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What Causes Constant Numbness On My Left Side Lower Rib Area Down To My Thigh?

Posted on Sat, 3 May 2014

Question: Hi, I am suffering from constant numbness on my left side lower rib area down to my thigh, had it for 2 months now, comes and goes a little bit. Also can spread briefly up to my left ear on walking up hills or lifting. MRI done of my back shows nothing. No other health problems. Fit 57 year old male. Tried massage, chiropractor, magnetic treatment, inversion table. Any ideas please. Thanks XXXXXXX

Answered by Dr. Sudhir Kumar (11 minutes later)

Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. I have noted your symptoms and am glad to note that MRI of your spine is normal. This rules out conditions such as tumors. Your symptoms are related to dysfunction of the nerve roots (that arise from the spinal cord) or the spinal cord itself. The common causes for the same are vitamin B12 deficiency, lack of blood flow, compression of the nerves, etc. As of now, you can start vitamin B12 supplements, along with pregabalin capsules. I hope my reply has helped you. I would be pleased to answer, if you have any follow up queries or if you require any further information. Best wishes, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (35 minutes later)

I am already taking a Vit B12 supplement which provides 50mcg daily. On checking Wikipedia I found the recommended daily requirement is only 2 to 3 mcg. So my symptoms couldn't be caused by a Vit B12 deficiency. Pregabalin is recommended for pain and seizures, but I don't have pain just numbness. The common side effects include dizziness, of which I am already experiencing some without taking anything, and I don't want to make that worse. Can you please re consider my question?

Answered by Dr. Sudhir Kumar (1 hour later)

Brief Answer: My replies are below. Detailed Answer: Thank you for getting back with more information. 1. Regarding Vitamin B12 deficiency, the recommended dose is mega-dose (about 1500 mcg per day). I agree that most people without nerve problem would require 50 mcg per day (this would provide 5 cg as only about 10% of what we take gets absorbed). 2. Pregabalin is also used for treating abnormal sensations caused by nerve-related problems (such as tingling, burning, numbness, pins and needles, etc). Giddiness occurs at higher doses (150-300 mg per day). In your case, I would recommend 75 mg of pregabalin at night. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 hours later)

thank you Dr XXXXXXX I am encouraged by your replies. Should I have a B12 blood test ? or just start taking the supplement today. I am keen to make progress. Also the drug pregabalin is sold here in New Zealand as Lyrica. But it is a prescription only drug. So is not available easily to me. Can you suggest another drug I could take that I could buy over the counter from a chemist please. I am very keen to get start following the path you have suggested and on the road to recovery. Thank you for your help. XXXXXXX

Answered by Dr. Sudhir Kumar (5 minutes later)

Brief Answer: My reply is below. Detailed Answer: Thank you for getting back. You can start taking the vitamin B12 supplement. The blood test is optional, as it does not reflect the vitamin B12 level in the spinal cord/nerves accurately. Also, high dose vitamin B12 is safe, and free of adverse effects. Lyrica is the standard form of pregabalin manufactured by Pfizer company. If possible, please get it prescribed by your doctor. Other alternatives for pregabalin such as gabapentin and duloxetine are also prescription drugs. Until then, you can continue vitamin B12 supplements. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (16 hours later)

I need some more help please. I have today been to my GP and he will not prescribe any of the drugs that you have recommended. BUT... he might after I have tried the B12 supplement. So today he gave me a B12 injection of 1000mcg of vitamin B12 supplement. I am to have an injection weekly for 4 weeks and then he will review my case. How long before I can expect to see some improvement after this treatment? I also have purchased an oral spray which delivers 1000 mcg of methylcobalamin in 6 sprays. I am wondering if I should take 9 sprays of this, ie 1500mcg daily, as well as the weekly injections. I look forward to your reply. Thank you,

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: This approach seems fine. Detailed Answer: Thank you for getting back. I have noted the observations made by your GP, and I agree with his approach. You can continue the B12 injections as per his plan, and oral sprays as per your plan together. It may take about one month to see a good response. Please let me know after four weeks. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (3 days later)

Hi again XXXXXXX I am really eager to get my body back to normal. So I have started eating meat again,( 2 days ago) will this speed up the recovery ? A month seems a long time to me, to wait for recovery, My numbness has stayed about the same, left ear, lower ribs thigh even down to my left toes. I had one injection on Wed ( 4 days ago) of 1000 cg and daily B12 supplement mouth sprays of 1500cg ( for 3 days), I am still a little concerned should I see some reduction in the numbness soon ? Thanks, XXXXXXX

Answered by Dr. Sudhir Kumar (35 minutes later)

Brief Answer: Thank you for getting back. Detailed Answer: I have noted that you have started eating meat, which should speed up recovery, as it has good amounts of vitamin B12. Also, you are taking vitamin B12 tablets as well as injections. Nerve recovery (after a disease or injury) is a slow process, so, it takes at least 3-4 weeks to see any obvious improvement, though in some cases, it can start earlier than that too. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 hour later)

thanks for the prompt reply XXXXXXX I am afraid patience isn't my greatness virtue, but it seems like I just have to wait for all the B12 I am taking by different forms to do their job of fixing my nerves. During this time is it ok to be doing some exercise ? Is golf an option or not ? I had been doing some walking, but had stopped when I found it seemed to make my ear in particular go numb and tingly mainly when I walked up a steep hill. I also do a stretching routine in the morning and night. What level of exercise do you suggest I undertake over this 4 week recovery period? Thanks, XXXXXXX

