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Ask Anthony Bray, MD Your Own Question

Anthony Bray, MD
Anthony Bray, MD, Doctor
Category: Health
Satisfied Customers: 6670
Experience:  14 years as clinician in the field of Family Practice
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I saw this post while I was searching for an answer I could

Customer Question

I saw this post while I was searching for an answer I could understand. My symptoms sound quite similar to his, although not totally. I have instances when my legs, lower back, muscle spasms, and changes in sensation, like pins & needles, temperature changes in the feet and lower leg areas, difficulty maintaining balance and walking. I have actually had people ask me if I was intoxicated.....
The symptoms have increased to complete numbness in my feet, then there are days they are so weak feeling. Then they begin spasms. I don't have any idea if this is related or not, but I stay fatigued, my vision has declined and eyes seem to hurt most of the time. I can't seem to stay focused on anything anymore. It seems to take the better part of an hour to work through the stiff, muscle pain like cramps in my legs and lower back, just to get out of bed. Then walking is an additional problem. I seemingly give a whole new meaning to bouncing off the walls. I can't sleep half of the time and usually end up passing out from exhaustion just from fatigue. I have began to dread the end of each day, as I am most aware of what the next day holds. The swelling in my feet is horrible. That seems to be brought about by the heat. We live in VA. And the climate is warm and extremely humid.

The Neurologists ran a series of blood work, EMG showed nothing really significant, but I am curious about this blood testing results. These tests were performed twice and the results were close to the same each time:

Immunoglobulin G, qn, serum. Result 662. Range(NNN) NNN-NNNN Abnormal - Low
Immunoglobulin A, qn, serum. Result 61. Range 91-414. Abnormal - Low

AN APPARENT NORMAL IMMUNOFIXATION PATTERN

---- 1 MONTH LATER. ------

2nd Series of Blood work results

Immunoglobulin G, qn, serum. Result 645. Range 700 - 1600. abnormal - Low
Immunoglobulin A, qn, serum. Result. 72. Range 91-414 Abnormal - low
Immunoglobulin M, qn, serum. Result. 31. Range 40-230. Abnormal -low

AN APPARENT NORMAL IMMUNOFIXATION PATTERN

What does all of this mean and is any of it connected? I just want some answers from somewhere. This has become life altering for me. I have always been so full of life, energetic and now everything is a major effort. I just can't handle much more of this.

PAW
Submitted: 1 year ago.
Category: Health
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray, MD : Hello!
Anthony Bray, MD : i have reviewed your question and your reported test results.
Anthony Bray, MD : You have mild deficiencies of your immune system > the three main types if antibodies are affected... IgG, IgA, and IgM...
Anthony Bray, MD : antibodies are made by white cells--- lymphocytes and plasma cells...
Anthony Bray, MD : I would advise that your work up should include seeing a hematologist ( specializes in blood disorders including blood related cancers such as leukemia and lymphoma--- I AM NOT SAYING THAT YOU HAVE EITHER OF THESE!!! Please do not go into panic mode-- OK??
Anthony Bray, MD : the results on your immune system could be simply you genetically run slightly lower numbers than the norm.
Anthony Bray, MD : HIV should be excluded as a possible cause( I would advise getting tested even if you consider yourself to be zero risk...)
Anthony Bray, MD : a condition that impaired the development if white cells could be underlying problem such as melodysplasia( don't worry about this term it would be a consideration for the hematologist)
Anthony Bray, MD : simpler possible reasons should be checked if not already done--- B -12 level!! This can cause BOTH neurological symptoms as well as the abnormal blood results... Easy blood test... Cheap and easy to treat so this should be checked if not already....
Anthony Bray, MD : So --- you evidently are diabetic ?? How long have you had this diagnosis and what is your last hemoglobin A1C?? Helpful to know these details to have better idea of possible role with diabetes and neurological symptoms...
Anthony Bray, MD : often BTW.. A low grade immune deficiency such as yours may not be diagnosed as to cause( if this happens - don't despair as this could be worse with some of the possible reasons,,, )
Anthony Bray, MD : Rbc folate should be checked...
Anthony Bray, MD : Do you drink much alcohol?? This is possible factor if you have much history here...
Anthony Bray, MD : thiamine deficiency may be associated with too much alcohol and combination capfuls tie to nervous system dysfunction...
Anthony Bray, MD : hematologist may advise pathology review if blood smear and possibly bone marrow biopsy...
Anthony Bray, MD : your immunoglobulin deficiencies seem mild ... If worse this can be treated with periodic IV infusions ... You would not seem to be at this stage if severity with your current levels however...
Anthony Bray, MD : If you should suffer severe or frequent infections then that may change the calculation on the potential need for such treatment however....
Anthony Bray, MD : Have you had MRI of brain and spinal cord??
Anthony Bray, MD : i would expect that these tests would be run by your neurologist with your history of neurological symptoms...
Anthony Bray, MD : I hope that this information is helpful for you! Let me know if you have further questions or information or discussion. I will be happy to get back with you!
Anthony Bray, MD : If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. That would be much appreciated!
Anthony Bray, MD : Thank You and Best Regards,
Anthony Bray, MD : Anthony Bray MD
Customer :

I drink very seldom maybe 3/4 times a year at best. As far as HIV my husband is Military and we are tested routinely. I am more concerned with the painful symptoms I am experiencing. They are bringing my life to a standstill. I had some questionable spinal stenosis in the cervical MRI. This muscular pain is horrible. I developed diabetes when I was pregnant with our son, that was 12 yrs ago. While the sugars were out of control during pregnancy 400-800 and fasting of 235, I have managed to keep them down by diet and exercise since. However within the last 3 months they are spiking. My PCP ran an A1c about 3 weeks ago and they were only slightly elevated and I am making adjustments to compensate.

