Sometimes You Just Gotta Treat It

“Red” McDougall had terrible leg pains soon after going to bed. He did have a bad back, and some mild spinal stenosis, but I hadn’t heard much about that in the past few years. He was just dealing with the ache in his legs when he was on his feet too long.

A few months ago he saw his vascular surgeon for a routine followup. He’d had a femoral-popliteal bypass to restore circulation to his right leg a few years ago. The vascular surgeon was intrigued by the fact that both legs hurt when elevated. That is usually a sign of severe ischemia, but Red’s pulses were palpable. To play it safe, the surgeon ordered formal pulse volume recordings and a CT angiogram.

The studies were normal and the surgeon speculated that the pain could be related to Red’s bad back.

I saw him for a diabetes followup a few weeks ago. He had ever so slightly decreased monofilament sensation in both feet and his legs had normal strength, normal reflexes and no atrophy.

“Does it feel like cramps?” I asked.

“Not really, they just hurt”, Red answered. “It’s so bad I have to sit on the edge of my bed and dangle my legs or walk around a bit before it goes away. But it’s driving me crazy. I hardly get any sleep anymore.”

“Well, we know it’s not your circulation”, I began. “It could be just a form of leg cramps, even though you can’t tell if there is spasm in the muscles. Or it could be a strange way for your spinal stenosis to act up in the opposite position from the way it usually behaves. So I have an idea.”

“Anything”, he was quick to answer.

“Cyclobenzaprine. A muscle relaxer that is related to the antidepressant amitriptyline. In addition to preventing muscle spasms, it has pain relieving properties and it usually helps people sleep.”

“Gimme some”, Red held out his hand.

“I’ll send in a script. Let me see you back in two weeks, because if this doesn’t work, I’ll need to do some serious thinking.”

I thought to myself about how often specialists are in a position where they can simply declare “Not my department”, but primary care docs are then more or less obligated to pick up the ball again and do something.

Two weeks later, Red was a new man.

I’m sleeping through the night, and no pain”, he grinned.

I still don’t know exactly what this was, but it’s gone.

Sometimes you just gotta treat it.

1 Response to “Sometimes You Just Gotta Treat It”



Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s




2018 Top 25 Doctor Blogs Award

Doctor Blogs

Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Mailbox

contact @ acountrydoctorwrites.com
Bookmark and Share
© A Country Doctor Writes, LLC 2008-2018. Unauthorized use and/or duplication of this material without express and written permission is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given.