Very Concerned About Demyelinating Diseases

[rmm82298]

My husband is 41 y/o, went to our PCP 9/09 with headache, neck pain, and pain in between his right thumb & index finger. In December, he also had severe abd. pain, and started seeing the Dr weekly, Brain MRI dated 2/10 stated "mild white matter changes that are more than is typically seen with a patient this age. Old trauma, old infection, chronic vascular headaches, vasculitis, early changes in Demyelinating Disease?" Has seen 2 different Neuro's at this point, neither one seems too concerned. Had a LP 4/10 with elevated protein as the only finding. He is still having a constant severe headache, with neck & face pain, along with all over internal muscle twitches/trembling.  He had a Brain Stem MRI and a T-Spine MRI which showed "degenerative changes within the mid to lower thoracic disc"  the Impression stated: "There is no significant central canal or foraminal stenosis within the thoracic spine."  An MRI of the Cervical Spine Showed the following: Impression: "There are degenerative central canal and foraminal stenoses at C3/4 through C5/6, mild to moderate in grade." When he moves his neck down, he describes the feeling as ratcheting, not a smooth motion. PCP has done multiple blood tests, no abnormal findings except +  EBV back in 1/10.  Both Neuros have done extensive physical neuro exams with no abn findings.  We can't get anyone to do the EMG test to rule out ALS.  This is our biggest concern, considering the symptoms he has seem to be that of ALS.    He has not worked for 9 weeks due to the severe headaches & abdominal pain, so there has been no physical activity or strenuous activity. Also back in 2/10, extensive abdominal tests were done, which ruled out Liver cancer, and the Upper GI showed the following conclusion: "mild duodenitis and mild pylorospasm producing slightly delayed gastric emptying."  
     He is on 25mg amitriptyline SID,  20mg Propanolol TID, Xanax XR 0.05mg at bedtime, Lorazepam .5mg PRN, and Omeprazole DR 20 mg SID.  
Please Help!!

[Abhijeet Ghosh]

Dear Friend,
Many thanks for the post. I understand your concern but here i must begin by telling that i would be able to give you some opinion, on the basis of the details provided by you. However since i have not examined him, there may be some variations.

To be frank, he is on too many medicines. The LP was just not required. Chances of  headache increases more after LP, especially when there is a mild leak of CSF, which slowly heals up.

There are some degenerative changes in the MRI, but it is not confirming the diagnosis at all. Hence we need to be extra careful. in the present scenario.

I would like you to have a Psychiatric counseling, before going any further  as the thought if some demyelinating disorder  may be doing all the damage, without the presence of any actual disease. Also i would want you guys to take a break from the present situation (after the counseling) and take a good time out (from the place and not merely from the work).

The medicines can be continued and left, only on the treating doctor's advice.
Please feel free to discuss more.
Regards

[rmm82298]

Thank you very much for your helpful reply...I'm not sure if I replied the right way the first time so here it is again... could you please answer a couple more questions?  Does or can a degenerative disease lead to a Demyelinating disease? and what effects can sleep deprivation have on ones body/mind? And are there many reasons for internal muscle twitches/pulsations/tremors?  

Thank you again....

[rmm82298]

Thank you very much for your helpful reply... could you please answer a couple more questions?  Does or can a degenerative disease lead to a Demyelinating disease? and what effects can sleep deprivation have on ones body/mind? And are there many reasons for internal muscle twitches/pulsations/tremors?  

Thank you again....