Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: hyperactive reflexes follow up question

Forum: Neurology Forum
Topic: Neurology - General


Thank you so much for your answer to my question involving hyperactive reflexes, which followed a period of lost function in right arm briefly, then continued pain, numbness, and tingling.
From your answer, I understand that this is something that should be evaluated by a neurologist. However, there seem to be many things going on with me at once, and I am uncertain how to prioritize them in order to provide the best medical care for myself. I have many symptoms suggestive of connective tissue disease, including positive ANA, and am undergoing evaluation by a rheumatologist....it will take about 3 weeks for bloodwork to come in, so have another appointment in a month. I have pain in my belly, along with a small amount of rectal bleeding (not in stool), and have an appointment set up for gastroenterolgist as I have a history of NSAID induced gastric ulcers in the past. I have had a terrible time with coughing, bronchitis, asthma since August, and have changed my follow up appointment for allergy doctor from December to this month. I injured my back at work last year (2 bulging discs on MRI, but not herniated) and the orthopedic doc treated it, I thought they were better but since quitting N
NSAIDS due to the possible gastric ulcer, the back pain has returned full force in the same spot that hurt before...so I guess it is not healed yet. I also seem to have severe sleep problems....most nights can get only 2 or 3 hours of sleep...and I experience excessive daytime sleepiness and fatigue.
I also have fever of unknown origen, am on hypothyroid. I am also significantly overweight. My gut feelings is that many if not most of my problems may be due to the underlying connective tissue disease, or at least may be side effects from the meds they have me on (which include prednisone, plaquenil, and relafin). Therefore I wonder if I should just wait for the next rheumy appointment and try to let him deal with the multitude of problems. On the other hand, the experience of even temporarily losing function in my right hand caused me worry, particularly when the internist said the reflexes on that side were hyperreflexive, and he confirmed a significant difference in strength between right and left sides, and he got worried and sent me to ER, who found normal CT scan and said neuropathy. The arm seems to me to be getting better, and I no longer have numbness, just pain and weakness. I feel also that the strength is gradually returning. Nonetheless, if it would be dangerous to wait a month waiting f
for the autoimmune testing, I can always call a neurologist on my own....fortunately so far I am allowed direct access to specialists, although some specialists require a referral. I don't know where to turn as my quality of life has decreased significantly in the past year, and dramatically more so in the past month since I started having the arm and stomach problems and went off some of the meds. Of all the problems I listed, which should I consider most significant and urgent? If the arm continues to improve on its own, is there still any reason to see a neurologist unless it happens again. I will add that I also worry because I am having significant memory and concentration problems....I almost feel like I have lost some of my intelligence....but I am aware that "brain fog" is common to connective tissue diseases.„‡ I am sure that I never had hyperactive reflexes before....I drink or consume very little caffeine, am not a hyperactive person as I am usually dead tired and too exhausted to move around m
much, and although I am on Synthroid for hypothyroidism....the TSH levels are perfect and there is no sign that I am experiencing hyperthyroid symptoms from the medicine. So here's my feeling...please tell me if you agree.
Go ahead and see gastroenterologist since I am already established with one and the pain has been persistent and there is a history of ulcers and I have continued NSAID therapy....so it seems to me the likelihood of repeated ulcers is fairly high.
Go ahead and see allergist as I have had severely rough time with asthma and bronchitis, and every time it flares up it seems like all my other problems get worse also.
Keep apppointment with new rheumatologist in one month...by then labs will be back....if problems with weakness or pain continue, ask about neurologist.
Postpone neurologist until after rheumatology appoitment, as long as acute symptoms are improving.
Make decision on neurologist after connective tissue disease issue is resolved...if necessary...especially since I am not already established with one. If problem were to suddenly get acutely worse...such as function disappears again, pain increases, or severe numbness recurs, consult with internist ASAP. Ask rheumatologist about significance of hyperactivie reflexes.
Does this sound like a prudent plan of action? Or should I see a neurologist right away. thanks Dee

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I think you would benefit from deferring the visit with the neurologist
until after the visit with the rheumatologist is complete, if you do this the
confounding factors of other diagnoses will be clarified somewhat and
he/she will be able to concentrate on the neurological issues.
I am comfortable with this plan a long as the neurological symptoms continue
to improve, if they worsen I would move the neurooogist up the pecking order !
Some rheumatological disorderes have neurological manifestations so if you
get things sorted out with yoour rheumatologist the neurological consultation
may not be necessary.

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