Answered by Dr. Sudhir Kumar (3 hours later)

Brief Answer: Yes, you can do exercises. Detailed Answer: Thank you for getting back. You can do exercises of moderate intensity. Golf sounds good. Stretching exercises are also fine. If you find that any exercises are making your symptoms worse, then, its time to stop or reduce them. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (4 days later)

Hi again XXXXXXX I had a scary experience this morning and need to ask your advice of what to do next. It was a normal morning, after a bit of a restless night where my left lower leg and foot seemed more numb than usual, but otherwise normal sleep. Some dizziness yesterday, but not much. Anyway as I was sitting at he computer this morning, my left knee started to twitch a little, so I moved its position. Then my left thigh felt odd and the muscle moving by itself, then the same happened to my calf muscle. I got up and then my left side just below my rib area to the top of my hip bone was pulsating in and out by itself. So I lay down and after about 5/10 minutes it all stopped. It all feels ok at the moment, but I do still have some numbness around my left ear area. It is Friday here in NZ and if I have a major problem, I need to get to a hospital today, as the weekends are not a good time to try and get medical help here. Can you please reply asap. Thanks XXXXXXX

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: Need to exclude focal seizures Detailed Answer: Thank you for getting back. I have noted your description of symptoms. Though it is possible that these are related to nerve weakness, we still need to exclude focal seizures. This is because involuntary movements on one half of body could occur with seizures also. I would request you to meet your GP and discuss these symptoms today and let me know his views. If you could meet a neurologist, it would be great. However, these are minor symptoms and there is no need to worry. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (4 hours later)

Been to see my GP today as you suggested. He did some reflex and other tests, all normal. No loss of strength in any of my muscles, and all my blood pressure, pulse and blood tests normal. He has referred me to a Neurologist, but here in NZ the wait time can be long. So I hope you can help me please. Thanks XXXXXXX

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: It is reassuring to note that your neurological examination is within normal limits. However, we still need to exclude focal seizures in your case. As you have only had a single episode, there is no need to worry and one can wait to see a neurologist (it is not an emergency). How many days would it take to see a neurologist? If the involuntary movements (possible seizures) recur, then, we would have to consider starting prophylactic medications. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (27 hours later)

My referral has gone to our free hospital system where a neurologist will look at my case and give it a priority. If high, appointment 1 to 4 months wait time, if low, appointment 4 - 6 months wait time. My doctor said he could refer me to a private neurologist cost would be $300 for first 45min consultation and $1500 for an MRI of my brain. Either system takes time, but private is likely to be weeks not months. I have had no more spasms since the first one, and dizziness has been a lot less today. Do you think the involuntary muscle spasms could be the result of the damaged nerves starting to recover ? I have now had 2 B12 vitamin injections plus the B12 spray daily for 10 days and meat daily...maybe it is starting to work for me. Is this feasible? Have you had this with any other similar cases ? Thanks

Answered by Dr. Sudhir Kumar (39 minutes later)

Brief Answer: My reply is below. Detailed Answer: Thank you for getting back. I hope you get a neurologist appointment soon. In India, you could see a neurologist within one day, for a consultation fees of USD 25, and the MRI too could be done on the same day at a cost of USD 125. I would be pleased to see you if you ever decide to visit India. Also, I am glad to note that you are getting better. Regarding improvement with vitamin B12 injections, I do see similar symptoms, but they last much shorter (a few seconds to a minute, and not 5-10 minutes). So, I hope it is related to improvement, at the same time would like to rule out other causes. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (22 hours later)

I wish I could visit you in India, but it is not possible. Maybe you should come here and set up practice, there is an obvious need. Anyway...I might have over estimated how long my muscle spasm lasted. It seemed like a long time to me, as I had never experienced anything like it before, but maybe is was only for a few minutes. Also I had a nice surprise at 5.30am this morning. I woke early and had some slight cramp in my left calf muscle, nothing much. But I was pleased to notice as I lay in bed most of my numbness had gone ! I got up and walked around and felt good. Went back to bed for a few more hours sleep. Then when I woke up and got up the second time, some of the left side numbness had returned, thigh, knee lower leg, then up to my ribs later in the day and into toes by night. I have had no further muscle spasms and no dizziness today, but the numbness got slowly worse during the day. I took it easy during the day, short easy Sunday stroll outside and then quiet in front of TV and computer and relaxing reading. Over the next 2 weeks waiting for the B12 to work fully, how have other patients experienced the numbness disappearing ? Further away from the damaged spinal nerves taking longer ? So then the feet will be last the feel the numbness going or could it be all at once everywhere feeling ok again in a another 2 weeks ? Or will it be progressively on a daily basis? Thanks

Answered by Dr. Sudhir Kumar (4 hours later)

Brief Answer: My reply is below. Detailed Answer: Thank you for getting back. I would love to come to New Zealand as a tourist, let us see when that happens! I am glad to hear that you are getting better though at a slow pace. That is what we expect. Other patients too improve gradually and it takes 4-6 weeks to see a significant difference. Once you improve, it would not get worse again, however, you would need to be on B12 supplements later on too. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar