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Dear Doctor - I Am A 55 Year Old Male

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Posted on Mon, 29 Apr 2019
Question: Dear Doctor - I am a 55 year old male , HIV positive but under treatment with ARV medicine for 12 years.
I enjoy good general health.
I used the drug - crystal mephetamine - in February 2018 ,about a year ago
injected and smoked.
The following morning when getting up - I had difficulty lifting my left foot and experienced loss of sensation and strength of my left calf.
I experienced no pain.
I visited a general doctor in panic and he was not sure what to do but gave my painkillers and muscle relax medication.
Over the following days and weeks the severity of my symptoms improved but during the day the weakness and 'buzzing' of my calf muscle returns.
I also visited a neurologist in January of this year 2019 - he conducted a full and thorough examination with tests.
I was to ashamed to mention to him my drug use but asked him about the possibility of neurotoxins.
He ruled it out but said that I have peripheral neuropathy due to injury to the peroneal nerve.
He said that no medical procedure of medication would be of help or given but that my condition could improve slowly.
Please advise me on your opinion given my confession and description.
Can anything be done or medication prescribed to improve the symptoms and facilitate healing?
I exercise daily with little improvement.
I would appreciate any assessment.
Sincere regards XXXXXXX Brand XXXXXXX
doctor
Answered by Dr. Dariush Saghafi (3 hours later)
Brief Answer:
Peroneal neuropathy

Detailed Answer:
Thank you very much for your inquiry.

I can understand your reticence in not being entirely open to even an examining physician regarding your use of methamphetamine. My previous experience as the Director of an Addiction Clinic and treatment center has taught me that your feelings as you described are not unique. However, there is no escaping the fact that in order for your doctor to FULLY and COMPLETELY help you with your condition...he/she must be FULLY and COMPLETELY brought into all aspects of things you use (prescription or otherwise) and ingest (or otherwise) into your body. A physician cannot be privy to knowledge of what happens once a patient leaves the confines of the office. Therefore, without judgement of any sort I highly encourage you to have a XXXXXXX conversation with your physician about any an all other types of drugs (including the meth) that you have had or currently have...and to simply allow them to make best use of the information.

Now, specifically to your problem. I agree that the symptoms are very reminiscent of an acute FOOTDROP involving the COMMON PERONEAL NERVE. This is known to occur on the basis of a number of metabolic as well as traumatic sorts of injuries. Since you say you are in good health and you say that the doctor did a full and thorough workup I assume that he looked for and ruled out the presence of diabetes, thyroid disease, adrenal disease, electrolyte imbalances, blood dyscrasias (or abnormalities), ongoing illicit drug use by doing a toxicology screen, heavy metal screen of the blood, done apparopriate imaging studies of the back and the head to rule out stroke, nerve root compression, or intracranial bleed (can occur with the smoking or other use of meth and similar products).

I'm also assuming he has diligently checked you for B12, folate, Vitamin D, and Mg, levels in the bloodstream recognizing that B12's of >450 are preferable and that Vitamin D levels of 60-80 are highly preferable when dealing with any form of neuropathic symptom.

I'm also assuming that you've been sent for a full and aggressive program of physical and even AQUATHERAPY with swimming as a central portion of the treatment and also modalities such as Ultrasound/diathermy, massage, and electrical stimulation therapy.

Daily exercise is good and I encourage you to continue, however, DAILY EXERCISE WITH A PROFESSIONAL SUPERVISING AND CORRECTING YOUR EVERY MOVE is quite a different type of daily activity.

If I've provided useful or helpful information to your questions and you have no further inquiries or comments at this time then, could you do me the utmost of favors in closing the query along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few days or weeks if you'd care to drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope this conversation has helped you give you a little more direction as to what you may wish to do as well as things you can discuss with your doctors.

This query required 65 minutes of professional time to research, assimilate, and respond in complete form.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2473 Questions

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Dear Doctor - I Am A 55 Year Old Male

Brief Answer: Peroneal neuropathy Detailed Answer: Thank you very much for your inquiry. I can understand your reticence in not being entirely open to even an examining physician regarding your use of methamphetamine. My previous experience as the Director of an Addiction Clinic and treatment center has taught me that your feelings as you described are not unique. However, there is no escaping the fact that in order for your doctor to FULLY and COMPLETELY help you with your condition...he/she must be FULLY and COMPLETELY brought into all aspects of things you use (prescription or otherwise) and ingest (or otherwise) into your body. A physician cannot be privy to knowledge of what happens once a patient leaves the confines of the office. Therefore, without judgement of any sort I highly encourage you to have a XXXXXXX conversation with your physician about any an all other types of drugs (including the meth) that you have had or currently have...and to simply allow them to make best use of the information. Now, specifically to your problem. I agree that the symptoms are very reminiscent of an acute FOOTDROP involving the COMMON PERONEAL NERVE. This is known to occur on the basis of a number of metabolic as well as traumatic sorts of injuries. Since you say you are in good health and you say that the doctor did a full and thorough workup I assume that he looked for and ruled out the presence of diabetes, thyroid disease, adrenal disease, electrolyte imbalances, blood dyscrasias (or abnormalities), ongoing illicit drug use by doing a toxicology screen, heavy metal screen of the blood, done apparopriate imaging studies of the back and the head to rule out stroke, nerve root compression, or intracranial bleed (can occur with the smoking or other use of meth and similar products). I'm also assuming he has diligently checked you for B12, folate, Vitamin D, and Mg, levels in the bloodstream recognizing that B12's of >450 are preferable and that Vitamin D levels of 60-80 are highly preferable when dealing with any form of neuropathic symptom. I'm also assuming that you've been sent for a full and aggressive program of physical and even AQUATHERAPY with swimming as a central portion of the treatment and also modalities such as Ultrasound/diathermy, massage, and electrical stimulation therapy. Daily exercise is good and I encourage you to continue, however, DAILY EXERCISE WITH A PROFESSIONAL SUPERVISING AND CORRECTING YOUR EVERY MOVE is quite a different type of daily activity. If I've provided useful or helpful information to your questions and you have no further inquiries or comments at this time then, could you do me the utmost of favors in closing the query along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few days or weeks if you'd care to drop me a line at www.bit.ly/drdariushsaghafi You can always reach me at the above address for this and other questions. I wish you the best with everything and hope this conversation has helped you give you a little more direction as to what you may wish to do as well as things you can discuss with your doctors. This query required 65 minutes of professional time to research, assimilate, and respond in complete form.