hi all
I'm wondering if anyone has anyone has worked with anyone with Churg strauss
syndrome..
its basically a systemic vasculitis.....also called allergic granulomatosis
my patient is a 61 y/o female presented to ER with a small bowel infarction
and ended up with a colostomy. Along with that came a bilat. foot drop due
to vasculitis with 0/5 dorsi flexors and 1/5 plantar flexors bilaterally
with absent sensation 80% of foot( happened in the space of 1 week)!.
I've been seeing her at home for the last 5 weeks .At the moment she's being
fitted for custon AFO's and she can ambulate with a walker approx 12 feet
with practice afo's on-otherwise she is W/C bound.
Sit to stand from raised seat with supervision but still has not enough
strength from the w/c. I've had to take things slowly as she has had
difficulty coping with the colostomy and pressure sores on her sacrum for
which she is being seen by a RN. They are healing but slowly
Steroids seem to be the only treatment and there is supposed to be
remission in 90% of cases.( per the literature)
My question is how agressive should I be with the foot drop. I'm getting
mixed signals...the neurologist does not have faith in e.stim even thought
the nerve conduction studies show some conduction, two PT's I talked to
think it's worth a shot but with care not to over fatigue the muscles and
they recommended 15 mins a day but they didn't have much experience with
neuropathy secondary to vasculitis
The skin of her feet is flaky with mottled toes but she has strong pedal
pulses, sensation is mostly absent
The other problem is that this lady does not have DME coverage so any e.stim
unit will have to be rented by her for $100/mth. She already is paying for a
W/C, walker, AFO's and I don't want to burden her with this if theres very
little hope in recovery...in the last 4 weeks she has had no improvement in
muscle tone but has got more sensation in one foot...I am hoping to get her
into outpt PT but until her husband gets to building a ramp she's homebound
by 7 steps, at the moment he carries her down the stairs.The MSW is also
involved but they are just over with their income to qualify for financial
assistance for the DME and ramp....we are still looking into community
resources.
She is willing to do anything and pay anything to get better ...her prior
level was independence, dance instructor
Any ideas? Any ideas on acupuncture, she's into natural medicine
Thanks in advance
Marguerite
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