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Hello All,

I have never posted before so please excuse any errors. I am looking for someone to shed some light on the following patient.

82-year-old male presents with painful feet and hands, which have been problematic for 3 to 5 years and is worsening. Distal extremities feel numb and are hypersensitive. Medical history is that of hypertension, gout, depression and anxiety, intermittent vertigo, atrial fibrillation, a permanent pacemaker, zoster over the first division of the 5th nerve and a prostatectomy. A CT brain scan during vertigo attacks shows chronic ischaemic changes.

Medications include: Cipramil, Coversyl, Rosuvastatin, Norvasc, Warfarin and Eplim. The patient is an ex smoker, reports he has never been more than a moderate drinker (2 glasses of wine daily) and that he has never been exposed to any industrial substances/chemicals which may be deemed hazardous to his health.

This patient has had a neurology review which reports the lower extremities show increased tone and reflexes bilaterally. The plantars were withdrawn (I assume this means plantar sole reflex). There is decreased sensation over the R/foot and calf to pinprick with preserved proprioception. There is decreased power of the R/hip flexion, L/knee extension and dorsal flexion all are graded 4/5.

So I’m not looking for a diagnosis but I am wondering if anyone has any suggestions for the symptomatic relief of the neuropathy, which may help the patient. Any takers?

Thanks

 

Possible:

sub acute combined degeneration of the chord secondary to Vit B deficiency,?

Lou Gehrigs disease (Amyotrophic lateral sclerosis) I think?

Seringomyelia?

T/T for neuropathic pain - Lyrica seems to be the new boy on the block.

Topical neurogen or capscasin p cream.

Good luck

 

Other t'ts for neuropathic pain:

Gabapentin - neurontin

Amytriptyline

Weed:bash:

 

Wow, At 82 you might suggest a warm stone massage followed by a glen fiddich ...

 

I wouldn't expect anything beneficial but psychological intervention at this point.