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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5395
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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I have asked questions here before regarding some

Resolved Question:

Hi I have asked questions here before regarding some neurological symptoms lhermittes, hand tingling, foot burning and leg and arm pains and cramps
I have been tested for Ms cervical and brain mri clear and so far normal neuro exam although it is early
I have had blood tests for b12, testosterone and folate and the results are as follows, could you tell me if they need any action
B12 467
Testosterone 13.7
Folate 6.9
I am awaiting calcium checks as I have had low calcium previously
I have paid extra to get this answered asap?! it's been 4 hours since posted!
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. Bob replied 2 years ago.
Sorry about the delay, but we are in vastly different time zones. Do you still need assistance? While reference levels can vary from lab to lab, these numbers apart to be within the normal ranges that we use.
Customer: replied 2 years ago.
For a 30 year old is the testosterone normal?
Also if these neuro issues turn out to be Ms is it normal for it to present with pinching muscle pains all over ie calf hamstring buttock bicep forearms hands feet
The feet are also burning and tingling and my legs are stiff after walking awhile
Expert:  Dr. Bob replied 2 years ago.
I'm assuming that is your free testosterone level and the units are ng/dL?
In this case they are normal for your age.
As for your symptoms, they don't fit the typical presentation of MS.
Customer: replied 2 years ago.
There is also lhermittes and foot tingling burning pain, the lhermittes has lessend from a 10/10 to a 1/10 if at all
The feet burning has lessened too but the leg pains and arm pains are getting worse, I have had clear MRI so far and normal neuro exam apart from the tight leg muscles but they say all reflexes are normal so far
Expert:  Dr. Bob replied 2 years ago.
So far so good, as they say. I would suggest you request nerve conduction tests next (i.e. NCV, EMG) to rule out a peripheral neuropathy. Have your doctors also checked your CK level and CRP/ESR?
Customer: replied 2 years ago.
What is the ck and crp/esr?
I also have mild disc dessication with disc bulges at c3/4 c4/5 c6/7
I have a nerve conduction booked for Wednesday plus a full spinal mri Thursday, Lp done waiting on results and had nmo antibodies checked
Expert:  Dr. Bob replied 2 years ago.
This is good. Your doctors are being very thorough. CK is creatine kinase, a marker for muscle inflammation or injury. CRP is C-reactive protein and ESR is sed rate. These are markets for auto immune and auto inflammatory conditions... vasculitis, myositis, arthritis, neuritis, etc.
Customer: replied 2 years ago.
Hi that's great thanks
I think the testosterone is the European measurement where he range is 13-29 so would be low for 30 yrs old? It was a standard blood test in the UK? Are you basing your measurement on US?
Also I have a big pain in my thoracic region when extending my back leaning over or back extreme right at the spine
Could this be pain from an Ms lesion? Or what could it be?
It's been getting worse for a couple of weeks simce the leg issues started,
I also felt a slight stinging twinge there a few weeks ago
Expert:  Dr. Bob replied 2 years ago.
Under either rules, the T level seems low normal... but this might be just the right level for you... there are feedback mechanisms in place in most individuals that keeps the T at a healthy level. As for the spine pain, it sounds musculoskeletal, not neurological.
Customer: replied 2 years ago.
Hi thanks Doctor
So at that level would you supplement with for example testogel to get it to a better normal range?
When you say muscular skeletal do you mean discs etc too? Would there be a risk of disc issues there because of the issues in the cervical spine?
Also a history of car accidents over 70mph
Expert:  Dr. Bob replied 2 years ago.
I would not suggest supplements as this is probably normal for you and there are risks associated with excess testosterone.
Disc disease at one level is a risk factor for disc disease at other levels, so this should be looked into, particularly if there is a history of MVA.
Customer: replied 2 years ago.
Hi thanks Dr Bob
The neurologist showed me some scans on some they looked to be impinging on the cord and centrally which he said was odd as it is usually one side or the other in the cervical spine
I worry all this is from Ms and has come on in four months as I read a lot about people having normal exams initially, also I worry it's ppms because of the leg pains and stiffness
Could the cervical or thoracic problems cause leg pain etc
I also had a low calcium level before Christmas before all the muscle pains etc started, could this cause the muscle tigjtness pains and shooting nerve pain feelings?
