A New VA - Part 2

Neurology Consult - I'm only here to consult on your neuropathy, I need a new consult to deal with your other Neurological issue ... REALLY? I will deal with my other issues later, I guess.

I will condense the results of several visits and multiple tests:

EMG/Nerve Conduction Studies - slow conduction times and other equally bad results = mixed mode (affecting both the nerves themselves and the myelin sheaths), Sensory Motor (affecting both nerve types - sensory affects ability to sense pain, heat, cold, touch, etc,and motor nerves affect movement) PolyNeuropathy (affecting more than one nerve group - in my case a good deal more than one).

CT (with myelogram contrast in some cases) of my spine - Osteoporotic changes of my entire spine; lots of arthritic changes; NO disk problems - it's all bone issues; a severe narrowing the spinal cord channel in my cervical (neck) spine (myelogram shows it dents the dura, but doesn't impinge on the cord itself - a close call, since compression of the cord is a bad thing ... but it will probably happen in the future). Overall, There is a lot going on with my spine and it will only get worse with time ... that's life.

Lab work - a long history of B12 and Folate deficiency, so most of my neurological problems are probably related to SCD (Sub-acute Combined Degeneration).

Final outcome of the consult with Neurology - I am a high fall risk (that was already in my record); I have to - literally - watch every step I take when I am not in my wheelchair to ensure I have taken a stable step; Physical Torture (or was that therapy) to build up my legs some since I was in a boot for my broken foot for over a year; continue taking supplements. Basically, nothing new except a sort of diagnosis.

Endocrinology Consult - a lot of lab work; more tests; nothing really new learned other than my Osteoporosis is probably worse than they thought and I still have deficiencies that will continue to be treated. A lot of hmmm about the bad reaction to the flu shot while I was on active duty in the military - it MIGHT have been; MAYBE it was; your current neurological issue COULD BE related; etc. (all this about GBS/CIDP).

On a positive note, my broken foot has FINALLY healed (or as much as it's going to, anyway). The boot is off, but I still need to be careful with it; Compression socks are recommended; Podiatry is going to give me a pedicure (okay, they will clip my toenails) because my sensory nerve neuropathy makes it dangerous for me to do so; have a nice day ...

Next up with the VA - another hick up.

A New VA - Part 1

Moving to Kissimmee also moved me to a new region in the VA system. You would think that it would be straight forward since all my information is in the computer system. Nope; Not going to happen; let's reinvent the wheel.

I get assigned a new Primary Care doctor - It's up to him to refill my medications ... and to place consults with the specialty clinics I was seeing in the old region. I get in to see my Primary Care, and he doesn't refill all my meds (leaving out some of the important ones). He also fails to send ANY consults for Specialty Clinic followups that I needed. He did send me to Cardiology - which was a waste of time. Cardiology has already said they have done all they can do and it will take a life threatening event for them to do more.

I started the process of kicking him to the curb ... and what a nightmare that was. By going around some people, I did manage to get into one specialty clinic (Pulmonary) and the Doctor there sent out consults for the other clinics. Pulmonary also said I have, "Compensated Metabolic Alkalosis".

Neurology agreed to see me; Endocrinology declined the consult - REALLY? More on Neurology in Part 2.

I finally saw my new Primary Care - we seemed to click and he agreed with most of my requests - more consults placed and various test ordered. He ran out of time and scheduled a return vist with a 1 hour time slot.

Endocrinology agreed to see me after the second consults (and the test results) More on that in Part 2.

With a few exceptions, the Orlando VA is as good as the North Florida/South Georgia VA Region. It is disappointing that the different VA Regions tend to act as totally different entities. If something is ordered in one Region, you would expect it to get done in another Region without massive quantities of red tape, but ....

More on the local VA in another blog.

Endocrinology

December 16th, I traveled to the Gainesville VAMC to see Endocrinology.

After an extensive workup, the Fellow went to talk with the head of Endocrinology, and I had the (questionable) pleasure of having a workup by her, too.

They are concerned, and want to find the root cause of the Neuropathy and Foot Drop - possible causes mentioned in the Doctor's Notes are scary ...

1. Guillain-Barre syndrome - possibly caused by a VERY adverse reaction to a Flu Shot while on active duty;
2. Subacute Combined Degeneration of the Spinal Cord - oh joys.
3. Possible exposure to Agent Orange

They have also confirmed the bone density loss ... and the increased risks of spinal fractures - especially IF (when) I fall.

Lots of lab work ordered, and return in 2 - 3 months.

Happy Birthday - the followup

Yesterday, I was called in by the VA ... to pickup a temporary wheelchair. They REALLY want me to stay off of the fractured foot!

After that, I had an appointment with my Primary Care ...

My B12, D3 and ... were low. Consult to endocrinology, prescribe D3, ...

Had concerns about lack of healing in my foot. Wasn't happy about the CT and Dexa Scans of my Spine. Prescribed Alendronate Sodium 70mg once a week.

This has not been a good week for me.

Happy Birthday?

Today I returned to the VA for follow-up on my broken foot. The news wasn't good. After 5 weeks, no signs of healing - other than one very tiny area. They are ordering a Bone Growth Stimulator - oh joy. They are also ordering a wheelchair. While that might be excessive just to immobilize a fracture, there are other reasons involved.

The previous CT Scans of my Spine and the DEXA Scan point point to an increased risk of a spinal fracture with NO trauma. Add in my risk of falling, and the chances of a Spinal Fracture jumps up markedly. As much as I don't want a wheelchair, I want a broken back less.

My B12 level is also low - low enough that Subacute Combined Degeneration of the Spinal Cord is a possible diagnosis being mentioned. This is NOT a good thing - but it does explain a lot.

Given all of the above, the Doctor is recommending:

Consult to Endocrinology;
The Bone Growth Stimulator;
a Wheelchair;
Prescriptions for some kind of Bone Growth/Strenghtener
Return in 6 weeks
NO weight on the fractured foot
Possible surgery in the future

What a way to spend a Birthday ... yes, it's THAT day. I am only 39 (plus tax) ... damn tax goes up every year.