Talk about Cold Feet: Autonomic Neuropathy and Pregnancy

[WhistlePig]

Hi Dr. Steve!

I also love listening to you on the show. I am fascinated by medical shit.
Here is my question: When I was pregnant over 2 years ago I started getting hot, tingling feet intermittently with having extra cold feet. I figured it was hormones and ignored it. I had my daughter in August of 2006 but I am still getting these episodes. I went to my general practitioner who referred me to a podiatrist which seemed like a waste of time to me so I didn't go (I'm thinking it's some kind of neuropathy) but maybe I'm wrong. It's mostly just one foot. It'll get ice cold, then once it warms up it's TOO hot. This happens mostly at night.
Any ideas what the hell this could be?

[Dr Steve]

Hi Dr. Steve!

I also love listening to you on the show. I am fascinated by medical shit.
Here is my question: When I was pregnant over 2 years ago I started getting hot, tingling feet intermittently with having extra cold feet. I figured it was hormones and ignored it. I had my daughter in August of 2006 but I am still getting these episodes. I went to my general practitioner who referred me to a podiatrist which seemed like a waste of time to me so I didn't go (I'm thinking it's some kind of neuropathy) but maybe I'm wrong. It's mostly just one foot. It'll get ice cold, then once it warms up it's TOO hot. This happens mostly at night.
Any ideas what the hell this could be?

Hmmmm....this is an odd one; what you're describing is the symptoms of an "autonomic neuropathy" (damage to the nerves that deal with temperature regulation, among other things), but honestly the only reference I can find in the literature to this and pregnancy has to do with diabetes. If you didn't have gestational diabetes (loss of blood sugar control during pregnancy), then I'd be somewhat at a loss on this one.

Actually, the podiatrist MAY be able to help, a good one will know a lot about neuropathies in the feet. A neurologist would be the other way to go; he/she would probably do a nerve conduction test to make the diagnosis. (I need to emphasize here that I am not a neurologist, and I'm a little out of my depth...where I can help is in choosing which specialist to go to.)

I think you could start with either one...if you don't get the answer you need from one, you can always go to the other. I'll look up other neuropathies of pregnancy this week and see if anything else fits.

your friend,


Steve

[WhistlePig]

Thanks for the advice!!! I was tested for diabetes but that was negative. I'm not overweight or anything either. It's just kind of weird.
I'll try the specialists and see what they say.
Thanks again!

[Dr Steve]

Thanks for the advice!!! I was tested for diabetes but that was negative. I'm not overweight or anything either. It's just kind of weird.
I'll try the specialists and see what they say.
Thanks again!

Ok! Write back and give us the "right" answer, when you get it; it'll be interesting and also help me to hone my online diagnoses in the future. :smile:

[WhistlePig]

Wow, it took me 6 months but I finally went to a podiatrist. He found no problems with blood flow etc. to my feet and referred me to a neurologist. I went to the neurologist and he did some tests and found no nerve problems. The diagnosis he gave me was it's either Raynaud's disease or signs of Lupus or Multiple Sclerosis (GULP!) but he was doubtful about the last two since I have no other symptoms related to these diseases. But of course I'm freaking out (MS!!) and am looking for other symptoms.

Questions for you, Dr. Steve:
I've been tested for Lupus before and it's come back negative. Can this just show up any time or once you're tested negative you're ok?
Is there a test to find out if you have Multiple Sclerosis?
Are there other tests to find out if it's definitely Raynaud's and if so, what kind of Dr. would perform them?

Thanks Dr. Steve!!

[Dr Steve]

Wow, it took me 6 months but I finally went to a podiatrist. He found no problems with blood flow etc. to my feet and referred me to a neurologist. I went to the neurologist and he did some tests and found no nerve problems. The diagnosis he gave me was it's either Raynaud's disease or signs of Lupus or Multiple Sclerosis (GULP!) but he was doubtful about the last two since I have no other symptoms related to these diseases. But of course I'm freaking out (MS!!) and am looking for other symptoms.

Questions for you, Dr. Steve:
I've been tested for Lupus before and it's come back negative. Can this just show up any time or once you're tested negative you're ok?
Is there a test to find out if you have Multiple Sclerosis?
Are there other tests to find out if it's definitely Raynaud's and if so, what kind of Dr. would perform them?

Thanks Dr. Steve!!

Thanks for the update! I can't believe a neurologist would just dump "well, you could have multiple sclerosis" on you without doing the followup tests to see if you do.

MS can be diagnosed with an MRI of the central nervous system. The classic picture of MS is the appearance of "plaques". These are areas where the fatty sheath of the individual nerves is breaking down, causing "short circuits" in the nerves going to all kinds of places in the body. It sure doesn't sound like you have it...most people with MS complain with limb weakness or unsteady gait or visual disturbances. If you have an abnormal MRI, they will probably want to do a lumbar puncture (spinal tap) but don't worry about that yet...if it comes to it, I'll let you know what to expect, but for now, this is an unlikely thing.

Raynaud's syndrome is an interesting one. it's very patriotic, in that the classic presentation is "Red White and Blue" (though not in that order.) You can do a test for Raynaud's yourself at home, though it's not perfect.

Get a bowl of cold water and put a few ice cubes in it. We need enough ice cubes so that they reach equilibrium and don't melt rapidly. Let the bowl sit for 5 minutes so the water gets really cold.

Plunge your hands into the water and leave them there for a minute (or until you can't stand it any more). Pull your hands out. If you have Raynaud's, you'll see the following:

1) Your hands will turn white as the arterial supply is cut off to the hands as the capillaries and arteries spasm because of the cold

2) they'll then turn blue as the oxygen supply to the hands is cut off

3) they'll then turn bright red as the capillaries open back up and blood flows back into the hands

really only a rheumatologist or a good primary care doc will be comfortable interpreting this test. I've seen a couple of true Raynaud cases and it's most dramatic.

hope this helps! keep us in the loop!



steve