A recurrence or something else? Viral myelitis

[scotsvet]

Hello to all.

I am hoping to gain some insight into what may be happening with my husband at the moment.  I will do my best to give as much information as I can although I do not have access to all the correct terminology.

My husband is an Armed Forces Veteran.  He is in his fifties, 6'8" tall and weighs over 19 stone.  He has always had aches and pains having been a warrior for a start, is also a past rugby player and a past member of the Field Gun crew at the Royal Tournament.  Consequently, he has put his body through some serious punishment over the years.

He has worked since leaving the military in 1991 - until earlier this year when he was made redundant.

Sadly, my husband also suffers from Combat PTSD - 18 years before he asked for help but he has been receiving treatment since 2008 through Combat Stress and has been diagnosed.  His medication for PTSD and his co-morbid condition of depression is Venlafaxine and Quetiapine.

His medical history is fairly standard - injuries and such like - although there have been a couple of unusual things.  In 1995 it was considered that he had suffered from Pleurodynia and the onset was extremely sudden but he recovered well from that.  He has also received treatment for ulcers and is on Esomeprazole.  He is also prone to viruses.  In 2001 however, something odd occurred.  The first symptom was a numb patch on his foot - by the next day the numbness had spread up his legs and we attended our GP surgery.  The GP immediately referred him to our local hospital and to his horror (it was quite amusing actually) they told him he had to stay.  The following morning the decision was made for him to be transferred to Aberdeen (over 200 miles away) as the numbness and loss of sensation had spread upwards - to below his nipples.  To our surprise (and concern) he was not taken by road ambulance as we expected but by helicopter air ambulance - for speed - to the High Dependency Unit at Aberdeen.  He had a good trip as it turned out that he had served in the military with the paramedic on board!  In Aberdeen, he was a subject of fascination - I believe he was poked and prodded by every consultant and trainee doctor, culminating in him telling a room full of experts about his symptoms.  Loads of tests were carried out and spinal fluid was drawn - easily to their delight as he felt nothing - and as far as we are aware this showed no abnormalities.  An eventual MRI scan showed an abnormality in/on/by his spinal cord, below his brain stem and he recalled something being said about a viral abscess which was no longer active.  He was asked about his history - whether he had been anywhere exotic and even though it had been 10 years since he had, there were questions asked about insect bites.  He recalled being bitten by something in 1986 - in a jungle - sorry I can't say where - but he had never known pain like it and was very ill but had to just keep going as they do.  It appeared as though the consultants were stumped to be honest and the only diagnosis was as I recall, viral myelitis.  Eventually all feeling returned to below his nipples however, he then lost all feeling in his hands and forearms.  He was given Gabapentin for quite some time afterwards - I believe it has neurological uses as well as being a treatment for epilepsy which he does not have.  Some feeling returned to his right hand and arm but his left hand is still badly affected although he can use it so long as he concentrates.  He was off his work for 7 months after this before returning on restricted duties.  Incidentally, when he returned to Aberdeen for a follow-up, a young doctor thanked him as she had used his case for her thesis.

Ok, so that's the history.  In August of this year, he was made redundant so has been under a lot of stress on top of his PTSD (which has understandably escalated).  In November he started getting a lot of pain in his right shoulder and eventually attended our GP who considered it to be a rotator cuff injury and prescribed anti-inflammatories.  The pain lessened but then he started getting discomfort in his left shoulder - a different kind of discomfort - and neck pain/discomfort/burning and what worries him the most, total loss of sensation towards his left shoulder and down to his left nipple.  A further appointment was made with our GP who, as his history made it difficult for her to assess what may  be going on, has referred him for a scan.  She also prescribed Tramadol and Naproxen.  Since then, I have been noting down his descriptions so I will list them and they can vary from hour to hour, day to day.  Right, he feels sometimes as though his left shoulder and upper arm are wrapped in stinging nettles; he gets the feeling of a hot wire from the tip of his left clavicle, along the clavicle to his left shoulder; he gets the feeling of bubbles (champagne like) at the top of his trapezius muscle or 'hamsters running around';  he has pain in his right shoulder and frequent headaches;  he has a total lack of sensation on his right chest from above his nipple and up to the top;  he gets tingling heat in the middle of the back of his neck; his left hand claws up; he is having 'toothachey' pains again.  Other symptoms have been days where he has no appetite, cannot stay awake,  can been freezing cold or boiling hot and sweating.  His gait is clumsy if he gets up and he has lost his balance a number of times.  He is also finding it difficult to go for a pee - taking him ages.  He is finding it difficult to sleep (except on the days that he can't stay awake).  Pain and discomfort fluctuates but the numbness is constant.

He has been in his bed which is most unusual for him, for the past 7 weeks.  We have a water bed fortunately and any pain is lessened when his upper body is supported by pillows.  If he does get up, it seems that the sheer weight of his arms increases any pain/discomfort/sensation.

I have no idea whether the above makes any sense at all.  I am worried about him obviously but am staying positive that the scan will reveal a mechanical reason for all of this and not a reactivation of the past condition (which is the doctors concern).  If a mechanical reason is responsible however, then things will not be easy for him.  Physiotherapists and similar will not touch that part of his body - he has been told this in no uncertain terms and it is highly unlikely that a surgeon will risk anything either.  I realise that we will just have to wait and see and hope that it is something that will take care of itself.

We both accept that stress may be playing a huge part but the medication is so effective in balancing his mood that I'm not so sure.

Any ideas?  

Thank you and apologies for the length of this.

[scotsvet]

Good morning Dr Kaul.

Many, many thanks for your response.  My goodness what a list of possibles - the human body is such a complicated machine isn't it?  We are still awaiting an appointment from our local hospital where he will be seeing the resident consultant and possibly having a CT scan - although I am told that it is likely, in view of his history, that he will be sent down to Inverness (100 miles away) for an MRI and to see a Neurologist/Orthopaedic consultant.  We shall see.  There are many benefits to living in such a remote and beautiful area but if anything goes wrong then it can make life somewhat difficult, particularly at this time of year when roads can be closed.

My husband is worried, particularly about the numbness but of course, I have been oozing with positivity and reassuring him that it could be any number of non-threatening things - which it could be!  He is not aware that I have joined this forum as it is just for my own curiosity.  Information such as you have given is useful and I shall be having a look at symptoms and descriptives.  Fear not, I have no intention of 'diagnosing' anything - goodness no - that's what we have have doctors for!  The reason is that I'm keeping a record of his symptoms so he will have as much information as possible I ask him how he is or how he's feeling and he tries to describe things bless him - and I could 'suggest' some descriptives and this will help him.  No, he doesn't know but I will tell him one day.

Yes, I'm being sneaky but he's the man I love and so I'm allowed to be.

Thanks again and you take care too!

[S. Kaul, MD]

Hi there!

Well, without a detailed clinical valuation it would be difficult to comment specifically on the situation. I would understand the difficulty in a clinical assessment owing the previous episode of myelitis with residual effects. Well, in the current satiation possible causes of the symptoms, that may need to be considered include neuro-muscular causes such as neuropahies/ myopathies, nerve impingement, infections/ inflammations, injuries to ligaments/ tendons/ muscles, hormonal/ endocrine abnormalities, micronutrient deficiencies, heavy metal poisoning etc. It would be best to have this evaluated by an internist and a neurologist/ orthopedician for a detailed assessment. After a cause(s) is identified, it can be managed accordingly.
Hope this is helpful.

Take care!