Question
For the last 2 months, I've had lower back pain that seems to be getting worse.  I am overweight & relatively inactive, and I have had back pain off & on for years, but this seems to be a totally different animal.  I feel relatively ok thru the day, but every night I get approx. 5 hrs of sleep b4 back pain wakes me up.  I toss & turn and try to stretch to relieve the tightness/pain, but no position makes any difference.  My lower back feels weak, as if I've spent hours lifting boxes, and I have to turn over using my legs & arms.  Getting up, for the 1st few minutes I can barely stand up straight, but after I've moved around a bit, the pain is quickly 90% gone.  I cannot get more than 5-6 hrs of sleep no matter what I do.

I'm also not quite sure what type of dr. to visit - GP, chiro., or gyn.; here is my history.  I have an intramural fibroid, not sure exactly where it is located, but as of last March it was the size of a small lemon; I have wondered if this could be pressing on my spine, but would've thought that would be an all-day pain, or at least not just in the mornings.  I have PCOS, and Type 1 von Willebrand's disease, which means I am supposed to avoid NSAIDS (altho in desperation I have tried ibuprofen before bed lately, with no success.)  I recently began taking depo-provera shots (5 months ago) for severe menorrhagia, and lipitor & tricor (3 months ago) for high chol. & triglycerides.  I am aware that statins can cause dangerous muscle problems but do not know if my symptoms fit.  

Any advice you might offer would be greatly appreciated!  Thank you.

Answer
Dear Toni,

Sorry for the delay, but this is a bit complicated, and I wanted to get you as much information as possible.  You have multiple issues to deal with, but they are all inter-related to some extent.

The first problem is that you have PCOS.   In women with PCOS, the ovary doesn't make all of the hormones it needs for any of the eggs to fully mature. They may start to grow and accumulate fluid, but no one egg becomes large enough, and some may remain as cysts. Since no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman抯 menstrual cycle is irregular or absent. Also, the cysts produce male hormones, (androgens) which continue to prevent ovulation. These imbalances can easily contribute to the fibroids you have mentioned.

Symptoms include:  infrequent menstrual periods, no menstrual periods, and/or irregular bleeding; infertility or inability to get pregnant because of not ovulating; increased growth of hair on the face, chest, stomach, back, thumbs, or toes; acne, oily skin, or dandruff; pelvic pain; weight gain or obesity, usually carrying extra weight around the waist; type 2 diabetes; high cholesterol; high blood pressure; male-pattern baldness or thinning hair; patches of thickened and dark brown or black skin on the neck, arms, breasts, or thighs; skin tags, or tiny excess flaps of skin in the armpits or neck area and sleep apnea.  Sounds like some of your complaints doesn't it!?

To complicate matters you have an inherited genetic disorder--V WD type I.  This is a problem with the vWD clotting factor.  Although this does predispose you to bleeding problems, most with Type 1 vWD require no treatment.  This a quantitative defect meaning you don't have enough of the protein clotting factor.  Trouble may arise in the form of bleeding following surgery (including dental procedures), noticeable easy bruising, or menorrhagia (heavy periods)...again contributory to your symptoms.  You have been warned against the use of NSAIDS because of their blood thinning ability and the fact that they can causes irritation/bleeding in the digestive tract.

So now you have been prescribed Depro which I am sure is intended to help balance your hormone levels, but may accentuate your problems by adding Progestin (active ingredient in Depro) to your system.  This is prevents ovulation and increases cervical mucus.  It will reduce your periods, but side effects actually include profuse uterine and vaginal bleeding which could be very serious in your case, pregnancy symptoms, weight changes and mental depression. This is an attempt to help your symptoms, but it is not addressing the root cause which comes from the PCOS.

In addition, you have been placed on tricor and liptor for your cholesterol and triglycerides which is also an attempt to control, but we have already discussed the reasons fro the increases in your case...PCOS...lipitor and tricor will do nothing for PCOS, and will only help to make your blood tests "appear" to be better!! Moreover, these drugs severely deplete the cellular levels of one of the most important anti-oxidants in your body (Co-Enzyme Q-10) which actually increases your risk of cardiovascular disease because co-q-10 reduces cellular inflammation.  And yes statins have a track record for causing other problems, most notably increased muscle aches and pains which can lead to a muscle wasting disease called rhabdomyolysis=possible back pain!  In addition, lowering your cholesterol will actually affect your hormone levels...all hormones in the body are synthesized from cholesterol!  **Tryglyceride levels on the other hand are very problematic, and you do need to increase your exercise regime for fat burning, work on proper dietary intakes for controlling your metabolism, increase fiber, and lay off all the processed foods/grains...these wreak havoc on your system.

