diagnostic process

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diagnostic process

Postby Jessco » Mon Aug 01, 2011 6:16 am

Hi, my name is Jessica and I am very new to this sort of thing-discussing my health problems that is. I am really just looking for someone else that my have some insight into my situation.

I am 34 and started having bi-lateral weakness in my hands the last year or year and a half. I really just dismissed it as getting old. I complained about it a my last physical in Mar 2011 and my doctor did some exams and said that there was slight weakness and that I could go to a neuro if I wanted. Well. I decided just to wait and see what happened. In about June 2011 I started having a radiating numbness and tingling down the right side of my spine (still have it intermittently) and after about a week or so I decided to make that appt with the neuro. He did a reflex test and said that I have hyper sensitive reflexes and ran the metal instrument from my knee down and asked me if the temperature was different at different points and to my surprise it was not as cold as he worked his way down to my foot. I had my first migraine in May and attributed that to traveling for 12 hours-I did tell him about that. (I have OCD which is controlled ok by Prozac) He said that I could have anxiety or a neurological disorder and that we will find out which through a series of tests. I had an MRI or the brain and it came back normal but showed slight arthritis in my neck-which doesn't hurt and I am also going to have a nerve conduction study and neuro recommended blood tests in a few weeks. Since MS was mentioned I have been doing research and other symptoms seem to be present- loss of memory, equilibrium is off at times, high anxiety, fatigue, urinary leakage-which I had attributed to child bearing and since the MRI both my hands have had pins and needles in different areas. I have had random numbness in buttocks and outer thighs, bilaterally but really marked it up to my epidural 2 years ago with my last child.

Is this all in my head? I feel like I am crazy. Or are these symptoms adding up to something bigger. Could it be MS or anxiety or something else. Any thoughts would be appreciated. Any questions that I need to ask my neuro would be appreciated also. Thanks.
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Postby jimmylegs » Mon Aug 01, 2011 7:37 am

hi there and welcome to the forum. you are certainly not crazy and from your description the doc knows it.

in case you are not already aware of this - OCD FYI:
http://www.nutritionj.com/content/7/1/2/abstract
Nutritional therapies for mental disorders
"Notably, essential vitamins, minerals, and omega-3 fatty acids are often deficient in the general population in America and other developed countries; and are exceptionally deficient in patients suffering from mental disorders. Studies have shown that daily supplements of vital nutrients often effectively reduce patients' symptoms. Supplements that contain amino acids also reduce symptoms, because they are converted to neurotransmitters that alleviate depression and other mental disorders".

the rest of the article is not as good, eg their 'Summary of proposed causes and treatments for common mental health disorders' (table 1) is only so-so and regarding OCD, it's actually pretty stupid.

so, from another source, a bit more info:

Vitamin B12 and folic acid serum levels in obsessive compulsive disorder
"Six patients (20%) of the OCD group had abnormal low levels of vitamin B12. This prevalence was significantly higher than that of the control groups. No clinical neurological or haematological abnormalities accompanied the reduced vitamin B12 levels."

i had to look at how they arrived at the 20% figure. turns out their cutoff for low vs 'normal' was 200 pg/ml.

the mean result for all 30 OCD patients was 328. the standard deviation was 162 so their range was 166-490. 6 patients had levels lower than 200, and 24 had levels higher than 200. 6 is 20% of 30 so that's how they arrived at that number.

i thought using 200 was a bit fishy, since i know that the cutoff for deficiency in SI units, is 180 pmol/L. (which only uses haematological criteria and does not involve cognitive deficits).

i couldn't remember the units conversion so i looked it up sort of expecting perhaps the pmol number would be a little higher than 200, or at worst it could take it down to 180.

units conversion factor: 0.738

200 pg/ml * 0738 = 147.6 pmol/L.

unbelievable. there is literature out there suggesting that 500 pmol/L should be the cutoff to prevent cognitive deficits resulting from sub-optimal b12 status. so by that standard, with a range of 166-490 for all OCD patients in the study, 100% had low b12. not 20% as stated.

i wonder what the heck assays they were using in order to conclude:
"No clinical neurological or haematological abnormalities accompanied the reduced vitamin B12 levels"

all this is by way of saying, your vitamin b12 and folic acid may be low. vitamin b12 deficiency is a major differential diagnosis for ms.

i was diagnosed at 35. i definitely had a documented background of b12 deficiency which went under the radar as the neuros were diagnosing me.

i had weakness of the hands and numbness of the feet prior to my first outright 'ms' attack. in early days it was reversible if i would take b12 supplements. as the years wore on with me largely ignoring things, i did enough damage that i can't reverse it 100% any more.

sorry i don't usually unload to that degree on a newbie, and if you were already aware of the b12 link, my bad - maybe it will help a future reader :)
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b12 level

Postby Jessco » Mon Aug 01, 2011 10:36 am

My B12 level was 643 in March. The only time my B12 was low was during pregnancy.

Thanks for the info! :D
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Postby jimmylegs » Mon Aug 01, 2011 10:37 am

fantastic! if i come up with anything else i'll let you know. do you have a folic acid level?
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Postby jimmylegs » Mon Aug 01, 2011 11:04 am

here's something:

http://informahealthcare.com/doi/abs/10 ... 0290025824

HYPOTHALAMIC DIGOXIN DEFICIENCY IN OBSESSIVE COMPULSIVE DISORDER AND LA TOURETTE S SYNDROME

the isoprenoid pathway might be something to investigate there... i'd be inclined to suggest magnesium for anxiety related issues, but if OCD patients have elevated serum magnesium levels, maybe there's something else in the mix and magnesium is not absorbed correctly?

http://www.nutri-facts.org/Health-Funct ... 802.0.html
Nutrient interactions
"High doses of zinc in supplemental form apparently decrease magnesium uptake in the body (‘absorption’) (2).
Large increases in the intake of dietary fiber have been found to decrease magnesium utilization (3, 4).
Dietary protein may affect magnesium absorption (5). "

thinking out loud :)
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