Problem with left leg....TIA???

[Mb]

Allowick and others:

I think you will recall where my husband had a TIA in February. He had two TIA's prior to going on coumaden.

He has been having a problem with his left leg since January. Started with weakness.....occassionally. Progressed in February, saw his PCP, then a nuerologist. Of course, MRI's were ordered, twice on the brain, once for his lumbar region, and then his cervical area. They found a very slight disc bulge, and a small growth in the cervical spine. They also found a new right sided lesion. Here is my question...............

He now has left leg weakness ALL of the time. Has a problem mostly going up the stairs. He can walk on it, but his gait can be off, so a potential fall concerns me. He is seeing the neurologist next week.

Is it possible for a TIA/stroke to cause PROGRESSIVE weakness. In other words, I thought that a stroke could cause weakness, but that it would remain the same., It is definitely worse than it was. And, all of the time.

I am hoping this will be a simple fix, but I am certainly concerned. Especially since the neurologist said the last time "well, we may have to wait for the disease process to "declare" itself....."

Any thoughts would be appreciated. - Marybeth

 

[lance]

Peripheral artery disease

Peripheral artery disease

My brother in law has peripheral artery disease that cause pain with exercise and improves with rest.

Has PAD been ruled out?

 

[bvdr]

Marybeth, I agree. Strokes, of which a TIA is often classified as a mini-stroke, don't really progress but rather get better with time and rehab. Please let us know what the neurologist says.

 

[perkicar]

It sounds more like something impinging on the nerve, whether it's that bulging disc or something else the neurologist will have to determine. Please let us know what the doc says.

 

[Mb]

Thank you for the replies. No, he definitely does not have PAD. And, I really did not think that the weakness would worsen with a TIA, but I really did need some input, as I could NOT find anything on-line. Well, we will see what happens next week. -

It is hard to think it is not related to his heart disease, but it is certainly a possibility. Coming this close to the TIA though....and with the new brain lesion, it is where I go to automatically. Maybe that is why he has so many Doctors.....I really do not know what I am doing. Heehee.

Wednesday and Thursday should, hopefully, bring some info.-Marybeth

 

[Nancy]

Have they defined the small growth on the cervical spine and the new right-sided lesion yet? I think I would pin the doctor down on both of those things.

 

[Guest]

It the effects lasted this long it is definitely not a TIA. The effects of them are short-lived by definition. The T in TIA means transient.

 

[Mb]

Dear Nancy and Allowick:

Nancy, the Dr. did not seem that concerned about the growth in the neck/cervical spine. At least at that time. The lesion? Could this have been a small stroke, rather than a TIA??? I thought I did read some where that TIA's don't always show up on a braian scan. In fact most don't. If I remember correctly. I am not sure if my husband will be comfortable with my coming to the next appt. - I pushed his Dr. so hard on the second appointment, that I think I may have made him uncomfortable. My husband is a gentleman....soft spoken, and very very kind. ++Sometimes I find people do not listen well to what he is saying. We will get through the weekend, see how he does with the leg. I did ask him last night, that if he compared how he is feeling now, with how he felt in January the last time we say his Boston cardio, would he say he was the same, or worse. He said worse. Very very tired. If we get no where this coming week, I will contact his Dr. ion Boston for a referral. - Any comments are welcome. - Marybeth

 

[PJmomrunner]

I have known two people in the last year to experience increasing weakness of a similar sort whose issues resolved when they were taken off the statin drug they were on. (Not before being diagnosed with Parkinson's disease and put through all kinds of misery in my mom-in-law's case) Just a thought.

 

[Nancy]

Hi Marybeth-

I hope you will go to the doctor with Wayne, and I also hope you will push to the MAX. Wayne really needs to get a diagnosis now, and not wait until something "declares" itself.

We are brought up to be soft spoken and "nice", and not make the other person uncomfortable. But when it comes to medical things, I believe it's a different scenario. Not getting the right answers can affect someone's life forever. Some doctors like to dilly-dally around, for what reason, I'll never know. Maybe it's insurance and HMOs that dictate some of this stuff because they don't want to pay for additional testing. I like to think that they really DO know how to diagnose things, and I'm always hopeful that this is the case.

I often make Joe uncomfortable because I can be very pushy, but I'm only that way when the right answers are not forthcoming and I see a life-threatening situation developing. I'll try "nice" first, once, in that case, and if it doesn't work, then it gets increasingly pushy.

I have a feeling, you're much like I am.

I am so sorry that Wayne has to go through yet another thing. I hope it turns out to be an easily corrected problem.

Let us know how it goes.

 

[bvdr]

Nancy, you are so right. If I hadn't spoken up even when it made ME uncomfortable to do so, I don't think I would be living the quality of life that I am now enjoying.

 

[PJmomrunner]

Hi Marybeth-

I hope you will go to the doctor with Wayne, and I also hope you will push to the MAX. Wayne really needs to get a diagnosis now, and not wait until something "declares" itself.

We are brought up to be soft spoken and "nice", and not make the other person uncomfortable. But when it comes to medical things, I believe it's a different scenario. Not getting the right answers can affect someone's life forever. Some doctors like to dilly-dally around, for what reason, I'll never know. Maybe it's insurance and HMOs that dictate some of this stuff because they don't want to pay for additional testing. I like to think that they really DO know how to diagnose things, and I'm always hopeful that this is the case.

