Brief Answer: Multiple issues Detailed Answer: Hello XXXXXXX Thank you for being so thorough. I have gone through your query multiple times and i have gone through the uploaded pdfs as well. Let me start answering 1 by 1. 1) Why B12 levels are falling so fast along with Vit D? A1) Weight loss, as in the weight loss you have had over the last few months is the issue. any time the body is losing fat, it needs to convert that fat to energy, this requires larger than normal amounts of stored vitamins and minerals to do the biochemical conversion. I think you should be on a multivitamin (eg, Becosules) when you are losing weight, intentional or otherwise. The alcohol usage also was not helping this situation, alcohol directly interferes with the bodies ability to absorb nutrients as it causes inflammation of the gut wall. 2) Can H Pylori infection be confirmed with the IgA test alone? A2) It's a great screening test, but it's not perfevt, we do get some false positives. But most doctors will begin the antibiotic therapy if that comes back positive. If you want 100% confirmation, you needs cultures and endoscopy. 3) Why is the level of URIC acid always high ? A3) Uric Acid is the break down product of certain foods and is supposed to be managed by your liver. Your history of alcohol usage and fatty liver will be two things that raise your Uric acid levels. You may note that the levels have come down to within close to normal since you quit drinking, I am willing to bet that they will be normal in a few months if you continue with tha abstinence from alcohol. 4) What could be the reason for high levels of Triglyceride always ? (despite good diet) A4) I see no proof that you are actually having a good diet.. :-). That having been said, high triglyceride levels have a genetic and exercise component as well. So even if you are eating healthy and exercising you may have high TG. Also, permanent liver damage can cause high TG, but i see no reason to suspect that here. Secondly I do not know what ayurveda drugs you have been on ond how they affect the liver. They are not all benign, ayurveda drugs are NOT without their own sideeffects 5) IMP: Why the ESR reading is almost ALWAYS high ? A5) ESR is a test of ciscocity in the blood. ANY situation that increases inflammtion in your body will increase ESR. It's a very nonspecific test and has very little use in general medicine. Most labs do it to make money and most doctors never even care what the result it. I would suggest that you ignore this test. Anyways, why is it high? Alcohol is the most likely issue here. Secondly, i don't know what ayurveda drugs you have been taking 6) Which Doctor should I be visiting Neuro, Gastro OR General Physician ? A6) A good internal medicicne specialist with a specialization in gastroenterology would help. I cannot comment on Ayurveda as I have no training in the field. 7) What all Diagnostics / Tests need to be carried out to eliminate serious ailments? 7.1) PERNICIOUS ANAEMIA: Will require a peripheral smear (Blood test), Redoing your vitamin levels and testing for 'Intrinsic Factor Antibody'. 7.2) Hypothyroidism: Get a TSH, T3, T4, Free T3 and Free T4 blood test done and we can rule out 7.3) Celiac Disease: 7.3.A) Blood tests for gluten autoantibodies (These are IgA based tests accurate only while on a gluten containing diet) EMA - anti-endomysial TTG - anti-tissue transglutaminase DGP - Deamidated Gliadin Peptide 7.3.B) A small bowel biopsy to assess gut damage. You need endoscopy for that 7.3.C) Implement the gluten-free diet. Our Dieticians can help with that Finally, as to your neck issues. I beleive that you are suffering from cervicogenic headaches due to dejenerative disc disease. I will share a youtibe video of a physical therapy excercise I would like you to attempt and then tell me the result. If the exercise works in stopping the pain, well and good, if not, you will need an MRI of your Cervical spinal cord and vertebral column (your neck). http://www.youtube.com/watch?v=Wa6XjHtKhoQ Finally 1) Sternocledomastoid problems are rare and splenius capitis problems are even more rare. I don't think those should be on your differential diagnosis. Nonetheless, if you want to look into it. You need to find the services of a good physical therapist. They would be the ones who can isolate and test those muscles alone for you. 2) Nothing you have mentioned has made me believe that an aneurysm, clot or hemorrhage is a possibility, but if you disagree, then you need a CT scan of the brain with and without contrast to rule them out. 3) The syncopal episode you had may be the effect of a cardiac issue or a vascular issue in the arteries of your neck. If it happens again, you will need to go to a cardiologist and check for Arrhythmias and get an ultrasound of your neck done (your carotid arteries to be exact). But as i said, one episode is no issue, just telling you what needs to be done if it happens again. I hope this answers all your queries to your satisfaction. Thank you for coming to HealthCareMagic.com Vinay

