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What Do These Following Lab Reports Indicate?
Question: I have tentatively been diagnosed (after months of different doctors and tests) with "Small Fiber Neuropathy" by a new neurologist. My symptoms have been extensive paresthesias in both feet and around my mouth, tinnitus, and facial twitching, all for 9 months, and next week I am having an EMG, followed by a nerve biopsy.
The lab drew 7 different vials of blood, and I am assuming (based on what the neurologist said) he is looking for genetic markers for Celiac Disease. Tests up to now have including extensive blood tests for Vitamin deficiency, 3 CBC's, blood sugar testing, brain and cervical spine MRI's, chest CT, and thyroid.....all normal.
Physical neuro exam was normal, with slight left side instability. I was also diagnosed in 2012 with an L4
herniated disc from a lumbar MRi.....based on this information, I would like your opinion as to what is "going on".......new neurologist said he sees no evidence of ALS or Parkinson's. Also, what should I look for in new blood work results that would indicate the presence of Celiac Disease, realizing that ultimately small bowel biopsies may be required to confirm the presence of Celiac Disease......but can there be a confirmation of NO Celiac's from blood work? My PCP diagnosed 'hyperventilation syndrome" from all tests, including an ABG which indicated "respiratory alkalosis".....any information would be helpful....it is VERY difficult to obtain new appointments from neurologists, and I'm hoping your impressions could temporarily provide a "second
opinion" of sorts. I recognize that there is only so much you can surmise from this message.....Thank You!
The lab drew 7 different vials of blood, and I am assuming (based on what the neurologist said) he is looking for genetic markers for Celiac Disease. Tests up to now have including extensive blood tests for Vitamin deficiency, 3 CBC's, blood sugar testing, brain and cervical spine MRI's, chest CT, and thyroid.....all normal.
Physical neuro exam was normal, with slight left side instability. I was also diagnosed in 2012 with an L4
herniated disc from a lumbar MRi.....based on this information, I would like your opinion as to what is "going on".......new neurologist said he sees no evidence of ALS or Parkinson's. Also, what should I look for in new blood work results that would indicate the presence of Celiac Disease, realizing that ultimately small bowel biopsies may be required to confirm the presence of Celiac Disease......but can there be a confirmation of NO Celiac's from blood work? My PCP diagnosed 'hyperventilation syndrome" from all tests, including an ABG which indicated "respiratory alkalosis".....any information would be helpful....it is VERY difficult to obtain new appointments from neurologists, and I'm hoping your impressions could temporarily provide a "second
opinion" of sorts. I recognize that there is only so much you can surmise from this message.....Thank You!
Brief Answer:
Read below.
Detailed Answer:
Hello and welcome back to HealthcareMagic.
Apart from biopsy which you yourself mentioned, blood tests for celiac disease would include serologic testing which look for certain antibodies in your blood. Whether such tests can confirm NO celiac disease....such a test should have a 100% sensitivity, meaning able to detect celiac disease in 100% of cases, only in that case its being negative would exclude the disease. These blood tests do have a pretty high sensitivity, reaching up to 95% (varies also with the laboratory), but none 100%, so while 95% is a pretty good number and would make celiac pretty unlikely if negative, still can't be said to give complete certainty. But if you have no other manifestations, I'd feel pretty safe though.
Hyperventilation syndrome comes from breathing too deeply or rapidly and is related to psychological factors, to your anxiety.
While it's great that your neurologist is being thorough and doing all the tests, even if small fibre neuropathy is present, I still believe there to be an at least partial contribution of anxiety. Small fibre neuropathy can cause paresthesias in your hand and feet, but is not enough to explain all the moving facial twitching and tinnitus, that is why I think anxiety to be a factor. Anyway, if there is something more than anxiety or small fibre neuropathy the tests will tell, so should still feel reassured at the end.
As for ALS and Parkinson's as you already know from my past answer to you, I didn't consider any of them to be the case even before your neurologist visited you, so can't but confirm what he said.
I remain at your disposal for further questions.
Read below.
Detailed Answer:
Hello and welcome back to HealthcareMagic.
Apart from biopsy which you yourself mentioned, blood tests for celiac disease would include serologic testing which look for certain antibodies in your blood. Whether such tests can confirm NO celiac disease....such a test should have a 100% sensitivity, meaning able to detect celiac disease in 100% of cases, only in that case its being negative would exclude the disease. These blood tests do have a pretty high sensitivity, reaching up to 95% (varies also with the laboratory), but none 100%, so while 95% is a pretty good number and would make celiac pretty unlikely if negative, still can't be said to give complete certainty. But if you have no other manifestations, I'd feel pretty safe though.
Hyperventilation syndrome comes from breathing too deeply or rapidly and is related to psychological factors, to your anxiety.
While it's great that your neurologist is being thorough and doing all the tests, even if small fibre neuropathy is present, I still believe there to be an at least partial contribution of anxiety. Small fibre neuropathy can cause paresthesias in your hand and feet, but is not enough to explain all the moving facial twitching and tinnitus, that is why I think anxiety to be a factor. Anyway, if there is something more than anxiety or small fibre neuropathy the tests will tell, so should still feel reassured at the end.
As for ALS and Parkinson's as you already know from my past answer to you, I didn't consider any of them to be the case even before your neurologist visited you, so can't but confirm what he said.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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