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Should I push my GP for more tests

Hi All-  Question for any MS experts out there kind enough to read through this.  I'm a 38 year old male and have been symptomatic for 8 months.  I'll give you the back story here:  It all started with paresthesia in my left calf.  I was running a lot at the time and attributed it to a possible injury.  I had pretty bad shin splints on that leg as well.  

During the late summer I came down with the terrible case of bronchitis and took several rounds of antibiotics and steroids.  Once the last steroid pill was taken, I began to develop (what I believe to be)  bilateral postural, asymmetric tremors in my hands and fingers;  my thumbs were most of affected.  It was worse when I held a phone in my hand.  The tremor was coarse and it would come and go randomly. It did seem to be worse when I was anxious.   The pharmacist explained that those steroids could cause tremors but had a very short half life and if it continued, I should see a doctor.  I waited it out and they continued.

One month later I noticed a constant ache in my lower stomach for 2 weeks straight.  A CT scan showed nothing and later they gave me a colonoscopy which showed a single polyp so they removed it- nothing at all pointing to my aches.  They diagnosed me with IBS and I went home.  Turned out, that polyp removal bled so I landed in the hospital for 2 days.  

Once released, I began to get dizzy.  Not vertiginous but lightheaded and it stayed that way for weeks.  The doctor said I was low on iron due to the bleeding but that proved to be untrue after they tested my blood.

By November, the dizziness would come and go as with my other symptoms but I developed a new one-  urinary frequency.  I had to go a lot and it would sting afterwards.  This is where I started think about MS.  I told my doctor I was concerned and the thought it was not consistent at all but gave me a brain MRI with and without contrast to be sure.

The results were the following:

"Focal area of white matter signal abnormality seen adjacent to the
anterior horn of the left lateral ventricle which is nonspecific and
shows no associated enhancement or diffusion signal and may be related
to prior ischemia or other white matter disease."

Now I am freaking out.  But the doctor called and told me that despite the report, he is 99% sure it is not MS.  It's probably a prior ischemia and his MRI looks similar. Also, that even if it is MS, this lesion would not make me dizzy.  

He then tested me in the office for various blood tests and UTIs which came back normal and said I have prostatitus for which he gave me meds.  

For the leg issues, he said I could work them out so I saw an orthopedic doc who imaged my lower back and told me I have mild to moderate degenerative disc disease at the L4-L5 region and similair issues right below that.  He said it could be causing the leg pins/needles/buzzing but it's not clear.  He wants me to have some electric nerve test in a few weeks.  

As for the tremors, the doc never mentioned a reason.  But I have a family history of Essential Tremor so he'll probably attribute it to that. They are very sporadic now.

Beyond all of that, I am negative for Babinski, I don't think I have experienced L'hermitte's Sign, I haven't had weakness yet that I noticed either and I allegedly passed other clinical tests for MS he gave me.

My GP, who I like a lot, believes explains away my symptoms except for the dizziness (which he thinks is NOT MS).  I however, have read many posts and stories on the web and have noticed a traumatic event can be the start of this illness. For me, it was bleeding out after the procedure as everything went downhill since.

When I look at these symptoms separately, I can see why doc is saying it's not.  But when I look at them all together, it seems like it is.

I worry about this a lot.  My concern over the cause of these symptoms might be greater than the symptoms themselves.  My dizziness now comes and goes more often but it is accompanied by tense shoulder, neck and back of the head pain.  It's mild to moderate but annoying.  The leg issues are now in my left foot as well and it's just a mild buzzing feeling.  

My friends:  well, they think it is ALL health anxiety and stress except maybe my leg issue which could be a peripheral neuropathy  or injury.

If you were me, would you push the GP for a follow up brain MRI?  Maybe a spinal MRI as well?  He seems pretty sure it's not but I worry about this stuff none the less.  Thanks so much, sorry for long post.
1 Responses
5265383 tn?1483808356
Welcome to the board!  Not an ms expert -- this is a patient moderated board.

I'm assuming you were checked for a urinary tract infection, which would cause frequency.

The results of the EMG of your legs will be helpful.  A positive EMG means your issues were peripheral nervous system caused (not MS).  

The family history of essential tremor means that is a more likely cause than ms for your tremors.

However, cipro (and other fluoroquinolone antibiotics) can have adverse neurological effects such as tremor.   Is there any chance you were on an antibiotic in this family?  That would absolutely account for onset of tremor that is declining in frequency.

