What causes burning sensation in skin, numbness in face and limbs?
My wife has had a rough 4 months and we are stumped and really need some advice.
Here is a shorten timeline and what we have done up to now.
It all started with a upset stomach and what seemed to be a blocked intestine and gas build up. Didn't clear up with lots of water and chicken broth, so we went to see her primary and after a few more days of jello and chicken broth, things seemed to get better for a couple days.
After that, we ended up in the ER with severer stomach pains. A MRI was done and came back fine. No blockage or signs of anything wrong. We went home and keep the diet light and lots of water, broth and jello.
Again, there was a couple days that were ok, but that is when the burning and pinching skin started and this kept her up most of the night. So she was not getting enough sleep. So we went back to her doctor and was referred to a Rheumatologist and prescribed Xanax for her pain and to help her sleep. After seeing the Rheumatologist, she prescribed Gabapentin for her nerves and a blood test. The blood test came back fine, besides a high liver count and a protein count. ( I forget the exact # and name, but the numbers were not off the charts.) This was the second blood test.
The synonyms continued to get worse and now she wakes up in the very early mornings with her hands and arm numb. She still have the burning and pinching skin, but starting to feel some numbness in her face and on her arms and legs. Sometimes her joints will bother her as well as pain in the back muscles.
We went back to the primary doctor and she referred us to a Neurologist. The doctor scheduled a MRI to check her brain and neck for lesions that could be MS. That scan came back fine with no signs of any lesions. So the did a nerve test using electrical shocks and a needle to listen to the nerves and that test came back fine. The doctor said to increase the dosage of Gabapentin and come back in a month to see him.
So we are back to square one and her synonyms are not getting any better, I would say slightly worse. I is driving her crazy not knowing what's wrong. We will call her primary doctor next week, to see what some other options we have, but we have hit a wall and are stuck on what to do.
I have read that some MRI's will not pick up all lesions and some can be there, but invisible to see. I don't know if we should try doing a Spinal Tap, as most of her synonyms point to MS, but I just don't know?
I thought maybe it could be something similar to Celiac Disease, but again, just don't know. We have been watching what she eats and try to stay very healthy.
Any advise on what it could be or what to try next would be greatly appreciated.
Thanks in advance!
I read your question carefully and I am sorry about what your wife is experiencing these last months.
Regarding the MRI and lumbar tap question, I would say that is not necessary, at least not for MS. MRI is positive in over 90%of cases in MS an in a case of MS with such extended symptoms to involve both sides I would say it would show something in almost 100% of cases. Also to be honest those symptoms and their evolution are not typical for MS anyway.
The symptoms do look compatible with peripheral neuropathy. It seems nerve conduction studies are normal, but that checks main nerves, small fiber neuropathy can be undetectable on nerve conduction studies.
If your wife has those ongoing gastrointestinal symptoms I think screening for celiac disease which you yourself mention is advise, as it has been linked with small fiber neuropathy.
Of course there are many other causes of peripheral neuropathy but it would be useful to know exactly what tests she's had, apart from routine liver and kidney function, blood glucose which I assume she's had other tests advised are complete blood count, ESR, CRP, fibrinogen, electrolyte panel, thyroid function, vitamin B12, rheumatoid factor, antinuclear antibodies, ACE (angiotensin converting enzyme) levels. I would bet she's already had some of those during her visits, but if you can review and perhaps upload the reports it might be helpful.
As for the symptoms since Gabapentin isn't working I might suggest to try an antidepressive which is also used in neuropathy, such as Duloxetine.
I remain at your disposal for further questions.
Thanks for taking the time to read my question and your detailed answer.
I wanted to send over the abnormal results from her blood test. Over the last 4 months, she has had 3 different blood test, the last one they took 10 vials to test.
Below is the abnormal results, everything else was within normal range.
Bilirubin, total 1.4 (0.2-1.2mg/DL) high
Absolute neutrophils 9069 (1500-7800 cells/UL) high
Absolute Eosinophils 10 (15-500 cells/UL) Low
RNP Antibody 1.1 POS ( greater than 1.0 neg AI) Abnormal
VIT D 24 (30-100 NG/ML) low
Protein total random 4 (5-24mg/DL ) low
We have been keeping a journal of what/how much meds and daily synonyms.
She has been taking daily:
2 - 5 gram Xanax (1 in the morning and 1 before bedtime)
2 - 300 gram Gabapentin
We are trying to stop taking the Xanax, so yesterday it was 1 Xanax in the morning an increased the Gabapentin to a total of 6 a day. She said it didn't seem to so far, but it may need to build up in her system?
I hope this is useful information.
Please let me know if you need anything else.
Thank you for bringing some more info.
Those tests indicate some mild abnormalities it is true, perhaps a repeat after some time is indicated to see possible changes. However none of those changes themselves is enough to explain her symptoms. It would have been useful if you mentioned at least the names of the tests even if normal, otherwise it's tough to know whether a test I think necessary was done and came out normal or wasn't done at all. I do think antibody testing for celiac disease is necessary considering that history of gastrointestinal problems. Also exposure to toxic substances at work or home should be kept in mind.
Regarding the treatment you must be reading the dosages wrong because xanax is given in mg, and even then 5mg is too much, something wrong in your calculations, could it be 0.5mg total perhaps. Also Xanax isn't given for pain but anxiety, it seems the doctor thinks that anxiety can be playing some part as well.
As for Gabapentin if you've gone to 6 times 300mg I don't think further raises are likely to add any benefit, I would stop there. I would try as I suggested before an antidepressant as it addresses both neropathic pain as well as anxiety better than Xanax (which shouldn't be used for long periods).
I hope to have been of help.
If this will help with the next thing to do, I have sent the type of blood work that was done and which ones were out of range.
Blood test 1
Comprehensive metabolic panel
Total Bilirubin 2.9
CO - 19
Blood, ua - small
CBC w/ PLT count & auto differential
MCH - 33.1
Blood test 2
Skin pinching & burning
Anti-centromere b antibodies-less than 0.2
Scleroderma diagnostics profile
Ana direct- positive
Antisclerodermo-70 antibodies less than 0.2
Creating kinase total serum -627
Cbc w/ diff/ platelet
Blood test 3
Skin pinching & burning
Comprehensive metabolic panel
Bilirubin, total - 1.4 high
Protein, total w/ creat, random urine
Protein , total, random ur less than 4 low
Absolute neutrophils-9069 high
Absolute eosinophils - 10 low
RNP antibody- 1.1 pos
Vitamin D -24 low
My plans are to get her off the Xanax very soon. If we ask her primary about a antidepressant medication, is there a few others that might work as well or just the Duloxetine? Is there a certain diet out there that we should try as well?
Thanks again for the detail answers. XXXXXXX
Thank you again for those lab tests. I would recommend also to have some of the tests I mentioned in my first answer, routine ones such as electrolyte panel, thyroid function and vitamin B12.
As for the antidepressant, the reason I mentioned Duloxetine is because it is used both for anxiety (can replace xanax) as well as for neuropathic pain, so it's sort of killing two birds with one stone. Other antidepressants who have the same indications are Venlafaxine (same class - SSRI) or amitriptyline.