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possible MS symptoms and health care frustration


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About a year ago I started having tingling all over my head occasionally.  This happened maybe a time or two a week and felt like pins and needles or icy hot (the muscle rub) on my head.  I didn't think too much of it.  In the last few weeks this feeling has been increasing so much that I feel this tingling almost all day and it's intensity has become bothersome.  Very recently, my back and shoulders have been experiencing this sensation.  My legs and arms have had the pins and needles sensation daily for years. I've also begun to feel extreme weakness and muscle pain in my right arm.  I Googled and found out that I have a lot of other MS symptoms as well, and so much so that I'm quite concerned at the moment.  I called my doctors office today to make an appointment and when the receptionist asked my why I was making it she right away transferred me to the nurse.  The nurse apologized several times and told me that the very soonest they could get me in is in a month, but that she would call me if they get a cancellation if I'd like.  I asked if there was something I could do in the meantime to ease my discomfort and she said there wasn't anything she could say without me being seen.  So, I'm not sure what to do in this next month to keep my sanity of wondering what is going on and if there's anything I can do to ease this discomfort.  Our family gets free state health care since March of this year.  While it is a blessing that our health care costs will be covered the wait times have been overwhelming.  When my husband tore his rotater cuff 2 months ago (no diagnosis yet, but his mom has done this twice so were very familiar with it and he tend to inherit her health problems!), the wait was 6 weeks for an appt.  His appt. is next week and I made it a few weeks after the injury.  They did say that he could go to the emergency room if he couldn't wait to the appt. and it would be covered by our insurance.  My husband is waiting and not using that arm in the meantime.  I guess I'm just not sure what to do and if that's normal if you're not receiving state assistance.  The nurse didn't offer for me to go the the ER if I needed so I'm assuming that my possible condition isn't something that couldn't be treated there.  You all seem to have some great advice and I could use some input.  Thank you.

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No advice on OTC for any kind of symptoms, just :grouphug: :grouphug: .  I wouldn't worry yet about MS specifically, as the symptoms can also indicate some other things, including fibromyalgia and Lyme's (although with Lyme's, I don't know if your symptoms are a direct match). Or it may be something else entirely.  You **might** find that staying out of the sun and getting a lot of rest if you are tired would give some relief.  There are also books that you might find at your library regarding diet and MS, but it's awfully early to make an assumption that's what you have.  Hang in there.  :grouphug:

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I have been tested for ms with similar symptoms. Turns out I had extremely low B12 levels. You can buy b12 OTC and its safe to take up to 1000mcg a day. I now have long term neuro issues that they think is due to undetected low B12 and my symptoms are exactly the same as ms. It's worth bringing up to your physician. In the meantime til your appt you can try taking a supplement to see if the symptoms subside. Mine started to go away within a week or two.

 

We are still doing some neuro screening and watching the symptoms but they have ruled out ms for now.

 

(Oh and aside, anxiety can present with tingling scalp and limbs so make sure you aren't over worrying or causing further anxiety as they can make the symptoms appear worse)

 

Good luck and take care of yourself.

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We have excellent medical coverage through DH work, and I have to wait a month to see a cardio for heart palpitations. I'm not sure what the problem is, but know that people with non state sponsored medical care are waiting and frustrated too. I hope you feel better soon and that it's nothing serious!

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Waits for specialists has been the norm for decades but that is pretty sad for you to have to wait so long to see your primary doctor. We always get in within the day for serious symptoms. I'd call back daily to ask if there has been a cancellation. So sorry that you are having to suffer.

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Oh and ER can also at least start the process of making a diagnosis and rule out anything emergent - if you are concerned about MS the only way to definitively diagnose it is with an MRI and an ER doc could possibly start that referral process, no? I got my MRI referral within days when I went to the ER about my tingly sensations.

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Drinking diet soda can also cause symptoms similar to MS.  I have a few friends that this happened to and once they stopped drinking diet soda, their symptoms went away.

 

Aspartame is the culprit here. If you use aspartame in any form, you could try cutting it out and see if your symptoms are relieved.

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I'm sorry you are dealing with this. I went through something very similar about 5 years ago and google had convinced me I had MS as well. Mine ended up being a combination of anxiety and the beginning of perimenopause. It started in my head, but soon I tingled all over. My left arm started aching - from the tension in my back. It all became a crazy cycle. My nerves were on edge. Not sure if either of those ring true for you. I hope you get answers soon. 

