Possible MS? Back/Neck Pain, Vision/Cognitive Abnormalities, Balance Issues

[extremepains]

Hi and thanks for reading.  I am not currently diagnosed with MS but I was unsure where to ask my MS related question..  

For the past 4-5 months I have been experiencing a wide range of symptoms which first appeared as vision blurring and abnormalities (december), then balance/coordination issues (january), and finally neck/back joint pains which are excruciatingly painful (past few months).

I just had a blood test done which revealed several abnormalities.  I had Vitamin D deficiency (25-OH D level at just 13!! D2 at 13, D3 <4. normal range is 20-100)  high eosinophils (5.4, normal is 0-4) and low Anion Gap (6, normal is 7-15).   Does anyone have any ideas what could cause my symptoms with this blood analysis result?  I was also negative for parasites in a stool test (apparently often related to eosinophils).  My doctor was about to prescribe me vitamin d supplements but I asked him to do a full D panel to see if the active vitamin d (1,25) is high (which I read means that there is a disease process going on).  

I have a return appointment to discuss that in a few weeks but I feel there is truly more that needs to be tested.   Specific concerns are blood diseases associated with Eosinophils, including its several forms (though rare) of leukemia, and also autoimmune diseases (such as ms). Does anyone have any ideas what could relate to my blood results and symptoms?  What should I ask for to be tested next to discover the cause of all this?  I am 99.999999% certain the cause of my ailments is not that i am simply Vit.D deficient.  I wish he would order an MRI to check for lesions but he seems reluctant to do this... My CT scan appeared normal.

thanks in advance

[sllowe]

I too am glad that you found your way back to us.

Please re-read Quix's thorough post. Please try to feel the comfort that knowledge and information brings, and embrace the relief disappearing symptoms bring!

Now, onto what's got you so mad - sounds like it's the pain! Get to the Dr. asap to describe your current problem so you can be thoroughly evaluated.  And, then go from there.

We are here to help,
Shell

[DeniseApril]

Dear extremepains,
Hi. I read your posts, and just had to respond. I was glad to hear that many of your original problems have eased up or gone away completely. That's a good thing. I sympathize with your horrible neck pain and stiffness... I know how painful that can be. My only suggestion
for you, is NOT to give up. You must be your own advocate, as hard as it may be at times. I know that so many of us are, or have found ourselves in similar situations, many of us for years, searching for the right Doctor(s) and a diagnosis. I too, have been trying to get an MS diagnosis for years, and still haven't. It is very hard to deal with much of the time!  In my own experience, I have found the members here on MH, to be so helpful. Even if I get only one response to a post, I know that someone has "listened" to me, and has taken the
time to write back... therefore, someone does care. Read through the many posts, and you will "see yourself" in so many of them. You are NOT ALONE in this, I promise.
I am in terrible shape, and have been for a long time, now, and yes, it would be easy to just
give up, I do think about it myself. See as many Doctors as you have to, or can. It can take a long time to find out what is wrong, but you WILL get there. We only have "one shot" at this thing called life-- you are loved, so fight for yourself, as sick as you are!
YOU CAN DO IT!!!
Please feel free to write me whenever you need to talk... I don't know much more than what I personally have gone through, medically, but we certainly can talk.
Feel better-- I am "pulling" for you!
God bless,
DeniseA

[extremepains]

Thanks for this response... I know I posted this a long time ago now, and never checked back, but that is primarily because my symptoms began to improve.  

In fact since the point that i was in extreme pain my vitamin d level had gone up to 20 from 13 so i decided not to take the prescribed 50,000ui of vitamin d assuming my body managed to self heal itself.

Unfortunately, this now seems not to be the case.  Basically for the past month or two, my vision has been perfect, and my balance as well. Hell even my cognitive abilities seem to have returned and I no longer am experiencing the brain fog I'd been struggling with.   I've practically forgotten how completely horrible shape i was in mid january or so...  

unfortunately, my neck is still a bit stiff and just today its in excruciating agony.. It felt a bit stiffer than usual when i woke up but later in the day, I coughed really bad... and i felt it *snap*.  It cracked and i initially thought, oh awesome! i finally cracked it and now itll hopefully be fixed,  but the opposite has happened :(   I remember this happening before when it hurt really bad and i cracked it.  It is now SO STIFF that just sitting in one place it starts to ache in agony sometimes.. if i move it to one side or another the pain increases, specifically to the right side.  

