Heat edema

A while back I wrote about heat rash. Now I have the option of swelling too.

I recently came on holiday to somewhere warm. In cold weather I stiffen up alarmingly so I've taken to fleeing the cold whenever possible. My warm refuge had a spot of warmer warm and I became a bit discombobulated with the heat. Yes, I get both heat and cold sensitivity symptoms - I'm just lucky that way, I guess.

Along with discombobulation, my legs and feet swelled up a bit. My ankles became 'tankles' and my thighs were oddly lumpy in sweat pants. Then we had a thunderstorm, and the heat broke, and within an hour I was headache free, clear-headed and… shrinking.

A bit random google research shows that heat odema is relatively common and usually benign. It is also quite prevalent among people with MS. (And people who are overweight. And women who are menopausal. I score 2.5 out of 3.)

Up till now I thought I was imaging things.

One website mentioned that some people with MS find that moving to a very stable, mild climate really helps their symptoms. Once I would have assumed that was a solution for 'rich' people. Now I'm beginning to understand you'll make a lot of sacrifices to feel well and move freely.

Proprioception and gait abnormality

This year my physical stamina took a hit. A succession of minor injuries meant I couldn't exercise until I healed. Healing was taking forever, with one damn thing after another. My physio finally pointed out that "only some of the problem seems to be bio-mechanical... the rest seems to be...the other thing...".  The other thing being possible/probably MS.  (Unless that was code for conversion disorder?)

The physio is charming, caring and kindly, but I gained the distinct impression that treating someone who can't be completely cured is a bit of a 'downer'. Suspecting that was the physio's attitude was a bit of a downer for me, too.

So I researched neurological physiotherapy. For a physio who routinely treats those with moderate to advanced MS, Parkinson's and Aquired Brain Injury, I'm a good news story. It's also reassuring to be treated by someone who believes they can help.

My proprioception isn't what it could be, and my gait is abnormal. A quick google suggests that CNS lesions and Parkinsons are the front-runners if it's not a mechanical issue (hip, knee or ankle damage) or a genetic disorder. Well, duh. There is an element of mechanical issue, the 'usual' joint deterioration of a middle-aged person, and some learned 'guarding'.

If you watch me walk, you probably won't see a problem, but my neurophysio can see it.

Gait and balance impairment in early multiple sclerosis in the absence of clinical disability.  (abstract)

Proprioception and locomotor disorders (google docs version)

Gait abnormalities in minimally impaired multiple sclerosis patients (abstract)

In plain English, brain lesions interfere with the pathways that determine some of the ways muscles work. Part of this can be caused by compensation strategies - your muscles stiffen up to literally keep you upright - which interfere with the normal proprioception.

The good news is that brain plasticity means we have the potential to be retrained in more beneficial ways. As long as we act early enough.

My exercises seem incredibly simple and 'easy'. Because they are working very specific muscles, and my brain, they are quite tiring - even the neurophysio finds them tiring - but if they increase my body awareness (proprioception) and the muscle strength of the weakened muscles, they will be well worth doing.