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Both my sister, who has a diagnosis of fibromyagia, and a good friend, who has a diagnosis of MS, use a gluten-free diet to limit their symptoms. Both have a lot of success with it.

 

Just a suggestion if it takes that long to see a doctor and you're looking for something to try. 

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They thought I might have MS, but my MRI was clear. I was a real mess (tingling and other strange skin sensations, dizziness, extreme fatigue, constant muscle twitches all over my body). Mine turned out to be metabolic..I had low coq10 at the time. I also had low vitamin D and sleep apnea.

 

They can't just refer you to neurology, can they? If it's possible, I might just ask. Because you'll end up there anyway I suspect. I saw my doctor, who ordered the MRI so neurology would have it and referred me onward. Barring that, can they put you on a cancellation list?

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Oh and ER can also at least start the process of making a diagnosis and rule out anything emergent - if you are concerned about MS the only way to definitively diagnose it is with an MRI and an ER doc could possibly start that referral process, no? I got my MRI referral within days when I went to the ER about my tingly sensations.

 

So much of this depends on the exact clinical situation which can't be fully clarified a full history and physical exam.  From what the OP has shared if she presented to our ED we would do some labs (so that would exclude the electrolyte and basic vitamin and mineral deficiencies, rhabdo, anemia, ischemia etc), an EKG, and likely a Head CT (because ruling out a CVA or subacute CVA would be necessary).  Other tests would be dependent on more detailed history probing and the physical exam.  If any of the initial workup showed a problem that would addressed; possibly with admission for further inpatient treatment if needed, or if symptoms were felt to be a TIA then she might meet the risk score where inpatient diagnostic workup is necessary.  

 

As far as diagnosing MS, you're correct that an MRI of the brain is needed.  In our ED we can only get MRIs emergently if there is an emergent need for the MRI and doing the MRI emergently through the ED is needed to drive the treatment plan.  So we can get an MRI for a patient with known malignancy and concern for cord compression where after the MRI IR/radiation oncology will be starting radiation therapy immediately that night.  We can't get an MRI for a patient who has back pain and reported radicular symptoms but a normal neurologic exam, normal rectal exam, and no concern for cauda equina syndrome.  Usually in situations where outpatient MRI is needed we refer patients back to their PCPs to order the MRI because it fosters continuity of care (someone needs to coordinate the care once the MRI is obtained and the ED physician is not in a position to really do that) and also because more and more insurance companies are rejecting orders for major diagnostic studies written by someone other than the PCP.  

 

I'm not discouraging the patient from going to the ED.  If she feels that symptoms are escalating then it may be the best option for her now.  However, I do think it is important for her to understand that it just may not be logistically possible for her to get an MRI through the ED, or have an outpatient MRI ordered by an EM physician approved through her insurance. 

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No advice on OTC for any kind of symptoms, just :grouphug: :grouphug: .  I wouldn't worry yet about MS specifically, as the symptoms can also indicate some other things, including fibromyalgia and Lyme's (although with Lyme's, I don't know if your symptoms are a direct match). Or it may be something else entirely.  You **might** find that staying out of the sun and getting a lot of rest if you are tired would give some relief.  There are also books that you might find at your library regarding diet and MS, but it's awfully early to make an assumption that's what you have.  Hang in there.  :grouphug:

 

I have wondered if being in the sun a lot lately  had maybe dehydrated me or something because it seems to really exhaust me.  I quit coffee a few days ago thinking that might help.  Thank you.

I have been tested for ms with similar symptoms. Turns out I had extremely low B12 levels. You can buy b12 OTC and its safe to take up to 1000mcg a day. I now have long term neuro issues that they think is due to undetected low B12 and my symptoms are exactly the same as ms. It's worth bringing up to your physician. In the meantime til your appt you can try taking a supplement to see if the symptoms subside. Mine started to go away within a week or two.

 

We are still doing some neuro screening and watching the symptoms but they have ruled out ms for now.

 

(Oh and aside, anxiety can present with tingling scalp and limbs so make sure you aren't over worrying or causing further anxiety as they can make the symptoms appear worse)

 

Good luck and take care of yourself.

 

I will be picking some B12 asap and will ask my doctor about it. I am so sorry to hear about your permanent neuro damage.   :grouphug:  Thank you.   

