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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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Last time we talked, it seemed like the next step was blood

Customer Question

Last time we talked, it seemed like the next step was blood work. I could eat a little healthier, but my cholesterol actually looks better than my blood test 4 years ago. Everything else such as liver function and B12 seems normal. I've attached the blood work.The doctor did reflex and circulation examinations and everything was fine as well.I've been trying to find answers, but blood doesn't seem to show anything. Overall I would say I am better than I was in November/December, but we're talking 20-30% better.I'm still experiencing numbness, but it is hard to describe. I have numbness in my pinkies/ring fingers because of my back sometimes, so I know the difference in feeling. It's more of a tight feeling or a hollow feeling in the muscles. It's primarly in my calves/sides of the legs down to my ankle and face, and is triggered by exercise, although prolonged sitting, touch, heat (only sometimes, and might be because of touch), etc makes it worse. I experience numbness in my thighs/butt sometimes but seems more attributed to sitting a lot. Most symptoms are there at 2/10 or so, and then when aggravated go up to a 5-8/10. I do have crawling under my skin in my ribs and stomach, but it's typically after sitting all day and occurs in the evening.I've gone to a chiropractor since November, and I do have some slight degeneration or hereditary issues in my upper neck, as well as upper neck pain. Nothing significant, though. I'm also using a Posture Pump to put the curve back in my neck.It seems unlikely to be stress related, although stress and caffeine can make it works.At this point I'm looking for ideas/options, or if it's just time to see a neurologist.
Submitted: 9 months ago.
Category: Neurology
Expert:  Dr. Frank replied 9 months ago.

HI. that file is listed as a .pdf, but I cannot open it. Could you resubmit it? Good to hear your examinations were ok, I am not sure what you had done, but the general exam is pretty basic. So it sounds like you are debating to get the Neuro exam (which was probably done by the GP/internist) but moreover to get the EMG? Get back to me and I will reply. Somehow that pdf file has a link attached. Dr Frank

Customer: replied 9 months ago.
See if this works. If not I can attach a JPG or something. Had blood work/a physical with a GP when mentions of my symptoms, so they did additional tests on B12, etc. Some super basic circulation and reflex testing. No neurological-specific tests. They've offered to recommend a neurologist, I'm not sure if they do neurological work there.
Expert:  Dr. Frank replied 9 months ago.

I cannot open the labs when I click on it. I can read the header of the file only. Can you take a pic with your phone and upload that?

Customer: replied 9 months ago.
Plain JPG of just the numbers.
Expert:  Dr. Frank replied 9 months ago.

Your blood work is fine, and that is helpful. It did not exclude the issue of MMN, but the examination really does. If you have no demonstrable weakness on manual motor examination, and your sensory exam excludes a sensory neuropathy, then your paresthesis is probably related to metabolic issues as seen in hyperventilation. So the anti-MAG and anti-GM1 and the workup for vasculitis is probably not needed at this point. Get back to me with more specific symptoms if you have them and I will reply. dr Frank

Customer: replied 9 months ago.
Upper neck pain, sometimes up to my temples, tension headaches. Have had a bit of it since I was a teenager. I have really, really stiff shoulders, specifically under my shoulderblades, and where it connects to the neck. It has gotten significantly better as I've paid attention to my posture.
- Twitching under my eyelids after I squint hard. A few months ago it was more of a tight/numbness around my eyes when I'd squint. Sensitivity in face after being touched (not always). Specifically my upper lip. Some pain in jaw/cheek area, but not very common. Twitching in my forehead/eyebrows sometimes as well. After I use the muscles sometimes it will feel off, that tight feeling. Days that I'm thinking hard, working a lot, rubbing my face are when my face is the worst. Sleeping on my side can make it worse too.
- Crawling under my skin in lower ribs, sides of abs, usually later in the day.
- Sometimes crawling in shoulders and arms, but less common, usually on a particularly bad day, or triggered somehow. Sometimes in my very lower back.
- Dead thighs/butt sometimes, but I think it's from sitting, have had it happen since I was a teenager.
- Numbness in wrists/forearm rarely, as well. Typically on a bad day.
- Numbness, in small fingers, but much more rare these days due to fixing of posture issues. Rarely reduces mobility.
- Numbness/tightness in calves, typically worsens when I work out on a treadmill/elliptical, but walking/standing has no real effect unless I do it for a prolonged period of time.None of the numbness really reduces my mobility except for dead legs, and if I stand a bit more it goes away. I don't feel that it's related, although whatever is going on may aggravate it.I have minor light sensitivity (gets way worse by caffeine or if I don't sleep) and a lot of floaters in my eyes, both have been present since I was a teenager. I work indoors a lot and probably could use more sunlight. My vision is 20/15 though, not blurry or anything like that.Issues are typically on both sides of the body, but just not the exact same spots. My hands bother me on the same days, my legs bother me on the same days, etc. Left leg is more on the side/front, right leg is more on the side/back, but on both legs it's restricted to that area.Some of it seems like a hypersensitivity sort of thing. For example I put up some curtains with a screwdriver, and my palm hurt for days afterwards. But I'm not in a lot of pain in general, so it's confusing.Not much else going on. Some anxiety issues with my stomach, but goes away when I'm calm. Part of why I haven't felt this is stress related, because it stays. Not really tired or exhausted more than a normal amount.I think that's about everything.
Expert:  Dr. Frank replied 9 months ago.

Wow. So there is a disconnect between your symptoms and your exam and lab findings. Maybe you need the neurologist and the EMG as what you have shown me for labs doesn't cover it. You symptoms are muscular maybe with spasticity but that does not coincide with normal reflexes Dr frank