--Alan couldn't be "co-morbid", as it were, and have more than one condition contributing to his symptoms.

The spinal fluid protein definitely suggests an autoimmune component to his symptoms, but with the spinal aspects that you've indicated Alan has, it's also possible that some degree of compression may contribute to his symptoms, and be part of the reason why different positions make his symptoms vary.

There's no guarantee that just because we develop one condition we won't develop another. My initial neuropathic symptoms definitely pointed to primarily a small-fiber syndrome (if only the first group of doctors consulted had realized it)--unless it was a central nervous system syndrome. Fortunately, that aspect was well-tested for and ruled out. But, when I recently had my traumatic neural symptoms in my right hand (resulting from the muscle tear in the right shoulder and the unnatural cervical spine position that produced), if I had not been able to communicate to the physicians exactly what had happened and how the symptoms developed, I might not have gotten the cervical MRI that showed the C5/C6 nerve root pulled into an oesteophytic spur with a moderately reduced foraminal space. Standard doctors might simply have assumed that it was another development in my original neuropathy.

Fortunately, I generally only have to deal with doctors now who know me well enough to recognize my knowledge and take me seriously. That's very important, as the way doctors perceive you and the way you present your symptoms has great influence on how they persue investigations and diagnose--as Dr. Jerome Groopman's book How Doctors Think points out.

Liza Jane is another good example--she's certainly got a peripheral neuropathy, but her more recent pressing problem has been arthritic deterioration and cystic development around her lumbar spine, and the initial symptoms were similar enough to get her and several doctors thinking it might be an extension of her peripheral problem.

The probability of us having multiple, basically unrelated conditions increases as we get older, and it takes a really open-minded physician not to lump everything in with an initial condition. We have to fight not to be seen as just "the diabetic" or "the osteoarthritic" or whatever when symptoms crop up or change in intensity or kind.