Is going to a walk in clinic an option? (I'm in Ontario so I'm not totally familiar with your health system.) at least they would be able to order some bloodwork and such while you are waiting to see your primary physician?

 

I have to see the doctor and clinic I'm assigned to from my understanding.  

 

Oh and ER can also at least start the process of making a diagnosis and rule out anything emergent - if you are concerned about MS the only way to definitively diagnose it is with an MRI and an ER doc could possibly start that referral process, no? I got my MRI referral within days when I went to the ER about my tingly sensations.

 

My husband wants me to go to the ER (he wanted to take me last night actually), but I think I'll look more into to it to find out if the could do something there or refer me or if it would be a big ordeal for nothing.  I might just try some of these suggestions for a time to see if I start feeling better before making a decision either way.  Thank you so much.

 

Drinking diet soda can also cause symptoms similar to MS.  I have a few friends that this happened to and once they stopped drinking diet soda, their symptoms went away.

 

I don't drink diet soda, but this is good to know.  It also gives me some hope that some of these lifestyle/dietary/nutritional suggestions can make a difference.  Thank you.

 

For right now, avoid hot baths, hot showers, and hot temperatures in general.

 

I will do this. Thank you.

 

I'm sorry you are dealing with this. I went through something very similar about 5 years ago and google had convinced me I had MS as well. Mine ended up being a combination of anxiety and the beginning of perimenopause. It started in my head, but soon I tingled all over. My left arm started aching - from the tension in my back. It all became a crazy cycle. My nerves were on edge. Not sure if either of those ring true for you. I hope you get answers soon. 

 

Thank you for sharing about your similar symptoms and that it wasn't MS!  This is very encouraging.  

 

Both my sister, who has a diagnosis of fibromyagia, and a good friend, who has a diagnosis of MS, use a gluten-free diet to limit their symptoms. Both have a lot of success with it.

 

Just a suggestion if it takes that long to see a doctor and you're looking for something to try. 

 

I did very well on a gluten and dairy free diet and have fallen off the bandwagon in the past few years. I know how much better I feel and now I have a very good reason to get back to it.  Thank you.

 

They thought I might have MS, but my MRI was clear. I was a real mess (tingling and other strange skin sensations, dizziness, extreme fatigue, constant muscle twitches all over my body). Mine turned out to be metabolic..I had low coq10 at the time. I also had low vitamin D and sleep apnea.

 

They can't just refer you to neurology, can they? If it's possible, I might just ask. Because you'll end up there anyway I suspect. I saw my doctor, who ordered the MRI so neurology would have it and referred me onward. Barring that, can they put you on a cancellation list?

 

Thank you so much.  I will look into coq10 and I have been wanting to have my vitamin d levels checked.  I may have years ago, but it's hard to remember that far back.  I did a sleep apnea a test a few years ago because I don't sleep very deeply and feel refreshed in the morning and it came back fine. I didn't have it.

 

 I don't know if they can just refer me.  I probably should call and ask.

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Thank you so much for all your encouragement, sharing your experiences and good thoughts/advice.  I was so relieved to read your replies this morning.  I need to have dh read these, as well.  He's been so concerned.  Thank you so much again.

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Another person who had MS symptoms which turned out not to be MS.  I know that it is hard not to worry but the wait times sound reasonable.  That's great that she offered to put you on a cancellation list.  

 

Thank you for that perspective.  I didn't take her up on the cancellation offer because when I asked her how soon the notice would be she said it could be just a few hours and that would be too stressful for me.  My husband commutes to work and isn't available for watching our children without a day or so notice.  

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Thank you for that perspective.  I didn't take her up on the cancellation offer because when I asked her how soon the notice would be she said it could be just a few hours and that would be too stressful for me.  My husband commutes to work and isn't available for watching our children without a day or so notice.  

Oh, I would ask to be put on the cancellation list anyway.  You don't have to be available if they do have a last minute cancellation but if you are available and the cancellation comes with enough notice, then you have that option.  

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So much of this depends on the exact clinical situation which can't be fully clarified a full history and physical exam.  From what the OP has shared if she presented to our ED we would do some labs (so that would exclude the electrolyte and basic vitamin and mineral deficiencies, rhabdo, anemia, ischemia etc), an EKG, and likely a Head CT (because ruling out a CVA or subacute CVA would be necessary).  Other tests would be dependent on more detailed history probing and the physical exam.  If any of the initial workup showed a problem that would addressed; possibly with admission for further inpatient treatment if needed, or if symptoms were felt to be a TIA then she might meet the risk score where inpatient diagnostic workup is necessary.  

