numbness in pinky/ring chest wierdness (not pain/pressure)

[koralis]

About 2 weeks ago I developed minor numbness in my left pink and ring fingers. I can stil feel them, they're just dulled.  This coincides somewhat with some odd sensations in my upper chest.. mostly on the left side just under the collar bone.  It's not pain so much, nor "crushing pressure", etc, that would have had me running to the ER ASAP.

For background, to complicate things...

1)  My chloresterol levels have been slightly bad, my dad had a heart attack a few years ago, and my triglycerides apparently worrying to my doctor (don't have the numbers on hand) such that she prescribed vitorin 10/20.  With a baby on the way at that point, I got busy and lost the prescription so it was never filled.  I haven't gotten back to get it reissued (I know, bad me.)

2)  Since I was a kid I've had some instances of spontaneous numbness that tend to go away quickly (usually unpleasant taste, once my left side.) A consult with a neurologist at that point said that he felt it was migrains and not worth an MRI, though there was a small chance of a tumor.  Since then, taking an aspirin when I sense the taste buds going has quickly squashed it when they show up (very rarely.)

I intend to get to my primary care physician next week, but have been putting it off unreasonably.  Any insights?  Tumor?  Heart attack?  Stroke?  Merely cubital tunnel?

[mike1105]

yes a protein electrophoresis would have detected the spike.  and thanx patsy

[patsy10]

Mike I think your posts are very informative and I like reading them.  I think you are very well read!

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.    
   The symptoms that you describe in your left hand, sound like an ulnar nerve compression syndrome (this causes numbness in the ring and pinky finger). Ulnar nerve fibers can be compressed at several levels, the elbow (most common), at the level of the clavicle (brachial plexus) and at the vertebral level (nerve root compression).  From the history you provided it is not possible to differentiate among these, but I would suggest an EMG (nerve-muscle test) to localize your area of deficit.  As far a tumors are concerned, the potential tumor to be concerned about in this case would be breast cancer/ or lymphoma that might cause large lymph nodes that can compress the nerves onder the clavicle.  In conjunction with the EMG some imaging of the cervical spine (MRI) would also be helpful to evaluate for possible disc disease.
   Please...never take Vytorin (contains a statin called simvastatin) during pregnancy, if you maybe or even thinking about pregnancy (it causes severe birth defects).  Statins can be useful in addition to diet and exercise in controlling your cholesterol (but not while pregnant).
I hope this has been helpful.

[slipnslide]

Everything I've read thus far states that my Protein Electrophoresis test would have detected a monoclonal protein or MGUS. They separate the 5 proteins and one would have shown a spike.  Correct?

My diagnosis of leukocytosis, thrombocytosis, neutrophilia seems to only correlate with polycythemia vera, which is what I am being watched for.  My Hema/Onco feels I could just be an anomoly (but my counts are a bit high) so it could be PV in a dormant state just waiting to explode...I am hoping I am just an anomoly...lol

[slipnslide]

I believe my marrow biopsy did not come back normal.  The tests performed on the Flow Cytometry Report were CD2-5/7/8/10/11b/11c/13-16/19/20/22/23/25/26/33/34/36/38/45/56/57/64/71/103/117/138,Kappa IgG Light Chain, Lambda IgG Light Chain, HLA-DR, and FMC7.

On the Bone Marrow Differential, the Myelocytes & Rubricytes were low, the Band & Seg Neut's were high, and Megakaryocytes appeared increased on smears.

The Bone Marrow Exam report stated the microscopic description as:  Megakaryocytes are mildly increased in number.  There is only minimumal clustering of megakaryocytes. The histological findings are those of mildly hypercellular bone marrow with mild megakaryocytic hyperplasia.  Clinical correlation & appropriate follow-up is recommended.

Would that rule out the MGUS?

