.Finally, after two weeks of seemingly constant doctor appointments, this week we have some slack. The only physical contacts are that my wife has a hair appointment on Friday at 1500, and we have a dialysis team meeting at 0920 on Friday. I do say ‘we’ because, until the situation with my legs going to sleep gets resolved, no pun intended, she has been driving me to all my appointments.

Speaking of my wife driving me, if I haven’t elaborated on her now being my “official” VA Caregiver, it is worth noting that we have heard nothing further from the VA. Not that we expected to be overcome with aid and attendance. I’m certain that all will come in due course.

Now that we have physical appointments out of the way, that’s not to say we don’t have several follow-ups to make. We received a bill from Pentec for two weeks of IPN. That’s all well and good. It was in the neighborhood of less than $800 for our share after estimated payments by Medicare. That said, there is no evidence that Pentec billed our secondary payee, Tricare for Life, which generally picks up whatever Medicare does not. I called Pentec this past Friday and pointed this out, and was told they would check it out and get back to us.

The second hanging thing is we are supposed to have the temporary back device installed on 8/18. We have received no word on the exact scheduling of this procedure. If we don’t hear anything by Wednesday, it’s off we go seeking answers.

One of the hobbies my wife and I have is gardening. Even though it is getting more and more difficult to keep up with it because of my escalating conditions, we’re trying.

I have noticed on our local Nextdoor several different people on different occasions asking where they can purchase homegrown tomatoes. My suggestion to them and you is to grow your own. We have had ripe tomatoes from our gardens on the table since late March/early April, and continue to have an abundance. We have also provided select neighbors with the fruits of our labor. I made the short video embedded below to “show you how it’s done,” so to speak. Enjoy.

We have another almost full week of doctor’s appointments as follows for me:

1. Monday 8/4 dialysis labs at 1300
2. Tuesday 8/5 1115 postop catarac surgery plus new eyeglass prescription
3. Wednesday 8/6 1100 Dr Watkins Ft Worth Neurologis workup for neuropathy treatment 8/18

I have been doing more research into my lower extremity diabetic neuropathy. Below are twenty symptoms of it, with comments as to whether I am experiencing them: Graphic above and symptoms from this link: https://neuropathyjournal.org/top-twenty-symptoms-of-peripheral-neuropathy/

Each person’s experience varies depending on their type of Neuropathy, but in general, the following are the most common Symptoms of Peripheral Neuropathy:

1) Severe strange pains in your feet, legs, hands, and other parts of the body; including “crawling insects” under your skin; Mine come and go

2) Balance is difficult when walking, getting dressed, getting out of bed, or whenever you close your eyes; Yes, I have this. My wife has to help me get out of bed.

3) Numbness / heavy / cardboard / heavy cement feeling/ Novocain feeling in your feet and legs; Yes, bottom of my feet at times.

4) Tingling or “vibration” like feelings in your feet and hands; Just my feet.

5) Electric shocks starting at the bottom of your feet/foot that shoot up your leg(s) and on almost any part of the body; No, not my trip.

6) Bone pain, especially in the feet on walking or standing; No, not yet.

7) Painful muscle spasms/cramps; Yes, all the time; wakes me up.

8) Skin may become painful to touch or lose the feeling of touch, with Agent Orange skin rash; Yes, loss of touch

9) Burning sensations in your feet and hands; Very few times, but yes

10) Loss, or lessening, of sensation for hot and cold; Yes, plus cold feet.

11) Feeling like you are wearing socks when you are not; Nope.

12) The feeling you are walking on crumpled socks or stones; Yes, a few times.

13) Feet feel swollen or large; Nope.

14) Difficulty moving your hands or feet; Feet, yes.

15) A feeling of clumsiness, tripping (foot drop) or dropping things; Yes, as relates to feet.

16) Attacks of daily severe exhaustion with strange fatigue; Exhaustion, yes.

In more severe cases of Peripheral Neuropathy, you may also experience the following:

17) Problems with not sweating in the lower body with excessive sweating in the upper body; Yes, upper body.

