Hello and thank you for this service.
I am a 34 year old caucasion male (only slightly overweight) who has been plagued with a multitude of symptoms over the last few months. I do not drink or smoke. I have had issues with stiff neck and headache for sometime, and also seem to have issues an hour or two after eating (fatigue, marked increase in pvcs and heart rate, lower abdominal pain). In the last 3-4 months, I have had numbness and pain in my lower legs/feet and lower arms/hands that is equal on both sides. I also have had some episodes of what I call waves of fatigue which comes with a general ill feeling. I have also had pain in my abdomen (constant, separate of the eating pain) on the left side at or below the bottom of the rib cage. I have had numerous tests and it was revealed yesterday that I have a very low B1 level. The doctor has recommended I take B1 tablets at 100mg to see how I respond. I also have a fasting glucose level that hovers around 105. I have a good appetite, am not losing weight. I take a beta blocker, ace inhibitor, and paxil. The lisinopril and paxil have been for years. I also take a multi-vitamin and B-complex, so I am surprised that I have a B1 issue.
I have had been tested for lyme, hep A,B,C, CMV, all negative. ANA, ESR, TSH, SPEP, Protein C, all normal. Heavy metals in blood and urine was normal. HbA1c, ALT, AST, lipase, amylase, bilirubin, triglycerides, cholesterol all normal. Electrolytes, B1, folate, homocystiene normal. MRI of head was essentially normal (1 tiny white matter lesion). MRI cervical spine normal. Celiac negative. EBV IgM negative, IGG positive. Some ketones in urine. Gastric emptying and gallbladder test (CCK?) normal. These tests were all within last 2 months. CT scan of abdomen in June of 06 revealed a couple small (4mm) cysts in the liver, believed to be benign. I had pain then too and it ended up being peptic ulcers which were treated and as of March of 2007 were healed. I do not have the same kind of discomfort I had at that time, so I do not believe that to be the problem. I was taking aspirin which was found to be the cause. I am not on it right now.
My concern is what is the root cause of this, and is this really the reason for the neuropathy/and or other symptoms?
1. Based on my workup so far, what possibilities would you suggest as a root cause of the neuropathy, and do you think the B1 is really the cause?
2. What is the likelihood based on my workup that the abdominal pain (more like a constant gnawing pain/pressure at or below left ribs) is related to the neuropathy or B1 deficiency?
3. If B1 is the cause, what if the oral supplements are not absorbed? Will shots work? Will the lack of absorption give clues to the root cause like malabsorption?
4. What next steps would you recommend?
5. My biggest concerns are obviously cancer and/or pancreas/liver involvement. What is the likelihood of these organs being involved, and does any of the workup I have had lately help to minimize concerns relating to them?
Thanks so much for your time and for this service...