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Most of the parents/children that come to my office have already been diagnosed as being somewhere on the autism spectrum. Many times they come in with multiple issues as is common among the autism spectrum. That is, we will see a child ADHD and OCD features. Perhaps, Tourette’s syndrome with OCD features or PDD with ADHD. For those of you that are familiar with the hemispheric integration model, this makes perfect sense and is fairly common. Most parents come in with a multitude of records psychological evaluations. Many times they have been to a biomedical/D.A.N doctor and have had considerable amount of lab work and specialty testing. This is great for me as I have the benefit of all this additional information quantified before I begin to form my own impression. As of late, some folks in Tampa have begun to recognize me and asked me a few questions while I am out and about in the community. These questions as of late have been with regard to “Do you think my child may be autistic? “as opposed to”Do you think you can help my child?” Many times the answer is quite obvious, but many times it is not. Of course making a diagnosis on the street without the child even being present is difficult and not very professional. However, I understand that people are looking for help and answers. Since this is in my hometown, I usually refer them to our support group or this blog for information. That assumes of course that they are not ready to make an appointment for a consultation. I found this autism screening questionnaire on a wonderful website that I thought I would post a link to. As always, I hope this is helpful.
http://autism.lovetoknow.com/Autism_Screening_Questionnaire
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I got a call from a long time friend of the family this week. Now, this has nothing to do with the Autism Spectrum directly but highlights 2 good points.He asked me if I would see his brother in law who was having severe leg pains.The brother in law walked in with a cane. He had severe leg pains and cramps especially at night which started about 2 days before he saw me.
My friend thought that he might have neuropathy which is a condition that is known to cause numbness and pain in the feet. We treat neuropathy with high power laser therapy.
The patient was worried that he might have suffered a stroke of some sort.
His wife thought he may have sciatica, a condition of the sciatic nerve which can cause intense leg pain.
Let’s look at some of the differential reasoning. Strokes and T.I.A.s ( transient ischemis attacks) dont usually cause pain in both legs, more commonly they cause one sided problems i.e. the left side of the body, left face and arm etc.
You have 2 sciatic nerves, one in each leg. For the sciatic nerve to be the culprit he would have had to pinch both nerves, unlikely but we can check this on exam.
Neuropathy doesn’t typically have a sudden onset, it usually comes on gradually over years.
Central canal stenosis could cause pain in both legs. Stenosis is narrowing of the canal where the spinal cord is before the nerves branch off into 2 sciatic nerves.This is a possiblilty an something that can be checked on exam.
Phlebitis an inflamation of the veins in the calf can cause sudden intense pain and is very dangerous as a blood clot can dislodge and move through the circulatory system.
On examination he did not have any signs of stenosis or back tenderness. the sciatic notch was nontender. His vitals i.e. blood pressure were fine. His cranial nerves exam ( the nerves in his head that go to your eyes,face etc. ) were okay (lookin higher up.) There was only mild soreness in the calf from cramping and Homan’s sign a test for phebitis was negative.
Ther is an old saying in medicine that goes like this ” when you hear hooves, think of horses not zebras.” The most common and easiest to remedy, cause of leg cramps at night is a calcium deficiency. I asked him if he drank any milk or diary products and he said not really. So we gave him a good multivitamin and a calcium supplement and told him to take an increased dose and come to see me again on Monday. I just found out that he still doesn’t feel great yet but had no cramps last night.
The facts I gave you were generalized and over simplyfied but I think it gives you an idea of how a doctor thinks when you present with any problem including an Autism Spectrum Disorder. Localizing a lesion, going through the possibilities. It also shows how basic nutients can cuase serious problems, in this case pain and disabilty. Now as a good functioal medicine practitioner I most go back and make sure there is no reason for the calcium issue.
