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Another Day in Paradise

Jul 18, 2012 - 1 comments

Just loving this. NOT. I’ve been having significant issues again and the heat is only making it worse.

I went to the doctors on Monday to start wheels in motion again and found it odd that my temperature was 99.7, when my normal is 97.6. It’s now Wednesday, the third day of heat and I’m running a degree above normal. Now I understand exactly what Uhthoff’s is all about.

My vision is way, way off. I can’t read the long paragraphs in posts and now understand why the forum asks members to break them up. LOL.

Balance is also wicked. Would love to take a shower, but afraid to do so. Might fall if I close my eyes.

My stomach feels like it is upside down between the vision and equilibrium thing. I can’t sit still for more than 15 minutes.

Both hands have been really tingling like crazy, so much so that it is waking me up at night. Also having muscles in my right leg flutter and bugs crawling on my lower legs.

Wish that I can get an answer to this soon. I am truly afraid that I will be losing my job.

I feel like a shut in right now : (


The More Things Change, The More They Stay The Same

Dec 04, 2011 - 0 comments

I’ve taken a long break from being active on this forum, yet still have checked in from time to time to see how people are doing and watching for any new developments.

In November of 2010, I went to a neurologist at Yale New Haven for a second opinion. His observation was that I had evidence of cerebellar atrophy which he attributed to chronic alcoholism. I had been drinking more than I should have been and accepted this diagnosis.

I stopped drinking and am now in the process of tapering from Klonopin/clonazepam, which was prescribed by a neurologist back in 2003 for vertigo and dizziness. While my neurological symptoms started before being put on benzodiazepines, long term use of this class of drugs can lead to neurological symptoms. I am disheartened with the response, or more aptly, the lack of response by the number of doctors that I have seen over the years, none of whom questioned why I was on benzos or for how long. These meds are highly addictive and should only be used short term (two weeks) as they shut down the GABA receptors (class of receptors that respond to the neurotransmitter gamma-aminobutyric acid (GABA), the chief inhibitory neurotransmitter in the vertebrate central nervous system). IMO, I never should have been on this medication for this long.
If you thought that neurologists were fun to deal with, try psychiatrists for a change. I started to see one to help me get off the benzos and am dropping this guy like a hot potato. He is patronizing and I have been unable to get him to collaborate with me in setting up a plan to taper. He’s the boss…seems like he wants his 10 minutes to write a scrip (without refills) and get me out of his hair until the next appointment 30 days later where he can get paid a hefty fee for ten minutes time of “work”.
I’ve been fortunate this past year to have some relatively long quiet spells, but am now back in the throes of neurological symptoms. Like others in LimboLand, I am frustrated by having to go through all of this without a diagnosis. I’m also frustrated by the medical profession as a whole and find myself going back to questioning their judgment in terms of tests and diagnosis or absence of one.
I’m not sure why so many of us have this kernel of trust in doctors, however small. I did accept the second opinion of the neurologist who said that my brain has shrunk from booze. Now I’m doubting him, as I read about Quiz, with her own experience with brain atrophy before lesions appeared. None of the radiologists’ reports indicated any atrophy, which is something that I will have to specifically address when another MRI is done. I also came across an article online on the NINDS Cerebellar Degeneration Information Page which includes MS as an associated disease.
As I write, I am having difficulty with my vision, which has been one of my recurring symptoms. While I have mentioned this to both neurologists and ophthalmologists over the years, no exams or tests have been done to determine whether or not this is optic neuritis. If it were optic neuritis, would that clinch a diagnosis of MS? Who knows?



Lower Back Pain/Hip Pain...this may be the answer

Nov 07, 2010 - 4 comments
Tags:

Lower Back Pain

,

hip pain

,

spasms

,

vibrating sensations

,

fluttering



I was googling today, because I have not had any answers to my posts on lower back and hip pain that has been ongoing on a daily basis now for almost 5 weeks. It started on Saturday, Oct. 2 and was only lower back pain, which felt muscular. The next day it was even worse; I felt like I had been run over by a steam roller or had been in a car accident. Even picking up a cup of coffee brought pain.

