Re: Update: ?TM or MS
AZMAINIAC (AZMAINIAC(AT)prodigy.net)
Thu, 04 Feb 1999 09:11:10 -0800
AZMAINIAC wrote:
>
> Christopher Leighton wrote:
> >
> > 23/1/1999
> >
> > Well, thought I might update my story from October 98. I am guilty of
> > not following the internet postings the past 4 months. My second flare
> > abated slowly. The spasticity and weakness in my left leg has
> > improved but comes and goes so now I have a permanent limp. Bladder
> > frequency and mild incontinence are also appearing. I have developed
> > new problems with my vision including intermittent dimming of my sight
> > from the right eye. The color vision is also distorted from my right
> > eye so at times, it is like wearing 3D glasses. I have had bouts of
> > stabbing eye pain, and occasional double vision. I have now seen 7
> > neurologists from Windsor to Toronto, Ontario. Also, throw in a
> > rheumatologist, and neuro-ophthalmologist for good measure. I have
> > had all types of responses to my numerous, unusual problems from
> > compassion and concern to the other end of the spectrum One
> > neurologist spent 5 minutes reading my chart while I was talking,
> > spent about 1 minute examining me then suggested I had an anxiety
> > disorder. This, after driving 4 hours through a blizzard to see him.
> > Being a physician I felt like reporting him to the College of
> > Physicians and Surgeons! I am becoming more convinced that my problem
> > is evolving into multiple sclerosis though, MRIs have not been
> > abnormal thus far. I am keen to start interferon therapy, however,
> > without plaques to see, my neurologist is not keen to prescribe.
> > Unfortunately, as I write this I am once again having severe neck pain
> > and suspect flare #3 is starting.
> >
> > I am always taken aback by the responses I have had from co-workers,
> > friends and families. One friend emailed me recently and asked "how
> > is the wheel chair ramp coming". Is that supposed to be funny?
> > People at work try to be helpful... but when you are asked how are you
> > feeling 30x time in a day it becomes taxing! Unfortunately, working
> > in a smaller city, it is harder to preserve my privacy. People I
> > hardly know suddenly feel entitled to know the details of my medical
> > assessments -- I guess I should be grateful to see this perspective
> > first hand. I hope it will make me a better physician. But for now,
> > I have to struggle with adapting the workplace so I can be comfortable
> > and continue to practice medicine.
> >
> > The literature the past few months has been scant. One Scandanavian
> > study looked at EMG studies (shocks applied to muscle groups) with
> > patients presenting with TM. Patients with abnormal EMGs early on may
> > have more long term disability.
> >
> > I would be interested in knowing if anyone has been started on
> > interferon or Copaxone without a firm diagnosis of MS (ie recurring
> > transverse myelitis).
> >
> > Sincerely,
> >
> > C. Leighton MD
> >
> >
> Dr. Leighton,
> I used to have dimming. It was strange. Things would get brighter when I
> was urinating.(Things would look brighter when I was"pissed off"?). I
> had quit smoking for 5 years. I had a tiff with my ex one day and went
> out for a drive. I stopped to get a soda and bought a pack of
> cigarettes. When I went home I went out in the backyard and had one. I
> coughed a few times, but as I was smoking my eyesight got better.I
> learned that nicotine can be a vasoconstrictor or a vasodilator,
> depending on the person.DON'T ANYONE START SMOKING!!! READ FURTHER!
> My psychologist confirmed this by telling me that he had some people
> doing biofeedback. When some people smoked, biofeedback was easier and
> for others it was harder.
> I was also have problems that I felt was losing my hearing every now
> and then. I was checked out by a well known opthamologist, a
> neuro-opthamolgist, otolarnynologist?(Ear, Nose and Throat) and an
> endocrinologist(check my thryoid).I was sent to a woman Neurolgist who
> helped the problem. She gave me this to read.
>
> "Annals of Neurology", Vol 21, No. 5, May 1987, 'Disorders of the
> Autonomic Nervoous System: Part 1. Pathophysiology and Clinical
> Features'
> J.G. McLeod. DPhil, FRACP, and R.R. Tuck, PhD, FRACP--From the
> Department of Neurology, Royal Prince Alfred Hospital, and the
> Department of Medicine, University of Sydney, Sydney, NSW2006
> Australia(Thumbs up to those from 'down under'! Hi, Errol.)