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Brief Answer: Multiple issues Detailed Answer: 1) "For the last two months , once in a while I have been experiencing a sort of cold sweats once in a while" Cold sweats are normally due to dehydration, remember, in summer its much more easy to get dehydrated than in winter, so you have to drink more water. If you work in an airconditioned environment, you dehydrate faster as well. Now these symptoms COULD be due to other endocrine issues. Like adrenal insufficiency and such, but that chances are remote. So overall, i would just say that must listen to your body and drink more water. 1.1) Further yesterday I had given blood for testing along with Stools for HPSA as well as Routine and Micro. I got all the blood reports. TLC is reducing slightly (10400) and RBC is increasing slightly (4.97). All returned good values except Lipids. I am surprised that B12 was also high enough ! That's great, the TLC will bounce around through the day. slightly higher in the morning, slightly lower around 2pm. So don't look at them too closely. These numbers are all good. 2) Currently my local physician has given a sublingual B12 tablet ( mycobalamin - 1500 mcg) for the next 30 days. I started the same just the evening before I gave a blood sample for b12 testing. It gave a result of 591 which is sufficiently high. Is the B12 result correct or has it been distorted because of the single dose of sublingual b12 on the evening prior to the sample. Can we still not rule out pernicious Anemia ? This is very good, i would still take the supplement to get those levels up higher. I would say that your chances of pernicious anemia are low. But if your intrinsic factor levels and antibodies have not been checked, we cannot rule it out. 3) My TSH, T3 and T4 ( Free T3 and Free T4 have not been done) are alright (3.18, 92.97 and 7.10 respectively) as of yesterday. So can we rule out a Thyroid problem? Local doctor says if these are sufficiently high no need to go for free T3 or FreeT4 or RT4, However he has ordered for a TPOAb. Absolutely right, I am happy with these numbers, thyroid ruled out until TPOAb is back. 4) Vitamin D also came out to be 44 ( sufficiently high), HbA1C is 5.8 (prediabetic range). Uric acid has reduced further to 7.4 even though it is yet to come down below 7.2. Please control your sugars better, have more fiber in your diet and more complex carbohydrates. Diabetes causes dehydration.. so keep that in mind. 7) Tiglyceride was 258 , LDL was 160 and HDL was 29. This was the only major concern from all the blood tests done yesterday. My local doctor says I need to take ROSUFIT CV 10 mg ( ONE PER DAY ). I told him that I was having suspected Muscle Cramps with ROSULIP 20 Mg earlier. But he insisted that Rosuvastatin is the best drug among all. Can you give your opinion on the same. I like Rosuvastatin. But I like it because it protects the brain in situations of head injury. I'm not a primary doctor so i can't really say whether it helps control CHOLESTEROL better than any other statin. 8) Despite all the above I still am unable to find comfort of good health as the "fainting feeling" is still haunting me at least once or twice a day. Not knowing what is happening seems to be more worrying than the problem itself. With my detailed background and the elaborate diagnostic tests already done, do you suggest any other area to be explored ? ( cancer, etc which might have been missed out by us so far). Have you had an ECG, do you have any heart issues? Your blood sugars are on the high side. I would like you to concentrate on these things to explore the possibility of diabetes or an arrhythmia causing your feeling of faintness. 9) IN your opinion, should I start a course for H Pylori even if the Stool Test is negative? Do you see sufficient role for H Pylori in my case ? In case you are of the opinion that we can rule out H Pylori by taking one course, I am ready to follow your advice. NO! DO NOT TAKE ANTIBIOTICS WITHOUT HAVING A REASON. We can investigate with further testing, a gastric culture and such if your symptoms warrant further testing. Antibiotics have their own side effects and i do not want to subject you to them. 10) Gastro-enterologist wants to do a endoscopy here. Are there any complications of getting the same done ? The doctor was not convincing enough in terms of what he expects to see thru Endoscopy. So i was in doubt. Can you advise if there is any need for Endoscopy for my case? Yup, you are above the age of 40 and you are male. Time for you to start getting endoscopy every 10 years till you hit 55, then every 5 years. Its the ultimate screening test for colon cancers. Get it done, stay safe. Even if you see nothing, that means you didn't see cancer. It's just part of routine screening nowadays. Risks? It's very safe. There will be some sedation given, so the risks from the sedation are minor. The risk of irritation to the colon and having some diarrhea after the procedure is possible. But otherwise, I've never come across a situation where a routine endoscopy ended up causing any major issues. You are talking about colonoscopy right? Take Care, Sorry for the delay in replying. Will try to be faster from now on. Vin

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Brief Answer: MS doesn't present like this, Esophageal reflux? Detailed Answer: You: I have observed that the neck tightness is coming after eating something. Mostly it is coming after Lunch (most severe) and sometimes after having tea in the evening. If I take Hot Milk , it is helping me a lot during these episodes by porviding some relief at least for an hour or so before starting again. Also in the morning when I wake up and have breakfat, I have this very light electrical shock like thing passing into the shoulders as soon as I swallow the first bite. Me: Now esophageal reflux or abnormal tightening of the sphincter at the bottom of the esophagus can cause this. If it continues, you need to get back to the gastroenterologist and scopy has to be done. Thats the only way to prove it one way or another You: The second observation is that there is some slight pulling of the vein/nerve in the left thigh (cyatica ?) which has been observed by me various times (earlier also) during these episodes. Me: Slight? Sciatica hurts like the devil! But again. there is not real good way for me to really diagnose this issue unless i examine you myself. A test that can be done to rule out the issue is an MRI of the lumbar spine. Though that is a bit drastic. Your local neurologist could probably rule it in or out by examining you. YOU: pl let me know if MS (Mutiple Sclerosis ) can be ruled out in my case ? (The Scalp tingling in sleep & a slight pain in top of head is still there). Me: MS has multiple symptoms of onset, the least of which are sensations like these. I am not worried about it. I believe it's more likely that you might have a small nerve entrapment in the neck. Of course if you are still worried about MS, there is no real good test, it has to be ruled in or out over time by a neurologist. You: Also would request your suggestion on which doctor (Gastro/Neuro etc) to consult for further investigation here. Me: For the esophageal issues a gastro is your choice. For your Sciatica / MS fears.. a neurologist would be your choice. From what you have described here. I believe the possibility of esophageal issues to be more likely and i would suggest you find a good one in your area to go to. Hope this helps. Feel free to bounce more ideas off of me Vin

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