Do my symtpoms warrant a visit to a neurologist?

[abcmt6]

I am a 44 year old woman with these current symptoms, none of which are debilitating:

- a mild but constant tingling/vibration sensation in my lower legs and feet that isn't relieved whether sitting, standing or lying down; more rarely an almost painful pins and needle sensation on the toes or bottom of the feet; also more rarely a muscle cramping painfully unexpectedly. Occasionally my legs feel weak but not to the point I'm afraid I'll fall. I can't recall when this started, it's been going on for some time. I sometimes feel vibrations and muscle tremors and spasms or shooting pains in other areas of the body, including my scalp, but nothing severe enough to compromise normal usage. I thought this were just normal.

- I occasionally get electric shock sensations in my thumbs, which is brought on when using them normally to grasp something. These sensations seem to have occur in episodes lasting several days each, although following the birth of one of my children some years back it lasted several weeks.

-  I have dizziness almost daily, sometimes severe enough to make me nauseous or affect my productivity; it  might be brought on or made worse by movement such as turning to look for the kitchen towel, or turning back and forth to hang laundry. The dizziness feels coupled with a strange feeling of motion, such as with travel sickness. I have had vertigo with spinning sensation on a few occasions, but all times the spinning was for short durations lasting from a few minutes to half a day.

- I have a constant faint ringing in my ears that rarely has quickly increased then decreased, as though someone had suddenly turned up and down the volume; I don't feel that my hearing is overall affected

I would not have thought of MS, actually I dismissed most of these things as normal aging, except that I recently asked my ob/gyn about my overactive bladder and stress incontinence -  she thought I was young to experience even mild incontinence (despite my having six children) because a sonogram revealed my bladder was properly positioned and looked healthy. This caused me to research urge and stress incontinence, where I saw it listed among my other symptoms as those related to MS. In retrospect, I realized that I've had other symptoms as well:

- I frequently yawn or try to breathe deeply; it's like I can't get air to the bottom of my lungs; I have sleep apnea and sometimes I realize I'm not breathing regularly while awake
- I have some cognitive issues - cloudy thinking sometimes such as I can't do calculations; I frequently forget what I'm doing while in the midst of starting it; I've had two scary episodes of becoming completely disoriented while driving (these were several years apart); daily can't remember what I was just thinking or have difficulty remembering a thought or a sentence I've just read
- I've started to drop things more frequently than normal, particularly in the kitchen - sometimes they just seem to fly out of my hands
- my hands, feet and nose get abnormally cold
- I can get a head rush sensation just standing still
- I've had episodes of fatigue, usually onset in the late afternoon, that I couldn't shake off; I had borderline iron counts on blood work done a few years ago so I've been taking iron daily, but I notice occasionally the fatigue returns despite this
- I had an episode of blurred vision at age 34 that lasted several weeks; it was rather subtle, realized I couldn't read the news ticker on the television or read fine print; went to my opthamologist (I'm quite nearsighted) who thought it was perhaps scratched corneas and she was satisfied when it resolved on its own
- I get very weak and shaky when overheated (long shower, hot car ride, etc.)
- I've had my knees buckle but not make me fall, with no sciatic pain
- I had several episodes some years back of my leg giving way when I got out of bed; it was like it had completely fallen asleep but my sleeping position was normal; I don't remember it hurting or pins and needles sensation as I regained usage a few minutes later
- I can remember in high school getting the strangest, heavy-legged clumsy sensation during some of my track meet races. It was as though my legs got unbearable heavy and clumsy and I was running in slow motion. I would physically slow down. I have no idea of that is at all connected, but it comes to mind. I also recall urge continence just before my races.

I'm just wondering if I should visit a neurologist, primarily for the tingling in my legs and for the dizziness. I want to emphasize that so far my life pretty much goes on as normal, except for dizziness affecting my sense of well-being. I don't want to think like a hypochondriac, but nor do I want to ignore symptoms that warrant a doctor's visit. But should I be concerned?

[abcmt6]

Thanks so much for your feedback. Yes, I agree the trick is getting a doctor to pay attention. I live overseas, so I can go directly to a neurologist without a referral, but doctors here seem very put off by patients who have done lots of reading or homework. They deal with many uneducated people. Because I'm in a developing country, they also tend to treat only the most dramatic cases, so perhaps my symptoms would only be taken seriously if I presented with gait or balance problems. My instinct is that there is something going on, but perhaps I should just take a wait-and-see approach.

[caregiver222]

You ask some very good questions. The first thing I would do is to write down all these symptoms, and include the first time they happened, the intensity, whether intensity increased over time, and do this with all your complaints. Do this in a chronology. For example, one page of paper for every year. You are not a hypochondiac. The problem will be getting a physician to pay attention to your problem. Rather than a single physician or neurologist, you need a "work-up" at a hospital specializing in neurological disorders, preferably a teaching hospital. You don't need a "visit". The number of tests required for a proper evaluation suggest a short hospital stay would be appropriate, but it can be done on an outpatient basis. It seems you may have several things going on at once. It is impossible to even suggest what they are without a complete lab work-up. I could list tests you should have, but it would be pointless. They will do what they like. The important thing is not to be "put off" until you have recieved a thorough evaluation from the tip of your nose to the bottom of your toes. In the United States there are also a few so-called "diagnostic facilities", which, for a fee (usually, but not always covered by insurance) will provide an unbiased evaluation of your medical status. These are best used when a "second opinion" is needed. Usually an appointment with a neurologist requires a screening appointment with a physician. These represent two "gates". Sadly, the liklihood is you may be ignored at both of these gates. Another possibility is to present youself at an Emergency Room on a Monday Morning early, and "exaggerate" a bit on your complaints. I know you are not supposed to fib, but ER's do not like to evaluate people who have had the same complaint for the last twenty-three years. You have to tell them that "it got worse last night, and I became worried and my uncle, son, priest, garbage collector, nurse, etc, told me...you better get an an ER!" Then you fib a bit more and tell them "I REALLY didn't want to go, but you know how it is with family."