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A little over 4 weeks ago I started having a feather like sensation to the left side of my shin. Days later it turned into a pins and needle sensation and tingling all over my body (feet, legs, hands, arms, torso, etc.)
In addition to these symptoms I started to also have burning sensation in many different areas (Burning sensation seems to occur more noticeably when pressure is put on the skin but feel it quite a bit with no pressure on scalp, shoulders and forearms). Most recently I’ve also felt this burning sensation on my scalp and sensitivity around my eyes as well.
The only thing that occurred around the time that the tingling sensation started was that I started a prescription Vitamin D2 50,000 iu X 2 a week. This came from a low vitamin D of 18 found during my physical. The feature like sensation started hours after I took my first pill. All my doctors tell me they have never heard of Vitamin D2 causing neuropathy type symptoms and told me to keep taking them. After 3 weeks the symptoms got so strong I stopped taking Vitamin D2. I have now been off for close to two weeks. I do feel that the symptoms have gotten a little better especially the pins and needles which I still have but not as aggressively. The burning sensation however has only improved very slightly. Am I nuts or could Vitamin D cause this either directly or coupled with something else we have not yet discovered? If you believe Vitamin D2 could have caused this, how long till I should start feeling better? I took a total of 6 pills over 3 weeks. I have found the Half-life of Vitamin D2 is about 2 days.
Over the last 30 days I’ve had the following tests done:
• Thyroid came back fine
• Lots of blood work which included Lyme that only showed
o That I’m pre-diabetic with slightly elevated glucose
o Low Vitamin D
• MRI of upper and lower spine
o Showed spinal stenosis but nothing concerning to the neurologist
• MRI of Brain
o Showed no lesions or anything that made my neurologist believe it was MS
If you also feel there is no way that Vitamin D2 could have caused this directly or indirectly, what would you suggest next steps be and what do you feel like it could be?
A little over 4 weeks ago I started having a feather like sensation to the left side of my shin. Days later it turned into a pins and needle sensation and tingling all over my body (feet, legs, hands, arms, torso, etc.)
In addition to these symptoms I started to also have burning sensation in many different areas (Burning sensation seems to occur more noticeably when pressure is put on the skin but feel it quite a bit with no pressure on scalp, shoulders and forearms). Most recently I’ve also felt this burning sensation on my scalp and sensitivity around my eyes as well.
The only thing that occurred around the time that the tingling sensation started was that I started a prescription Vitamin D2 50,000 iu X 2 a week. This came from a low vitamin D of 18 found during my physical. The feature like sensation started hours after I took my first pill. All my doctors tell me they have never heard of Vitamin D2 causing neuropathy type symptoms and told me to keep taking them. After 3 weeks the symptoms got so strong I stopped taking Vitamin D2. I have now been off for close to two weeks. I do feel that the symptoms have gotten a little better especially the pins and needles which I still have but not as aggressively. The burning sensation however has only improved very slightly. Am I nuts or could Vitamin D cause this either directly or coupled with something else we have not yet discovered? If you believe Vitamin D2 could have caused this, how long till I should start feeling better? I took a total of 6 pills over 3 weeks. I have found the Half-life of Vitamin D2 is about 2 days.
Over the last 30 days I’ve had the following tests done:
• Thyroid came back fine
• Lots of blood work which included Lyme that only showed
o That I’m pre-diabetic with slightly elevated glucose
o Low

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Answered in 7 hours by:
2/17/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,257
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I am sorry to hear about your health as you have described above. As a Neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

I will try to discuss your health concerns point by point below here;

A) It is possible these symptoms indeed are secondary to vitamin d intake

B) This is certainly not a known side effect to ingestion of vitamin d, so this appears a very rare side effect

C) There is also a possibility this is not directly involved with the vitamin d too, rather some of the other ingredients that are present with the preparations. A medicinal preparation may contain one or more inactive ingredients (excipients) such as fillers (also called as bulking agents or diluents), binders, disintegrants, coloring agents, preservatives, flavoring agents etc

D) So there is a possibility this is a reaction to one of the excipients present in that preparation in the form of some kind of allergy or chemical irritation of the nerve fibers

E) So this appears a kind of peripheral neuropathy (peripheral nerve damage or peripheral nerve irritation)

F) And there also appears irritation of the small diameter nerve fibers too – a condition also called as SFN (Small fiber neuropathy) because symptoms such as burning sensation is most often caused by irritation to the small diameter nerve fibers, rather due to irritation of the large diameter nerve fibers

G) One or otherway this appears some kind of nerve irritation, diffuse nerve irritation to explain the diffuse symptoms, and this could be related to either vitamin d itself (if so then this has to be an extremely rare side effect since this is not known to occur), or more likely a reaction to one of the excipients as mentioned earlier above

H) Either way this is expected to resolve with time, this is unlikely going to be a permanent nerve irritation

I) In the meantime you may try the following diagnostic & therapeutic measures;

a) If a nerve test called as EMG/Nerve conduction test has not been done then this test is needed now and this test can tell us more about the possibility of nerve irritation or damage (peripheral neuropathy)

b) Tests for small fiber neuropathy such as skin biopsy test (which is a simple outpatient procedure) is needed too

c) Avoiding the same brand of vit d2 in the future, and to try some different preparation in the future

d) In the meantime you may also try nutritional supplements such as the following;

Methyl Guard Plus (which is a combination of active forms of vitamin b12, vitamin b9/folate, vitamin b6, vitamin b2)

Vitamin B1 (Vitamin B1 it comes in various forms, the Benfotiamine form is considered as the best for peripheral nerve irritation)

ALA (Alpha lipoic acid)

Acetyl L Carnitine

Coenzyme Q10 etc

These above mentioned nutritional supplements too can help in getting relief from the symptoms, and also assist you with faster recovery too.

