I was just wondering about the chloride level which was one…

I'm sorry to hear you're having such a difficult time - I think the responses that the website received were a little jumbled, but I think I understand what you're writing. it sounds like you have a really uncomfortable mix of pain, cough, some of what you're calling "neuropathy," some abnormal labs in the recent past, and some debilitating anxiety to make it all that much worse for you. I'm so sorry to hear about your struggle. In this internet age when patients can easily look up symptoms and diseases online, without a clear organization of who is writing the information, and without a clear way to connect the information that one may be reading, nor context to understand it and relate it to one's personal experience - the information can be very confusing, and very scary. When you use phrases like "neuropathic pain" and "paraneoplastic sensory neuropathy" - are these terms you have found for yourself, or terms that have been diagnosed by doctors? The Tylenol and Advil you're using - is this self-prescribed or by doctors? I look forward to your reply.

I'm sorry for your suffering - I can tell you that with these symptoms, it is extremely unlikely that you have paraneoplastic syndrome, and it is almost surely not appropriate for you to be "planning for your exit." For this particular concern, I think it is important for you to consult a doctor/nurse practitioner/physician's assistant, in person. There are aspects of your experience, features of the history you're telling me and some things that are left out (even unknowingly), and certainly features of a physical exam of your body that can't translate over this type of online communication. Unfortunately, because of the nature of this type of chat, some important concerns could be easily missed, and I could unwillingly get the wrong impression from you, or give you information based on incomplete information. I would never want to say anything that would cause harm for you, and I sense you have a tendency to become very concerned and anxious with what you read online. I can reassure you, with minimal second guessing, that what you have is very unlikely to be cancer, and unlikely to be a grave threat to your life. For more specific diagnosis, a physical exam, and further testing would be needed. 1- consider keeping a written journal of what is going on, what the experience is like. It doesn't have to be long or wordy, but it will be helpful (to you and to a healthcare provider that could review the journal later) to have information about the timing of the feelings, what makes it better or worse, if anything you're doing (or medications you're taking) effect it - either for better or worse, and what else might be going on (end of a work day, or spending long hours on your feet, feeling stressed out, just ran a block, etc.) Oftentimes, small details that are sometimes difficult to recall after the fact, can be vital to finding a way to treat the greater concerns. Plus, reviewing these kinds of things can help point out that things are getting better, and that is reassuring too. 2- consider increasing the amount of full body stretching and exercise that is included in a daily, regular routine. Even if that’s already part of the daily (or weekly) schedule, perhaps there are little bits that could be added? A few extra minutes here or there? Stretching in the shower, marching while you brush your teeth, sitting up straight more throughout the day, etc. Increases in exercise can not only lower blood pressure, but can also reduce internal stress and anxiety, and these may help improve the illness. There was a recent article that describes the health benefits of exercise very well. We in medicine sometimes like to think we know the human body better than nature, but truthfully, exercise is still almost always the best medicine. Here is the article, if you’re curious: http://mobile.nytimes.com/blogs/well/2013/12/11/exercise-as-potent-medicine/?_r=1 3- The field of medicine and medications are sometimes helpful, and sometimes not. I would recommend considering some alternative approaches to health . Although many doctors think that medicine is the "be-all" and "end-all" there are whole disciplines that are practiced throughout the world, even today, that don't view illness or treatment the same way, and they have many sick (and improving) patients, much like the Western world. Acupuncture, for example, has helped many people with anxiety and difficulty with blood pressure. Massage, Yoga, even improving nutrition can have very real, measurable effects on your health. Your local doctor is the best resource to help direct you to what would be most appropriate, but if you feel adventurous, the internet is always full of resources that can help guide you to more information, too. 4- consider adding a little extra de-stressing to the daily routine. Modern life is powerfully stressful, even when we aren't aware of it. Stress, even in small amounts, produces Cortisol in the body, and this can wreak havoc to the the system and a body’s natural internal ecosystem. We are built to tolerate small