An Unrelated But Good Example

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.