Doc called - NO NEUROPATHY - Nerve Studies Normal - Now what? Doc?

[spankyandrex]

I was hoping for some answers today, but nothing. I know, I know, I need to be patient. I am really trying to be so. However, my nerve conduction studies for any kind of neuropathy in arms and legs came out NEGATIVE. So, there is nothing "right now" to explain my burning feet. "I" truly believe it's coming from my lumbar spine area. But when I tell the docs that, they say it doesn't fit the protocol because it's "bilateral", usually only unilateral if a disk problem. Well, I know I have spine issues - last MRI was evidence of that. So, he asked if the Gabapentin was working - I said no, but it's only my 4th day taking it. They are still waiting for the LUPUS Panel, the VDRL and the Immunoe/ Electrophoresis studies to come back. Otherwise, the tests that came back normal are the B12, Lyme Disease and ANNA.

If all of this comes back normal - what other possible diagnosis could I have? I still truly wonder about MS - even though he said my MRI was fine (prominent virchow-robin spaces high signal intensity in centrum semiovale - normal I guess). Maybe he would recommend a spinal tap next? I am still having problems with all of my other symptoms - losing train of thought when talking - just now, I was talking to a customer and I friggen stuttered 3 times and my jaw/head twitched, they looked at me funny. I am about in tears here.   Thanks - any suggestions?  My last lumbar MRI was in 2005.

[spankyandrex]

Hi Greg, thanks for your response.  yes, I have been tested for diabetes and do not have it (thank god!).  Also, I have a job where I sit at a desk and get up and down to wait on customers, so I don't stand on my feet all day.  So, no pressure there.  Also, my feet are not "painful", they are "annoying", it's a burning feeling.  I have researched up and down and unfortunately there are many other causes.  Athletes Foot (don't have) is one of the others.  I have been going to a chiro since I was 13 (I'm 38 now) and have tried and used orthotics and heel lifts because my spine/body lifts my body to my R making my left leg shorter than the other.  Ihave had sciatica pain on R due to a disk problem in my lumbar spine, but never a bilateral sciatica.  Now, I have no sciatica whatsoever, my back actually feels as good as it "can feel", but my feet burn all the time.  And it's ONLY when I am sitting down, so that leaves me to believe it's my lumbar spine. I will be asking for a repeat MRI of that area since it was 04 since my last one.  JUST to be sure it's that or "not that".  

Stresswise, I am not under any undue amount - my job I love, and I love my life.  It's just these medical conditions whatever they may be are bringing me down, ya know?  They have for years and I am finally trying to figure out what the heck is going on.  

I will agree that I probably am dehydrated and don't drink enough water, so I am going to make it my personal goal to drink more water.  I drink about 2 cups of coffee in the AM and then throughout the day I might have 1 bottle of water, but then the rest is diet pepsi ;)  

THANK YOU so much for your response!  
Sandra

[ggreg]

Dear Spanky,
I would like to offer a couple other ideas about your painful feet.  Diabetes can sometimes cause that, which your sugar levels should be checked for that.  Also, a simple reason, people who stand on their feet all day can have your symptoms.  And when a person is in pain, I don't care if it's ordinary foot pain or serious back pain, they can be affected mentally, like with your stuttering and depression.

This is not to say that your spine isn't goofed up.  But I will tell you that no one thought my back problems were anything to worry about, and yet they finally gave me a nerve pain medication, and lo and behold my pain went away.  So, I am thinking the Neurontin you take might eventually help.

If it is indeed pressure on your feet from work, I can suggest some helpful solutions.  Wearing support hose, thick socks, and supportive running shoes will ease discomfort.  If you can't wear running shoes at work, there are also casual shoes made just for bad feet, or sometimes jell inserts with an arch support will do.  But if you are standing on cement floors, that's bad, and you'll need to either go to an orthopedist or a podiatrist and get special orthotic fittings.

I might add that some of your other symptoms, specifically dry eyes, trouble swallowing, and indigestion, can all come from one thing:  Dehydration.  This can be caused from something as simple as needing to drink extra water during the day, or some medications cause it, or it can even be connected to poor circulation...which the latter can be related to Diabetes.

