Is this stress, somatic, or neurological?

[Kelly to Dr. KDK]

Thank you so much for reading my question.  I have been having difficulties for almost a year, since I had a baby.  Right after the birth, I fainted when I got up.  Two days later, I almost fainted again, and when I laid down I got this horrible headache which travelled down my spine and across my lower back.  My doctor felt it was possibly the beginning of hypovolimic shock since my fluid was low and my blood was low.  She gave me a blood transfusion.  Ever since then, though, I have never been the same, and everyone attributes it to anxiety.  I had severe headaches and after a normal CAT scan and spinal tap, they diagnosed them as severe tension headaches.  I had heart palpitations and after a stress echo, several EKGs and a Holter monitor, diagnosed that as anxiety.  I've had many other symptoms that just puzzle me, and won't go away.  I have neck and head pain.  When I lay down I feel lots of pressure in my head.  Sometimes when I exercise I get the same pressure in my head.  I have joint pain in my wrists all the time, it comes and goes in my hands, feet, elbows and knees.  My muscles are weak, sometimes they hurt and sometimes twitch.  I have tingling in my hands and feet, and sometimes around my mouth.  I have a spot on my spine where it feels like someone is pressing on it.  Several months ago, after doing push-ups, the next morning a feeling of electric shock traveled from that spot (in the middle of my back) down my spine.  That hasn't happened again, however.  But I can still feel the pressure on that spot.  I also get dizzy sometimes.  I know that severe anxiety can mimic neurological symptoms, but some of these symptoms don't sound anxiety-related to me.  Do you agree?  I know that sometimes anxiety can be expressed in somatic symptoms.  Could this be what is happening?  Also, in MS, do the symptoms come on all at once, then leave all together, or can they occur at different times?  I was under the impression that you had "attacks" of it, then it got better for a while and you were symptom-free.  This is not the case with me, although there are times when I am better than others.  But I am never symptom-free.  I am very scared, which makes everything worse.  I have terrible, constant anxiety that there is something wrong with me.  My doctor doesn't feel I need to see a specialist because she feels they are somatic in nature.  Do you agree?  Please help me.  I am very afraid.  I have a baby that I want so much to be healthy for.  Thank you for your response.

[CCF Neuro[P] MD, RPS]

Dear Kelly:

Sorry to hear about your symptoms.  Since I can't examine you or see the results from all your lab tests, I really can't give you much of a diagnosis.  MS is episodic with relapsing and remitting symptoms (hence the name multiple).  There are uncommon forms of MS that start and just progress.  However, in both conditions, the CSF finding and neurological exam are pretty diagnostic.  Usually, there are motor symptoms associated with MS and you do not describe any muscle symptoms.  I think for your peace of mind, you ought to see a good neurologist and have a good neurological exam.

Sincerely,

CCF Neuro MD

[kelly]

Thank you for responding so quickly.  By motor symptoms, do you mean muscle pain and twitching?  I do have that.  Do you feel that the episode right after the birth of my baby was neurological in nature (where I had the pain in my head which travelled down my spine) or could it have been symptoms of shock from loss of so much fluid?  I lost two liters of fluid in the period right before this happened.  Do you believe that any or all of my symptoms could be caused by anxiety or a somatoform illness?  I know it's difficult to give definitive answers without examining me or seeing lab tests, but with the information that you have, should I be concerned about a neurological problem?  I do intend to ask my PCP for a referral to a neurologist, but in the meantime, I would like to know if you think that is what I'm dealing with.  thank you so much.

[CCF Neuro[P] MD, RPS]

Dear Kelly:

No, I do not think that what you described are the motor symptoms of MS. The motor problems found in MS are objective weakness, inco-ordination of muscle movements, cramping, severe fatigue with muscle use, etc.  I don't know what happened after you delivered.  What did your neurologist tell you?  Kelly, it is impossible to tell you much over the internet.  Yes, problems that you describe can be somatoform in nature.  Yes, the might be a neurological problem.  You really need to see a neurologist, get a good examination, go over the lab results and imaging studies and then procede with what care he/she thinks would be best for you.

Sincerely,

CCF Neuro MD

[Dr Similiar question]

Dr Dr,

I have a similair question to Kelly's.  I also had a baby 5 mos ago, and have had strange symptoms, blurred vision occasionally in both eyes, not double, just blurred.  Went to opthomologist and said had far sightedness, also optic nerve looked good.  have some tingling in mouth area, leg and heavy arms.  Baby is 20 pounds very huge, maybe related?  Went to my Practicioner and he did an MRI with the contrasting agent and nothing showed on it, was normal.  Can you have neuritis and it not show on an MRI or a complete thorough eye examination?  Was under the impression that with neuritis it gets worse quick then better, my blurriness has lingered for several months, yet normal exams, I would think something would show on one of the tests.  What are your thoughts?  I also am exhuasted, could this be the cause for all my probs?  Help im at my ropes end.

