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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35709
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have been having problems with bilateral weakness and

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: 6 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 6 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 6 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 6 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 6 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 6 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

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