Could it be MS?

I ahve been having symptoms for a little over 2 years.  It started when I developed Mono at age 39.  I was sick for about 3 months with it.  I began to feel a little better, but not normal.  I have had fatigue ever since.  I also gained alot of weight and exercise and diet does not help.  I have had bell's palsey at 33.  I have pain in my legs that gets worse with cold, mostly in shin area.  I had Lasik on eyes 5 years ago, but am now having sight problems (blurred and trouble seeing up close.)  This past spring I had episodes of feeling wonderful followed by severe nausea and dizziness.  This happened 5 times.  TSH levels were at 6.7.  TSH 4 weeks latter was 4.7.  Put on 50 MCG of Synthroid.  TSH last lab was 2.1.  I still am extremely fatigued with muscle weakness and burning in arms and legs.  My Dr,. dosn't think it is related to Thyroid.

I also have urine leakage. Small amount-not related to sneezzing or coughing. I do not even feel it happening. This is becoming worse.  She recommends an rhematologist.  I have tested neg. for artharitis and lupus in past.  I also have had bout with tendonitis in hip that still hurts some after a year.

Sorry this is disjointed and long.  I do not know what is related. Just trying to think of everything.  

[Craig Brooker]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without being able to take history from you and to examine you, I cannot tell you what the cause of your problems is, and I cannot give you a diagnosis.

Your group of symptoms seem to be complex, and with multiple manifestations. They are not specific for a disease process, and can be a manifestation of multiple conditions.

MS is a diagnosis that is based on symptoms, objective neurologic manifestations, and tests such as MRI, or other tests like Lumbar puncture and evoked potentials. The “MS attacks” are manifested as episodes of focal neurologic symptoms (such as numbness, weakness, visual symptoms, coordination problems, etc) affecting different areas of the central nervous system at different time points. So when patients have symptoms that may be suggesting MS, if they do not fit the criteria, a second evaluation after a second attack can give a higher yield. In the evaluation of patients suspected to have MS, the MRI plays a major role, as it can detect lesions (usually lesions in the white matter of the brain), and subsequent MRIs can demonstrate appearance of new lesions in different areas at different time points. If there is still no diagnosis after neurologic examination and repeated MRIs, and if there is high suspicion, lumbar puncture for specific markers is performed, and if there is still doubt, other tests such as evoked potentials can be performed.

When patients have objective neurologic findings, and there is doubt about the diagnosis, other rarer conditions come to mind, including vitamin deficiencies, toxic exposure, genetic conditions, autonomic disorders, and as I mentioned before, infectious and systemic illnesses. I cannot say that one of these could be causing your problems, as a detailed history is needed to consider diagnostic options.
Unfortunately I cannot give you a diagnosis based on your symptoms, and the conditions mentioned above should be only explored if there is a possibility that they may be involved. What guides the work up is the history and the exam.
I suggest that you should discuss other possible diagnosis with your neurologist, or consider obtaining a second opinion if still in doubt. It is important when you do this, that you provide all your previous tests, to avoid repeating the same tests.

Regarding your specific symptoms, many of them can be found in MS (e.g. blurred vision, urinary incontinence, weakness, and fatigue) but that does not mean this is MS.  Most people with MS have episodic symptoms, most often following an infection or stressful time.  These episodes of symptoms most often improve nearly completely or resolve and many not happen again for months or years.  You don't seem to describe such a time course.  Also there are many other possible reasons for your symptoms.  Most people around your age start to develop some difficulty with seeing close objects as their lens is less flexible.  And many women who have given birth previously may have some urinary incontinence (though there are many other reasons for this as well).  Weakness and fatigue have vast potential causes too numerous to attempt to detail here.  If your GP has recommended a Rheumatologist, that is probably a reasonable recommendation.  Rheumatologists often work closely with neurologists in challenging diagnostic cases and often have some insight if a particular problem is more neurological than rheumatological.