18) Digestive (fullness; alternating diarrhea/constipation) and/or urinary problems (overflow incontinence); Yes, fullness but could be do to IPN

19) Sexual problems (loss of sensation/feeling/moisture); Yes, no feeling.

20) A tightening of your chest with an increased difficulty in breathing and/or swallowing; uncorrectable vision problems. Not yet.

Yesterday, we reviewed the results of a recent Doppler Scan I underwent as part of a workup for treating the numbness in my legs. Today, we will review an adjacent MRI, followed by a blog on what is projected to be done about the numbness.

Below, I will first post in layman’s terms the result of the MRI that Perplexity provides, followed by an embedded three-page PDF of the actual findings for your comparison.

Layman’s version:

Thoracic Spine MRI (middle back)

• No evidence of active bone injury or fracture.
• Increased thoracic kyphosis: The curve of the upper back is more pronounced than average, which is common with aging or weakened spinal support.
• Degenerative disc disease: The discs between the vertebrae in the middle back are worn out (“dehydrated”) and narrowed. Some rough bony outgrowths (“osteophytes”) and uneven endplates are seen—signs of arthritis in the spine.
• No protruding (“bulging”) discs, no joint arthritis, and no pinched nerves: The spinal cord, nerves, and bone structures look normal.
• Other tissues, blood vessels, and areas around the spine look normal.
• No signs of cancer or other destructive processes.

Summary: The changes seen are typical age-related “wear and tear” (degeneration) of the discs and spine in the middle back, but nothing immediately dangerous or unusual was found.

Lumbar Spine MRI (lower back)

• Age-related changes are present (“degenerative disc disease”) throughout the lower back. This includes worn-out discs, bone spurs, and arthritis in the joints between the spine bones.
• Mild scoliosis: The lower spine curves to the right a bit.
• Evidence of muscle spasms, with the low back being “straighter” than normal.
• Hemangioma at L1: A benign (non-cancerous) blood vessel growth in one of the bones of the spine—this is typically harmless.
• No evidence of acute fracture or bone marrow problems.
• Nerve canal narrowing (spinal stenosis) and “pinched nerves” at several levels:
  • L5-S1, L4-5, and L3-4: There are disc bulges and joint changes that significantly narrow the spaces where the nerves exit the spine (“neuroforaminal narrowing”) and the central spinal canal (stenosis). This can cause pain, numbness, or weakness in the legs (radiculopathy).
  • No herniated discs or significant narrowing at L1-L2 or L2-L3.
• A small fluid-filled area in the abdomen (“peritoneal fluid signal structure”) is noticed by chance and needs more scans (CT or MRI) to figure out what it is, but it may not be related to the back symptoms.

Summary: There are multiple sites in the lower back with “wear and tear” changes, some causing significant narrowing around nerves, which matches complaints of nerve pain. There is also a note about a non-spine-related fluid area in the abdomen that needs further checking, but otherwise, there’s no sign of serious bone disease or cancer.

Takeaway: Both MRI reports show typical age-related changes in the back with areas that could cause pain, stiffness, or nerve issues, but no immediate life-threatening findings. There is one unrelated area in the abdomen that needs further evaluation to determine its nature.

Actual MRI:

Yesterday, we had a visit from a VA social worker to conduct a home visit as part of the process to attain Caretaker status for my wife, who is acting as such. It was straightforward as far as the visit went. He asked a list of canned questions about my abilities to care for myself, and by extension, what my wife was doing to assist me. He took a walking tour of our home to check for safety-related items, trip hazards, in-place smoke alarms, etc. All pretty standard stuff; he found no items missing or needing correction.

We did pick up a few requirements we did not know about and other tidbits.

1. We must finish the online Caretaker course before our file goes to the final decision board.
2. In over several hundred such inspections, only two have been rejected at the point we are now at.
3. I am required as part of the program to travel to the VA in Ft Worth once a year to be reviewed by my VA team. It is a requirement to be in the program.
4. The VA will provide my transportation if requested for the meetup in 3.
5. We will be eligible to receive 12-17 respite hours per week for my wife at our request.
6. While we have out work cutout for us to finish the caregive course, the end, regardless of the outcome, is in sight.

