How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia , Doctor (MD)
Category: Health
Satisfied Customers: 31183
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
Type Your Health Question Here...
Dr. Arun Phophalia is online now
A new question is answered every 9 seconds

cold sensations in arms and legs

Resolved Question:

I have been having problems with bilateral weakness and radiating cold sensations in both my arms and legs. It gets particularly bad after surgery and seems to be helped by short doses of steroids. It never fully goes away, but comes and goes. I have never had problems with anxiety or depression, but the problem does seems to be effected by stress. Any ideas? Could this be a symptom of an autoimmune disorder?
Submitted: 5 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 5 years ago.



Your symptoms can be due to polyneuropathy. Following are the causes of polyneuropathy (many times cause it is not known);


1) Diabetes

2) An underactive thyroid gland

3) Alcohol

4) Thiamine deficiency

5) Vitamin B 12 deficiency (pernicious anemia)

6) Vitamin B 6 (pyridoxine) taken in excessive amounts

7) Drugs, medications, herbs

8) Autoimmune diseases

9) Heavy metals such as lead and mercury.


Following investigations are done (many of which had been done for you);


1) Electromyography/nerve conduction studies (EMG/NCS)


2) MRI of the spine and brain


3) blood glucose and glycosylated hemoglobin


4) serum B12 level with methylmalonic acid (with or without homocysteine),


5) serum protein electrophoresis


6) Anti-nuclear antibody


7) Lyme testing


8) Rheumatoid factor


9) Sjogren's syndrome testing (Anti-Ro, Anti-La Antibodies)


Skin and nerve biopsy may be needed / recommended after the results of these investigations


Please feel free for your follow up questions.


I would be happy to assist you further, if you need any more information.


Dr. Arun

Customer: replied 5 years ago.
I have already been tested for most of those things. I do not have diabetes, my thyroid is fine, I do not drink alcohol or take drugs, my B vitamin levels are normal, I do not have Lyme disease, lead and mercury levels checked out fine. I have had slightly elevated ANA tests - but the doctors say that's normal after surgery. I have been tested for myasthenia gravis - but nothing was conclusive. MRI's on both my head and neck did not show evidence of MS. However, I have not done a spinal tap or an EMG to rule out those options completely. I was hoping to get more answers before I jumped into the next level of expensive and painful tests. If it provides more insight - I have had lung problems flare up after every surgery that I have never had before that are only helped with steroids. Also, both of my knees have begun to swell over the last year or two that cannot be traced to any kind of injury. I have to get cortisone injections in my knee caps to keep the swelling down about every 9-12 months. Any further information you can provide on narrowing this down would be great. Thank you.
Expert:  Dr. Arun Phophalia replied 5 years ago.

You are very welcome.


A recurrent lung and knee problem is more pointer towards autoimmune disorders. Steroids do help in autoimmune disorders. A skin and nerve biopsy will rule out or rule in the neuropathy and may indicate the type. It is easier than a spinal tap and less hazardous. Chronic Inflammatory Demyelinating Polyradiculoneuropathy can be one of the possibility. The other diagnosis to look for would be;



Nutritional Neuropathy

Systemic Lupus Erythematosus

Toxic Neuropathy

Tropical Myeloneuropathies

Uremic Neuropathy

Vasculitic Neuropathy


Again the biopsy of the skin and nerve can be a clinching evidence. Blood and urine immunoelectrophoresis if not done also would be helpful. You may get an EMG which is non invasive and can give you a crucial direction for the diagnosis. Otherwise a spinal tap would be next step and mandatory.


It is privilege assisting you.


Dr. Arun

Customer: replied 5 years ago.
Where do they take a skin or nerve biopsy from and how is it done? Would a neurologist do this kind of a test or a general surgeon? Am I required to go under general anasthesia for this procedure, or is it an outpatient procedure? General anasthesia will trigger breathing difficulties and generalized muscle weakness for me that will require more steroids and months to gain my strength back. It is a tricky balance. Are the different types of neuropathies you mentioned previously considered autoimmune disorders? Thank you for your continued help.
Expert:  Dr. Arun Phophalia replied 5 years ago.

You are most welcome.


Skin and nerve biopsy are done from the area which has maximum symptoms. Leg would be likely area in your case for the biopsy. This needs only a local anesthesia and is an out patient minor procedure. Not all neuropathies we discussed are autoimmune. SLE and vasculitis are autoimmune.


Dr. Arun

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 31183
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 2 other Health Specialists are ready to help you

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Previous | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ

Meet The Experts:

  • Family Physician

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
< Last | Next >
  • Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
  • Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • Dr. Ketch's Avatar

    Dr. Ketch


    Satisfied Customers:

    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    Board Certified NP, MS, RN. Private practice & hospitalist
  • Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    U.S. Physician/Surgeon in Neurosurgery
  • Dr. Gupta's Avatar

    Dr. Gupta

    Doctor (MD)

    Satisfied Customers:

    Vastly experienced MD Physician with 19 years of experience.

Related Health Questions