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Suggest Treatment For Paresthesia In Hands Radiating To Limbs
Question: Hello: I recently developed a troubling paresthesia issue which started in my hands, went to my feet and now is traveling up my limbs. It moves around and comes and goes in intensity. The biggest effect is my muscle weakness and then my swelling. Over 4 weeks time, I am at a point where I can't button my pants (Grip), squeeze a bottle, and I feel like I am going to collapse (legs) when the symptoms are most intense. I have trouble going up the stairs. I can't lift my 4 year old anymore (4 weeks). My blood pressure has risen slightly from 114/89 to 126/89.
I discovered that heat and alcohol inflame the situation. I've since ceased hot showers, my occasional glass of wine, until I know what is going on or this is resolved.
I've had a EMG and some muscle tests that were inconclusive (didn't indicate nerve damage) but I have an EEG next week.
I know there are many things this can be associated with, but I am concerned that some serious ones haven't been ruled out while we are focused in 1 area.
I've had a uterine fibroid in my inverted uterus which was proclaimed as the potential source of my unexplained "coccyxdania". I've only had an xray that showed no injury. Is it possible that something else is going on there that is causing the coccyx pain and now is pressuring a nerve or my spine? This has been going on for a year. I have had an odor in my private area that I can't explain. Should I request an MRI?
Also, I had a bad virus in late October that had me bedridden (strep ruled out); but I had a high fever for 2 days and just weak after. A week later, I took a flu shot for the first time. My paresthesia started 2 weeks later. Is it possible my immune system is attacking itself?
My MD and neurologist have not been very urgent about ruling out some of the concerning causes. I've tried to be proactive and asking questions, as these symptoms are starting to be dehabilitating. I'm just told to wait until 2 weeks for the scheduled EEG. I think they each believe the other is managing the holistic care. Should that be driven by the MD or Neurologist?
I did request some auto-immune lab work.
I've had a comprehensive metabolic panel, CBC with differential, heavy metal assessment (well), vitamin d, urinalysis. Everything came out ok except:
The ANA and rheumatoid factor came ok, but the sedimentation rate was at 40. I'm told that suggests something inflammatory. From my WBC and my HCT count, my HGB, HCT and MPV are slightly low comparative to the thresholds. I am also ok on my iron count, but my absorption rate is low. The urinalysis shows blood in the urine. My creatinine is just below the threshold and my bun/creatinine is just above the threshold. Is it possible that these flags in the lab work are nothing to be concerned about?
I discovered that heat and alcohol inflame the situation. I've since ceased hot showers, my occasional glass of wine, until I know what is going on or this is resolved.
I've had a EMG and some muscle tests that were inconclusive (didn't indicate nerve damage) but I have an EEG next week.
I know there are many things this can be associated with, but I am concerned that some serious ones haven't been ruled out while we are focused in 1 area.
I've had a uterine fibroid in my inverted uterus which was proclaimed as the potential source of my unexplained "coccyxdania". I've only had an xray that showed no injury. Is it possible that something else is going on there that is causing the coccyx pain and now is pressuring a nerve or my spine? This has been going on for a year. I have had an odor in my private area that I can't explain. Should I request an MRI?
Also, I had a bad virus in late October that had me bedridden (strep ruled out); but I had a high fever for 2 days and just weak after. A week later, I took a flu shot for the first time. My paresthesia started 2 weeks later. Is it possible my immune system is attacking itself?
My MD and neurologist have not been very urgent about ruling out some of the concerning causes. I've tried to be proactive and asking questions, as these symptoms are starting to be dehabilitating. I'm just told to wait until 2 weeks for the scheduled EEG. I think they each believe the other is managing the holistic care. Should that be driven by the MD or Neurologist?
I did request some auto-immune lab work.
I've had a comprehensive metabolic panel, CBC with differential, heavy metal assessment (well), vitamin d, urinalysis. Everything came out ok except:
The ANA and rheumatoid factor came ok, but the sedimentation rate was at 40. I'm told that suggests something inflammatory. From my WBC and my HCT count, my HGB, HCT and MPV are slightly low comparative to the thresholds. I am also ok on my iron count, but my absorption rate is low. The urinalysis shows blood in the urine. My creatinine is just below the threshold and my bun/creatinine is just above the threshold. Is it possible that these flags in the lab work are nothing to be concerned about?
I forgot to mention that my voice is getting raspy at times. That comes and goes too. I had a copper/metallic taste in my mouth for 5 days which has since went away; there is no oral infection. I saw my dentist as I had a history with my gums; everything was fine.