So now you are on three separate drugs which are all covering symptomatology, and all have side effects which directly correlate with your complaints...This is a problem in itself and clouds any possible true diagnosis.  Your main problems still remains that you have a hormonal imbalance and PCOS.

Okay...moving on.  Back pain, the reason for you inquiry.  As you can see from above, this is a muddled mess.  From your history and current situation, I don not think that your back pain is likely to subside any time soon and will most likely continue until the above issues are addressed.  This sounds more like a systemic issue rather than a mechanical issue, although increased weight and a sedentary lifestyle is always contributory to low back pain.  The fact that movement in the morning helps the pain improve indicates either a muscular dysfunction or an inflammatory arthritis vs. a degenerative arthritis.  

In relation to your concern of the fibroid pressing on the spine, this is  also a possibility, but not likely as the spine is encased in large muscle fibers, and the body of the vertebra basically blocks the abdominal organs from placing pressure on the spinal cord, or nerve roots which would be responsible for low back pain.  Chiropractic care would be of great use to you with your condition, but with all of the other complicating issues, I can not be certain it would eliminate your pain.  Rather it would help to improve your biomechanics, and alow for free motion of the vertebral segments, and the myofascial structures of the low back could be addressed as well which may offer you the most benefit at this point.

I would recommend that you seek out a medical physician in your area that has training in Alternative Healthcare and actually practices that way.  A GP is not likely to have any advanced knowledge of nutrition/hormone balancing, and an OB/GYN is a good choice if they are willing to delve into the issue rather than simply medicate. Most regular medical doctors don't usually have any training in "health care", but rather treat disease processes with drugs and surgery.  Instead of giving you drugs, we should be invested in trying to resolve the reasons why you have PCOS, Fibroids, and back pain, not just cover up the symptoms.  

Balancing the hormones in your system is the key to doing this and may require significant work with the endocrine functions of your body.  Many patients have gained amazing results with PCOS when treated with pharmaceutical grade nutritional supplements and low level hormone creams.  We have had success in our office with these protocols, and many other physicians, chiropractic, naturopathic, and medical alike have as well.  I truly believe you need to address the underlying issues present before you will be able to control the back pain/sleep issues.  Make sure that you discuss all of this fully with the physician you choose, and make sure that it is all explained back to you as well.  

Below you will find the protocol we utilize in our office...all the supplements are from company called Standard Process; they only sell to doctors, so you will need to discuss this with your chosen physician, and remember that only a medical physician can change your current meds.

PCOS PROTOCOL

Symptoms:
?  Hirsuitism (increased hair)
?  Hypothyroid symptoms (dry hair and skin, heat intolerance, sluggish, weight gain)
?  Galactorhea (nipple discharge)
?  Weight gain
?  Insulin Resistance (sugar cravings, hypoglycemia, sluggish metabolism)
?  Deepening voice
?  PMS symptoms with difficult and painful periods

Common Hormone Imbalances:
?  ↑ Estrogen (weight gain, increased risk of female cancers)
?  ↓ Progesterone (PMS symptoms)
?  ↑ Testosterone (increased body hair, deepening voice)
?  ↓ FSH (causes lumpy, bumpy, painful ovaries)
?  ↑ Prolactin (nipple discharge)
?  Insulin Resistance (weight gain, inability to lose weight, diabetic symptoms, sugar cravings, hypoglycemia)

1. Chaste Tree (2 Tablets before getting out of bed)
?  Helps to modulate prolactin, FSH and LH levels and helps reduce testosterone levels, supports ovulation and production of progesterone
2. Tribulus (1 Tablet, 3x/day from days 5-14 of cycle ONLY)
?  Helps to modulate testosterone and prolactin, helps clear the lumpy outer ovarian layer
3. Licorice High Grade (2mL, 3x/day) and White Peony (3mL, 3x/day)
?  Helps support the adrenals, reduce prolactin and help blood sugar balance
4. LivCo (1 Tablet, 3x/day)
?  Helps support the liver to clear excess hormones, especially excess testosterone, prolactin and LH
5. GastroFiber (2-3 capsules before breakfast and dinner)
?  Helps to clear hormone metabolites from the intestines
6. Pituitrophin (2 Tablets, 3x/day)
?  Helps to support normal endocrine function

*PCOS often has an insulin resistance component. Treat as necessary.


Hope this all helps Toni, I know it was a lot of info. Good luck with your journey to health and feel free to write back if you need to.

Respectfully,
Dr. J. shawn Leatherman
www.suncoasthealthcare.net