[mike1105]

i am not an md, just a very well read dentist. MGUS is an elevated level of antibody protein in the plasma with no underlying disease as the cause (hence MGUS---Monocolonal (antibody) Gammopathy (overproduction) of Undetermined Significance (unknown reason)). when the elevated level is found, a bone marrow biopsy is done to try and identify if there is indeed an underlying disease like myeloma or lymphoma or amyloid or Waldenstroms macroglobulinemia that can explain the elevated level of protein. If not, it is called MGUS. The protein level is determined by an electrophoresis of the plasma. While the bone marrow biopsy may rule out certain diseases, it does not rule in or out MGUS I believe. So, I think the answer to your question is no, your biopsy does not rule out MGUS, but it may have ruled out cetain disease conditions that can casue the elevated protein. As I understand it, you need the protein electrophoresis to detect the protein (antibody) in the plasma

[mike1105]

were you tested specifically for MGUS?  it involves  protein electrophoresis. it is NOT part of routine bloodwork at all. It is a separate test. It cannot hurt to have one if you have neuropathy. You can indeed have MGUS and a normal marrow biopsy. In fact, part of the MGUS diagnosis IS a normal marrow biopsy. IF you have elevated M protein(s) and an ABNORMAL marrow biopsy, the diagnosis is something more serious usually, and less common- like myeloma, amyloid, or more rare and unusual plasma cell disorders. MGUS is not uncommon----2-3 % of the population over 50 years old. In some cases, though, it can cause neuropathy.

[slipnslide]

Mike,

I found it odd but smart that you suggested that!  Many folks don't think that any types of blood disorders might affect the nerves.  During my pre-op testing for my ACDF surgery, my WBC's were high.  To make a long story short, I've had a full blood work up and a bone marrow biopsy since all my red blood cells were out of range.   The marrow results were negative for any signs of abnormal cells and the DNA test came back negative for the Philadelphia chromosome .  I see an Onco/Hema every 6 months to monitor my counts to make sure they don't get extremely high.  My current diagnosis is leukocytosis & neutrophilia.  What I get re-tested for every 6 months is polycythemia vera which they have not been able to rule out since my WBC's stay in the upper teens.

Thanks,

Kim

[koralis]

Thanks for the insights everyone.  Yes, I'm a computer user.  I'll take a look at your diagnosis and may mention it to the doctor if it seems to fit.  I probably should still head in to make sure it's not something decidedly wrong and of a life-threatening nature though.  It wouldn't do to have my newborn fatherless.  :)

[mike1105]

I'm sure many readers of this forum are sick of hearing about me--- I had the same initial symptoms as Koralis 3 years ago. They got incredibly worse-- i saw scores of doctors and had some unnecessary surgeries before I discovered on my own what the problem was--- and I am learning that many people have it and doctors know squat about it. There is a family of syndromes (Upper Crossed Syndrome, Thoracic Outlent Syndrome, Pectoralis Minor Syndrome, Scalene Syndrome) which (unless there is an anatomical variation such as an extra cervical rib) can all basically be due to the same problem-- a tight closed in chest with shortened and tight scalene muscles (the attach from the neck to the inside of the collar bone and first rib) and a weakened mid back. this leads to hunched over posture and a chronically flexed torso. lemee guess--are you on the computer alot? Look up these syndromes on the internet... see a website by Erik Dalton for real detailed information-- see a website by Jolie Bookspan on how to fix this with the proper posture, stretching and exercise. It will take time, but it is fixable and only you can do it. Your case at this point seems mild---- you have pain in just one area (UL chest --ie scalanes/ pecs) and these muscles are so tight they are pinching the nerve that runs throught them to the 4th/5th fingers. I'd consider trying to fix this on your own before trying to get help from a doctor, especially if an MRI shows no obvious c7/t1 (the level that innervates 4th 5th fingers)  problems. this is just my advice, and I am not an MD.

[slipnslide]

Could be one of many things...TOS, Brachial Plexus, Ulnar neuropathy.  Have you ever had an EMG/NCS done?  An MRI of the C-spine?  Chest and spine xrays?

I recently had an EMG/NCS that showed ulnar neuropathy but it also showed global sensory slowing in the upper extremities and decreased ulnar motor conduction velocity, which would indicate polyneuropathy, but when my leg nerves were tested they were fine, soooooo, I'm being sent for a new MRI of the C-spine and then to a neurologist.

An EMG/NCS might be a good place to start.

Best wishes,

Kim

[mike1105]

slipnslide-- you may want to request blodwork that involves testing for monoclonal proteins for possible MGUS--overproduction ofthese proteins may cause the polyneuropatthy