More tests or "wait & see"?

[cjtmn]

Hi - this is my first post to this forum. I'm curious on your opinions regarding continuing to test for possible MS or just taking a wait & see attitude. A little history:

I had a first bout of Abducen's Palsy in 2008 lasting about 3 weeks. Brain MRI w & w/o contrast was completely clean. All signs cleared up completely & we chalked it up to a random occurrence.

I had a 2nd bout of Abducen's in September of this year with additional symptoms (double vision to the right, then to the left and eyes not tracking together for lateral movement. Also, significant eye pain when looking around & disorientation + vision distortion). The eye issue cleared up within 4 weeks & my 2nd Brain MRI came back clean, but I was left with some really unpleasant dizziness/balance issues that are MUCH better, but on-going + continuous tinnitus. Ophthalmologist check-up showed completely healthy eyes, so he referred me to a neurologist.

I have now completed a spinal MRI, which showed very subtle T2 hyperintensity in the left cord @ C3 without enhancement and also subtle signal change at the right C4-C5. I have mild spondylosis in the cervical & thoracic regions (I'm 43 & a family history of degenerative spin issues, so not a surprise). The Radiologist notes said my findings were "most consistent with demyelinating disease".

MRA/v with & without contrast came back fine. Tons of blood work with only some CRP elevation (9.2) and ACE elevation (68). Other than the dizzy issues & ongoing headaches, I feel fine. The neuro has recommended additional blood tests, CT Scan for Sarcoidosis, somatosensory and brainstem EPs, and a lumbar puncture. I also have an appointment with a vestibular specialist later this month.

Neuro-Ophthalmologist confirmed healthy eyes, but even though my Myasthenia Gravis test came back negative, he suggested that if a 3rd episode occurred, to come in promptly & they would test for it during a flare up. Apparently the blood test only catches 60% of the cases.

My question for the group is: with such subtle findings on the spinal MRI, 2 clean brain MRIs (2008 & 2014) & limited symptoms, should I pursue so many additional tests? Or should I take a "wait & see" approach and if another round of eye problems/other neuro problems present themselves, then go back in & continue testing?

I can look back & see lots of potential signs - extreme fatigue, tingling on R shoulder blade/arm, stumbling, chronic headaches - but they seem so generic, I feel they could be attributable to just about anything (which is why I never saw a doc for any of them).

I should also mention that my B12 was 380, but my MMA results came back fine. I will be supplementing immediately.

Thanks for any opinions. I feel a little like this is needle-in-a-haystack work and feel a little crazy for chasing after something when most of my symptoms have cleared up.

[Positivenelly]

The CRP with a 9.2 is a giant red flag, in my opinion. I'd keep up with all the tests and make sure you find what is causing you inflammation.

[jimmylegs]

fyi crp is negatively correlated with serum magnesium.. see if any of these symptoms ring a bell maybe
http://www.ancient-minerals.com/magnesi ... igns/#list

[cjtmn]

Thank you both for your responses. I was also worried about the CRP levels, but my neuro did not really seem concerned calling it "slightly elevated". They would like to test for Sarcoid b/c of the ACE levels, but I have almost none of the symptoms, so I will rule it out as a last effort to avoid the radiation of a CT Scan.

I will also look more into the magnesium. Some of the symptoms are applicable, but most are not. I do not believe I was tested for this and already know that I have some work to do on cleaning up my diet. I will put this down as a discussion point for sure.

For now, I am doing a few more blood tests (I cannot believe that are more to do!), hearing/vestibular testing, and 2 evoked potential tests. Hopefully I get a better picture from this of what to chase after to explain all of this.


cjtmn

[jimmylegs]

no problem

magnesium does so many hundreds of things in the body, that the list of possible symptoms is extensive and it would be rare for every possible magnesium related wheel to come off at once. so it makes very good sense to have some mag deficit symptoms only.

serum mag testing is atypical and interpretation is problematic for most docs. according to the WHO when the ranges were established they are likely to have included magnesium deficient subjects without realizing it, due to the state of knowledge at the time (a problem which is perpetuated by this ongoing use of ranges that are far too broad especially at the low end).

if you can ask for serum magnesium when you're next in for tests, the range is often 1.5-2.5 but optimal levels are more like 2.3-2.7 mg/dL. if you need that in SI units just say. you should be able to justify a request for serum mag based on the elevated CRP alone. here is some research you could take to the doc to back up your request:

.....Relationship between serum magnesium levels and C-reactive protein concentration, in non-diabetic, non-hypertensive obese subjects.
.....http://europepmc.org/abstract/MED/12075573
....."The results of this study show that low serum magnesium levels are independently related to elevated CRP concentration..."

.....Dietary Magnesium and C-reactive Protein Levels
.....http://www.tandfonline.com/doi/abs/10.1 ... GDaSvnF9rk
....."Most Americans consume magnesium at levels below the RDA. Individuals with intakes below the RDA are more likely to have elevated CRP"

.....Magnesium supplement intake and C-reactive protein levels in adults
.....http://www.nrjournal.com/article/S0271- ... tract?cc=y
....."Magnesium supplement intake is associated with a lower likelihood of elevated CRP in people with low dietary magnesium intake."

dietary mag targets are in the 400 ballpark for maintenance when you feel great, more like 600 per day to restock when you feel symptomatic. healthy dietary sources with mgs per serving here: http://www.whfoods.com/genpage.php?tnam ... #foodchart
note that the serving sizes given for those top two leafy greens apply to the volume after boiling. it's a 1 min boil for spinach, 3 mins for swiss chard. the boil time is specific to retaining nutrients while reducing oxalic acid content.

it is also important to be aware of foods fluids medications and activities that can contribute to magnesium depletion, and where possible to limit or avoid their influence on your day to day routine.

if you need a supplement to help achieve the daily intake target, be aware that not all forms are created equal. magnesium glycinate is the best one i've found to date. forms like magnesium oxide are cheaper and totally fine if you need a laxative. not so much if you actually want to absorb the magnesium.