I often make Joe uncomfortable because I can be very pushy, but I'm only that way when the right answers are not forthcoming and I see a life-threatening situation developing. I'll try "nice" first, once, in that case, and if it doesn't work, then it gets increasingly pushy.

I have a feeling, you're much like I am.

I am so sorry that Wayne has to go through yet another thing. I hope it turns out to be an easily corrected problem.

Let us know how it goes.

Joe is extremely lucky to have a caretaker/advocate/life partner like you, Nancy. I have read many of your posts and, I'm ashamed to say, I actually find myself a bit jealous!

 

[Guest]

I agree that it could be the statin. I wasn't thinking along those lines.

 

[Mb]

Thank you for your interest in this, all of you.

The idea of the statin causing the problem would be valid, except he does not take a statin drug. His cholesterol level has always been low, and he has no narrowing, anywhere that has been tested.

Nancy, you and I are very much alike. I really did push the Dr. the last time I went with Wayne. I will have to finagle a bit to go this time though. Since Wayne got sick, I've tried to let him make the decisions regarding his care, since he would have to live or die with whatever decision was made. I certainly have stepped to the front at times, and really pushed hard. This is the first time it has made him uncomfortable, so I backed off, and did not go the last visit. I think if I nudge today or tomorrow, he probably will agree to have me accompany him. Truly the issue is his personality.....he is just SUCH a nice man.....and soft spoken. People often just don
t hear what he is saying.

The leg hasn't worsened in the last couple of days, but neither is it any better. I watched him go up the stairs the other night, and he uses both handrails. Standing doesn't appear to be a problem.

Oy vey! - Marybeth

 

[Mary]

MaryBeth,
I can share a similar experience, I think, since I suffered a TIA yesterday (my second this year), and I talked at length to the ER doctor concerning it.
I don't think a TIA can cause ongoing problems. By definition, it is a transient blood stoppage that causes temporary nerve damage. Yesterday I experienced some hand numbness that resolved very quickly and almost total numbness of my calf and leg. It took several hours for that to disappear. I am walking fine today, so my experience seems to bear out a TIA.Perhaps what your husband experienced was more than a TIA. It's possible that the "lesion" is a small bleed that remains active. In that case, there would be worsening of his leg.
I am sure when you see the neurologist you will get some answers. I echo what others have said. You must report everything to the doctor and press for answers. Good luck and let us know what you are told.

 

[Guest]

While it is true that individual TIAs leave minimal damage, repeated TIAs can add up to permanent damage.

Mary, I hope you will see your doctor to determine why you are having these. Was your INR above 2.5? If so, you need a workup to find out why these are happening. Having 2 TIAs in a few months is a huge risk factor for a stroke.

 

[Mb]

Hello everyone -

Well, here is the update. He went to see the Dr. today ( I did NOT go), and the Dr. said he "could make a case for it being the lesion, TIA/stroke" or whatever. Said there is not much he can do for him. He goes back in three months, unless something else happens. If it is indeed a series of small TIA's, then another occurred about 12 days ago or so, because the leg is always weak now. He walks OK, it is going up stairs that seems to be the issue. Frankly, this really does not surprise me all that much. Prior to his surgery, he had two TIA's. Since the surgery, he twice had "blue toe syndrome" from the coumaden - throwing off microscopic emboli to his feet.(Usually happens with people first on coumaden). His tricuspid valve has worsened, so perhaps that is the culprit. And, I do understand that as long as you therapuetic on coumaden, there is a significant decrease in the liklihood of there being another event, and, there is really not much they can do. I'll just keep on praying. -
I've come back to add more, since I realized that this means he probably has had two events this year. The first in January, when the leg weakness started, and then in February (other side of the brain). And, we are going on a much needed vacation next week....flying. - Marybeth

 

[Guest]

If he has been throwing off chloesterol microemboli, this would explain why he able to have TIAs while fully anticoagulated. Warfarin may actually make this worse as you mentioned with his feet. I'd ask for a referral to a hematologist to see if he is being helped or hurt by warfarin.

 

[Mb]

Dear Allowick:

Frankly, that is another idea. The only issue is that in January he went twice to clinic, and he was within range. This is when the right sided lesion happened. Mid February, he had a TIA when I was with him, left side of brain that time. His INR was 1.9 at that time, and he had not taken the baby aspirin for 2 days. His INR last summer, when he had the "blue toe syndrome", his INR was within range. He has been in range since. It is almost four years since he has been on coumaden. I do think the Dr. is right....I do not think there is much anyone can do. What could be done, is already done.....anticoagulation. He sees his PCP tomorrow (Friday). We will se what he says, but I am not looking for much input from that quarter.
I have decided to e-mail his cardiologist in Boston this morning. I told Wayne last night that I was going to do tht, and he had no objection, so we will see if Boucher thinks he should see someone in Boston.
Thank you all for your input. THis is all what I suspected, but it is sobering to realize how fragile everything really is. - Marybeth

 

[Nancy]

Marybeth-

I will continue to keep you and Wayne in my thoughts and prayers. I hope he can somehow be stabilized so nothing more will happen.

You are so right about the fragility of things, no easy answers when there are multiple problems.