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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5970
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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These are the symptoms I have had - my DOB is 29/4/64 Optic

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These are the symptoms I have had - my DOB is 29/4/64

Optic neuritis in both eyes – started April 2012
Locking thumbs which is incredibly painful – also started April 2012
Muscles twitching constantly all over my body – May 2012
Tremor in right arm – pretty much constant – pre April 2012
Back spasms - extremely debilitating and very painful – May 2012
Numbness – on the right side of my face and down my neck, my thumbs, and the tops of my fingers- May 2012
Pins and Needles – random pins and needles in my face, neck, arms and legs – May/June 2012
In the morning I feel like I cannot move properly – all my muscles and bones are so painful – June 2012
Right foot turned outwards for over 6 months now - always been painful and now my knee and hip hurts too – now have a walking stick as it is getting worse all the time – August 2012
Balance problems where I have no balance and topple over occasionally and walk into walls doors etc. covered in bruises from this! I have days when my balance is so bad I can't stand up! These are prob about once every couple of days – July 2012
Shooting pains in my arms and legs – feels like an electric shock – June/July 2012
My bones hurt particularly in my hands and feet – July 2012
My hands and feet burn – particularly if I have walked more than a few steps – this becomes painful to the point where I feel sick – August 2012
Strange sensations in my legs like someone tipping cold water upwards from feet to knee – Sept 2012
Fatigue - prob the most debilitating symptom as I'm sleeping for prob 16-18 hours a day – Pre April 2012
Itching all over particularly back legs and arms June 2012
It's like my internal temp control has gone mental - constantly sweat on my head and neck only - it's like my head is on fire. To touch its so hot too - sweats are random and all day and night. I'm trying to see if these are linked are the pain at the moment. May/June 2012
Forgetfulness so bad that I can't remember going on a holiday to Crete a couple of years ago! Apparently I enjoyed myself :) I have forgotten my date of birth, PIN numbers, phone number etc etc. I forget tv programmes I have seen the day before and rewatch them, etc Pre April 2012
I also forget words for everyday things which makes shopping difficult!
Spatial awareness is rubbish - it's like I don't know where I am in relation to furniture, walls etc May 2012
My joints hurt – eg I can't lift my arms up to my head without my shoulders hurting, my wrists and fingers hurt too Pre April 2012
Numbness in my thumbs, right side of face and underneath me May 2012
Bladder urgency - not had a need for Tena lady yet thankfully!! But I don't go anywhere I don't know where the toilets are May 2012
Horrible crushing pain in my ribs on my right side but has been on the left side too Pre April 2012
My skin feels extra sensitive and it hurts to touch me eg. Top of my left leg at the moment feels like an electric shock every time I touch it. A few weeks ago it was my right arm June 2012
Blood blisters under the skin – at times I have tiny patches of blood under my skin – particularly on the underside of my arms Jan 2013
Eye sight problems – feels like everything is moving around very fast, and I feel dizzy and sick and have to stop and sit down – Jan 2012
Blurry sight – from April 2012
Buzzing in my ears – pre April 2012

1. SWINE FLU IN SEPTEMBER 2009 AFTER WHICH I REMAINED TIRED FOR A GOOD FEW MONTHS
2. I HAVE NEVER HAD ANY PROBLEM WITH MY EYES/EYESIGHT PRE APRIL 2012
3. I HAVE STEADILY LOST WEIGHT FOR THE PAST TWO YEARS – HAVE LOST OVER 1 1/2 STONE NOW

Please note that I have seen a Neurologist who a MRI of my spine and brain - clear, VEP - clear. EMG - clear
I have had lots of blood tests, but I am not sure what they were for.
Any help would be brilliant, and I am also seeing an Endocrinologist who specialises in ME in a few weeks time.

Is there a possibility of this being Chronic Lyme disease? Approx 7 years ago my dog constantly got ticks which I was removing.
I also had Swine Flu after which I felt constantly tired.

Doctor-Bob :

Hello. Have you had a lumbar puncture as part of your neurologic work up? Does you neurologist have a "working diagnosis"?

Customer:

The neurologist said that as all bloods were ok and the mris were clear, that i didnt need one

Customer:

Im not due to see the neurologist again now as she said her work was done - whatever that means

Doctor-Bob :

Sounds frustrating. How could any of your docs job be "done" when you are still having so many symptoms?

Doctor-Bob :

Did they check a Lyme titer?

Doctor-Bob :

Did they do a rheumatologic work up?

Customer:

I dont think they did, but I wasnt told what they were checking for! I asked my GP if i had been tested for Vit B deficiency - i was.

Customer:

rheumatological work up? i have no idea - sorry i am not much help i know but here in the UK our doctors dont tend to tell us what they have tested us for - just for us to go have more blood tests

Doctor-Bob :

Some central nervous system conditions, including post-infectious ones, often do not show anything on MRI. Lumbar puncture (spinal tap) can be complementary to the MRI as it often shows things in the fluid that reveal processes the MRI can't "see". I would recommend you discuss this again with your neurologist. It is slightly invasive and has some risks but they are generally easy to avoid.

Doctor-Bob :

It can be a helpful part of working up many different conditions including MS, Lyme disease, syphilis, etc

Customer:

i wont be seeing the neurologist again now.. am seeing an endocrinologist who specialises in ME in a few weeks time

Customer:

Ah i dont have syphilis as that blood test was clear

Doctor-Bob :

As for rheum conditions, many of them can mimic neurologic ones as they can affect the very tiny blood vessels that supply nutrients to the nerves.

