Medical Opinion: Leg problem could be caused by several conditions

Editor's note - Board-certified specialists from a panel of Yuma-area physicians provide to-the-point answers to questions submitted by Sun readers. The answers are only the opinions of the answering physicians and are not meant to be a substitute for medical consultation or physician care. Submit questions by e-mail to medicalopinion@yahoo.com, or via regular mail at Yuma County Medical Society, P.O. Box 4476, Yuma AZ 85366.

Q — I had a quadruple bypass seven years ago; the doctors took two veins out of each leg for the procedure. Since the operation, I have had no power in my legs. I had treatment for my legs administered by my heart doctor. I also was checked by a neurologist to no avail. My circulation in my legs was also checked and is fine. No one seems to be able to figure out the problem. It gets worse every day, I can hardly walk. Please help!

  A — Thank you for the opportunity to answer your question. I wish, though, that the description of your symptoms was a bit more comprehensive and detailed.

  The difficulty in this case is a description of symptoms that could be interpreted in several ways. Your symptoms could possibly be caused by neurological, cardiovascular, musculoskeletal and connective tissue conditions. A detailed description and examination would help a clinician narrow it down to the systems involved.

  Certain conditions need to be confirmed, requiring further diagnostic studies. When you say you have "no power in my legs," are you describing difficulty in walking as far as was normal before the cardiac bypass? Are you able to stand? Do you have pain leading to difficulty moving the legs?

  You need a full history and physical by a qualified clinician, followed by neurological and cardiovascular workup. Saying that you were checked by a neurologist is very nonspecific, as you don’t mention what testing the neurologist pursued, nor the results of this testing.

  The statement that your leg circulation was "checked and is fine" is also nonspecific. What sort of testing was used? What did your doctors advise or diagnose?

  Several conditions could be the cause of your problem. This could be a cardiac limitation, or even an unusual presentation of claudication. You could have experienced a stroke associated with the surgery, leaving a deficit in leg strength bilaterally. You could have many kinds of spinal cord lesion, lower motor neuron lesion, or myopathic weakness. There is even the possibility of an ongoing nerve injury in the legs due to saphenous vein harvesting.

  Although the problem occurred acutely after your bypass, this may be due to some underlying rheumatic or endocrine problem. Your list of possible diagnoses with the given information is nothing short of enormous.

  All of these issues should be addressed first with your primary care clinician, who should perform a thorough history and complete physical exam. You should then work with your primary care clinician to coordinate all specialized testing necessary, to include whatever cardiology workup, assessment of CVD and PVD, EMG testing and clinical imaging is needed to help you come to some satisfactory conclusion of this problem. We would like to wish you luck with further diagnosis and management.

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Manjunath Nathan, M.D., is board certified in internal medicine practicing in Yuma.