 

As far as diagnosing MS, you're correct that an MRI of the brain is needed.  In our ED we can only get MRIs emergently if there is an emergent need for the MRI and doing the MRI emergently through the ED is needed to drive the treatment plan.  So we can get an MRI for a patient with known malignancy and concern for cord compression where after the MRI IR/radiation oncology will be starting radiation therapy immediately that night.  We can't get an MRI for a patient who has back pain and reported radicular symptoms but a normal neurologic exam, normal rectal exam, and no concern for cauda equina syndrome.  Usually in situations where outpatient MRI is needed we refer patients back to their PCPs to order the MRI because it fosters continuity of care (someone needs to coordinate the care once the MRI is obtained and the ED physician is not in a position to really do that) and also because more and more insurance companies are rejecting orders for major diagnostic studies written by someone other than the PCP.  

 

I'm not discouraging the patient from going to the ED.  If she feels that symptoms are escalating then it may be the best option for her now.  However, I do think it is important for her to understand that it just may not be logistically possible for her to get an MRI through the ED, or have an outpatient MRI ordered by an EM physician approved through her insurance. 

 

Thank you for taking the time to explain this.  We were wondering and appreciate you sharing.

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Oh, I would ask to be put on the cancellation list anyway.  You don't have to be available if they do have a last minute cancellation but if you are available and the cancellation comes with enough notice, then you have that option.  

 

Maybe I should.  I would feel badly having to say no several times before a yes.  The nurse seemed to focus on that it could just be a few hour notice when I asked her specifically so I just avoided a potentially stressful situation.  I will talk to dh about that.

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I have been tested for ms with similar symptoms. Turns out I had extremely low B12 levels. You can buy b12 OTC and its safe to take up to 1000mcg a day. I now have long term neuro issues that they think is due to undetected low B12 and my symptoms are exactly the same as ms. It's worth bringing up to your physician. In the meantime til your appt you can try taking a supplement to see if the symptoms subside. Mine started to go away within a week or two.

 

We are still doing some neuro screening and watching the symptoms but they have ruled out ms for now.

 

(Oh and aside, anxiety can present with tingling scalp and limbs so make sure you aren't over worrying or causing further anxiety as they can make the symptoms appear worse)

 

Good luck and take care of yourself.

 

Phoenix, do you have a brand that you recommend?  I see lots of different brands and B12 sources like cobalamin, dibencozide, and methylcobalmin.  I would love to hear what you take that has helped and brought levels up.  

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I used Johnson B12 supplements. I don't have the bottle on hand, but will try to find the info for you later.

 

I took 1000mcg a day for 3 months initially. I have unfortunately been slacking on taking them lately. I ran out some time ago and keep forgetting to pick up a new bottle.

 

I also upped the B12 rich foods into diet and tried to cut out artificial crap.

 

Most days now my symptoms are non existent but once in a while they flare up again and I will have tingling body parts lol.

 

I'm on my phone but can answer more later :)

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I used Johnson B12 supplements. I don't have the bottle on hand, but will try to find the info for you later.

 

I took 1000mcg a day for 3 months initially. I have unfortunately been slacking on taking them lately. I ran out some time ago and keep forgetting to pick up a new bottle.

 

I also upped the B12 rich foods into diet and tried to cut out artificial crap.

 

Most days now my symptoms are non existent but once in a while they flare up again and I will have tingling body parts lol.

 

I'm on my phone but can answer more later :)

 

Thank you!  I searched for Johnson with no success.  Do you by chance mean Jarrow?

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My B12 was low last appointment and I started 5000 mcg - jarrow brand on Amazon. From what I have read it is best to take them on an empty stomach and let it dissolve under your tongue. There is a lot out there about not being able to over take B12, so read up on that and see if you are interested in getting started before your appointment.

 

http://www.amazon.com/Jarrow-Formulas-Methylcobalamin-5000mcg-Lozenges/dp/B0013OQGO6/ref=sr_1_1?ie=UTF8&qid=1399672462&sr=8-1&keywords=jarrow+b12+5000

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My B12 was low last appointment and I started 5000 mcg - jarrow brand on Amazon. From what I have read it is best to take them on an empty stomach and let it dissolve under your tongue. There is a lot out there about not being able to over take B12, so read up on that and see if you are interested in getting started before your appointment.

