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What causes coldness in arms and lower calves while walking?

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Posted on Fri, 15 May 2015
Question: Hi,

I am still terrified, Dr. Panwar but holding on to my faith in the Lord. I went for a very long walk down by the lake this evening...it was so beautiful. I took my new testament with me. I read that there are milder cases (15-40%) Another site stated only 5% that have a mild progression or stabilize. Mine would be the latter at this time (coldness in arms and can feel a cool sensation in lower calves & sometimes around the ankles when I walk) There has also been some coolness in my back but it is not always there -- it appears as if the middle part of the spine is the culprit. (dorsal root ganglion -- neuronal damage possible or encephomyelitis) It still strongly appears to be a subacute sensory neuropathy (assymetrical small fibre would be the most likely case scenario -- it really does exist)
I will be seeing s rheumatologist on the 8th of May -- I am so scared, Dr. Panwar. (The waiting is so difficult) I hope that he will send me for the tests asap. I will let you know what happens. I feel that I must proceed with the antibodies and FDG-PET scan. I will keep you posted. The suspicion is so strong, Dr. Panwar, that I feel that I must proceed in this fashion first. However, if I do manage to acquire a copies of my previous exams including MRI CD, I will send them your way. I will see what I can do--however, I sense that the situation at hand is urgent and I must try and see these specialists asap. My app with the gynecologist won't be until the latter part of May, I believe. I will be in touch with you soon. God Bless.
doctor
Answered by Dr. Ajay Panwar (6 hours later)
Brief Answer:
Sure,you should go for investigations-antibodies.FDG-PET scan may wait.

Detailed Answer:
Hi,
Thanks for being connected.It feels good to have your detailed follow-up.

Sure,you should get opinions from a Rheumatologist and obviously from a Gynecologist as we already discussed.A rheumatologist's/immunologist's opinion may prove to be of value regarding autoimmune etiology.
And as I said,mental peace is the key and the first step towards good physical health.So,to achieve that,I think it's time you should get the investigations done- autoimmune antibodies testing.Though,I think there is no clear indication and its early to get FDG-PET scan.

I am still, having doubts,regarding it being small fibre neuropathy(unless it is one of those rarest cases),when we have spinal degeneration(causing radiculopathy) as an obvious cause.

Even,I am waiting for your MRI CD,so that I can further make a better opinion.Please get the antibodies testing done and take a consultation from clinical immunologist/rheumatologist and Gynecologist & keep updating me regarding the developments.Even I am greatly curious,in your clinical course and further developments.

Hope that I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.

Regards

Dr.Ajay Panwar,
MD,DM(Neurology)



Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (41 hours later)
Thanks so much again for taking an interest in my case, Dr. Panwar. As I mentioned earlier, the specialists that I saw could not find spinal degeneration matching up with this kind of clinical picture -- abrupt onset, assymetric pattern & symptomology -- coldness more than anything else right now but it was more severe burning and coldness until several months ago. The doctors told me that my legs would not be involved. (actually, I feel cool patches in upper and lower legs & even around the ankles. It was more pronounced yesterday than today. The arms are still cold - the burning is much more suppressed now but is still felt at times at a v low level. (was far more predominant up until a few months ago) All of these symptoms appear to match up with a classical subacute sensory neuropathy -- how I wish it were not so. I have been traumatized for more than a year now because it all seems to be pointing in that direction from where I am standing. (esp when one takes the gynecological info into account although it could be lung) However, I am still trying to remain neutral until I have the results. It has been a year and four months -- such a long and frightful journey but I do have an indomitable will and faith. (the news would still be devastating) The statistics are alarming -- only 20% ever make it to three years. (I am afraid for my dear daughter)The Mayo Clinic has mentioned that some cases can actually be reversed but they must be caught early--one must test positive for the antibodies and the tumor must be found and eradicated before further damage is done. However, one must also respond to the treatment for the neurological deficits as well (most are ineffective) -- 47% will die from encephomyelitis if the tumor does not kill them first. (metastasis or other complications) I will keep you abreast of what is happening to be sure -- there are so many variations -- more test positive for the antibodies;only 16% have the disease and do not test positive. (according to what I have read online) As I mentioned, several of the doctors I have spoken do not believe that it can be a radiculopathy. (even two neurologists -- because of the involvement of the legs) They also mentioned that the radiculopathy would usually only involve one side as well. I could not even find coldness as a common symptom. I wish that I were in a different place where there was a higher level of suspicion & treatment could begin immediately. I could not find any information on clinical trials since there are very few (if any) at this time. I know that I need to know what my current status is before proceeding or deciding upon the best clinical approach. Your opinion is a valuable life line to me at a time when there is so much uncertainty. I get the feeling that this is the kind of situation where there is isn't much time to ponder; one would need to find out what and where the best treatments are in terms of immunological, chemotherapeutic, alternative, experimental -- perhaps specific combinations -- one needs to be in a place where they are open to trying different approaches if certain modalities fail) Still worried that these symptoms could worsen at any time. (esp the coldness in spine)
doctor
Answered by Dr. Ajay Panwar (6 hours later)
Brief Answer:
Please try to be mentally reassured and relaxed.