Brief Answer:
Neurologist work up; MRI brain is in order...
Detailed Answer:
Hi,
I went through your post. You reported to have developed ?abrupt onset, short duration (4 weeks) symptoms of paraesthesia and weakness involving upper and lower limb. You wish to know the probable cause and about its seriousness. I would like to address this concern in the following way:
1. At the outset, the distribution and abrupt nature of symptoms are against the possibility of lower back / coccyx nerve compression + fibroid/inverted uterus. So I would rule that as a possibility.
I am glad you mentioned the details of blood tests performed. Those are routine investigations performed in such cases. I would have also ordered for MRI brain along with EEG as first choice investigations in this case especially if there are objective signs of weakness.
2. I have read random reports of neurological disturbances following flu shots. However I haven't found convincing evidence to prove its relations in literatures. Vaccines in almost all cases are safe and are the least likely cause of these disturbances. If there are structural damages on the nerves / brain secondary to vaccines, I believe EMG and brain scans should reveal it.
3. ESR is a very non specific marker. Marginal raise in ESR with normal ANA profile in the back ground of acute presentation should not bother you.
4. If the comprehensive metabolic panel test didn't include vitamin b12 and thyroid hormone assessment, this are two test that I will want to assess.
5. Neurologist would be the apt specialist with whom you can pursue treatment at this point of time.
In a nutshell, I understand the genuine nature of your concern. But based on your current list of symptoms and the mood of your local doctors, chances of serious organic / neurological disorder seems to be meagre. MRI brain, vitamin b12 and thyroid hormone check along with EEG are the list of tests that would be helpful in this circumstances. Discuss about it with your doctor/neurologist. If they also turn up inconclusive, I would treat you with reassurance, physiotherapy and neurotrophic drugs such as gabapentine/amitriptyline.
Hope I have not missed out on any of your concerns. Let me know if you need clarifications.
Regards
Neurologist work up; MRI brain is in order...
Detailed Answer:
Hi,
I went through your post. You reported to have developed ?abrupt onset, short duration (4 weeks) symptoms of paraesthesia and weakness involving upper and lower limb. You wish to know the probable cause and about its seriousness. I would like to address this concern in the following way:
1. At the outset, the distribution and abrupt nature of symptoms are against the possibility of lower back / coccyx nerve compression + fibroid/inverted uterus. So I would rule that as a possibility.
I am glad you mentioned the details of blood tests performed. Those are routine investigations performed in such cases. I would have also ordered for MRI brain along with EEG as first choice investigations in this case especially if there are objective signs of weakness.
2. I have read random reports of neurological disturbances following flu shots. However I haven't found convincing evidence to prove its relations in literatures. Vaccines in almost all cases are safe and are the least likely cause of these disturbances. If there are structural damages on the nerves / brain secondary to vaccines, I believe EMG and brain scans should reveal it.
3. ESR is a very non specific marker. Marginal raise in ESR with normal ANA profile in the back ground of acute presentation should not bother you.
4. If the comprehensive metabolic panel test didn't include vitamin b12 and thyroid hormone assessment, this are two test that I will want to assess.
5. Neurologist would be the apt specialist with whom you can pursue treatment at this point of time.
In a nutshell, I understand the genuine nature of your concern. But based on your current list of symptoms and the mood of your local doctors, chances of serious organic / neurological disorder seems to be meagre. MRI brain, vitamin b12 and thyroid hormone check along with EEG are the list of tests that would be helpful in this circumstances. Discuss about it with your doctor/neurologist. If they also turn up inconclusive, I would treat you with reassurance, physiotherapy and neurotrophic drugs such as gabapentine/amitriptyline.
Hope I have not missed out on any of your concerns. Let me know if you need clarifications.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello: Thank you for the reassurance & feedback. Also, I appreciate the understanding that this progression is disconcerting. Holistic and knowledgeable care is priority. However, some level of empathy is important too for trust.
I want to note that I requested the lab work, including the auto-immune. This was not their first course of action by either dr. We don't have the MRI scheduled, but I assume the MRI may be the next course if anything, depending on the EEG.
Is there any chance the iron absorption has anything to do with this? I've had conflicting input. Neurologist suggested this, but the MD does not think so due to my iron stores. My iron is at 55, iron binding capacity and transferrin are in the mid range, but the transferrin saturation is at 13 (just below threshold). Either way, I am still working on this with appropriate supplementation and diet. I was put on a 3 day Mirapex trial to test the theory and saw no change, but was told it still could be the issue.
