Balancing and nerve condition

[bluebanded goby]

A few months ago, a dive doctor gave me a neurological examination during a routine checkover. He said that I had a slight insensitivity to vibration in my left foot, and suggested that just to be safe I have an exam by a neurologist at my regular HMO.

It took a while to book this visit, but I had this exam last month. The neurologist confirmed that I had slight insensitivity to vibration in my left foot, but said I didn't have any conditions to warrant any concern (predisposition toward diabetes, etc), so since it wasn't bothering me he suggested just "keeping an eye on it."

Last night I was reading the firsthand account of a diver treated for DCS. He mentioned that the main neurological test used at the hospital where he was treated in Australia was this: the subject stands with one foot directly in front of the other as if walking a tightrope, then places the hands on opposite shoulders, and closes his/her eyes. Supposedly an average subject can hold this pose for 60 seconds before losing balance. When admitted for chamber treatment, the writer could only hold this pose for about 10 seconds.

After reading this, I stood up and tried this test myself. It took quite a bit of effort to remain standing for 10 seconds! I tried it again the following day, with the same results.

I was never given this particular test by either the dive doctor who saw me a few months ago or the neurologist who saw me more recently. Is it indeed a standard test of neurological function? Would my relatively poor performance suggest that maybe I should be checked out further? I've found that the doctors at my HMO tend to wait until people are pretty far out of normal ranges before they treat various conditions. Thanks for any comment on this.

 

[watergal]

Hi, Goby.

I am a family practice doc with about 10 years experience in both diving and medicine, no position on this board, and no relationship with any HMO. While I have a special interest in diving physiology and have gotten some extra education in it, I have no dive medicine credentials. In addition, I am new to this board, so I don't know how the medical regulator works--if I am overstepping the bounds please forgive.

The test you describe is a variation on a standard neurological test for proprioception--balancing though the feel of your body. The most common form done in these parts is called the Romberg test--you may have read about that. In that position one stands straight with ones feet touching side by side, closes ones eyes and extends ones arms straight out in front. We do this mostly because it is easier to keep ones balance--we can still get information my how much a person wavers, but we don't have to pick people up off the floor (much). The test you describe eliminates most cues except the brainstem/inner ear and the bottoms of the feet. If you are asking if the medical folks here think it is a reasonable test for a doctor to do my answer is, "yes". If you are asking if your doc(s) should have done exactly that test, my answer is, "no". The same information can be gained though other means--it doesn't mean he/she skipped something.

I will not be much help in advising you on your situation personally as so much depends on age, other health conditions, other symptoms, exposures/risk factors (yes, including microbubbles), family history....
What I can say is that I cannot think of any medical condition which manifests itself first by loss of vibration sense in one foot only and goes on to cause serious problems without the person or his/her physcian noticing any other concerning signs or symptoms first.

I can also say that if a person is concerned about a health problem despite one reassuring opinion, there is nothing wrong with a second opinion.

That's my comments. As always on these forums, this message is provided for general information only and does not constitute diagnosis, treatment or the establishment of a doctor patient relationship. It is not a substitute for seeking the care of a qualified medical practicioner.

Happy Thanksgiving to all

 

[BillP]

Originally posted by watergal


I am a family practice doc with about 10 years experience in both diving and medicine, no position on this board, and no relationship with any HMO.

In addition, I am new to this board, so I don't know how the medical regulator works--if I am overstepping the bounds please forgive.

Hi Watergal:

Nice response! I don't set the rules around here, but as far as I'm concerned any board member is welcome to post here. As you pointed out, all "answers" here (particularly mine ;-) are for information purposes only and presented "for what it's worth, take-it-or-leave-it". I try to give good information when I post, but I claim no more qualifications than any other board member. It's not at all uncommon that someone "with no position on this board" other than membership has more or better information than I do. I think that's part of the beauty of this open forum.

BTW, congrats on the "no relationship with any HMO" thing. Can I move to South Carolina? (grin)

Bill

 

[bluebanded goby]

Thanks for the response, Watergal. I suppose there were a variety of questions implicit in my post, but the main thing I was wondering was, "Should I be alarmed [or concerned, or curious] because I have to struggle to keep from falling over after a few seconds of this proprioception test, where the average subject supposedly can stay balanced for a minute?"

As I mentioned, apart from the fact that the dive doctor discovered this slight insensitivity to vibration in one foot, I'm not bothered by it in any other way, so as the doc said, maybe I'll just keep an eye on it. (On the other hand, one condition that is more problematic for diving is that I get numbness at night in my hands, as well as occasional tingling even in daytime, and this has been difficult to distinguish sometimes from symptoms of mild DCS. But the neurologist seemed to think that that was the result of some nerve compression situation and didn't think it was related to the foot thing.) Thanks again!

 

[watergal]

Hi again, Blue!

Once more, I really can't say much about your personal situation without a lot more info, but I can't think of any reason what you describe should compromise your diving at this point.

Oh, BTW, I am not convinced that you really had a "poor performance". When I tried it for kicks, I only got to an average of 30 seconds or so on several trials. My buddy was against the wall by 10 seconds, but he has inner ear trouble. I haven't looked up norms for this test, but I will try to do so after the turkey is digested. It might be just as helpful to do a poll here. Any takers?

 

[foothillsdiver]

Well Watergal,
I had my wife try the balancing act and she made 45 seconds with no problems. Shamed you and I both.

She immediatly countered that maybe that is why she gets sea sick so easily, because she has such sensitive ears.


Who knows !!!!


FOOTHILLSDIVER

 

[artsprite]

Ok Watergal,
I took you up on your challenge, and was pleasantly surprised, and confused.

I have Fibromyalgia, and people with FMS regularly walk as if drunk, bang shoulders on doorways, trip over next to nothing, and seem clutsy because FMS affects brain stem activity and causes all kinds of balance problems, and cognitive problems. I thought I'd last about 3 seconds.

With my left foot in front of my right, I could only last 8 seconds...
not surprising...
but with my right foot in front of my left, I actually lasted 19 seconds one time. I was pleasantly surprised at this. That's better than I expected, but I'd probably be one of the worst performers of this test on the board because of the reason I stated above.

This was a lot of fun anyway! LOL the things we find out on Scubaboard!