New Neuro Dr. and Tests - what to expect?
 

Hello All:

I just had a first visit with a neurologist after my GP referred me for PN. I've had a couple of EMGs in the past, but they came up normal. Is this normal for PN patients, or is it because I didn't have any nerve or muscle damage then?

The new dr. has ordered a MRI of the brain with contrast. I have had spinal MRIs,but not of the brain, and the contrast part is a little scary. Has anyone had this done? If so, what can I expect?

Lastly, he seemed to indicate that PN can be diagnosed with blood tests. I have never heard or read this before. Is this a new technology? He also mentioned lupus. I didn't realize that lupus can be cause of PN? I don't have a rash, but a few of the other symptoms.

Many thanks to all who respond.

I think the blood tests are to rule out some conditions that can cause PN. I had many of them to test for different conditions, including one for lupus. I actually do have rocacea that flares up on my face, but several tests are negative for lupus. The blood work also tests for vitamin deficiency, rheumatoid arthitis, Lyme disease, etc. It also depends on the doctor. I had one neuro that ordered very few blood tests, while another ordered many.

Autoimmune issues show up in the blood.
Low B12 shows up that way too.
Also some heavy metals/toxins can be tested for.

Lupus is an autoimmune disease.

Small fiber nerve damage may not show up on an EMG.
And if you don't have muscle damage your needle conduction test would be normal as well.

Lupus would need a special blood test.
Its called an ANA.

Its an auto-immune disease.

It does't need an MRI.
For that they may be checking out Multiple Sclerosis.
Which is in the Central Nervous System, and would not have peripheral neuropathies.

I would look up in the "important links" and look up small fiber neuropathies.
Have you been tested for diabetes and B-12 deficiency?

Thanks to you all for your responses. I have been tested for diabetes but not lupus. I'm dreading the EMG. The last one I had, I nearly had to tell the doc I was done before he was finished.

How long ago was your last EMG? Was it within the year or over a year ago?

If it was a year ago and this one still shows nothing then I'd say you either have SFN or you don't have PN.

What are your symptoms?

P.S. Here is a list of things that have SF damage:

Metabolic
Diabetes mellitus
Hypertriglyceridemia
Hereditary
Amyloidosis
Hereditary Sensory Neuropathy I (HSAN I)
Congenital sensory neuropathy with anhidrosis (HSN IV)
Congential insensitivity to pain sensation without anhidrosis
Hereditary ataxia with thermoanalgesia & loss of fungiform papillae
An-α-lipoproteinemia (Tangier's)
α-galactosidase (Fabry's)
Hereditary sensory neuropathy + Spastic paraparesis (Cavanagh's variant)
Hereditary sensory neuropathy with loss of pain perception
Congenital indifference to pain

Navajo neuropathy with arthropathy
Cold-Induced Sweating Syndrome
Toxic: Kepone; Ciguatera
Infection: Leprosy
M-protein
Idiopathic: Often painful

Hi my first set of NC/EMG came back normal but my 2nd plus the ssep did not. I have had the brain mri 2 times and teh spine as well. I think it can check for MS but also rule out something pressing on the spine causing the pain and or issues in the leg. The contrast is no big deal unless you are allergic but most are not. It is just like when they put an IV in. Since they are mentioning lupus so on can you ask if you should see a rheumatologist? I had so many tests for auto immune and the reason is like others stated is it can cause these problems like PN but if you treat the underlying for ex if you had lupus or low b12 that would help the PN. Keep us updated and don't forget to keep all your records so you can compare and bring to the next apt.

Thanks all. My first EMG was over a year ago and was normal.

My symptoms are:

feet feel like they are freezing cold
can't feel my feet on a bicycle
electric/shocking pains in forearms
pain in feet in certain shoes
numbness, tingling in hands, feet, arms, legs
exaggerated sense of touch (i.e. tap on the arm can cause pain)
don't like things touching my skin

However, I looked up lupus, and it seems I have some of the symptoms including:

extreme fatigue
muscle and joint pain (especially in the knees and elbows)
unexplained fevers
headaches
anemia
chest and rib pain
depression

I don't have the skin rash or hair loss. The anemia is what struck me, because I've been taking iron pills sometimes twice the dosage at the instructions of my doc to combat the anemia. It also states on various websites that lupus is often confused with other diseases/conditions I've already been tested for - thyroid problems, fibromyalgia,and rheumatoid arthritis. I'm going back to my GP tomorrow to see what he thinks. I haven't been able to work, and am going broke in the process.

OK, back from the GP. He seems to think I have an underlying condition that has a rheumatological (sp?) base. He bases this on the fact that when I have taken prednisone in the past, my symptoms are greatly improved. However, as soon as the dosage ends, my symptoms return. He said based on this, it was highly unlikely it was MS, and he referred me to a rheumatologist.

Does anyone know of another rheumatological condition other than lupus that could cause PN?