Give It To Me Straight - Still Undiagnosed

[davincidanes]

I just returned from the Vascular Surgeon, who was the last step (I think) in the process of the Great RULE-OUT Process, with the results from my arterial studies.  The good news is that there is absolutely nothing wrong with my vascular system.  My arteries show no hardening, narrowing, aneurysms, or plaques. He said this news would be greatly helpful to my neurologist on the continuing path of determining a diagnoses for this numbness, fatigue, and pain in my legs.  But hell, it sure did confirm that I have some sort of problem... only after 1 minute and 47 seconds at a slow walk on the treadmill, my thighs, calves, ankles, knees, feet,& buttocks ached so bad and were so unbelievably tired, I had to stop... or fall flat on my face.  :(

I actually, fully expected to have some sort of circulation issue because I've been a heavy smoker for 40 years, but he says no, I don't. Now I'm a reasonably intelligent person and I know I need to quit smoking for a lot of reasons, and I am working on it.  I'm down to less than half a pack a day from two packs a few months ago.  Now my family doctor is fully convinced that all of my pain, fatique and numbness will magically go away if I just quit smoking.  His position is that because my blood can't get healing oxygen to my structurally injured areas, that  what causes inflammation and pain.  I do have arthritis, with nerve issues in my neck, sacrum, and a stress fracture in the thoracic spine.  These are all from older injuries.  Three weeks ago, I had a 3 day course of Solu-Medrol infusions and my pain level has decreased dramatically...Even to the point that I am not taking  hydrocodone any more, and it's great!  :)  But I don't know how long that might be expected to last.

So, my "tell it to me straight" questions are. Is it really possible for me to NOT have done any damage to my vascular system by smoking all these years???  Or am I (or the doctors)  maybe missing something?  And what effect does smoking have on a definitive diagnosis of MS?  I will continue to be in "Limbo Land" until I'm able to see an MS Specialist in late February.

Thanks!
~Linda

[davincidanes]

Thank you all for your comments. I have had this structural pain for a very long time.  But the most recent year, I've developed the numbness in my legs, loss of balance, and trouble walking.  I have lhermitte's with pain going down my right arm and leg, depending on how I flex my neck.   I have had several MRI's over the past year with lesions in my brain and neck.  

When I first consulted with my family doctor a year ago, he ordered a neck and thoracic spine MRI, and found the lesions there and the compression fracture, but he still insisted that I just needed to quit smoking and all would be well.  He didn't seem to "get it" that I was also numb and having these other issues and just figured I was out to get pain med prescriptions. :(

After a few months of that, I made a list of all of my history and symptoms for him... and researched and categorized them for him as being symptoms of either a vascular or neurological cause (or both).  It's like I had to hit him over the head with it in order for him to refer me to a neurologist.  That was done in July.  

Since then, I've had 5 more MRI's and confirmed lesions in the brain and spinal cord.  I had several other tests to rule out vitamin deficiencies, heavy metals, and I don't know what else.  Just a LOT of testing with no other specific results, including a negative lumbar puncture. Clinically, I did not do well on the gait, strength and balance tests. A month ago, I was finally referred to the vascular surgeon to rule out if the numbness was being caused by a blood circulation issue, and so now that is ruled out as well.  

Like I said in my first post, I had I had Solu-Medrol IV three weeks ago and it has made me generally feel much better with less pain and numbness and I'm surely grateful for that.

Now, I guess I just wait to see the Neuro MS specialist in February, and in the meantime, I am quitting smoking, so that will help with my general overall health. I have learned that determining a diagnosis for anything takes a long time and it just gets very frustrating.  

Thank you all for taking the time to respond.

Hugs,  ~Linda

[essdipity]

Here is one article on MS and smoking, and there are quite a few others. Try Google.

http://www. medscape.com/viewarticle/706194

You're lucky you don't have vascular issues, but that really has nothing to do with whether or not you have MS. There are lots of studies relating smoking to the onset of MS, but there is no proved cause and effect. Just more probability. Lots of people who have never smoked have MS.

For a diagnosis you need clinical evidence, after other possible causes have been eliminated. Lesions disseminated in both time and space must be evident, and the usual way to see this is through MRI. The clinical examination is of paramount importance for a diagnosis, with other testing (LP, etc.) either adding to the weight of evidence or providing no information one way or another.

Good luck.

ess

[supermum_ms]

Hey Linda,

I don't think the elephant in the room is your smoking history, I think it might be your collection of older spinal injuries [arthritis, with nerve issues in my neck, sacrum, and a stress fracture in the thoracic spine]......

Q: "Is it really possible for me to NOT have done any damage to my vascular system by smoking all these years???"
A: Wouldn't the answer have to be yes because "there is absolutely nothing wrong with my vascular system.  My arteries show no hardening, narrowing, aneurysms, or plaques." which isn't at all supportive of your family doctors 'idea' of smoking related vascular issues.

Q: "what effect does smoking have on a definitive diagnosis of MS?"
A: Technically nothing if you have diagnostic evidence of MS eg enhancing brain and or spinal cord lesions. Being a smoker or ex-smoker doesn't on it's own, exclude MS from probably diagnostic causes, if the evidence of MS is there. Interestingly, research into MS and smoking actually increases your odds, not lowers....

Q: "am I (or the doctors)  maybe missing something?"
A:  Maybe not missing something, but it's possible, if you don't have evidence that's more specifically suggestive of MS, that your looking beyond what your diagnostic evidence is actually indicating, which 'could be' the alternate explanation of your sx's.  

Cheers.........JJ

ps. If i find where i put the latest smoking and MS research, i'll post it for you.