And very importantly, please see this certainly does not appear a permanent type of damage, rather this is a temporary type of damage that is unfortunately taking long time to heal, but these types of health conditions are expected to heal completely, it may take some time though - but recovery is the rule, in the meantime please consider the above diagnostic & therapeutic interventions that will assist with confirmation of the diagnosis and treatment; and once again and this type of health condition can be diagnosed & successfully treated, so please not to be scared.

Wishing you a quick & complete recovery! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further. Please do not forget to take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Customer reply replied 4 months ago
Thank you for the thorough answer. I do have a couple follow up. If this being cause by some inactive ingedients in the vitamin D how ling would you expect it to be before most or all of this goes away? I have not taken a vitamin D in 2 weeks. I've improved some but definitely still feeling it all over. My second question is if this was not caused by the vitamin D prescription what else do you think I should make sure I'm getting checked out for? I did have an emg by yhe way. It was done on my legs a few days after this started. I was told the results came back fine. This tingling feeling being all over my body for as long as it has is very unerving]
Customer reply replied 4 months ago
I want to be sure I'm not missing anything I should be looking for or doing.
Customer reply replied 4 months ago
I will definetly leave you 5 stars

You are very welcome! Sorry, I could not reply earlier since I was away from the computer and just returned. To your first question - as mentioned previously too, please see this is not a permanent type of damage and this will resolve with time. And all the symptoms are expected to go away too. To your second question – please see this still could be irritation of the small diameter nerve fibers, the emg test is done to rule out large fiber neuropathy and it cannot rule out small fiber neuropathy. So this still could be small fiber neuropathy, and this could be secondary to some inactive ingredients present in the vit d preparation you had taken, but one or otherway this is certainly & unlikely to be a permanent type of nerve irritation are all expected to resolve completely.

Appreciate for the rating in advance!

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There were couple of typos above, the sentence should be read as “unlikely to be a permanent type of nerve irritation, and your symptoms are all expected to resolve completely”. And also I had mentioned – “ the symptoms are expected to resolve in about couple of weeks from now” – but during some correction it appears this statement too got accidentally deleted, and sorry for these typos.

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,257
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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Customer reply replied 4 months ago
Hello Dr Subbanna, unfortunately the last 24 hours the tingling and pins and needles all over my body seems to be getting worse again. It had been getting a little better since getting off of the D2 but I now feel i took a step back the last two days. If this was not caused by the D2 I don't even know what to get checked for next. I will mention the SFN biopsy to my Neurologist when I'm able to get back in in a few weeks but even if that comes back positive it only a symptom not a cause correct? Can small fiber neuropathy be its own thing or is it just a symptom caused by something else?

Hello, sorry to hear the symptoms are becoming worse again, and this does raise some suspicion for something else causing these symptoms rather than the vit d or its excipients etc.

The symptoms however do sound like sfn related but the question is what is causing the sfn, if this is not the supplement vit d2 you received then we need to suspect other possibilities

There are myriad underlying health conditions that can cause sfn such as the following;

Diabetes mellitus

Prediabetes or Impaired glucose tolerance

Vitamin deficiency (especially B12)

Certain infections including lyme disease

Sarcoidosis

Vasculitis

Celiac disease

Sjorgen’s syndrome

Other autoimmune conditions

Hematological conditions

Alcohol

Medications (this was the initial consideration in your case – in the form of vitamin d)

Exposure to heavy metals etc

Not all of the above may be applicable in you, I am providing a list like this so that you are familiar with the various possibilities that can cause the types of symptoms you have been having.

I am sure you have had investigations done and already ruled out many of the above mentioned conditions, but if any of the above conditions have not already been ruled out then further investigations are required to rule out the above possibilities.

And many times there is no precise cause is identified for sfn and this is called as idiopathic condition (means no identifiable cause is found)

And stress, anxiety disorder too can cause the type of symptoms you have been having. Of course this possibility to be considered only if the other possibilities mentioned above are ruled out and also if you feel you are having some health anxiety, fear of serious illnesses, stress etc – otherwise these are not applicable to you.

In the meantime you may try one of the nerve pain pills such as the following;

Gabapentin

Pregabalin

Duloxetine

Amitriptyline etc

And the above meds can help you with providing the symptomatic relief from these bothersome symptoms while you are awaiting further evaluation and investigations from your doctors.

Sometimes more aggressive treatments such as the following may be required to get relief from these symptoms;

Intravenous immunoglobulin infusion

Plasma exchange etc

But of course first we need to identify the precise cause for the symptoms you have been having (if this is not related to the vit d or the excipients) and in this regard the skin biopsy to rule out or rule in the sfn and also the additional investigations mentioned above can help and this will give us further directions regarding the best course of treatments for managing the underlying health condition you are having that is causing these symptoms you have been having.

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Customer reply replied 4 months ago
Thank you for the fast response. As a final question if the SFN test comes back negative, what would you suggest for next steps?

You are very welcome! If sfn biopsy test comes negative then we need to be looking at the possibilities of psychological issues such as health anxiety, stress, functional disorder or medically unexplained physical symptoms etc (all these are benign possibilities).

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