I'm at a loss as to what to do.  My doctor is going to be angry that i didn't take his vitamin d supplements and have no interest in referring me to any other specialist i'm sure... i am not covered on any expensive insurance at the moment and i'm just getting county assisted health care, so I'm not even sure if that covers an MRI-  my doctors i've been *assigned* to don't really seem to think anything serious is wrong with me and i remain trapped and frustrated.  

Any suggestions or ideas?  I duno what to do.  I guess the world just wants me to die and i'm starting to lose the energy to fight for myself anymore. No one really cares about me and  I have no other real advocate. I hate the world.  Why won't they admit me or at least send me to every specialist possible so i can get a diagnosis?  bleh the way the medical system functions is so infuriating

[Quixotic1]

Hi and welcome to the forum.  Of course this is a fine place to post if one is concerned about MS.

In general, Vitamin D deficiency does not directly cause disease - except the diseases of low calcium absorption such as Ricketts.  It is implicated in being one of many risk factors for MS and autoimmune diseases, but only that - a risk factor.

In my professional experience, a minimally elevated eosinophil count is either inconsequential or associated with allergies and hay fever.  MS has no significant association with MS, though some study may have seen an association.  A count of 5.4 is pretty unremarkable.  Remember that the highs and lows have to do with standard percentiles.  When eos are indicative of one of their associated diseases the percentages are often more like 15% to 30%.  One associated test with eosinophils that is often sent is the serum IgE level.  IgE is the antibody group associated with eos.

The minimally low anion gap may or may not mean anything.  The workup for this would include the rest of a full chem panel and examination of the electrolytes in the urine.  Again, one point outside of norm is not usually assoicated with disease.

A CT scan is worthless for finding the lesions of MS.  It was never useful and still isn't.  An MRI is the imaging technique of choice.

Were your eyes examined for problems when you had the visual blurring and problems in December?  Were you diagnosed with optic neuritis or any other disorder?  That is important.  An exam now, especially a Visual Evoked Response would still show evidence of the prior inflammation.

During the balance and coordination problems, did anyone do a good, thorough neuro exam on you to see what was going on?  That can be very helpful, one in documenting the episode and two in seeing exactly which areas are malfunctioning.

The severe neck and back pain deserves a work up.  Severe pain is never normal.  One approach would be to have you see an orthopedist who then would likely do an MRI of the spine.  However, the MRIs that they order rarely are done with the MS MRI Protocol.  Another approach would be to request a Neurology consultation to see if there are any neurological defects associated with this pain.  That would be my recommendation, so that you could get the needed neuro exam.  The vast majority of neck and back pain, even severe pain, is musculoskeletal and not neurological.  If a neurologist suspects MS, then they would order the proper techniques to be used for any MRIs - we hope.

Did these problems improve or go away before the onset of the next problem?

I assume you are dealing with your primary doc.  You need to be on treatment for the low Vit D - and again there are many approaches to bringing it up.  You want a level over 35 at the least.

As for the diagnosis of MS.  That is made by looking for 2 or more attacks of symptoms suggestive ov demyelination.  If the eye problem was Optic Neuritis, that would be one.  If the Balance and coordination could be shown to be due to problems in the central nervous system as opposed to the iner ear, that would be another.  If the back pain can be shown to be secondary to lesions in the CNS, that would be a third.

There are no blood tests to diagnose MS.  The blood tests that are sent during the work up are to rule out MS Mimics such as autoimmune diseases - which don't formally include MS as it's true cause has not yet been determined.  It does include a strong autoimmune process, but it is not known if that is primary (the direct cause) or secondary to some other primary cause.

Many of the MS mimics can be homed in on, by using blood tests such as the ANA, and ESR or sed rate, testing for some infections such as Lyme Disease, VDRL, HIV, and the B12 level.

The other testing that you could "possibly" benefit from would be the Visual Evoked Potential and possibly a BAER - brainstem audio evoked potential.  It is far too early to consider an LP.

I think you need a full neuro eval at this point.

I hope this helps.

Quix, MD