After two days, the stiffness subsided, but the pain was still there. By Friday, I was having pain in my right hip. It was deep in the hip, but there was no swelling, heat or grinding. Movement or position does not seem to alleviate the pain other than possibly lying flat on my back. The pain is 24/7 and wakes me up at night. After a few weeks, my leg muscles in my calves started to tighten, causing even more pain and then the muscles in my thighs became involved. During this time, I have noticed that while driving, putting pressure on the gas or brake pedal can cause my right leg to shake. Within the past week, I have had had vibrating sensations in a specific spot on the R leg just above the knee on the outer side of the leg; this vibrating sensation occurs on a daily basis and last for a minute or two and repeats throughout the day. I've also had fluttering sensations in the mid interior portion of the calf.

So what did google find?

"The Iliopsoas Muscle -- The Great Pretender

By Ken Rich, DC
The description is appropriate. The iliopsoas muscle is a major body mover but seldom considered as a source of pain. It mimics low back pain, hip pain, and leg pain individually or in combination.

Have you ever had a patient with classic lumbar sprain/strain symptoms that didn't seem to get better in a reasonably short time? No matter what adjustments or therapy you administered, did the condition gradually worsen? Did it seem to spread to surrounding areas in the hips, legs, and thoracic regions? The chances are you were dealing with an iliopsoas muscle spasm. It often accompanies other conditions affecting the low back.

It's very important to understand the anatomy involved. The iliopsoas muscle is comprised of two parts. The iliacus and psoas muscles are joined to each other laterally along the psoas tendon. The iliopsoas originates anterior to the transverse processes of the T12 to L5 vertebrae and inserts into the lesser trochanter of the femur. Both are innervated by the 1st through 3rd lumbar nerve roots. As a combined muscle it is a major flexor of the trunk at the pelvis. In fact, it is considered the most powerful flexor of the thigh. It traverses the body internally, and is only accessible in a very small area in what is known as the femoral triangle, where it inserts into the lesser trochanter of the femur.

This location, major action and inaccessibility account for it being a great pretender. Since it originates anterior to the transverse processes and angles internally there is no therapy which will penetrate deep enough to affect it from the posterior. The lumbar attachment and innervation account for the pain felt in the posterior lumbar region. Because it is a major flexor, if it is in spasm, it will cause many of the regional muscles to compensate and become overused, hypertonic, spasmodic and painful in their own right. Since it is a muscle not known nor understood by most people, it is difficult for most patient to describe the location any more specifically than the low back.

Classic symptoms of an iliopsoas muscle spasm are diffuse achy- type low back pain of a few days onset. The history is generally not specific to an injury which would be considered for low back pain, but it can be. The pain seems to spread to the rest of the low back, lower thoracic and even into the gluteal and lateral hip regions. Most often a key factor is initial pain upon rising from a seated position which may dissipate in a short time. It is difficult to stand upright quickly. Standing, walking and laying down don't seem to affect it badly. Occasionally there may be pelvic discomfort and bowel complications in the history. Relief of pain is often experienced by sitting down. However, extending the leg, as in driving, can make the pain worse. The types of physical actions which seem to cause this condition are standing and twisting at the waist without moving the feet; any action which causes the leg to externally rotate while in normal extension; and even doing too many sit ups (this is the muscle which completes the last half of a sit up).

A few simple tests are in order. Since the action and position are specific, have the person externally rotate their leg and foot 90° and extend it backward with the knee straight and the forward knee flexed and pelvis straight. (Think of kicking a soccer ball with the instep of the foot while doing a fencing forward thrust). This may produce minor pain. Have the person lie on their back and raise and hold both legs 12 inches off the table. This may produce pain, but usually a weakness, especially on the injured side. Have the patient do a sit up against resistance at the 45° position. This should produce some moderate pain in the groin area. The most positive diagnostic test is to have the person flex the knee, hip and externally rotate the leg, such that the lateral malleolus is laying on top of the contralateral knee. Palpate the femoral triangle deeply (press with a single finger 3/4 to 1 inch deep) and look for a reaction. Do this over an area enclosed within the femoral triangle, not just in one spot. If the iliopsoas muscle is in spasm the patient will jump off the table. Believe me, it's that painful. Many patients have said it's worse than childbirth, nonanesthetized root canals or body piercing with a flaming sword.

