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Internist
Internist, Board Certified Physician
Category: Medical
Satisfied Customers: 4761
Experience:  Int. Med., Gastroenterology. Fellow American College of Physicians. Trained, located in the U.S.
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hi, im not a patient but a phd nutritionist and i have a female

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hi, i'm not a patient but a phd nutritionist and i have a female patient, age 51 healthy in general but suffers of condition that makes her gait very much like croutching gait, has tested negative for CMT and for Guillan Barret syndromes. her walking is very unsteady, she falls easilyand she complained of frequent falls in the childhood. she has a hard time lifting the knee above the waist level, when the knee is flexed the foot goes into inversion (both do the same) the only abnomal finding i can point to is a very low ferritine level in the blood even thou her hemoglobin is in the normal range. i do have a wild guess that she may have suffered of pernicious anemia since youn age and it had passed unnoticed. what will be the best list of test to perform to support the possibility or denial of it, unless you have a better direction to look at. thank you. dr. erwin salomon phd (e-mail:XXX@XXXXXX.XXX)
Submitted: 2 years ago.
Category: Medical
Expert:  Internist replied 2 years ago.
Hello, What is her present hgb/hct?
Customer: replied 2 years ago.
hgb 14.5 hct 42%
Expert:  Internist replied 2 years ago.
I just wanted to make sure she was not iron deficient in view of the low ferritin. The Shilling test was popular years ago but now there are more accurate ways to make this diagnosis. The blood smear may be helpful if megaloblastic. But now Intrinsic factor antibodies are very suggestive for a diagnosis of pernicious anaemia and are found in almost 100% of patients with a fairly high level of sensitivity. Anti-parietal cell antibodies are not as accurate and less specific than intrinsic factor antibodies.


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Customer: replied 2 years ago.
i understand that you point to the tests necessary for the pernicious anemia diagnosis, but is that the diagnosis consistent with the symptoms she has ? the specified anemia is kind of my huntch driven by her low ferritin. could it be a different neuro-muscular disease ? by the way she has no atrophy or nervous paresis of any kind, all her EMG test are normal (+-) maybe some slowering on the left side. thank you.
Expert:  Internist replied 2 years ago.
Her neuro muscular symptoms may be secondary to P.A. This would have to suggested by a careful neurological exam. To exclude that possibility the antibody test would be most useful. Low ferritin is consistent with iron deficiency which would give her anemia but not neuro symptoms.

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Customer: replied 2 years ago.
just to make sure i understand PA stands for Psoas Abscess or other condition ? you see the symptoms look very much like a distrophy of some kind but all nerves are actualy functioning the muscles are fully developed and still she can walk like a normal gait, she walks by throwing the pelvis forward to move each leg, when asked she can lift her legs that the knees reach the pelvis hight, but when walking she cannot. still when on her back on streight surface she can go biking in the air but not standing, it feels like all proprioception is gone when weight bearing.
Expert:  Internist replied 2 years ago.
No. Pernicious anemia, Vit. B 12 deficiency which can cause neurological changes but again that would require a careful exam.


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Internist, Board Certified Physician
Category: Medical
Satisfied Customers: 4761
Experience: Int. Med., Gastroenterology. Fellow American College of Physicians. Trained, located in the U.S.
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