Gina

[Gina]

Dr,

I had posted previously,  As mentioned in my post, ive had intermitent blurry vision on and off for the past 2 mos, yet its been having epidosed for the past 3 years, noticed it more the past few months, but with optic neuritis, I hear it gets real bad quick and then improves within a few months.  With me it comes and goes, one day its good, or fair (im not 20/20 anymore) then another day more so blurred.  I get dizzy, possibly to my changing vision?  I was given glasses which do help, but she said im still borderlne for needing them all the time.  i get an occasional tingle on my left side of face, almost if I think of it it will happen.  Then I also get a tingle in my right leg.  I think im more scared then it is bothersome.  I had an MRI with the contrasting agent, it took about 40 minutes for them to do teh scan.  Nothing showed up and the tech showed me my optic nerve which looked in her words, perfetct no swelling or lesions.  So this is probably not optic neuritis you think?  Maybe my vision is just changing as my opthomologist says?  She said the optic nerve upon examination was very healthy and with MS you usually have double vision and its only in ONE eye, rarely both are affected.  Its in both my eyes, one is is alittle worse then the other and at times that eye feels heavy, normal for a weaker eye??  Since my MRI came out perfect and I have experienced odd symptoms for the past several yrs,should I be relieved and do you think that something would have shown on my MRI?  I am a 31 yr old mother of two, my baby is 5mos old and this really kicked in about 2 mos ago, I read with MS exaberations are common after pregnancy, yet mri normal.  I dont know weather Im exhausted or what, I dont get much sleep these days.  Anyhow sorry for the lenght of this message.  I just need some info.  My doc says normal mri so dont worry, Thanks so much!

[CCF Neuro[P] MD, RPS]

Dear Gina:

I don't think that you have optic neuritis.  You would see changes on the MRI and would actually lose vision, not just have blurry vision.  The normal MRI is a good finding.  If I remember your previous postings, I think your physicians thought there was a high anxiety component going on.  Anyway, stress of raising children can have a bearing on how we feel.  I really don't think you have MS.  I would try and time manage yourself together with your children to get optimal sleep.  Take some time for yourself (small vacations of relaxation, maybe 1-2 minutes at a time during the day).  Hang in there, children are really a blessing.

CCF Neuro MD

[Thank you :)]

Dr,

Your an Angel, and a very nice person to take your time to respond to our postings.  Thank you.

You know, its odd, my vision was great today then I came home to a stress full home and bamo, it all went blurry.  I think im partially nuts, but it really does happen.  Then the diziness kicks in, then even the leg tingle.  But your post did make me feel better. I also get this pressure in my head, I've read of high intracranial pressure, I have no idea what that is. If you have a moment could you enlighten me?  I just wonder if im off my rocker.   Anyhow thank you so very much.  I live about 30 min from the clinic and its good to know such great care is so close to home.

Gina

[TanjaLynn]

I have had similar problems that started when I was under severe stress.  I have been fatigued, lightheaded, muscle cramps and twitches, forgetfulness, trouble talking, being off balance....
I  thought I had MS.  I went to the neurologist.  He said my neurological exam was completely normal and not to worry about MS.  Shouldn't he do an MRI or other test?  Or should I attribute it to stress.  I have had these symptoms off and on for 15 years.  The neuro didnt' seem concerned.  
My question is:  can a complete neurological physical test rule out MS?
I have already been tested for anemia, thyroid, lupus, and rheumatoid arthritis.  What else is left besides a severe stress reaction?????
Thanks for your site and help....

[Katherine]