I've found this to be a very common condition. On the average I see about 8-15% of my patients having this in connection with their low back pain. Because of its major function it is a common muscle to become either overused or injured during extension and external rotation of the leg or flexion of the trunk.

Now that you've found it, what do you do? Unfortunately because of its location it is not treatable by most normal therapies. Many times even an adjustment will not relieve the condition, because once the adjustment is done the hypertonic muscle will return the joint to subluxation. I've found that in most cases I need to treat the surrounding regions of associated muscle pain, I do trigger point therapy within the femoral triangle to the insertion region of the muscle. This is extremely painful to the patient, but phenomenal in its positive effect. If you are not into causing pain, even for good therapy, send the patient to another doctor or massage therapist who will do this therapy.

Advise the patient that they will feel severe pain, but that it will only last for about 15 to 30 seconds. The patient is to tell you when you hit a spot which feels like a hot knife being stabbed into their muscle. The actual trigger point therapy is performed by applying strong pressure into the femoral triangle. When you find the right spot the patient will react strongly to the pain. Continue to apply the pressure without moving your fingers. Have the patient tell you when the pain begins to become less sharp or begins to subside, not when it's all gone, but only when it begins to subside. Move your finger a fraction of an inch in any direction and look for more trigger points. Generally you will find from 3-6 trigger points within the femoral triangle. Once you have treated each point, go over them one more time to retreat stubborn ones which have come back. This process will take about 2-3 minutes per leg. When the therapy is done apply a stretch to the muscle by pressing down on the bent knee and the contralateral hip against strong patient contraction of the muscle for about 10 seconds. Have the patient relax the leg and apply a little more pressure to the leg to give a small additional stretch to the muscle in a relaxed state.

I have my patients return the next available day for a follow-up. I continue to treat until the trigger points are not there when I palpate for them. The general sensation of pain will subside before this point is reached, but therapy must continue so that the dormant trigger points won't return.

This condition, like many other we repeatedly face, may be overlooked if one isn't looking for it. Often it is the low back pain we notice instead. The next time you have a diffuse low back pain patient who isn't responding as expected, try looking for a different muscle -- the iliopsoas muscle -- the great pretender.

Kenneth Rich, DC
Fremont, California

Is Patience Really a Virtue?

Oct 30, 2010 - 9 comments

One of the things that we learn while dealing with chronic symptoms, which are either diagnosed or undiagnosed, is to become more patient when dealing with an ever changing body and symptoms.

Our dear LuLu just spent considerable time in the hospital with a potentially life threatening blood infection that stemmed from an improperly treated urinary tract infection which started in July.

RedFlame has had problems now for a considerable time with a canker sore that won't heal and problems with swelling in her neck and tongue.

I have had lower back and hip pain for a month now that will not go away and it seems that my leg muscles are joining in the party. I've contacted my PCP and neuro and am now waiting to hear back from a rhuematologist for an appointment.

With this amount of patience, it would seem difficult for anyone to call people in our positions hypochondriacs, as we would have been rushing to doctors long ago.

So why do we wait, and should we? How do we know when we should be calling a doctor or recognize that treatment is not working?

I do think part of the delay in seeking medical treatment comes from sheer exhaustion over the number of medical appointments which often result in no answer. I guess that in these instances, we should be asking the doctor "Should I contact you if this continues and are there any changes that I should report to you?"

Another reason that we may be more patient is that we are dealing with so many different and often fleeting changes in our bodies. There's nothing that makes one feel more foolish than to have had a problems for weeks on end and get to the doctor's office feeling fine that day. Is it a normal part of aging, something completely unrelated or is this yet another symptom? Can I tough it out and wait until my next visit or is this more than I can bear?

Yes, I am musing here, but did not want to write this as a post. My thoughts for the day, and I am grateful that LuLu is home and on the mend.

Audrey