For appointment on 12th October 2016

New Symptoms

•Occasional vision issues/ sudden blurring/ difficulty focussing

•Tinnitus (very high frequency whistle - left ear or both 24/7?) – over sensitivity to noise

•Uncontrollable body temperature swings – sweats (especially at night)

•Very itchy, stinging fingertips despite no sign of dry skin

•Severe pain with stiffness in knuckles – early hours of every night. Can't lift duvet or move pillows about without excruciating pain in little and index knuckles of both hands. Eases during the morning. Severe pins and needles in both hands and wrists.

Worsening or ongoing symptoms

•Dizziness/vertigo/ disequilibrium/ sensation of dropping into space when head lifts or turns/ out of kilter walking - trouble interpreting unfamiliar steps and patterned flooring/ artificial lighting all cause confusion.

• Weakness in hands, wrists, elbows, knees and ankles, especially while resting

• Pins and needles in hands, wrists, gums, lips and eyes and wet, skin crawling sensation on legs. Lips and gums feel permanently tight, sore, swollen.

•bone pain in feet and shins and arms

•Facial numbness now affecting eyes

•Bad taste 24/7 – (salt, vinegar, off milk)

•Frequent need to pee

•icy cold extremities – sometimes with colour changes, mainly toes with hard, powdery white or shiny skin

•Insomnia and Fatigue

•Constipation

Questions:

1.Could all the presumed small fibre neuropathy actually be Raynauds/ circulation related?

2.Could my dizziness, off kilter, disequilibrium, and tinnitus actually be inner ear related?

3. Could the cause of the pins and needles everywhere all be due to nerve entrapment from inflamed tissue (given my consistently very high PV/ ESR and raised CRP)

4. If you think my problems are neuropathic then would punch skin biopsies to assess for small fibre neuropathic nerve damage taken from each leg be a next appropriate step - given that this was last done by a GP (Scottish island) 18 months ago – who had never done this before and wasn't even sure where to take skin from or where samples would actually go or how they would be transported?

5. Could temperature swings, awful taste, constipation and dizziness be dysautonomia relating to my Sjogrens and hypothyroidism?

6 If tests confirm this - would treatment such as IViG be helpful in minimising the progress of these types of sensory neuropathy?