If it's not B12 deficiency, then what?

[KGG42]

I am a 42 year old female, who started down a road of health problems about 8 yrs ago: ruptured appendix w/multiple abcesses in 2001, gallbladder removed in 2005 and beginning in 2008, I started experiencing severe "thunderbolt" headaches. In 2008, my PCP gave me a battery of tests and a CT scan and determined that I was borderline B12 deficient and started me on a series of injections, which have calmed my headaches. The injections and B12 vitamins also calmed my other symptoms, which included uncomfortable numbness and tingling in arms and legs. After three months I stopped the injections and the numbness and tingling returned, now I have fatigue in my upper back and arms, burning sensations in my lower left leg, difficulty sleeping due to creepy feelings in legs, numbness at the tip of left thumb.  I also experience severe itchiness on my scalp and all over my body which led me to an allergist who tested me for allergies and found a high level of reaction to various environmental factors, including dust and mold. I plan to go back to the allergist to test me for chemicals which also cause me pain from irritations.  
I started the injections again, but they are not calming my symptoms as they did before. and I am writing this in middle of the night since, once again, I am unable to sleep because of my leg distress and panic about what ails me.  
I have alot of anxiety in my life right now, death in family, new job as a manager, two young boys, etc.  I wonder if my symptoms could be related to stress or early MS?  Doesn't stress contribute to the development of MS symptoms?  In my mind, the B12 treatment plan seems like a dead end since my symptoms are back, except for the headaches.
I plan to go back to my neurologist, what tests would you recommend be done to diagnose my problem at this point?

[Dr Rajgopal]

Hi,
Your symptoms may be due to Peripheral neuropathy caused by deficiency of vitamin B 12 as well as toxic nerve damage due to environmental factors. The symptoms are being aggravated by stress. Many treatment strategies for peripheral neuropathy are available that are symptomatic. Researches have shown that neurotrophin-3 can oppose the demyelination present in some peripheral neuropathies. Antidepressants and antiepileptic drugs have been found to be useful in managing neuropathic pain. Commonly used treatments include use of  Tricyclic antidepressants (such as amitriptyline) and antiepileptic therapies such as gabapentin or sodium valproate. These have the advantage of being effective as well as relatively low cost. Pregabalin( Lyrica), an anticonvulsant drug used for neuropathic pain has also been found effective for generalized anxiety disorder. Other treatments that can be effective include TENS (Transcutaneous Electrical Nerve Stimulation) and complementary therapies. Please discuss these treatment options with the physician.
I would suggest you to discuss the symptoms in detail with the doctor to rule out Fibromyalgia and restless leg syndrome because your symptoms do resemble those of these two conditions. MS may not be the cause since you have no neurological symptoms to suggest of the disease. Still MRI of brain and spine and lumbar puncture may rule out the disease if you are too concerned. Please consult a neurologist for the same. Hope this helps you. Take care and regards!

[ggreg]

The Vitamin B12 deficiency is causing your symptoms.  That deficiency can exact untold misery on a person.  The reason MS might come into the picture is because it's one of a number of causes of B12 deficiency, in that people with MS don't metabolize it correctly, but you'd have to have many other markers suggesting MS, like high homocysteine levels, to get to such a diagnosis, and your doctor would know all the stuff that would suggest MS.  As for the allergy aspect of your health picture, sometimes people who have allergies will be treated with B12, because for some reason it cures around 8 out of 10 people who have, say, asthmatic breathing problems or skin rashes.  So, it follows that a lack of B12 in your system may be allowing some allergies to develop unchecked.

As I said, there are many causes of B12 deficiency, but the treatment is the same, to get the shots.  If you quit the shots, you can get extremely ill and even become much sicker.  You can talk to your doc about how the shots are not helping as much as they did before, perhaps he can adjust how much to give you, and he could also investigate if there's been any nerve damage from the deficiency and give you medication to ease those symptoms better.  He could also give you short-term tranquilizers to get you through this rough patch, as you report your life is getting a little overwhelming, if he decides he doesn't need to give you those nerve damage treatments I mentioned.  Also, your doctor could indeed try to discover a possible reason for the B12 deficiency, like the MS you are concerned about, to sort of ease your mind on that issue.