My B12 seems fine, at 454.
Also, I don't see any of the thyroid tests. TSH, Free T3, Free T4. In the past, these labs came out ok, but it's been a year. I will ask my neurologist if he can run them.
I also inquired a few times regarding the prescribed Neurontin ordered, but was told we'd review the labs and any open questions in my visit next week. I get that the holidays and end of year visits are hectic. The pharmacist reviewed with me that a side effect is swelling and muscle weakness. None of this was discussed during my visit. Because that is what I am trying to solve for, I was concerned with taking it. Is this typically ordered to treat weakness?
Thank you again.
I want to note that I requested the lab work, including the auto-immune. This was not their first course of action by either dr. We don't have the MRI scheduled, but I assume the MRI may be the next course if anything, depending on the EEG.
Is there any chance the iron absorption has anything to do with this? I've had conflicting input. Neurologist suggested this, but the MD does not think so due to my iron stores. My iron is at 55, iron binding capacity and transferrin are in the mid range, but the transferrin saturation is at 13 (just below threshold). Either way, I am still working on this with appropriate supplementation and diet. I was put on a 3 day Mirapex trial to test the theory and saw no change, but was told it still could be the issue.
My B12 seems fine, at 454.
Also, I don't see any of the thyroid tests. TSH, Free T3, Free T4. In the past, these labs came out ok, but it's been a year. I will ask my neurologist if he can run them.
I also inquired a few times regarding the prescribed Neurontin ordered, but was told we'd review the labs and any open questions in my visit next week. I get that the holidays and end of year visits are hectic. The pharmacist reviewed with me that a side effect is swelling and muscle weakness. None of this was discussed during my visit. Because that is what I am trying to solve for, I was concerned with taking it. Is this typically ordered to treat weakness?
Thank you again.
Brief Answer:
I doubt the relation with iron....
Detailed Answer:
Hi,
Apologies for the late reply.
I can understand your current state. Yes, sometimes symptoms that seems progressing can be disturbing especially when we have no clear answers. Unfortunately, there are many such conditions/situations where answers are not immediate. So I will suggest you not to loose hope yet.
Now, to answer your queries:
1. Iron deficiency also present with weakness and paraesthesia. However as the numbers are not significant I doubt the cause is precisely iron deficiency at this point of time. But it would be good idea to improve iron stores with iron rich food. I would target to improve hemoglobin values.
2. Hypothyroidism is also known to cause weakness. Therefore my suggestions to check thyroid functions.
3. Though vitamin b12 numbers are good, many neurologist here treat limb paraesthesia with vitamin b12 supplements. B12 and alfa lipoic acid have nerve regenerating functions and could be helpful in such cases.
4. I like the idea of sequential testing. I guess MRI scan is in the line with or after EEG study. We can plan next step of investigation and treatment based on the results. You keep your doctors informed about the symptom progress as and when needed. I will be glad to help you if your doctor's aren't available then.
5. Physiotherapy is an useful treatment if there is significant weakness. Check with your doctor.
Lastly neurontin would be started after weighing benefits and side effects. Your doctor will titrated the dose to suit your needs. So don't be bothered about it now.
Hope this answered all your questions.
Regards
I doubt the relation with iron....
Detailed Answer:
Hi,
Apologies for the late reply.
I can understand your current state. Yes, sometimes symptoms that seems progressing can be disturbing especially when we have no clear answers. Unfortunately, there are many such conditions/situations where answers are not immediate. So I will suggest you not to loose hope yet.
Now, to answer your queries:
1. Iron deficiency also present with weakness and paraesthesia. However as the numbers are not significant I doubt the cause is precisely iron deficiency at this point of time. But it would be good idea to improve iron stores with iron rich food. I would target to improve hemoglobin values.
2. Hypothyroidism is also known to cause weakness. Therefore my suggestions to check thyroid functions.
3. Though vitamin b12 numbers are good, many neurologist here treat limb paraesthesia with vitamin b12 supplements. B12 and alfa lipoic acid have nerve regenerating functions and could be helpful in such cases.
4. I like the idea of sequential testing. I guess MRI scan is in the line with or after EEG study. We can plan next step of investigation and treatment based on the results. You keep your doctors informed about the symptom progress as and when needed. I will be glad to help you if your doctor's aren't available then.
5. Physiotherapy is an useful treatment if there is significant weakness. Check with your doctor.
Lastly neurontin would be started after weighing benefits and side effects. Your doctor will titrated the dose to suit your needs. So don't be bothered about it now.
Hope this answered all your questions.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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