Detailed Answer:
Hi,
Thanks for being in follow-up with further details.

I feel concerned the way you are stressed about your health condition.I have all my sympathies and support with you.

I want to make few points out of here -

Firstly,When we have nothing in favour of a cancerous etiology in your case,why you are stressed so much about it?I suggest you to get proper evaluation for a cancerous etiology so that you can be on one side and get rid of these uncertainities.

Secondly,in a clinical background of degenerative spine disease,why is the diagnosis of radiculopathy disputed?Of course,it may not be,ultimately the diagnosis.But,atleast we have a strong possibility here.Regarding the other neurologist's opinion(whom you consulted) about it,I am confident to say that-

No neurologist in the world can say that Radiculopathy don't involve legs.There is some possible misinterpretation in it.Further,hallmark of radiculopathy is asymmetry and not the 'side restriction'.Of course though,the most important clinical manifestation of asymmetry is -on one side.But,it can be more on one side and lesser on another.Any asymmetry is infact,in favour of radiculopathy.Besides,when we have degenerative spine disease,it is often that we can see bilateral radicular involvement.

Coldness is not a symptom which can rule out or in,a diagnosis.

Lastly,I would say that this is a clinical picture and it is medical science.Science is nothing without evidence.If it is cancer,there has to be evidence,If it is radiculopathy,there has to be evidence.

Bottom line-Please follow-up with the investigations mainly MRI and Nerve conduction studies(NCS) with brachial plexus protocol and F-wave,so that we can arrive at a conclusive diagnosis.

I am not negating anyone here,but it just can't be 'beating about the bush'.Investigations have to support the diagnosis.

Please be mentally relaxed and have faith in GOD.I am curious to track your clinical developments.Please be in follow-up.

Hope that I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.

Regards

Dr.Ajay Panwar,
MD,DM(Neurology)


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ajay Panwar (7 hours later)
Thank-you so much for your valued expertise, Dr. Panwar The patchiness of this condition also leads me to fear the worse but as you say, the necessary tests have to be done.

I will let you know what happens in the coming days.





doctor
Answered by Dr. Ajay Panwar (8 minutes later)
Brief Answer:
Waiting for your further query.

Detailed Answer:
Hi,
Thanks for appreciating.

Sure,I shall keep waiting for your further query.
It has been my pleasure so far,to have your follow -up.

Hope that I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.

Regards

Dr.Ajay Panwar,
MD,DM(Neurology)


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ajay Panwar

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What causes coldness in arms and lower calves while walking?

Brief Answer: Sure,you should go for investigations-antibodies.FDG-PET scan may wait. Detailed Answer: Hi, Thanks for being connected.It feels good to have your detailed follow-up. Sure,you should get opinions from a Rheumatologist and obviously from a Gynecologist as we already discussed.A rheumatologist's/immunologist's opinion may prove to be of value regarding autoimmune etiology. And as I said,mental peace is the key and the first step towards good physical health.So,to achieve that,I think it's time you should get the investigations done- autoimmune antibodies testing.Though,I think there is no clear indication and its early to get FDG-PET scan. I am still, having doubts,regarding it being small fibre neuropathy(unless it is one of those rarest cases),when we have spinal degeneration(causing radiculopathy) as an obvious cause. Even,I am waiting for your MRI CD,so that I can further make a better opinion.Please get the antibodies testing done and take a consultation from clinical immunologist/rheumatologist and Gynecologist & keep updating me regarding the developments.Even I am greatly curious,in your clinical course and further developments. Hope that I have answered your query.If you have any further questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me. Regards Dr.Ajay Panwar, MD,DM(Neurology)