MS lesions that are beside the ventricle have a specific shape; the radiologist has labelled yours "non-specific" because it is not that shape.

Make sure you do a vitamin and mineral blood work panel (I repeat myself all the time here); in particular get vitamins D and B12, and magnesium assessed.

Because of this paragraph:

"I worry about this a lot.  My concern over the cause of these symptoms might be greater than the symptoms themselves.  My dizziness now comes and goes more often but it is accompanied by tense shoulder, neck and back of the head pain.  It's mild to moderate but annoying.  The leg issues are now in my left foot as well and it's just a mild buzzing feeling."

... I would not pursue any more testing at this time.  Other than the EMG booked already.  At this point, your best option is blood work, breathe, and re-engage in life.  Stress can cause symptoms (the tightness in your neck etc. shouts stress) and also magnify symptoms of organic illness.  It's very important you get back to your regular life with symptoms that are low-key.  Hopefully they are anxiety related and you will slowly recover from these extra symptoms.  If not, clearing out anxiety symptoms will help you and  your doctor figure out what is left.

Low magnesium can also heighten anxiety and depression so you have a two fold reason for checking into it.  The blood test is not particular accurate and one of my doctors told  me even if my test was low, to supplement.  Supplementation helped me lose a lot of non-ms symtpoms I experienced.

I hope something here is helpful, and let us know the results of your EMG :).
3 Comments
Hi Aspen2,  Thanks for the response. The UTI test was negative but he thinks I have Prostatitus.  He didn't test for it which is why I questioned whether my issue was really that or if it was neurogenic bladder.  

I do believe one of the antibiotics was in the Cipro family as you mentioned. However, That was last September and the tremor re-appeared just 2 weeks ago.  That said, you're probably right about the Essential Tremor being a more likely cause.  I do know that it affected my uncle and grandfather later in life and not at my age but am not sure if that matters.

I take a ton Vitamin D.  I don't know about Magnesium but I will look into that.

Okay-- I will take your advice and just do the EMG.  Perhaps I only push for another MRI if that test comes back normal which would mean the issue is in the CNS.  

This has been very helpful.  I guess my remaining question is this:  Do paresthesias tend to go away with exercise or exertion and re-appear afterwards?  Or do they persist during exercise and people just deal with it and push through?

Mine go away during exertion and come right back when I am done.  It's quite strange.

Thanks again.

Hi and another welcome from me,

Please keep in mind that the information you receive is personal opinion, experience etc but not from professional medical backgrounds....

"Do paresthesias tend to go away with exercise or exertion and re-appear afterwards?  Or do they persist during exercise and people just deal with it and push through? "

There are numerous causes of paresthesias, IF they disappear when you are physically or mentally occupied, basically disappear with distraction, it's very unlikely to be due to a neurological condition like MS.

To be honest I think it's more likely to be mental health related because with neurological conditions and organic causes in general, symptoms typically worsen with physical activity and what you are describing is usually associated with conditions like health anxiety, conversion disorder etc It might be very helpful to consider how much anxiety you have currently and talk to your family dr about mental health support if you feel this might be a contributing factor in what your dealing with.

"I will take your advice and just do the EMG.  Perhaps I only push for another MRI if that test comes back normal which would mean the issue is in the CNS."

Not necessarily, CNS is only one possible explanation and not the more likely one from what you have mentioned, try to take a step back from working it out and try not to assume meaning and or focus on any specific medical explanation, you'll likely get it wrong and be worrying unnecessarily.....breath!

Hope that helps.......JJ
Meant to thank you for the update.  It turns out my GP thought to be safe I should have a follow up MRI 3 months after the initial one I quoted above.  This is scheduled for Monday.  The EMG test is scheduled for this upcoming Thursday.

I still have lightheadedness and some mild visual disturbances such as floaters, halos around lights.  But I haven't noticed colors appearing washed out or permanent holes in my vision so I am not sure what that means.

I don't completely understand why he is not ordering images of my spine at the same time considering lesions could exist there as well but I am assuming he knows what he is doing so I'll leave it at that.  

One small correction to your comment, Supermum_ms-- it's not that paresthesia goes away with distraction.   When I exercise, I am fully aware and conscious of my foot and leg and even anticipate the return of the symptoms.  I feel like it has something to do with movement but I cannot be sure.

In any case, I appreciate the responses and I'll be sure to post any test results.  Here's to hoping for the best for me and all others out there!
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