amounts of stress, once in a while, but not the kinds of stress that many normal people experience - every single day. 5- Meditation can be a tremendous resource for anxiety/pain relief. It has been a useful practice for thousands of years in the East, and millions find it helpful in their daily use even today. Meditation can mean different practices for different individuals. For some, it involves peaceful sitting and focused attention on breathing, without outside distraction, where someone can simply observe ones breathing, and monitor the racing thoughts that may come and go. This can be a way of teaching your body how to insert some degree of calm into your daily experience, and over time it can be a valuable lesson that becomes easier and easier to insert into your daily routine for regular relief. For some others, meditation comes in the form of a relaxing daily walk, where they can similarly distract themselves from daily stressors, and instead enjoy some peace and quiet, perhaps thinking calmly, or enjoying the natural environment around them. These days, there are countless resources available for help with discovering what type of meditation would be the best match for you. 6- Nutrition is a much underestimated source of trouble for us all these days. Did you know that after you eat a meal, your body’s sugar levels spike? This is true, of course, more so when meals are high in simple sugars, carbohydrates, fats, but also true of almost all meals. Once those sugars are processed, either by storage or use, that spike of increased levels of sugars falls very quickly, and can make us feel tired, without energy, even to the point of feeling depressed and hopeless. On the other hand, some foods can help us feel energized, excited/happy, even push us toward being positive and focused. There is a sizable body of literature that shows us the healthy, healing power of good nutrition, and just as much that warns us of the terrible effects of bad nutrition. Mst of us don't eat the foods we should to keep our immune systems optimally healthy. Eating a good serving of the national daily recommended foods (http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables) is essential. Without appropriate food, your body will "make do,” and can make a healthy immune system that much weaker. 7- Perhaps above all else, the basics of sleep and water can be the most needed, and most neglected, solutions. Almost irrespective of your daytime demands, and without regard to individual differences, we all need at LEAST 8 hours a night. This has been proven time and time again, in fact - especially - for the people who think they can do with less. if we are not getting that much, we are not only poorly arming ourselves to fight illnesses naturally, but we setting ourselves up for not only more prolonged, sometimes worse illness. Water is also a vital part of staying healthy. Someone who is having yellow urine during the day (except for the first of the day, that one can be yellowish), is most likely dehydrated, and also an easy set up for prolonged illness. Urine, after the first of the day, should be clear, like water. One should be drinking more and more water, until urine is clear. That’s a simple way to measure enough water intake. 8- medications. Some doctors believe in the power of medications more than I do, but Tylenol and Ibuprofen are (generally) safe medications you can try at home, provided you are following the general guidelines of use, and there are no contraindications in this case, specifically. Tylenol is a safe medication to take at home if he's feeling uncomfortable. A dose of up to 3000 mg over 24 hours, best divided out into 1000mg every 8 hours, is a good, useful dose, without much risk of side effects for anyone. Very few people take the appropriate dose. Ibuprofen (or Advil, Alleve) is also generally a safe medication, provided there aren't any contraindications (easy bleeding, stomach problems). That can be take up to 2400mg in 24 hours, or about 600mg taken every 6 hours. It is best taken with food, to avoid any potential stomach issues. - Again - I tend to believe in making sure the basics are covered first, before relying on medications, but many people feel differently, and there is certainly not one correct answer. it's all individual preference. Here are some resources you may find helpful for you. http://www.fammed.wisc.edu/integrative/modules/low-back-pain http://www.lifehack.org/articles/communication/ways-beat-stress-and-anxiety.html

Thank you for your generosity. I did receive the payments completely, without trouble.

Again, I hope you will continue to see me as a resource for you at your disposal. When you request me by name, I am notified by email and I will come to the website to respond as soon as I am able.

thank you again for all the hard work you are putting in to support your own health - that is one of the strongest signs that a patient is likely to improve quickly. Motivation is difficult to come by, and you've already got it. You should be proud. Keep up the good work. I hope some of what I've written will be helpful as you move toward seeing a doctor in person.