Brief Answer:
Suggest that you obtain a neurological examination

Detailed Answer:
Thank you for bringing your question up to our network and hopefully, I can shed some light on your concerns. In your case and with the types of symptoms you seem to have I believe it is to your advantage to obtain a good solid neurological examination by a neurologist who can take the symptoms and put the information together into a coherent story that can then, be tested by acquiring relevant and appropriate tests to be performed upon you such as possible imaging studies like an MRI of the brain or lab studies looking at Vit. B12, Vit. D, and inflammatory markers that could point to things such as occult infections, autoimmune diseases, or even some form of toxic reaction to a substance or chemical you may have become exposed to unknowingly.

If you've already had an MRI of the brain which was normal and this was done after having done a good neurological exam then, it may be that your symptoms are not being generated by the central nervous system and so we are then, left with metabolic/chemical issues to investigate as I've summarized above or as you bring up the possibility of stress and anxiety reactions which can also be considered at that point since some of your symptoms certainly can occur following stress filled moments and events.

I do notice that you've placed a number of questions having to do with unusual symptoms not adequately resolved to other colleagues on this network. Nevertheless, I believe you should have a good neurological examination by a qualified neurologist as well as a good solid chemistry workup to be sure no stone has been left unturned.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you'd like.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 43 minutes of time to read, research, and respond.

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Brief Answer:
Normal B12 and Normal Vitamin D? Are you SURE?

Detailed Answer:
If you'll provide me with your numbers I'll tell you whether you're really NORMAL in both parameters. 98% of the population on the planet are deficient in at least 1 if not both of these things.....Normal B12 should be MINIMUM 350 and a normal Vit. D (as far as I am concerned who's looking with neurological types of problems on my mind....but Normal Vit. D levels are considered at least 60-80 units....not 30 or 25 as some labs have.....the LOWEST limit of what they consider their normal ranges....and as long as you land in the range....you're good.....that ain't true.....use my numbers and you'll be glad you did.

As far as the MRI is concerned....did you get it with GADOLINIUM CONTRAST.....If not then, you should get the study redone with GADOLINIUM CONTRAST...no guff about it from people who think CT scans are good enough for everything. As far as MS is concerned....if your MRI was definitely clean....then, I think it would behoove you to get some additional workup and get the enhanced MRI.

Also, on all my SUSPECTED MS patients I always try and get your studies done then, look at the results...and then, 3-6 months later get some repeat studies just to follow things up.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you'd like.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 94 minutes of time to read, research, and respond.


P.S. There are a number of additional tests that can be obtained from blood samples WHICH CANNOT DIAGNOSE MS but they can certainly give you a better warning rather than just letting things start happening making you feel that you were taken by surprise! Cheers!

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Brief Answer:
After rereading your symptoms I think you'll be fine...still---

Detailed Answer:
Good afternoon. Thanks for getting back to me with your numbers as requested.

I agree that your B12 should not be of further concern. It's perfectly normal and is least likely the cause of any of your symptoms.

However, your Vit. D (though it falls within NORMAL LIMITS by most lab standards) is quite below where I and most neurologists like to see the numbers in anybody who has neurological symptoms. Therefore, 38 in one of my patients would prompt me to suggest a replacement protocol. I always advocate getting Vit. D levels up to a minimum 60-80.

I will provide you with a list of other lab tests that I might consider in someone with your symptoms:

1. Folate
2. Free T4
3. TSH
4. Vitamin D, D2, and D3 in serum
5. Urinalysis
6. Magnesium in serum
7. ESR
8. C- reactive protein

You said that your MRI of the brain was normal. Again, as a neurologist my habit in ordering MRI's in someone with your symptoms (not taking into account your recognized condition of Health Issue Anxiety) would be to do it with GADOLINIUM CONTRAST and I'd also include the cervical spine in the study since lesions giving odd symptoms as you describe can exist in the neck and not be found at all in the brain.

If you have the actual MRI report to upload I'd be happy to look at it. The physical examination that should be done in my opinion is a NEUROLOGICAL examination which is not simply a "physical" examination as performed by a primary care doctor. The difference being the focus of maneuvers and the amount of emphasis placed on central nervous system components such as cranial nerves, eye movements, motor and sensory function of both a central and peripheral nervous system.

Now, if after doing all these tests and imaging studies as suggested, still nothing shows up then, I would say that there is little chance that any neurological problem exists and pursue other options taking into consideration your health anxiety issues as well.

I'd appreciate your rating this interaction with a HIGH STAR SCORE and CLOSING THE QUERY with a few words of feedback so that all questions and responses can be processed in a timely fashion for both yours and my benefit.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like once your doctor decides on which tests to get and you have the results.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 127 minutes of time to read, research, and respond

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