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No need for me to look for a title this time! I love alliterations, maybe this is the reason why fate has presented me with a disease with the name Spinal Stenosis. It's the No 1 of all spine related diseases, if you haven't heard about it yet, you're most likely younger than 60 and the older members of your family are lucky not to have it. What is it? Stenosis means narrowing of the channels in the spine where the nerves run. When it occurs in the lower back (as it does in my case), it's called lumbar spinal stenosis. Arthritis may cause it but it may also come simply because of the normal aging process and *walking upright*! The soft tissues and vertebrae may harden or become overgrown or slightly shift their position thus narrowing the channels and squeezing the nerves which carry the messages from the brain to the muscles of the legs and feet. Symptoms The disease starts slowly and subtly. Looking back I can now say that the first symptoms showed more than three years ago. I stumbled more than is normal, one morning on my way to school I stumbled and fell over a curb stone and arrived at my school with bleeding hands. When the secretary was bandaging them, she gave me the advice to have a check for diabetes, she thought I could have had a shock. The general practitioner didn't find the least hint of diabetes and sent me to a neurologist. He made an electroencephalogram of my brain and measured the electrical activity of my legs. My brain activity was OK, the one in my legs wasn't. He told me that obviously the messages sent off from my brain into my legs didn't arrive properly. Sadly, the man was incapable of interpreting the results, instead of concentrating on the area which interrupted the flow, i.e., my lower back, he was keen on finding out if I suffered from epilepsy. (?!) He gave me a calendar into which I should write the dates of further falls so that he could see if there was a pattern. I haven't fallen once since then, I look where I put my feet now and lift them a bit higher, which may look odd but helps. In my last year at school before retirement I noticed that I had problems moving around in the classroom. I had some smaller classes and could sit while teaching, when I had to get up from behind my desk and move to the board to write something on it, I did it with difficulty. When I had to walk up stairs, I pulled myself up the railing although I'm not overweight and my heart is in tip top shape. At the end of the term the disease really set in, just in time to spoil my retirement. When I was walking along a street, it happened more and more often that my feet suddenly became numb and felt heavy, the left one more so than the right one, it was as if I was wearing shoes made of iron. Either together with this numbness or without it the feet tingled as if someone was pricking needles into them. The disturbing thing was that I could never detect what started the sensations, on some days I could walk for nearly one kilometre in the morning and in the afternoon had to stop every 50m - or the other way round, each day was different. I got to know all benches, chairs and low walls downtown where I could rest for some minutes. I know why spinal stenosis is nicknamed 'shop window disease'! In order not to look too dumb I stopped in front of shop windows and pretended to be interested in the displays when I needed some rest. When I had to stop in a street with no shops, I did look dumb, no doubt. Imagine an elderly lady holding tight to, say, the post of a traffic sign and staring at nothing in particular for some minutes. Later I also occasionally got a pain in the buttocks radiating down the legs to the hollow of the knees (the scientific term is 'sciatica') and a general muscle ache as if I had done a lot of sportive exercises the day before. The phenomenon didn't all occur at once, but there was always something. Like all patients with spinal stenosis I felt relief when leaning slightly forward. In the end I only left the house with a walking stick when I didn't have a trolley (for my shopping) to lean on. I had always mocked people who didn't use walking sticks because of their vanity although they needed them badly (my mother-in-law!), but I can tell you now that it may be a small step for mankind but it's a big one for the individual. Suddenly you belong to a completely different category of human beings, you're *ancient*. People with Spinal Stenosis may or may not have back pain, I was fortunate and didn't have any. I felt good when sitting on a chair or lying down, which is typical, so I did this more than walking, understandable but not advisable as you can imagine. Common walkabouts with my husband became rare, I couldn't walk as fast as he does, he couldn't walk as slowly as I had to. To say nothing about travelling to farther destinations. Therapy A radiologist made a computer scan which proved without doubt that I had Spinal Stenosis. I then went to an orthopaedist