While it’s a mouthful, the subject is what was conducted on my tired old bones yesterday. My GP ordered it in an attempt to get a handle on what is going on with the numbness in my legs, and in particular, my right leg. The test was called an MRA by my GP. This Friday, I am to have an MRI ordered by Trinity Paine Management to aid in the diagnosis of the same problem. Naturally, we need to know more about this procedure, so I turned to Perplexity with the following result:

A Doppler ultrasound scan of the legs from groin to ankles—often called a lower extremity arterial and venous Doppler—is a noninvasive test used to assess blood flow in the arteries and veins of your legs124. Here’s what the results can tell you:

What the Test Evaluates

• Blood Flow: Measures the speed and direction of blood flow through the major arteries and veins in your legs, detecting any abnormalities124.
• Blockages or Narrowing: Identifies areas where arteries or veins are narrowed or blocked, which could be due to atherosclerosis (plaque buildup), blood clots (such as DVT), or other vascular diseases1247.
• Venous Insufficiency: Detects if blood is flowing backward in veins (venous reflux), which can lead to varicose veins or swelling2.
• Arterial Insufficiency: Assesses for reduced blood flow due to narrowed or hardened arteries, which can cause leg pain, cramping, or skin discoloration12.
• Other Abnormalities: Can identify vascular tumors, inflammation, or structural changes in blood vessels1.

Normal Results

• No Narrowing or Blockages: Arteries and veins are open, with normal blood flow.
• No Blood Clots: No evidence of deep vein thrombosis (DVT) or other clots.
• Normal Blood Pressure Differences: Blood pressure measurements at the thigh, calf, and ankle are within expected ranges, indicating healthy circulation5.

Abnormal Results

• Arterial Blockage: May indicate peripheral artery disease (PAD), often due to atherosclerosis. This can cause pain, cramping, or even non-healing wounds in severe cases25.
• Venous Blockage or Clot: Suggests deep vein thrombosis (DVT), which is a risk for pulmonary embolism if the clot travels to the lungs24.
• Venous Insufficiency: Backflow of blood in veins, leading to swelling, varicose veins, or skin changes2.
• Other Findings: May reveal vessel narrowing (stenosis), widening (aneurysm), or inflammation.

How the Test Is Performed

• Gel and Transducer: A gel is applied to your skin, and a handheld device (transducer) is moved along your leg from the groin to the ankle to capture images and measure blood flow124.
• Blood Pressure Cuffs: Cuffs may be placed at various points (thigh, calf, ankle) to compare blood pressures and help pinpoint blockages5.

Why It’s Ordered

• Symptoms: Leg pain, swelling, discoloration, ulcers, or suspected blood clots.
• Risk Factors: History of vascular disease, diabetes, smoking, or prior clots.

Preparation and Risks

• Preparation: Usually minimal; you may be asked not to smoke before the test, as nicotine can constrict blood vessels and affect results12.
• Risks: The test is painless, noninvasive, and has no associated risks124.

In summary: A Doppler ultrasound of the legs from groin to ankles provides detailed information about blood flow, helping diagnose blockages, clots, and circulation problems in the lower extremities. Normal results show open vessels and healthy flow; abnormal results may indicate serious vascular conditions requiring further treatment or monitoring1245.

1. https://www.beatscardiology.com/arterial-and-venous-lower-extremity-doppler.html
2. https://www.mountsinai.org/health-library/tests/doppler-ultrasound-exam-of-an-arm-or-leg
3. https://www.mayoclinic.org/tests-procedures/ultrasound/expert-answers/doppler-ultrasound/faq-20058452
4. https://my.clevelandclinic.org/health/diagnostics/22715-doppler-ultrasound
5. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/vascular-studies
6. https://www.mayoclinic.org/tests-procedures/echocardiogram/about/pac-20393856
7. https://www.heartandstroke.ca/heart-disease/tests/doppler-ultrasound
8. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/echocardiogram
9. https://www.ncbi.nlm.nih.gov/books/NBK576430/
10. https://www.sciencedirect.com/science/article/pii/S0914508709002731