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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 46707
Experience:  Board Certified Physician
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Hello, Im a 43yr old female. Just over one year ago I developed

Resolved Question:

Hello, I'm a 43yr old female. Just over one year ago I developed physical fatigue, not explained by anaemia - Hb was normal, Ferritin low (9), B12 around 200. In the summer I noticed reduced physical ability - eg not able to sprint, struggled on occasions to climb stairs, couldn't complete assault courses, also had urgency of urine & fatigue persisted. Since I have developed an intermittent, but frequent tingling down the R side of my back & leg, my R second toe randomly curls under, intermittent urgency of urine, one UTI, visual changes in both eyes: bright lights have starburst effect, eyes don't adapt to darkness, brief, intermittent episodes of double vision, eye pain, mainly L, persistent whooshing in my R ear, occasional episodes of vertigo. MRI of brain & C-Spine was normal. Blood work all ok. Eyes ok apart from some issue with their movement. I'm awaiting visual & sensory evoke potential results. General health, I take Thyroxine for under active Thyroid gland, diagnosed 13yrs ago, I'm on iron + had B12 shots around Christmas otherwise I'm healthy, normal weight, non smoker, moderate social alcohol, active busy life - 4 kids, work as ED nurse. What could be causing such symptoms?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

assault courses can be quite challenging

Dr. David :

did you train before hand?

Dr. David :

what is your most recent TSH levels?

Dr. David :

have you had pulmonary function testing and cardiac stress testing?

Customer: The assault course wasn't challenging - it's really a kids course at a summer camp we go to every year, I have always been able to do it before.
Dr. David :

that could definitely been due to your low iron

Dr. David :

have you had your stools checked for blood?

Customer: Can't remember specific values of TFT's, but they were within normal limits. They're checked annually. I've not had pulmonary function or cardiac stress tests. Last year I was finding I got short of breath on exertion, but this has resolved now.
Customer: When on iron my stools are black, I've occasionally been off iron for brief periods, stools are normal then. I've not had them checked for faecal occult blood.
Dr. David :

it is normal for iron to cause your stools to be black.

Dr. David :

the question should be why has your iron been low.

Dr. David :

iron gets recycled in the body and usually most people get enough of it in their diets

Dr. David :

through meat, steaks, spinach, etc.

Dr. David :

if you are slowing loosing iron for any reason, or loosing blood slowly this can cause low iron.

Dr. David :

women are more at risk, because they loose blood on a monthly basis through their period.

Dr. David :

but another common area where you can loose blood slowly is through the GI system.

Dr. David :

a small hemorrhoid could be slowly loosing blood or a small poly can slowly be bleeding

Dr. David :

or a small diverticulosis in the colon could be bleeding slowly as well.

Dr. David :

that is when a stool occult blood test is a good idea to try to detect and small slow blood loss.

Dr. David :

hello?

Customer: Thank you Dr. David. I had bloods for coeliac disease & pernicious anaemia done which were normal. I've been anaemic on & off since having children. My B12 levels dropped below normal during my last pregnancy, 7yrs ago, they were restored with IM injections, but since have progressively dropped lower each year & levelled at the lower end of normal. I had a course of IM injections last December. My periods aren't heavy. I eat meat & spinach etc.
Dr. David :

I am glad you had testing for celiac and pernicious anemia.

Dr. David :

it sounds like you don't hold on to B12 and iron very well.

Dr. David :

this can be very common.

Dr. David :

you might eventually need an upper endoscopy to look in your stomach to check for stomach inflammation or gastritis.

Dr. David :

sometimes low stomach acid issues can cause poor absorption of iron and B12 and calcium in the stomach.

Dr. David :

so your stomach might not be making enough acid to help with nutrient absorption in the stomach

Dr. David :

or if you take excessive stomach acid blockers this can cause poor stomach absorption of iron and B12 as well.

Dr. David :

but it doesn't sound like you are taking acid blockers or proton pump inhibitors.

Customer: I'm not taking acid blockers or PP inhibitors. Meds I take are Levothyroxine 125mcg/150mcg alternate days, Ferrograd and when required analgesia for eye pain, mostly Paracetomol and Tramadol. I took Ibuprofen for a short while, but developed symptoms of gastritis, so stopped, I did used Ranitidine with the Ibuprofen, but was for a brief period only. I do have haemorrhoids since pregnancy, but there's evidence of them bleeding.
Dr. David :

perhaps your hemorrhoids are slowly bleeding into your stool

Dr. David :

and that is what is causing the low iron issues.

Dr. David :

and the low B12.

Dr. David :

B12 low of 200 is good.

Dr. David :

Normal values are 200 - 900 pg/mL (picograms per milliliter).

Dr. David :

sometimes viral infections can cause severe fatigue.

Dr. David :

so that can be checked as well

Dr. David :

like ebstein barr virus infections.

Dr. David :

good luck to you

Dr. David :

let me know if you have other questions.

Customer: Thank you Dr. David, I can get stools checked for occult blood. Do you have any opinion about my neurological type symptoms?
Dr. David :

those can sometimes be caused by low magnesium blood levels as well.

Dr. David :

so get that checked as well.

Dr. David :

low magnesium can cause the nerves and the muscles to not function correctly sometimes.

Dr. David :

and low B vitamins can do this as well

Dr. David :

you should probably take a B complex vitamin daily

Dr. David :

and get your magnesium levels checked.

Dr. David :

if they are low as well, you might need to go on magnesium supplements.

Dr. David :

let me know if you have other questions.

Dr. David :

if done for now, please leave positive feedback below the chat box

Dr. David :

you might have to scroll down to see the ratings area below

Dr. David :

you can always reach me as Dr. David if you have other questions.

Dr. David :

http://www.justanswer.com/medical/expert-dr-david/

Dr. David :

is my website

Dr. David :

if you need to reach me in the future

Dr. David :

we are only given credit for helping clients after positive feedback

Dr. David :

thanks for using JustAnswer.com

Dr. David :

do you see the ratings area below?

Dr. David :

do you have any other questions?

Dr. David :

good luck with the visual and sensory evoke potential testing.

Dr. David :

hello?

Customer: Thank you Dr. David, I'll follow your suggestions.
Dr. David :

you are welcome

Dr. David :

don't forget to leave positive feedback below

Dr. David :

let me know how it goes

Dr. David :

thanks for using JustAnswer.com

Customer: Thank you Dr. David, I will leave positive feedback. I've thought of another question. What types of neurological issues/damage show up on MRI scans, evoke potentials and other neurological tests? Can there be symptoms of a disease process such as Multiple Sclerosis before damage is visible on MRI/other tests? Eg can it take time for the damage to show? I'm assuming neurological issues caused by low Magnesium or B12 etc don't show on MRI or evoked potentials?
Dr. David :

MS would show up plaques in the brain on MRI scan

Dr. David :

low mag and low B12 issues would not typically show up on MRI scan

Dr. David :

but could show up in evoke potentials.

Dr. David :

with slowly nerve conduction velocities.

Dr. David :

hello?

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