>
> The following are excerpts that I feel are applicable and partially
> understandable to everyone with TM
>
> p421
> "Direct recording in humans has shown that symopathetic nerve fiber
> activity in muscles increases in response to a fall in blood
> pressure[44]to changes in posture from the lying to sitting anfd
> standing positions[31], and to the application of negative pressure to
> the lower body, which is thought to unload intrathoracic low-pressure
> volume receptors[173].".......
> (My eyesight would get better when I was lying down.)
>
> "Diseases of the Autonomic nervous system give rise to impaired control
> of blood pressure; heart rate; sweating and temperature regualtion;
> bowel; bladder, and sexual function; gastrointestinal tract; pupils; and
> lacrimal glands."................
>
> p 423
> "Disorders Associated with Peripheral Neuropathy
> The autonomic nervous system is affected in many peripheral
> neuropathies[96,115,,116]. From a practical viewpoint, they may be
> grouped into those in which autonomic dysfunction is clinically
> important and may be a presenting feature, and those in whwich it is
> mild and may often be unrecognized(see Table).".............
>
> "Impaired sweating ability on the extremeties is common, probably
> resulting from degeneration of the cholinergic postganglionic
> sympathetic unmyelinated fibers that travel with peripheral nerves to
> innervate sweat glands or demyelination of the preganglionic sympathetic
> efferent fibers. Hyperhidrosis may be seen in partial nerve injuries
> causing casualgia or when ther is pressure on the nerve root, which
> occurs in malignancy [14,88,94] and in some toxic neuropathies
> [14,88,99].When the ability to sweat is impaired on the extremeties,
> excessive compensatiory sweating may occur on the trunk and
> face.Orthostatic postural hypotension results from damage to
> small-diameter myelinated and unmyelinated fibers in affferent and
> efferent nerves in the baroflex pathways. Postural hypotension therefore
> most commonly occurs in diabetes and amyloid disesase in which these
> small fibers are affected and in acute inflammatory neuropathy when
> segmental demylenation affects the myelinated autonomic fibers in the
> vagus and sympathetic pathways. Orthostatic hypotension is most likely
> to occur when fibers in the sphlanchnic vascular bed are pathologically
> involved, since the latter plays an important part in blood pressure
> regulation in humans [112,115,116]. Impaired control pof heart rate
> results from vagal damage in patients with autonomic neuropathy,
> particularly with diabetes [112,185].
> Bladder dysfunction, impotence, and pupillary abnormalities are other
> clinical manifestations of autonomic dysfunction in peripheral nerve
> disease."
>
> As I was reading, I saw the part about sweating which has been brought
> up by others, so I included it.
> I have been taking Clondine and it helps.
>
> John, MD, GP {Manic Depressive, Guinea Pig(for baclofen pump)}
>
> P.S. I limped for many years after I recovered from the paralysis. Every
> doctor felt it was due to TM. After I got my baclofen pump and was
> walking, the doctor was watching me walk. he then had me lie down and
> measured from my navel to each ankle. My left leg was 5/8 of an inch
> shorter than my right.
> The doctor was Dr. Richard Herman, Rehab Medicine. He was Medical
> Director of the Good Samaratin Rehab Institue in Phoenix at the time. He
> did the blind study for the pump. He had spent 5 years at Temple, 5
> years at Stanford and 5 years at Dartmouth.
>
> P.P.S. I know should credit the references, but I am not a fast typist
> and there are 177 references in Part 1 and over 188 in Part 2 of the
> report. If anyone would like them, please let me know.
To all:
I have scanned and zipped the article. it is in Word format. The only
problem is each page is about 1MB and a total of 22 pages consisting of
Part 1 and Part 2.
I did not attach any of it because eveyone one think that there was
something wrong with their mail.
Does anyone have any suggestions? Would it be quicker to copy it
directly from my computer? I am willling to let people call and get it
that way. If so, I need some advice as to how to set up my computer to
do it.I have a 56k modem.
John