 

http://www.amazon.com/Jarrow-Formulas-Methylcobalamin-5000mcg-Lozenges/dp/B0013OQGO6/ref=sr_1_1?ie=UTF8&qid=1399672462&sr=8-1&keywords=jarrow+b12+5000

 

My hubby is picking some up after work for me.  I read the reviews which helped me know what to expect and any signs to look for that this may not be the supplement for me.  Thank you so much!  

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Dear Lavender Girl,

 

You have received a lot of good advice, so I'm not going to reiterate what has been said.  I have a friend who has MS and has kept it at bay fairly well, but she has done many things over about 15 years to make that happen.  Some has been expensive meds, some food, *always* exercise.  But the thing that has greatest impact on making her MS worse is anxiety and sleep deprivation.  

 

NOW, it is ridiculous of me to be writing all this about MS when you don't even have a diagnosis yet.  If you have to wait a month, you do.  It will take an MRI for positive diagnosis anyway.  But I don't think there is a condition in the world that gets worse with having enough sleep and eating a good diet.  You can Google Dr. Terry Wahls or look for a book about The Wahls Diet; my friend has been greatly encouraged by results with this diet, and it is somehting that people who DON'T have MS would not be hurt by.  :0)  It might be something to do while you wait.

 

It is easy for other people to say this when YOU are the one who has the tingles, but don't worry about this.  If it IS MS, worry won't help it get better.  If it isn't, then it's a lot of wasted worry.  :0)  

 

My dh has an autoimmune thing going and he has been trending toward the Wahls Diet recommendations and we are seeing a slow but certain improvement in his symptoms...  :0)  It's not MS he is worried about.  

 

Take care...

 

Hang in there...

 

Patty Joanna

 

PJ, thank you for this caring and informational note.  I will look into this diet and am very curious. Thank you so much.

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I don't drink diet soda, but this is good to know.  It also gives me some hope that some of these lifestyle/dietary/nutritional suggestions can make a difference.  Thank you.

 

Aspartame isn't only in diet soda- it's in almost every gum and breath-mint type of candy.  Also in a lot of sport drinks, energy drinks, an 'nutrition" or "diet" bars.

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Aspartame isn't only in diet soda- it's in almost every gum and breath-mint type of candy.  Also in a lot of sport drinks, energy drinks, an 'nutrition" or "diet" bars.

 

 

I noticed that the Kirkland/Costco brand had a sublingual, 5000mg B12 with the methylcobalamin at a great price but a reviewer pointed out that it has an artificial sweetener in it.  Bummer. 

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I had very similar symptom, had a full MS work-up done, and was diagnosed with exhaustion and a B vitamin deficiency.

 

I have found the "extended release" B vitamins to be really helpful. 

 

Edited to add: And sleeping. Sleep is really useful in fighting exhaustion.  :willy_nilly: 

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  • 2 weeks later...

For those of you who had a B vitamin def., how did it take for your numbness/tingling sensations to go away?   I've been taking 5,000 mcg B12 and a B vitamin complex coming up on 2 weeks now but haven't had a change in symptoms yet.  My  more bothersome symptoms are blurry vision, fatigue, and the nerve stuff.   :confused1:

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DH went to the emergency room once for symptoms like that.  He thought he might be having a stroke.  The doctor laughed when it turned out to be an electrolyte imbalance (too much hard exercise, not enough salt, potassium, or magnesium, slight dehydration, way too much caffeine, and not enough sleep).  Try a weekend getting off caffeine, drinking a couple quarts of gatorade every day, take a bath in epsom salts every night to increase your magnesium without stomach upset, get extra sleep and see if that helps.  If it does, increase the bananas and potatoes in your daily diet.

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Is your appointment coming up?  Beginning of June, isn't it?  

 

 

It's June 12th and getting closer.  I was doing really good not freaking out because I had things to try, but for some reason permanent damage loomed in my mind last night as I was trying to fall asleep despite the discomfort (and worry).  I'll be okay, I think.  Just a little freak out on my part.

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I didn't read all the replies, so forgive me if this has already been said.

