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My boss legs are weak, he was told it was his back, he had a…

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My boss legs are...

My boss legs are weak, he was told it was his back, he had a body scan and a MRI of the back. Diagnosis nothing was found wrong. His legs getting worst. What do you think is wrong

Doctor's Assistant: What seems to make the symptoms worse or better? Have you noticed any swelling?

When he stands his legs get early. He said it doesn't hurt and no swelling

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

No, he's pretty healthy until now with the legs no high blood pressure and no diabetes

Submitted: 5 months ago.Category: Medical
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Answered in 4 hours by:
3/14/2018
Doctor: Dr Subbanna MD, Neurologist (MD) replied 5 months ago
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Medical
Satisfied Customers: 6,422
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns related to your boss.

I see your boss has been having issues with his health in the form of weakness of his legs. As a Neurologist I frequently diagnose & treat this type of health situation, and I can certainly help you in this regard.

First I need to ask few questions so that I can gather more information related to your health concerns about your boss, kindly answer to these below posted questions, it will help me in gathering additional information related to your health concerns about him;

1) Did he mention how old he is?

2) Did he mention approximately for how long this has been going on?

3) Did he mention of any additional symptoms such as - headaches, neck or back pain or stiffness, nausea/vomiting, tingling (pins & needle sensation), or numbness, or loss of sensation anywhere on the body especially in his legs, any facial droop, one sided weakness of the arms or legs, gait difficulties, speech or swallowing difficulties, double vision, blurring of vision, dizziness, vertigo (spinning sensation), joint pain, joint swelling, loss of appetite, loss of weight, progressive atrophy of the muscles (loss of muscle bulk), bladder or bowel disturbances, tremors (shaking of the hands or legs) etc?

4) Did he mention whether he feels he has been feeling overall better recently, or feeling about the same (stable), or he feels his symptoms have been progressing or worsening?

5) Did he mention he has seen a Neurologist in the clinic already?

6) Did he mention of any investigations other than the body scan and mri scan of the back mentioned above? For example any blood tests, or scans of other regions of his body, or any other tests? And was the back mri he has had was of whole back/whole spine including the neck region too, or only of the lower back region?

7) Did he mention whether he is on any current treatments (including prescription medications or non-prescription/over the counter medications or herbal/supplements, or non-medication treatments etc)?

I can fully understand, since it is someone else having the symptoms so you may not have all these additional information related to his health, so sorry for asking all these extra questions, if you do not have any of the additional information I have requested above it is fine, I can try to diagnose the possibilities as well as try to recommend further management plan based on the very useful information already provided by you that I already have with me.

Kindly reply

Best Regards!

Dr Subbanna MD

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Doctor: Dr Subbanna MD, Neurologist (MD) replied 5 months ago

Hi, have you received the questions I have posted above? I hope you are not encountering any technical glitches to reply to me. If you require more time it is perfectly fine and I will wait here. Kindly try to reply to the above questions when you can, and I can certainly help you with your health questions you have mentioned above related to your boss.

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Customer reply replied 5 months ago
Thank you for helping us, well yes 66 yrs old. For approx 2 months the legs was feeling weak , last week he complain of headaches and before numbness in the hand, hand would sometime shake. He's feeling about the same he said no pain. He had seen a Orthopedic Surgeon about 10 months ago before having a cyst removed from his shoulder. On yesterday he had a MRI done of the head. He said he sometime takes a little Ciales. Thank you for your prompt attention .
Doctor: Dr Subbanna MD, Neurologist (MD) replied 5 months ago

Hi, you are very welcome! I appreciate for all these additional information. I am sorry, I am already answering another question, and I will follow up with you ASAP.

Best Regards!

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Doctor: Dr Subbanna MD, Neurologist (MD) replied 5 months ago

Okay I am ready, thanks for the waiting; I will post my answer here;

Please see the types of symptoms your boss has been having in the form of weakness of the legs, numbness, shaking, headache etc can be secondary to few different types of underlying health conditions. In otherwords these symptoms are not specific or diagnostic to any single particular health condition, rather there can be few different health conditions those all can present in this same way, and I will provide you below with a list of such underlying health conditions;

This is a list of various underlying health conditions that can cause the types of symptoms he has been having;

1) Certain structural conditions affecting the brain especially of the frontal lobe region of the brain or the cerebellum region of the brain

2) Myopathies (primary muscle related diseases)

3) Peripheral neuropathy (primary peripheral nerve related diseases)

4) Spinal cord conditions, especially of the thoracic or cervical spinal cord

5) Severe deficiencies of vitamins such as vitamin B12, vitamin B9/folate, vitamin D, vitamin B1, vitamin B6 etc

6) Autoimmune/inflammatory disorders

7) Heavy metal toxicity

8) Endocrine disorders such as thyroid gland dysfunctions etc

Please see I am not telling all these above health conditions are applicable in his case, I am mainly trying to provide you with a list of various possibilities based on what we see in our clinical practice to explain these types of new symptoms he has been having.