to be sent to a physiotherapist (this is the way it must be done in Germany). The orthopaedist gave me some injections on either side of the affected part of the spine although I had never had any pain there. The physiotherapist explained me that injections pay well and that they'd do the physician good if not me. Aha! At the physiotherapist's I got manual therapy, a kind of massage of the area where the lumbar vertebrae were affected. This didn't improve the situation. When I needed a new prescription, I went to a different orthopaedist who sent me to a different physiotherapist who kept up the manual therapy and in addition made me do exercises at workout machines to strengthen the muscles of the back which would do my spine good. I did this twenty times (always twice a week for one hour), my muscles got indeed stronger, the affliction stayed the same. When I reported this to the orthopaedist, he suggested I stop doing these exercises and prescribed lying for some time in the slings of a sling table after the manual therapy instead. All in all I went to physiotherapist sessions for one and a half year. I had heard that patience was needed, the radiologist had told me that he had had comparable problems in the neck which had passed after a two-year therapy. The more I understood my problems, however, the less I believed in the therapies I got. Why should a massage and stretching the body in a sling table influence dislocated or arthritic vertebrae? Then two things happened, friends from Berlin visited us in our small town in the south of Germany. They mocked my patient endurance, called me a masochist and told me about several people with the same illness who had had minimal invasive treatment and were content with it, they could live their old lives again. Big city dwellers are not patient! Besides, an acquaintance told me about an orthopaedist in the next big city specialised in Spine problems. I decided that I didn't want to go on in the same way and went there. This orthopaedist explained that in his opinion there were two further treatments for me: 1) 5 injections (once a week for five weeks) directly into the arthritic vertebrae which wouldn't do away with the cause of my problems but would possibly numb the nerves so that I wouldn't feel the symptoms any more. I agreed, but unfortunately the effect of this treatment was nil. 2) A minimal invasive operation with general anaesthesia during which he'd abrade the protruding arthritic parts of the vertebrae with a diamond file. The operation isn't without risk. The orthopaedist wanted o comfort me and said that less than one percent of the operations could result in problems. That's not a good ratio, I'd have liked one in 100.000 better. A mistake during the operation and paralysis (=wheelchair) can be the result. As this was the last treatment on offer, however, I decided to have it done. If I had done nothing, I'd also have ended in a wheel-chair eventually. It's not advisable to wait too long as the nerves get damaged when they're squeezed in the nerve canal. The operation lasted two hours because I had two near-closures in my lower spine and the membrane covering the nerves had become attached to the vertebrae, a lot of precision work was necessary. When I woke up from the general anaesthesia, I could move my feet and wriggle my toes and knew that all had gone well, no nerves had accidentally been cut and I was saved. When the surgeon came to see me, he complained of muscle ache! For you this would be the end of the story, but not for me. In Germany patients are sent to health resorts/spas for three or four weeks to get post-operation therapies. If the physician prescribes it, the health insurance pays for it. Such a therapy is not obligatory but recommended. Conclusion I experienced Spinal Stenosis as an irksome illness, not more. It didn't cause me unbearable pain but had a decidedly negative impact on my life and the lives of the people around me. I'm glad I took the risk of the operation and look forward to being able to walk as before. Should you or someone you know have the symptoms I've described at the beginning, find a specialist for spine problems, don't just go to any orthopaedist. Find out how severe the condition is and don't lose time doing useless physiotherapy. It may alleviate the symptoms if they're still light, in my case the Spinal Stenosis was already so advanced that it was wasted time and money. I'm aware how lucky I am to live in a highly developed country in which Spinal Stenosis is recognised and treated. If I lived in a third world country, I'd only be given a stick and would have to hobble along, maybe for years, and then end in a wheelchair - if wheelchairs were available at all. The orthopaedist said that he couldn't work miracles and make me into a young deer again. This expression is used in German to describe a person who capers around merrily. As I wasn't a young deer before the operation, I'm content to be an elderly deer without walking problems.