I wonder if you can put me at ease.  Here is my story.  SInce October of 1999 I have been assaulated with a series of big issues to deal with:  lasik eye surgery, my husband's loss of a job, getting pregnant very unexpectedly, then misscarrying and then having to have a D and c. It seems that the day I had the D and C done the numbness, achiness, burning sensations started.   I think most of this started while I was pregnant-I could not shake the thought that something might be wrong with the baby.  I was very anxious, could not sleep at night, becuase my thoughts would cause me to shake and genrally very upset about the whole thing.  I had slight headaches several times in the pregnancy and was fine.  I have had two whiplash injuries to my left side-so when I stiffen up in the neck on that side I don't usually think much of it. I went to the doctor co plaining of a neck ache and burning sensation.  He told me the pain was not coming from my head but rateher from my neck and to prove his point and to prove to me he had a cervical spine x-ray done.  What they found was a loss of lordosis and possible nerve impingement at c4-and c5 level possible due to an osteophyte. My doctor then referred me to a neurologist just to be sure everything was okay before proceeding with any treatments.  I went to the neuro and he did a neuro exam (Physical), ENG and nerve conduction study.  He found nothing-everything is normal. He did however put me on PAXIL and Ativan, suggesting that this is all due to super anxiety.  ( I really am very anxious and the pregnancy really was the ingredient that made the pot boil over). Several days later, I went back to the neruo in a panic with some tingling burning sensation in my left leg.  He told me one more time-that there were nofindings in his examination-no MS, No tumour and no evidence of stroke, but none the less, he decided to send me for evoked potentials-ears, eyes and upper and lower limbs.  (I had blurry vision for a couple of evenings-however I have since stopped taking the PAXIL and everything is fine).

I now also see a Psychotherapist-he also beleives that this numby, tingly, burning feeling is stress/anxiety/depression induced.  He said he would be very suprised if I had any physical findings.  He changed my medication to Zoloft and Trazadone (for sleeping) and things seem much better.  He feels that once I have been on the medication for a period of time, this will all go away.  What do you think and in your experience if this is truly anxiety how long could it take to settle down with the medications?  (I was on Paxil for 8 days at 10mg, then I took a one day break to start the Zoloft 25mg for 7 days and today I started the 50 mg. which is the suggested dosage).  I am also taking B12, B+c complex and Glucosomine.

The anxious side of me is still very worried, I think just because this tingling is so weird.  I have it in the back of my neck and shoulder blades, sometimes the left cheek and sometimes the right as well, sometimes across the top of my chest and down by left arm, and sometimes in my left leg-in the upper thigh.  It is not there most of the day, however, when I begin to think about what it is or about how bad/sad I feel for myself, I think it intensifies-it also does not affect all of the above noted body parts all of the time.   Can you shed some light on this?  I am seeing a chiropractor and a massage therapist for the physical aspect, but I'm not sure what to think.  (They both think that the neck and head tingling, is due to the muscles in my neck that are extremely tense-coupled with the fact that being as anxious as I am).  I am confused and would like to know if there is anything more I should do.  Please answer. ( I am sorry about the length of this).

Katherine

[Katherine]

Dear Doctor,

Please respond to my posting, I'm still worried.

[Katherine]

Dear Doctor,

Please respond to my posting, I'm still worried.

[CCF Neuro[P] MD, RPS]

Dear Katherine:

In the face of normal neurological exam, normal MRI, normal EMG, I would have to agree with all your doctors and tell you that your problems not due to MS or other worrisome neurological disease.  Yes, one can see the symptoms that you describe in patients with anxiety.  I would agree with your psychotherapist.

Sincerely,

CCF Neuro MD

[Kelly, if you see this please read]

Hi Kelly,

Im the one who posted shortly after you did, im basically in the same boat of sypmptoms as you are.  If you read this, would you like to email me?  I would also like to have someone who is experiencing the same episodes to talk with. Also i'd be interested in your outcome and findings.  I also have a newer baby and have had problems ever since then.  Did you have pregnancy complications? Thanks Kelly  ****@*****

[Katherine]

Dear Doctor,

Thank you so much for responding to me.  I think given the normal neuro and EMG/Nc Study, they did not have an MRI ordered-do you think I should ask for this?  And, I am going on the 27th of this month for evoked potentials-what will this show or not show.You also don't mention how long it might take for the anxiety to subside with the use of medication to bring down the symptoms?  I realize everyone is different-but is there a ball park?  I am now on Zoloft 50mg.  (I started with 25 mg for one week and now am on 50mg-one more day will make it a week). Any help you can offer would be greatly appreciated.

[Katherine]

Dear Doctor,

Please respond to posting of March 13, 2000.  I'm sory, but my anxiety gets the better of me, and I still have some unanswered questions.

Thanks, this site is great and your advice is wonderful.

[PLEASE RESPOND-Katherine]

Dear Doctor,

The last time I posted, there were some unanswered questions, can  you please respond?  I am sorry for being so bothersome, but your advice would be invaluable and I thank you in advance.

Katherine

[PLEASE RESPOND-Katherine]

Dear Doctor,

The last time I posted, there were some unanswered questions, can  you please respond?  I am sorry for being so bothersome, but your advice would be invaluable and I thank you in advance.

