After my diagnosis of Charcot arthropathy, the special specialist suggested I see a neurologist. But he couldn't refer me to the neurologist himself. Not sure why, but he couldn't. So I brought it up with my PCP, who got me a referral some time last month, but wasn't able to schedule me until today.
And so it was that I made the trip with Becky back to the very same hospital I was released from this past Saturday. The neurologist's office was beneath the main floor. Into the office, where I filled out a few forms and then waited. As usual, Becky accompanied me when I was called back to see the doctor.
But first, I was interviewed by a nurse, who also took my vital signs. I was, much to my astonishment, a mere 106 over 67 when my blood pressure was taken. Prior to my surgery, my BP was hanging around 140 over 80. It varied, but that was the average. The stress brought on by the pain in my toe, as well as the ongoing fear of infection, kept the pressure up...literally! So I attribute my reduced BP to the fact that I actually eliminated a problem.
Eventually, the doctor arrived. He was at an immediate disadvantage because I already had a diagnosis: diabetic neuropathy that had advanced to Charcot arthropathy. And so he inquired, "Why have you come to see me?" I told him that I was one of those rare patients who listens to doctor's instructions, (for the most part), and I was told to see a neurologist. He then asked what medications I was on for neuropathy pain, and what I'd tried in the past. He even asked if I'd ever used Capsaicin, which is a cream that uses a hot pepper extract to help alleviate pain. So I told him about the ONE time I'd used it, back in my late 20s, and...
Way back when, my attempt to use that cream resulted in me running from my desk at work to the cafeteria, where I would fill paper towels with ice, then try to line the area around my waist, just inside my jeans, where the cream had been liberally applied. After my third trip to the cafeteria, I went to my boss and said that I could no longer concentrate on my work, and that I was homeward bound. And when I got home, I ran to take an icy shower and scrub what was left of that cream from my skin. Even before I began scrubbing, my skin was red and raw in appearance, almost as though I'd been sun burned.
So, no...No more Capsaicin for me...EVER!
The only other drug under consideration was one that had been mentioned during several doctor visits with various specialists: Cymbalta. This is supposedly an antidepressant that also relieves pain. There's just one little problem with it. Y'see, there's this drug I take now for my neuropathy pain that has always worked called "Ultram," (or its generic name, "Tramadol"). Apparently Cymbalta and Ultram come together to cause seizures in those who combine them. I've never had a seizure from mixing Ultram with other drugs, as is the usual warning, but the neurologist didn't feel it was worth the risk. Besides, the Ultram was doing what it was meant to do. If it ain't broke, why fix it? (Right Facebook? >=P )
The doc then proceeded to give me a neurological exam. He checked my pupil reaction speed, my reflexes, and coordination.
One of the coordination tests was one to which I was unaccustomed. I was to touch my nose, then touch his finger. Simple enough, right? I did so a couple of times, and then he did the unexpected. He relocated his finger and expected me to continue touching it. Because he caught me off guard, I reached to where his finger was, and then cried out comically, "That's cheating!" Well...Becky smiled, at least. He did this to test my coordination on both the right and left side, and I was able to keep up just fine.
On my word, he didn't even bother testing me for sensation. I told him the best I'd feel was the contact between an object and my skin, bit I wouldn't be able to differentiate between dull and sharp.
With the exam over, he had virtually no suggestions as to what I should do. I jokingly suggested I play more video games to help prevent the wasting that's been evident in my hands, and he actually agreed! The use of a console game controller could, indeed, help prevent some wasting, as well as rebuild muscles in my hands. My feet...? Well, any wasting there would be difficult to address, as I have other issues there.
What surprised me was the lack of knowledge as to HOW Charcot arthropathy affects the joints. Doctors have a good idea about what causes diabetic neuropathy, and they know neuropathy affects various autonomic functions. But how it affects the joints...? Nope. They remain in the dark on that one. Even if you go to the major source of information online, Wikipedia, you'll find only theories as to what's happening under "Disease Mechanism."
That was really the end of the visit. There was nothing new to diagnose, and there weren't any other treatments for what was ailing me. The doctor finished the visit with, "Well, you were told to see a neurologist, and you've seen one."
Yes...Yes, I had.
Be well, and DFTBA!