### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am an extremly active 59 yr old female. I have gained 38 lbs or more over the past 3 years. I eat very little. I clean houses 2 times per week that takes me 8 to 10 hours. I also am a live in care giver for an obese woman & some times ya just have to lift her. But, litterally, over night, my hips, the joints, started hurting very bad.Also my lower back & has now moved into the groin area. I m now walking with an extreme limp. After cleaning a house, that same night, I awoke racked in pain like I never experienced before. From the hips, swollen knees, to the groin area & swollen feet, I could not move- at all. It was that painful. It took me at least an hour to lift one leg to the floor. I could not walk at all. I went to 3 specialists with no answer. No rehitoid artritis, no gout. I have been going to a pain clinic 20 years every 2 months due to lumbar facet disease. Plus on opiat medication which does nothing now. This pain doc is not using steroid but some kind of cocktail injections. He is a very good doctor with an impecible reputation. He s even been on T. V. 2 times!!! Last week, the very same thing happened to me again. After over an hour to crawl out of bed, I wrapped myself in ice packs. This time after the last incindent, It left me feeling unwell for the next 3 days. Please do not tell me that I am getting older. I am sick of hearing this. I have always been extremly active but what ever this is, it s slowing me to a crawl. And it happened like the very next day. no onset of symptons, nothing. I ve also gone to a chiropracter with no relief. Please, have you ever heard of any thing like this? My e-mail is YYYY@YYYY

### output:

Hi there. Lumbar facet disease is a type of degenerative arthritis that can cause narrowing of the canal through which your nerve roots pass and depending on the level of the vertebrae that is getting affected. I can understand that a person with a very active lifestyle like you hates being told again and again that they're growing old, but that is not the only problem you are having. You're a caregiver and have history of lifting heavy weights which kind of add to the loads that your back is facing and probably worsening the facet problem. Now the various treatment options for this are taking rest, lifestyle changes, weight loss, physiotherapy exercises like core muscle and para spinal muscle strengthening exercises. For somebody who is having a persisting problem like you are I would like to recommend a trial of ESI or Epidural steroid injections. These are mainly used for disc related pain, but they might prove to be of some benefit in chronic inflammation of the nerve roots which can occur in facet disease. Also, please avoid lifting heavy weights, I can understand it is an integral part of your profession, but there are certain physiological limits to which you can exert your body. Besides, that these injections, even surgery will take care of your pain in the thighs and around the hips and the groin, but the back pain may reduce or may even persist. The reason being that there are numerous pain generators in the back which might contribute towards your local back pain, not just facets alone.