 

I had similar symptoms and was eventually diagnosed with a pinched nerve from a herniated disc in my neck. For me, the tingling and weakness were signs that the neurological signals weren't traveling correctly, but the cause was much more treatable than MS

 

So sorry it is going to take a while to get an answer to your questions. Praying for a clear treatment plan.

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It's June 12th and getting closer.  I was doing really good not freaking out because I had things to try, but for some reason permanent damage loomed in my mind last night as I was trying to fall asleep despite the discomfort (and worry).  I'll be okay, I think.  Just a little freak out on my part.

 

:grouphug: :grouphug: :grouphug:

 

Hang in there. There seem to be a lot of possibilities, and many of them seem pretty simple to remedy.

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It's June 12th and getting closer.  I was doing really good not freaking out because I had things to try, but for some reason permanent damage loomed in my mind last night as I was trying to fall asleep despite the discomfort (and worry).  I'll be okay, I think.  Just a little freak out on my part.

I understand.   :grouphug:

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I thought I was developing MS over the last couple years because I had a lot of numbness which was increasing in my left foot and needles in my toes as well as the tips of my ears. I also had worsening restless leg syndrome that turned into neuropathy I think - it was in the legs, hands and arms, shoot from my spine and in my face. It was be tickling feeling and sometimes numb. Some nights worse than others. I took mag/calcium supplements, vitamin B supplements but I couldn't figure out the trigger until I was researching celiac disease for my daughter who has abdominal and growth issues then I realized I had a lot of the neurological and skin (I have the DH itchy rash) symptoms. I also have autoimmune hypothyroidism and the dr. said it was that that caused my nerve and muscle weakness, even when my labs were ok. I went off gluten and lost a ton of water weight within days (I had pink pee for a week after because of the toxic fluid) and my restless legs went away! Even DH said "What the heck did you do!" He couldn't believe it. I looked so different. Never I thought in a million years that would be my problem and it isn't cure for everyone's ailments but it is rather easy to try out to see if you feel better and you'll notice within days. I agree with cleaning out your diet of artificial things and try supplements. A nutritionist told me it's best to take your B vitamins balanced (all 7) or you can become relatively deficient in the others. Shaklee has a good supplement that has all of them. Improving diet usually will see improvement slowly over time. I hope you the best. Stuff like this is scary :grouphug:

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  • 4 weeks later...

Well, I missed my appointment, because, drum roll please:   I forgot.  Yep.  I've been forgetting really important dates (things that I'm really looking forward to) for about a year.  I completely forget the day of.  I was running around doing errands and thinking there was something I was forgetting.  

 

So...I have an appointment later today.  I'm not real hopeful about it though.  Dh went in for something serious that most likely needed an operation and they told him that his injury would get better on it's own and they encouraged him to use it as he'd been babying his injury.  Weeks later and it's worse.  He's had some times of awful pain.  What kind of dr. doesn't check things out thoroughly?  Um, maybe the universal health care kind (were got on this in March of this year).  I was so upset when he came home and told me they had done NOTHING for him except give him some pain medication.  I was excited to finally have health care again, but honestly, yeah, um, okay...

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glad you can see someone!  i have used dr. wahl's diet, "eating for your mitochondria", with great success.

 

i do not have a diagnosis.  

 

however, supplements of potassium and magnesium and vitamin D dealt with the dizziness and lethargy.

eating her diet, esp. kale every day, has helped the pain a lot.

 

and when i am doing it all, there is no tingling or itching, either :)

 

let us know how it turns out!

ann

 

eta: however, nothing i have done so far has helped the tendency for my hip to send me off in a random direction at random times.  (getting out of the car is the most exciting ;)

i am working with strengthening muscles to see if that makes a difference. 

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For those of you who had a B vitamin def., how did it take for your numbness/tingling sensations to go away?   I've been taking 5,000 mcg B12 and a B vitamin complex coming up on 2 weeks now but haven't had a change in symptoms yet.  My  more bothersome symptoms are blurry vision, fatigue, and the nerve stuff.   :confused1:

 

Are you using the sublingual type?

 

The thing about B-12 is that, unless you are someone who eats little or no animal products, the most common cause for B-12 deficiency is decreased ability to absorb it, so taking oral supplements doesn't necessarily help. The sublingual type is supposedly absorbed directly into the bloodstream, bypassing the stomach, so is more effective if there is a problem with absorption.

 

Of course, it's also possible that the symptoms are caused by something else.

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