*$&% Spasticity!

[jensequitur]

Well, I had another flareup of what the vascular surgeon is calling superficial phlebitis.  My left leg gets swollen, there's a giant red patch that looks like sunburn on the back of my leg, and the patch is painful to the touch.  I've been wearing the compression sock and trying to take care of it.

My left calf muscle is now REALLY spastic.  It keeps cramping up - feels like it's getting tighter and tighter.  Sometimes it feels like it's going up my hamstring, into my gluteus maximus.  The phlebitis is getting better, but the spasticity is getting worse!

I broke a toe on my right foot, and my right calf got spastic...  now I have an injury to the left leg, and the left calf gets spastic.  

So what do you think?  Should I tell the neurologist about it and get a scrip for Baclofen, or whatever?  The spasticity gets really bad only when I injure myself, looks like.  It just makes living with the injury even harder.

[jensequitur]

No worries, chica - I knew that your condition involves cold extremities, so I could understand the confusion.  

I see the vascular guy again on Monday about the phlebitis, and then maybe a scrip from neuro for some sort of Baclofen.  He's given me one for a muscle relaxer, which I'm not sure will help.

[Quixotic1]

We're BOTH right!  From the CRPD Association website:

http://www.rsds.org/2/what_is_rsd_crps/index.html

Complex Regional Pain Syndrome Type I (RSD)

The presence of an initiating noxious event, or a cause of immobilization

Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event

Evidence at some time of edema, changes in skin blood flow (skin color changes, skin temperature changes more than 1.1°C difference from the homologous body part), or abnormal sudomotor activity in the region of the pain

This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction

Sorry for countering you so quickly.

Quix

[Quixotic1]

Hmmmm.  I must have misremembered from old reading.  It was the cool swelling that tipped off my docs.  Perhaps it is a matter of temperature instability leading to either warmth or coolness.  I'll read some more.

Certainly redness, warmth and swelling are the signs of an immune inflammatory repsonse - or even just an inflammatory response alone.

The sympathetic nervous system is responsible for "constriction" of the blood vessels in the limbs - which would make it pale and cool.

Q

[jensequitur]

Hey, how's the health pages coming along?

I was looking at the NINDS website, which says that "Another theory is that CRPS is caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area."  

http://www.ninds.nih.gov/disorders/reflex_sympathetic_dystrophy/reflex_sympathetic_dystrophy.htm

[Quixotic1]

Typical Complex Regional Pain Syndrome has a cool, swollen limb rather than a warm one.

[jensequitur]

Of course, the neurologist said today that the cramping in calf was not spasticity, but spasms.  So the tightness in my thumbs and upper thighs is spasticity, but the calves are not...  But last year he said that the tight muscles were not spasticity.  He's either not keeping track of what he's saying, or he's learned more about spasticity since last year.

Yes, I know, I need a new neuro.

[jensequitur]

I'm due to see the vascular guy again about the phlebitis on Monday.  I have to wonder why I keep getting phlebitis... if that's what it is.  Fortunately no blood clots - they dopplered my leg, but didn't find anything.

Quix mentioned chronic regional pain syndrome, which is similar to my symptoms, but not the same.  I don't have sweating, and the pain itself isn't all that bad, but I definitely have redness, swelling, and heat in that area.  

She's working on a health page about the autonomic, sympathetic, and parasympathetic nervous system...  I'm eager to see what she comes up with.

[slightlybroken]

I'm glad your leg has stopped cramping. Do talk with your doctor about using something when you need to.

I know that when I had blood clots in my leg, the cramping and spasticity seemed worse in the leg. It seemed to aggravate the spasticity problem. I could barely walk on the leg because of the pain, so I think I know what your experiencing.

I hope your getting over this. Does the doctor know why you keep getting phlebitis?

[jensequitur]

Yay!  Finally my leg has stopped cramping.  It's funny how we forget how much something hurts when it's not hurting...

The funny thing is that my dog managed to give me a swollen lip last night - jumped up and banged my lower lip.  Right now it looks like I just got a collagen injection in my lower lip only.  So at least I don't have to put up with my leg cramping and my lip swollen.

[jensequitur]

Cool, Zacksmomi!  Thanks - it's still bothering me today, as well as the hamstring.  I just need to find someplace at work where I can lay on my back!

I will definitely talk to the neuro about being able to take the drug when needed, rather than all the time.  Most of the time I don't have this much problem with spasticity.  (knock on wood!)

[Zacksmomi]

Sorry to hear of your pain.  My neuro just had me taper off my zanaflex for a week to see if it caused my fatigue and I realized...I take the stuff for a reason.

I did read that the zanaflex can just be taken as needed (please correct me if I am wrong) and doesn't need to build up in your system like some meds.  I wonder if Baclofen is the same way? I would at least get some to keep around.

To stretch the butt muscles (I hope you can visualize this)...
-lay on your back with one foot flat on floor (bent knee).
-Cross the other leg up over the bent leg so your ankle rests on your thigh. Your up leg should look like a little triangle  
-Now put your hands on the hamstring of the leg on the floor and gently pull toward you.

This should stretch the butt of the up leg.  If that is too much, simply lay on your back, bend your leg and pull your knee up and accross your chest.  I have bad hip spasticity, but apparently I am too flexible for the latter stretch...go figure.

I do hope you feel better soon.

[PastorDan]

Wow, I think it's been 15 years since I heard anyone mention Skelaxin.  Maybe 20.

[jensequitur]

Got an appointment with the neuro for Friday.  Finally.  I don't know if I'm going to have the same level of spasticity that I had last Thursday, but I'm going to go ahead and ask for Baclofen, or whatever he recommends.  

Those Skelaxin I was taking?  Fifteen years old, not ten.  

[jensequitur]

Oh yeah, and how do you stretch a butt muscle?  The left one is really getting in on the action, and I'm not having any luck stretching it out.

[jensequitur]

Nope, I'm ambulatory, so I'm stretching as much as possible.  Exercising, too - at least I did Monday and Wednesday.  And it does help - but I work sitting down, and around the middle of the day it starts tightening up on me.  I get up and stretch as much as possible, but even with the stretching it was really painful for a couple of hours.  

I've been scheduled for a followup with the vascular guy about the phlebitis, but the next opening they have is for the 23rd.  The lady made me promise that if it gets worse, I'll go to the ER... but really, the phlebitis is getting better.  I'm wearing my compression sock, and what with all the stretching, it's getting plenty of movement to keep the blood flowing.

The way this went down last time, I had broken a toe on my right foot.  A week after I broke it, the spasticity in my right leg got really bad.  However, the toe itself was healed before the spasticity got better.  I think it took a week after I healed up for the spasticity to improve.  I'm not looking forward to the same scenario - the phlebitis is getting better, which means probably at least a week before this other stuff goes away.

I've been taking this ancient Skelaxin from hubby that seems to help, at least for a little while.  They're ten years old, so I doubt they're very potent.  

[Quixotic1]

Jen, are you on bedrest?  I don't think superficial phlebitis requires that.  Is there any contraindication to stretching?

One of the fiercest triggers of worsening spasticity is a "noxious" stimuli like pain or an infection.  So treatment/removal of the noxiousness would be the first order of business.

Q

[jensequitur]

Yup, called the neuro, and we'll see if they call me back tomorrow.

[Wobbly]

I would call the Neuro and see what they think...you should get some help with this... it doesn't sound very good.

take care of yourself and let us know what the Neuro says..

wobbly

[wadeheather]

You never know unless you ask!  It's worth the conversation one way or another.