I know it seems odd to be Ms and in so many places all at once which is what is worrying me
Sorry for all the qs
Expert:  Dr. Bob replied 2 years ago.
The calcium and other electrolytes need to be checked for sure, as they could be affecting both the nerves and muscles.
As for MS, this seems very unlikely, though as you say the diagnosis is often tricky... and delayed. Disc disease as an explanation also seems unlikely, though is worth ruling out. You would have to have some sort of spinal stenosis to explain upper and lower extremity symptoms and this is usually clear on MRI.
Customer: replied 2 years ago.
Thanks doctor
I think it's more likely Ms because of lhermittes
The one neurologist seems to think the lhermittes etc is caused by cervical issues and the feet but the other is not sure
There was no stenosis mentioned at all
The rate of the issues is my biggest worry so far, RRMS I could cope with and the average times to progression etc but this seems very fast so far and attacking so many areas
I am taking high dose vitamin d too if that makes any difference
And suffer from extreme anxiety and ocd
Expert:  Dr. Bob replied 2 years ago.
Try to avoid excess vitamin D as it is fat soluble and can cause toxicity. For most of us, 20 minutes of sunlight per day is sufficient to promote vitamin D synthesis by the skin.
Await LP results as they should help with MS issue. If normal, you will probably not meet the criteria for diagnosis at this time.
I would also advise assiduous management of anxiety, as this can spill over into health anxiety and result in symptom amplification and difficulty sorting out ones diagnoses.
Customer: replied 2 years ago.
Hi thanks again Doctor you've been a great help
I've been taking 5,000iu of vitamin D a day for two months or so now, I assume that's too much?
I also have started taking pregabalin for the anxiety 150mg is that ok?
Expert:  Dr. Bob replied 2 years ago.
Check in with your doctor about whether to continue the vitamin d. While that dose does not seem too excessive, 2 months is a good time to recheck ones levels.
pregabalin is a good pain medication and can serve as a mood stabilizer as well. Ask your doctor about the need for something more specifically tailored to anxiety.
Customer: replied 2 years ago.
Hi Dr
I've been given sertraline aswell, but I've read that lowers testosterone? Not sure where I read that
Would you suggest the pregabalin or sertraline first?
Again Thankyou for your answers they are the most thorough I have seen
Also sorry regarding Ms, because lhermittes and some other sensory symptoms have remitted somewhat , would this suggest RRMS if Ms or ppms becaue the leg and arm symptoms have slowly gotten worse, although they came to a sudden level three weeks ago and have gotten better a little
Expert:  Dr. Bob replied 2 years ago.
Sertraline has been known to affect sex drive and sexual function but there is no conclusive evidence that it lowers testosterone levels. if this is a major concern, you could, under your doctor's supervision, lower or taper off your sertraline and see if the T levels rise. Otherwise, it is a pretty good medication for anxiety disorders.
Your symptoms don't suggest MS at all, really, but if it were an atypical case, it would be the RRMS type most likely. The LP results should help to clarify this. And of course, time is a great diagnostician. :-)
Customer: replied 2 years ago.
Hi thanks Dr Bob
I know time usually tells biut I worry about the speed of all this and where it will be in say 6 months time
I woke up this morning with sharp shooting pains in leg muscles and burning feelings, from thigh to hamstring to foot to calf it's really painful
The only other thing suggested is fibromyalgia?
And yes I know the Lp should say a lot more
Is there anything I can do for these sharp pains they fee like someone stabbing me with a needle in the muscles and even up to gluteus and lower abdomen
Expert:  Dr. Bob replied 2 years ago.
Work with your doctors to find an explanation. This is the most important thing. In the meantime, give the pregabalin more time to work. Request an increase in the dose if you feel it is not suppressng these sharp pains, as it is a very safe medication for most people. Also, try to get some exercise every day, as this promotes the production of natural pain killers by the body.
Customer: replied 2 years ago.
Ok Thankyou doctor
One other thing well two other things
Could this be Lyme disease or fibromyalgia
Expert:  Dr. Bob replied 2 years ago.
Lyme is unlikely but you could be tested for this. Fibromyalgia is a very common affliction but mostly affects women (80-90%) in their 40s and 50s, with avg age of onset at about 45. A rheumatologist could tell you if you have this disorder or at risk for developing it over time.
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