Purple foot...

[tag0620]

We got into our back surgeon early today. He (unfortunately) says that while the herniation at t6/t7 is large and the cord is quite compressed...there is no spinal signal disruption showing that any part of the cord is dying...so he's not convince that the herniation is causing any of his problems. I don't know if he'll agree to surgery to correct this herniation as it's a very invasive surgery.

This doesn't make sense to me...I don't know where to turn next.

I have a question though. His left foot where the drop started with his accident is now turning purple...we've had two people question this now...what could this mean and could this be als related?

The surgeon questioned that there is no pain with this herniated disc and if were problematic...he'd have pain...but he had no pain with his back break and stenosis either. Could this in itself be a peripheral nerve deficit? He has most feeling, but just started having some sensory deficits in his feet and calves.

Any input would be helpful..THANK YOU!
Tracy

P.S. On top of everything else...our furnace broke...we don't have heat and I'm waiting on the furnace guys to come so that I can spend lots of money on repairs...UGH..."when it rains..." lol

 

[crystalkk]

Tracy,

Is his foot very cold? If you warm it up will it go back to normal color?

Why don't you get another opinion about his back? and unbiased opinion.....

 

[tag0620]

Crystal
It will go back to normal color, but I think it seems to change when he's in a sitting position...it happened while sitting on the table at the neuro's office with his feet hanging over the edge...and it happened today while sitting in a chair getting ready to have his leg cast for a brace to help him with his foot drop...but then he puts his socks on...and we haven't watched it....

It does get VERY cold at times too...but I haven't put the two together yet. Now that I'm paying attention...I'll watch and see if it all happens at the same time.

We keep talking about going to a thorasic specialist out of state if they tell us no...he's going to have another test run that will measure blood flow through the cord...but we don't know when that will be yet.

I'm at a loss...
Tracy

 

[liz]

Both of my feet are swollen and purple - more so since I've stopped walking. My doc says it's due to reduced circulation from disuse. Much to my delight and my husband's dismay, daily foot rubs were recommended. Let's just say they work great when I can get them.

 

[wright]

Hey Tracy

I'm not sure why they need the cord to be dying to indicate there is a problem. Compression of the cord does not have to cause cell death to have an impact; you can have signal disruption without cell death. If there is cell death, then the damage it is causing would more or less be irreversible (neurons of the central nervous system do not have the ability to regenerate). It simply doesn't make sense to me and I think you need to ask him to elaborate.

You don't have pain when solely the spinal cord is compressed (this would present with painless weakness). Compressing a spinal nerve will most likely present with pain. However, a spinal nerve is made-up of a spinal sensory nerve root and a spinal motor nerve root, both of which come together to form the spinal nerve. Think of the letter "Y": the top portion of the letter "Y" has two stems that come together to form the bottom part of the letter. Think of the bottom part of the letter as being the spinal nerve and think of the two stems as the spinal nerve roots . . . one of which is the sensory nerve root and the other is the motor nerve root (both of those nerve roots connect to the spinal cord itself). It is possible to compress just the sensory nerve root or just the motor nerve root before they join to form the spinal nerve. If just the sensory nerve root is compressed, it will more than likely present with pain. If just the motor nerve root is compressed, it will present with painless weakness and muscle atrophy.

Does your husband have any muscle atrophy? Are his problems in both legs? Are his symptoms progressing?

It sounds like his foot discoloration is due to circulation problems, especially if it feels cold and you can regain normal color with movement.

I also just read your other recent posts and think you should leave no stone unturned.

 

[tag0620]

Hey liz...I've already been buffalo'd into the foot rub thing...but I'll do it gladly as it helps his cramping!

Thank you Wright. His MRI states this....

Findings: The alignment of the thoracic spine is normal. There is a focal central disc extrustion at the T6/T7 disc space. This protrusion exerts mass effect on the thoracic spinal cord but there is no focal cord signal abnormality.

The surgeon is the one who said that the signal abnormality would be a signal that parts of the cord were starting to die.

I've since found a syndrome (normally found in pediatrics, but sometimes adults) called SCIWORA (Spinal Cord Injury WithOut Radiographic Abnormality)...could this be possible

I thought that if you have a herniated disc in this area, and you were presenting with neurological problems...they should operate and fix it...not say "I don't think that's it"....I'm sure it's just because of that als diagnosis and I'm just beside myself. There is no urgency because they think they already know what's wrong...we just disagree SO strongly.

Wright..you think we need to pursue this disc herniation right? How can we push to have this surgery done without bruising egos or making it look like we're the crazy people trying to just disprove als?

Tracy

 

[wright]

Hello again Tracy

You can simply insist on that surgery and if this current surgeon won't do it, find someone who will. Another thing that might be an obstacle is getting the insurance company to pay for a surgery that in their eyes (because he has the ALS diagnosis), is not warranted.

I can't sit here and say your husband doesn't have ALS. He has been seen by competent neuro's and that is what they diagnosed given his clinical and electrophysiological exams. However, even the best of neuro's can be wrong and there is enough evidence that warrants further investigation. This is your husband's well-being we're talking about here (and the well being of your family), so he has every right to more thorough examination. You have been a wonderful advocate so continue with your quest until you are fully satisfied.

I wish you and your family the best.

 

[KANSASTOM]

Tracy, The very first Dr. that did one of my EMG's suggested that I have a myelogram to see the effect of my herniated disk. But because of my EMG results in my upper limbs, which was an occassional +1 positive sharp wave, we went down the ALS path with nobody ever mentioning the myelogram again. It really makes me mad that I have wasted a year and just now we our discussing my back condition again. Maybe a myelogram could be useful in your husband's case, has anyone even talked about one?

 

[tag0620]

Hey Tom...Thanks!
I will ask about that....I was also going to ask about a DWI (Diffusion weighted MRI) which may show something that a regular MRI wouldn't if it's spinal cord injury related.

I'm not sure what this next test is that measures blood flow through the spinal canal (I have a husband who's not too detail oriented and didn't ask the test name)...I'm hoping the neuro's office will at least call today to schedule it.

I kind of feel like the "als goggles" are on in my husband's case too! If we have it...we'll learn to live with that fact...but I'm not willing to let him become a paraplegic if this is injury related (and the timing of EVERYTHING is in correlation with his accident...and he still has this severe herniation in a delicate spot) just because one doctor may have overlooked everything and maybe gave a hasty diagnosis

 

[patricia1]

I just had a complete workup for my blue feet and they blame the toprolxl i am on . It is a beta blocker for tacacardia .i had a dopple test and circulation is good

pat