Customer:

My doctors were all convinced I had MS at first, then after the MRIs were clear they just said, no you dont have it, so we dont know what it is

Doctor-Bob :

They are inflammatory (auto-immune) conditions that can cause a variety of non-specific symptoms and be very difficult to diagnose.

Doctor-Bob :

There are many other conditions that can mimic MS.

Customer:

my GP said it could be a Guilliane Barre type syndrome - but i feel like my gp is now treating me like i am lying and there is not nothing wrong with me.. there is no possible way i would lie about this, and there is no possible way my right leg could twist round on its own! its very frustrating

Customer:

i have gone from being a personal assistant to a successful author, to living on a disability allowance and hardly leaving the house. and NEVER leaving the house without someone to help me!

Customer:

I forgot to tell you the medications i am on at present... amiltriptylene 50mg at night, propranalol 10mg once a day, tramadol 300mg throughout the day, carbamazapine 800mg (400 am and 400pm)

Customer:

I have days where the back spasms are so bad I cannot move and my right arm goes into 'convulsions' - thats the only way i can describe it as the shakes are so severe

Customer:

it is mainly my right side that is affected, but the weird sensations are also on the left side too

Doctor-Bob :

nobody want to be this way...clearly there is something wrong...but these types of conditions...and I have seen manh...tend to be on the margins of what medical science knows...they usually turn out to be auto-immune in nature. Do any of these meds help with your symptoms?

Doctor-Bob :

meant to write...and I have seen many...

Customer:

well the tramadol used to help with the pain, but has never stopped it totally. the arm convulsions only happen if i dont take the propranalol or if im late taking it.

Customer:

Ive told my GP and the neurologist that I have always believed i have some kind of virus in my CNS - is this possible?

Customer:

Can i also just tell you about the swine flu i had in 2009.. i had never felt 100% well after it.. kept going to the drs and telling them that i just didnt feel great. they kind of ignored me and would do a blood test and tell me i was fine

Doctor-Bob :

that's certainly possible...EBV for instance can linger in one's nervous system and create a host of symptoms, sometimes on and off (probably related to how vigorous the immune system is being in going after it)...and lead to CFS or similar syndroimes

Doctor-Bob :

have you ever been on a short course of prednisone to see if you symptoms improved?

Customer:

yes - in june when i started seeing a new dr, i had Optic Neuritis in both eyes. The ON improved in my left eye, but has never gone from my right eye. i felt a little better on it, but some of the symptoms i have today i didnt have then

Customer:

i was on prednisone for 3 weeks

Doctor-Bob :

that's a good trial...you should consider asking your doc for another short course...this can be therapeutic and diagnostic in that if you improve you know it is most likely an auto-immune process...when and if prednisone fails, you can then "move up" to more effective therapeutic options...a rheumatologist (or immunologist) would be able to handle this type of work up and treatmen plan.

Customer:

Ok, so when I go back to my GP tomo morning, I should ask for another short course of prednisone and perhaps ask for some more blood tests? maybe a referral to an rheumatologist and an immunologist?

Doctor-Bob :

1) Request tapering prednisone course (could wait until rheum appt if not too long out)

Doctor-Bob :

2) Request rheumatology referral.

Doctor-Bob :

3) Ask about Lyme titer and rheumatologic tests (could wait if rheum appt not too long out)

Doctor-Bob :

4) Ask about utility of LP at this point

Doctor-Bob :

I would want to see LP results.

Customer:

one last question too.. could ME cause my right leg to twist.. I can hardly walk now and only with a walking stick. my leg is turned outwards from my hip to my foot at about 90 degree

Doctor-Bob :

ME is a form of encephalitis (inflammation in the brain) so it can cause almost any symptom...the twisting could be a type of spasm or dystonia from a central lesion, or it could be due to something local ( a "lower motor" problem) due to stress, fatigue, medications, poor condti

Customer:

if its an inflammation of the brain would it have shown up on the MRI i had?

Doctor-Bob :

Usually not, because we are talking about a microscopic process. If an inflammatory lesion in the brain is there long enough, and gets large enough, it may show up as a tiny focus of high attenuation such as is looked for in MS

Customer:

ok, so does that mean that if i had another MRI in the future it may show up then? the neurologist did say that if i am still getting symptoms i should maybe have another one in a years time

Doctor-Bob :

Yes, that is how MS (for one) is diagnosed...by changes in terms of # XXXXX lesions, location of lesions, and timing of lesions.

Customer:

Ok well thank you for your help

Doctor-Bob :

Hello. Did you hit the wrong button?

Doctor-Bob :

Did you mean to rate my service poor?

Doctor-Bob :

Would you please reconsider this rating as it reflects poorly on both of us. If you do not want to pay you do not need to provide a rating at all. If you need more help please say so and I would be happy to try to help you further.

Doctor-Bob :

Hello?

Doctor-Bob :

Was this intentional?

Customer: I'm so sorry but I must have pressed the wrong button!! I didn't even realise I had pressed a button! It's because I went from using my PC to my phone! How do I change it?
Doctor-Bob :

This happens sometimes, so don't feel bad. If you can open up our chat when you are on your PC you should be able to click on the appropriate button. I do thank you for correcting this. If you have trouble doing so, you can contact customer service and they can assist you....hope all goes well for you, and your doctors get you the care you need...God bless.

Customer:

Thank you - you have been really helpful

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