Anthony Bray, MD : Hello again,
Anthony Bray, MD : it sounds to me that it is likely that SOME TYPE of peripheral neuropathy may be responsible for your pain symptoms. Your muscle spasms as well... While statistically diabetes is the most common cause of peripheral neuropathy there are actually over100 possible causes....
Anthony Bray, MD : thyroid function should be checked, liver function, electrolytes, B-12, screening for autoimmune disease ( ANA, ANCA, rheumatoid factor , sed rate, C- reactive protein)
Customer :

I was told by a physician in St. Barth's he believed it might likely be MS

Anthony Bray, MD : simetimes a aural nerve biopsy may help in diagnosis...
Anthony Bray, MD : you should be screened for heavy metal e posture...v
Anthony Bray, MD : .... Mercury, lead, cadmium and arsenic are most commonly tested here....
Anthony Bray, MD : do you garden?? Organophosphates via pesticides would be a consideration...
Customer :

Oh geez arsenic???? Wow... No gardening.

Anthony Bray, MD : MRI of brain and spinal cord would be most helpful to rule out MS( treatment is available for MS if you should be diagnosed with that...)
Anthony Bray, MD : Any family history of neurological problems as far as you know??
Customer :

Neurologist wants glucose tolerance testing in the morning

Customer :

Yes a lot of Parkinson's & MS

Anthony Bray, MD : Reasonable I would say --- if your hemoglobin A1C were less than 7.0 then diabetes would not seem likely to be your cause-- it is usually that patient diagnosed with diabetes for ten plus years before neuropathy becomes issue BUT I have seen exceptions to this rule of thumb as well...
Customer :

They were only 6.1

Anthony Bray, MD : meds like Lyrica or Neurontin or Cymbalta may be helpful to quell your discomfort to a degree...
Customer :

neurontin intolerate

Anthony Bray, MD : Ok yes at 6.1 it would seem unlikely for diabetes to be your culprit...
Anthony Bray, MD : do you have very high triglycerides??
Anthony Bray, MD : in the few exceptions to diabetes vs severity of neuropathy it has seemed to me that triglycerides being very high has been a bit if recurring theme...
Customer :

At one time unbelievably high 1400+ while cholesterol was perfect

Anthony Bray, MD : Cymbalta you would probably tolerate OK...
Customer :

thought that was for depression not that I'm not headed there

Anthony Bray, MD : AH HA!! I bet that is part of your culprit! This does not seem to be well defined as to the cause at this time... Some connection between fat matabolism and neuropathy here though ... I have seen that pattern several times!!
Anthony Bray, MD : Cymbalta is for depression -- you are right-- but it also has indication for neuropathic pain...
Customer :

they are normal now

Anthony Bray, MD : it modulates hoe strongly your CNS processes pain signals...
Customer :

What are the long term implications of MS?

Anthony Bray, MD : well I think that there is some connection with a persons metabolism and this peripheral neuropathy... Probably deserves more research....
Customer :

having looked it up I am inclined to agree it is a likely culprit. However does it affect the blood levels?

Anthony Bray, MD : MS may vary widely -- tends to have periodic flares and you may have steps down neurologically with slow partial recovery between... Symptoms can vary all over the place as MS is caused by small diffuse brain lesions--/ several treatment options available for most common firms if the disease... Can also be quiescent ... Episode of trouble and never any further trouble... Like I said--- variations are all over the place....
Customer :

Mine are periodic flares

Anthony Bray, MD : MS would not be expected to affect your immunoglobulin levels as far as I am aware... It is thought to be part of an autoimmune process though....
Anthony Bray, MD : yes that could potentially fit with MS-- I would advise MRI of brain and spinal cord if you have not had this within past 6 months---
Customer :

Whatever it is it flares up like sciatica

Customer :

Occasionally and slow to exit

Anthony Bray, MD : Well spinal stenosis would be part of the potential list of possible diagnoses.... MRI of both brain and spinal cord would eval for MS, other potential brain diseases, spinal stenosis, radiculopathy, etc...it would seem a must test in your situation!!
Anthony Bray, MD : I hope that this has been helpful for you!
Anthony Bray, MD : let me know if you have further questions and I will be happy to get back with you!
Customer :

yes and I certainly appreciate your time, thank you

Anthony Bray, MD : if my answers have been helpful and to your satisfaction then please remember to leave positive feedback! That would be much appreciated !
Anthony Bray, MD : Thank you And best regards
Customer :

i certainly will

Anthony Bray, MD : Anthony Bray MD
Customer :

thankwill thank you

Anthony Bray, MD : YOU are very welcome!!

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