WHEN I WALK My Legs Immediately Begin To Tire. The

Posted on Wed, 4 Sep 2019

Question: WHEN I WALK my legs immediately begin to tire. The tiring can include any or all parts of a single or both legs, pain increases over short distances, and if I attempt to speed up the ability to ambulate deceases and shortly I can not move at all. A short break, standing or, better, sitting, allows rapid recovery. Upper and lower tracing of blood flow does not reveal any significant blockage. I am 78 years old, have a history of 10 spinal surgeries.Most vertebra are fused including the lumbar totally, much of the thoracic and all but the top cervical vertebra. Meds. include Morphine 30mg X 3 per day, Oxycodone 30 mg up to 4 X day; Katemine 50 mg at bed time, Horizont 90 mg morn. and eve., 60 mg at noon. I also take Tamsulosin, Citalipran, Levoxal (thyroid), and Metformin (Type II, Moderate). This problem began 10 or more years ago. At first the affliction was much less moderate but has slowly progressed till several years ago when the symptoms excellorated.

Answered by Dr. Bhagyesh V. Patel (3 hours later)

Brief Answer:
muscle ATP or trace elements at fault.

Detailed Answer:
Hello XXXXXXX
Welcome to Ask A Doctor services.
I have read your query and here is my advise.

* As per my clinical experience, long standing ambulatory disturbances with
improvement by sitting indicate muscle exhaustion via depletion of ATP
molecules necessary for muscle contraction via various metabolic
processes, trace elements deficiency as zinc, calcium,magnesium or other
neurology issues.
Usually in such cases blood circulation remains unaffected.

Kindly provide me further details so that I can answer your query completely.

1. Does diabetes remain under control ?
2. Any alterations in sensations over the feet ?
3. History of smoking if any ?
4. Any neurology work up as nerve conduction study or else carried out ?

Awaiting for your response.
Regards.
Dr Bhagyesh ( MS consultant surgeon )

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Answered by Dr. Bhagyesh V. Patel (38 hours later)

Brief Answer:
have not received any answers XXXXXXX

Detailed Answer:
Respected XXXXXXX
Welcome for follow up.

Sorry to say but I have not received any of your answers.
Kindly recheck and resend the same please for my proceedings.

Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyesh V. Patel (9 minutes later)

I answered the 4 questions yesterday. Please respond or if a repose was sent, send it again right away.

Follow up: Dr. Bhagyesh V. Patel (41 minutes later)

In answer to your 4 questions: 1. Yes, diabetes remains in good control. 2. Yes, both feet lack total sensation. Additionally, balance is less than 100%. 3. Quit smoking a pipe 32 years ago. 4. I will quote from the Electrodiagnostic Evaluation of 4/3/2018: "1. There is ...evidence most consistent with ongoing bilateral S1 radiculopathy. Mild active denervation is noted in the bilateral gastrocnemius muscles. 2. There is evidence suspicious for an underlying distal symmetric polyneuropathy. This may be secondary to his long standing boarder-line diabetes mellitus."

Answered by Dr. Bhagyesh V. Patel (19 minutes later)

Brief Answer:
follow up .

Detailed Answer:
Hi
Thanks for the details.

* The previous electrodiagnostic evaluation with suggestive result of bilateral
S1 Radiculopathy and diabetes of long duration indicate nerve damage at
microscopic level responsible for current agony.

* The same is possible with even controlled blood glucose levels as hidden
cellular changes go on in nerves and tiny blood vessels.

* So far as pain is concerned, you have best doses of Oxycodone and
Morphine for the relief ; what best additionally you can do is

- Short distance walking with intermittent rest ( to avoid depletion of total
energy sources of muscle compartment at a time ).
- Assisted physiotherapy to boost internal blood circulation and homeostasis.
- Addition of Zinc, Magnesium and other multi vitamins in current drug
basket.
- Pregabalin is a very well known proven molecule for your case with
excellent results over a span of time and the scope of this molecule must
be discussed with your treating physician during your next visit.
- Control of blood sugar, cholesterol, blood pressure and body weight.

Hope this information will help you.
Regards.

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Prasad