I may be wrong about all this, but just wanted to help you with what I know. GG

[spankyandrex]

THANK YOU SO MUCH!  :)

[Caliber2005]

Hi,
Myopathy means purely muscle disease. Neuropathy means purely nerve disorder. Neuromuscular disorder means involving both.
About MRI, I meant in general if you have to diagnose MS, then there should be definitive lesion on MRI.
Your MRI seems to be normal, definitely not depicting MS.
Bye.

[spankyandrex]

PS, here are my symptoms listed and noted to my neurologist and GP:

Ill defined paresthesias are noted (burning and tingling feet and tingling arms/hands)
Visual symptoms blurred vision are also present initially-dry eyes also.
Abnormal muscle spasms (all over my body).
Difficulty with balance (becoming more and more prominent - I have had + Rombergs with neur).
Problems in speech AND swallowing
fatigue and acute or chronic pain syndromes
bladder and bowel difficulties (incontinence and constipation)
cognitive impairment (stuttering on my words, not coming out right, coming out backwards).
depression - being treated with low dosage, only mild depression.

There's more, but that's all I can think of right now from your list ;)  Thanks.

[spankyandrex]

Hi thanks for posting, I appreciate this more than you know.Two questions:

1.  What is myopathy?  
2.  By this sentence "There are definitive lesions (suggestive of MS) on MRI also."   Did you mean that about my MRI?  Or in general?  I wasn't sure.  Here is my complete MRI findings just taken on brain in October.

Thanks for anything else you can offer.   I wanted to add also that when my neuro looked at my MRI he said "oh, virchow-robin spaces, I don't even comment about those".    But they must be something if the radiologist commented on them and said he wasn't sure, but "thinks" they are VRS's.  So do you think considering I just had the MRI in Oct I should ask for another one this soon?    

Anyway, here's the report:

T2 weighted imaging demonstrates punctate areas of high signal intensity within the centrum semiovale, possibly representing prominent Virchoe-Robin spaces. There is no evidence of abnormal enhancing lesion. The periventricular white matter appears normal bilaterally.

Post contrast imaging is negative for abnormal enhancing lesions. The corpus callosum appears normal in width and signal intensity. The foramen magnum and cerebellar tonsils appear normal.

Impression: Essentially normal-appearing MRI of the brain with and without contrast. Punctate areas of signal aberration within the centrum semiovale bilaterally, seen on axial T2 weighted imaging, may simply represent prominent perivascular spaces (Virchow-Robin spaces) and are not seen as discrete abnormalities on other sequences. END

[Caliber2005]

Hi,
I think a repeat MRI is warranted to come closer to rule out MS.
Hope this helps.
Bye.

[Caliber2005]

Hi,
If your NCV test is normal it suggests that there is no neuropathy, only myopathy is present.
Multiple sclerosis is a chronic remitting disorder characterized by multiple white lesions in the CNS separated by time and location. The most frequent presenting symptom is unilateral weakness or ataxia. Headache is common, ill defined paresthesias are noted, Visual symptoms like diplopia, blurred vision are also present initially.
MRI is the neuro-imaging of choice, small plaques of 3- 4mm can be identified, particularly those located in brain stem and spinal cord.
MS can cause changes in sensation, muscle weakness, abnormal muscle spasms, or difficulty in moving; difficulties with coordination and balance; problems in speech or swallowing, visual problems, fatigue and acute or chronic pain syndromes, bladder and bowel difficulties, cognitive impairment, or depression.
The initial attacks are often transient, mild and self-limited. The most common initial symptoms reported are: changes in sensation in the arms, legs or face (33%), complete or partial vision loss (optic neuritis) (16%), weakness (13%), double vision (7%), unsteadiness when walking (5%), and balance problems (3%); but many rare initial symptoms have been reported such as aphasia or psychosis.
Your symptomatologies as of now do not sound like you are having MS, but there are definitive guidelines, on which the diagnosis of Multiple Sclerosis is based. There are definitive lesions (suggestive of MS) on MRI also.
Once internationally accepted criteria’s are satisfied, then diagnosis of multiple Sclerosis can be made.
I think a repeat will be warranted to come closer to rule out MS.
Hope this helps.
Bye.