 (50,000 IU, 1 capsule per week), Pantoprazole (20mg, 1 tablet twice daily), and Amitriptyline (50mg, 1 tablet at bedtime). The patient has no known allergies to medications and does not take any over-the-counter medications, supplements, or herbal products.

Arora's Assessment

What might be happening

Based on the information you’ve provided, there are several serious conditions that could be causing your symptoms:

Cauda Equina Syndrome: This is a serious condition where the bundle of nerves at the end of the spinal cord is compressed. Symptoms include severe lower back pain, numbness in the legs, difficulty urinating, and weakness in the legs. This condition requires immediate medical attention to prevent permanent damage.
Spinal Cord Compression: Given your history of a cracked disc, it's possible that the disc is pressing on your spinal cord or nerves, leading to numbness, pain, and difficulty with urination. This also requires urgent medical evaluation.
Peripheral Neuropathy: This condition involves damage to the peripheral nerves and can cause numbness, tingling, and pain in the extremities. Chronic alcohol use can contribute to this condition.
Urinary Retention: Difficulty urinating and a weak urine stream can be signs of urinary retention, which can be caused by nerve damage, medications, or other underlying conditions.

What you can do

Seek Immediate Medical Attention: Given the severity and duration of your symptoms, you should seek immediate medical attention. Go to the nearest emergency room or urgent care center. If you are unable to get there yourself, call 911 or have someone drive you.
Describe Your Symptoms Clearly: When you see a healthcare provider, make sure to describe all your symptoms, including the numbness, pain, difficulty urinating, and any changes in bowel habits. Mention your history of a cracked disc and your alcohol use.
Follow Medical Advice: Once you receive a diagnosis, follow the treatment plan and advice given by your healthcare provider. This may include medications, physical therapy, or possibly surgery.
Limit Alcohol Consumption: Reducing your alcohol intake can help improve your overall health and may alleviate some of your symptoms. Consider seeking support for alcohol use if needed.

Remember, I am not a doctor, and this information is not a substitute for professional medical advice. Please seek care from a real health professional to receive a formal diagnosis and appropriate treatment.

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1 yr ago

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