Katherine

[Wish you felt better]

Katherine,  I think you should print this entire post and bring it to your Psychotherapist.  It may be useful to his understanding of your problem, but make sure you bring the ENTIRE post, including the redundent pleas for help.

As far as your question:
What do you think and in your experience if this is truly anxiety how long could it take to settle down with the medications?

His answer will be the same as the prescribing doctor.  In fact, your Psychotherapist is probably able to give a more experienced answer since those types of medications are what they deal with day in and day out and get to see first hand how well their patients have improved on them (No offense to neurologist).  The medication will settle and calm your anxiety.  It may take several weeks for you to notice that things are less anxious, it depends on how anxious and stressed you were to begin with.

You may wish to visit the following web site for support or answers to your medication questions.
http://neuro-mancer.mgh.harvard.edu/cgi-bin/forumdisplay.cgi?action=topics&number=28&SUBMIT=Go

Take care!

[Katherine]

Hi Wish I was feeling better, are you a neuro from this site?  Thanks for you comments anyway.  I really would like the neuro to respond, and in so far as the redundancy-that was my fingers and the computer mouse-not my brain.  I will look up the med site. Thanks.

[Wish you were feeling better]

No, I am not a neuro from this site, but I play one on TV.  As far as the redundant posts, thats ok, it just seemed to appear desperate since it happened more then once.

Also check out this site (same web sponser, different group)
http://neuro-mancer.mgh.harvard.edu/cgi-bin/forumdisplay.cgi?action=topics&number=70&SUBMIT=Go

[Hey wish!]

You play a neuro on T.V.?  Please tell us more.

[Wish here]

That was just a joke, trying to relax Katherine.  She has been all over this board trying to get the doc to answer if she should get a MRI and how long does it take for Zoloft to kick in.  The answer to the first is yes, if it will make her feel better and the answer to the second is not fast enough!

[CCF Neuro[P] MD, RPS]

Dear Kathrine:

I am not sure if the MRI would answer the question about MS, since all other studies are normal.  It would be whether your insurance company would okay a MRI, and if so, then if a normal MRI would help ease your mind then go ahead and get one.  I would think that it will be normal, but one can never know these things for sure.  I would call and ask your physician how long the Zoloft will take to have it's effect.  This should have been told you during the visit.  I do not want to take the place of your physician.  He/She needs to know that it hasn't had an effect after one week.  {I would think that once the proper dose is reached that within a week it should have it's effect].

CCF Neuro MD

[Katherine]

Thank you for responding!  I am now already feeling better--the parasthesia is less and less and actually only somewhat obvious in the morning, and around my head.  As it turns out, I also have what we (the psychotherapist and myself) think may be occipital headaches in the evening.  Possible cause-neck tension?? Can muscle tension in the neck also cause numbing, tingling, etc?  I am now looking forward to the evoked potentials to prove to myself that there is no physical etiology. This is on the 27th of this month-I will keep you posted-although I think the result take up to three or four weeks.  I will not go for the MRI-even if I think that our Provincial Health Plan will cover it-there probably is no point given the negative results of the neuro, EMG and NCS tests. This is a wonderful service you provide and I thank you for your advice.

Katherine

P.S. Hey Wish--The results of using the Zoloft-speak for themselves-don't you think?? Thanks for the funnies and the sites-but I was not able to log on, I will try again, although the addresses are quite long.

[CCF Neuro[P] MD, RPS]

Dear Katherine:

I hope that all works out well.

CCF Neuro MD

[kelly]

Hi, again, doctor.  I'm the original poster.  I have some further questions for you.  Aside from the muscle weakness and twitching that I originally posted about, I have some recent occurances that concern me.  I woke up about a week ago and my legs felt numb.  It persisted through most of the day.  I also get a sensation that someone is sticking needles in the bottom of my feet sometimes when I walk.  My feet don't feel numb, like the pins and needles feeling of your feet going to sleep.  But it's just like little needle pricks when I walk, and sometimes even when I'm sitting still.  My doctor put me on a low dose of Xanax (.25 mg) to see if it would help the anxiety.  I noticed a huge difference for a couple of days, but now I really don't see a great difference.  I'm concerned that the symptoms didn't go away on the Xanax.  Does that mean it's not anxiety-related?  Do you have any idea what could cause the pin-***** sensations?  Also, I have floaters in the peripheral vision of my right eye.  Any cause for concern there?  Thanks again for your help.

[CCF Neuro[P] MD, RPS]

Dear Kelly:

I am not sure what is causing the pins and needle sensations.  The floater are common and most people have them.  

CCF Neuro MD