As you see above there are several possibilities and this needs to be further evaluated and investigated to find out the precise cause for his new symptoms and in this regard he may try to see a Neurologist, so that he can receive a thorough neurological examination in the clinic followed by undergoing certain relevant neurological investigations too, such as some of the following;

1) MRI Scan of the brain – to study the brain structures (I see the MRI of the brain has been done yesterday so we need to follow up on the report of it)

2) MRI Scan of the spine – to study the spinal cord and spinal nerve structures

3) EMG/Nerve conduction test - a nerve & muscle test of the upper & lower limbs

4) Spinal tap (Lumbar Puncture) for the laboratory analysis of CSF (Cerebrospinal Fluid)

5) Blood tests such as the following ones;

a) Comprehensive metabolic panel – to check for the electrolytes, liver, and kidney related blood tests

b) CBC - Complete Blood Cell count

c) Serum total protein & globulin - tests for the status of nutrition, and also for status of immunity

d) SPEP (Serum Protein Electrophoresis), IPEP (Immuno Protein Electrophoresis), and Urine for BJP (Bence Jones Protein) – these tests are some additional immunological related tests

e) CPK, Aldolase, LDH - muscle enzyme tests

f) Vitamin B12, Folic acid, Vitamin B6, Vitamin B1 & B2, Vitamin D - Vitamin deficiency tests

g) TSH, T3, T4 - thyroid tests

h) ESR, CRP, ANA, dsDNA, Rheumatoid factor, SSA, SSB, Serum complement assay etc - autoimmune/inflammatory disorders tests

i) Heavy metal screening - tests to rule out heavy metal toxicity etc

And depending upon the results of the above tests sometimes additional tests such as the following too may be required;

1) Muscle biopsy

2) Nerve biopsy

3) A nerve & muscle biopsy etc

The above mentioned are the various investigations that are usually required and then treated appropriately depending upon the test results. But please see not all of these above mentioned investigations may be necessary in his case, after a thorough examination in the clinic the Neurologist will be in a position to decide which of the above investigations are required in his case. And also if any of the above mentioned investigations have already been done recently then there is no need to repeat them again, rather the focus needs to be on those investigations that have not already been done.

In the meantime he may consider trying some of the below mentioned treatments;

Healthy, Nutritious & balanced diet

Daily exercises

A course of Physical therapy to the leg muscles etc

In addition to the above, he may also consider trying certain over the counter/non-prescription nutritional supplements such as the following ones;

Methyl Guard Plus (which is a combination of active forms of vitamin b12, vitamin b9/folate, vitamin b6, vitamin b2)

Vitamin B1 (Benfotiamine form)

Vitamin A, D, E & C

ALA (Alpha lipoic acid)

Acetyl L Carnitine

Coenzyme Q10 etc

These above mentioned nutritional supplements too can help someone having weakness of the leg muscles.

To summarize once again;

1) Please see there are many possibilities as mentioned earlier above that can cause the type of new symptoms your boss has been having

2) A thorough examination in the clinic by a Neurologist followed by undergoing certain relevant investigations as mentioned earlier above can help us in finding out the precise cause for his new symptoms and then treated appropriately

3) In the meantime he may consider trying some of the treatments mentioned earlier above and these can help him with his leg muscle weakness

4) And very importantly, please see this type of health issue can be diagnosed & successfully treated, hopefully he will see a Neurologist asap and undergoes a thorough neurological examination & neurological investigations as discussed earlier above, and this will help him with the best outcome and best results!

Wishing you guys the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Doctor: Dr Subbanna MD, Neurologist (MD) replied 5 months ago

Hi, I see you have not yet rated my answer, is it because you are not satisfied with the above answer, or is it due to some technical glitches? If you are not satisfied and if you are still looking for more information, or looking for a different type of presentation so that things can be understood better please let me know and I will be very glad to continue assisting you as long as you need my services, and until you are fully satisfied. On the otherhand if rating was not done due to any technical glitches preventing you from rating please let me know and I can bring this to the notice of the company and they can help in fixing this glitch.

Please let me know.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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