What questions should I ask the doctor?

Any chance of a Diabetic Neuropathy?

From Web MD: “Causes of Tingling in the Hands and Feet

Diabetes is one of the most common causes of peripheral neuropathy, accounting for about 30% of cases. In diabetic neuropathy, tingling and other symptoms often first develop in both feet and go up the legs, followed by tingling and other symptoms that affect both hands and go up the arms. About two-thirds of people with diabetes have mild to severe forms of nerve damage. In many cases, these symptoms are the first signs of diabetes.

In another 30% of peripheral neuropathy cases, the cause is unknown or “idiopathic.”

No matter what there is a good chance that they (They being the medical community) will tell you it is idiopathic.

I have no history of diabetes, nor any other symptoms of that condition. Diabetic neuropathy would raise more questions than it would answer.

any major changes in physiology? Weight gain? Loss? lethargy? Nymphomania? ok, just foolin’ with the last one But seriously, any physical or mental changes over the past few years?

History of diabetes in the family?

When was the last time you had your blood pressure checked?

I weigh within 5 lbs of what I weighed in high school (12 years ago). No more or less inactive than ever except for pain avoidance, though I’m hardly an athlete. No history of diabetes that I know of (dad was adopted). I do have untreated depression and anxiety.

I’m sorry that’s happening and I hope a cause is found.

It sounds like you’re going to be looking at arthritis or nerve related ailments, unless there’s been an infection or some injury you know of, or that can be tested for.

I believe the main difference will be whether or not your joints are inflamed. One thing I’d mention is what you’ve tried that seems to at least help temporarily. Whether that’s rest, ibuprofen, etc.

I think they’ll probably suspect fibromyalgia initially, and I think we have a few folks here who have some experience with that, maybe they can help with some of the differentiators, but the tingling and morning fatigue (does it get better as the day goes on?) sound familiar there.

Questions I’d ask.
– what can we rule out? Because there’s going to be a lot of possibilities.
– is there any chance of something relatively simple like an infection or deficiency? What would that be?
– whatever diagnosis they’re leaning towards, ask how it can be confirmed, so you’re not spending time down the wrong path. A lot can’t be confirmed, but I’d just want to rule out as much as possible.

Good luck.

It could be a dozen different things, from Lupus to rheumatism to Lyme disease. See the doctor, and bring a list of any vitamins and supplements you take.

Mayo Clinic Symptom Checker

Web MD symptom checker for Women

Don’t forget to get the special exams that are only for females. It’s important. ;)

Covered and done, as part of my yearly physical. That’s one part of my body that I know is in, if not perfect working order, at least reasonable condition.

Any of these: bladder or bowel problems, loss of balance, numbness, paralysis, tingling, tremors, vision problems, or weakness.

Try that Web MD for women site but beware, it can scare the crap out of you, but you are the one who can answer the questions. I was just guessing at the symptoms and severity
.

Um, vision problems, maybe? I have chronic dry eye (I was on Restasis for a while but it’s expensive and I had really uncomfortable side effects). I’ve developed a couple of floaters in the last year or so.

Weakness is mostly a decrease in grip strength, and my shoulders can’t support weight like they used to.

Web MD is anxiety fuel.

Gotta start somewhere.

I’m going to start with my GP, if I can get the courage to show up, and then the courage to ask real questions… once I figure out what those questions should be.

They/he/she is going to want a barrage of tests to determine a starting point!

I would bring your list of symptoms in writing then see what he says. He will probably order blood tests. I’d write down the name of the tests then come home and research them. At the follow up appointment, if he doesn’t have a diagnosis, I would then ask about the possibility of RA.

Anything you want to know about him or her if you are asking as a means of interview. As for medically, anything you want. Period. And, if you can’t, you need a new doctor!

I would describe your symptoms, let the doc write up whatever blood he wants to draw, and then make sure he is testing for:

Vitamin D
Vitamin B12
TSH
Iron and/or CBC

I can’t stress these enough considering your symptoms.

He will also likely test for Lupus, and other rheumatological indications like the blood tests CRP, ESR, or an ANA profile, and other stuff. That’s fine, I’m not saying don’t get that stuff tested, I’m only saying make sure what I suggested is tested too. It’s likely he will automatically test for at least some of what I suggested anyway.

Even if you, God forbid, have a rheum diagnosis, deficiencies in what I suggested can exacerbate symptoms. If your rheum tests are all negative (hopefully) the tests I suggested might significantly help your symptoms if you are deficient in one of those and you correct it.

Edit: maybe do a CMP blood test too?? Or, CPK? I’m more sure about the ones I named above considering your symptoms.

One question, are your symptoms at the worst when you wake? Or, do they get worse as you use your muscles throughout the day?

You might want to ask whether any meds you may be taking could be making it worse. My grandma has similar issues, and she found out that one of the pain medications she is taking is said to exacerbate that kind of problem.

Sending over some courage. Not knowing is probably worse than whatever it turns out to be.

I know you don’t want to hear this, but it does sound like the Rheumatologist is the appropriate next step. I developed rheumatic symptoms about 4 years ago; I am fortunate that my symptoms are mild in the scope of things, and treatment helps some. I am in many RA and invisible illness groups online, and all your symptoms are common among auto-immune disorders: RA, Lupus, Fibromyalgia, Sjogren’s, etc.

The comment that got my primary to take me seriously was when I said, “I feel like I imagine arthritis would feel, but I’m too young for that, right?” The PCP tested me for Lyme’s disease (even though you’re in Florida, if you’ve been in the northeast US in the past several years, it might be a good idea to be tested) and they tested my Rheumatoid Factor (RF) and my Erythrocyte Sedimentation Rate (ESR). Lyme’s was negative, but the other two were elevated so I was sent to a Rheumatologist (or Rheumy, as we call them in the support groups). There they tested Vitamin D, Thyroid, among other blood work that identifies markers for specific rheumatic diseases – mine is non-specific and my symptoms seem to range across several autoimmune disorders; supplementing the deficiencies in Vitamin D and Magnesium does help me, along with one of the milder first-level medications for Rheumatism.

There are people who are seronegative, meaning they have symptoms but the bloodwork shows nothing. X-rays of the hands and feet are common to search for visible evidence of joint damage and to have a baseline. The tingling/numbness may also warrant additional testing by a neurologist and maybe an electromyogram (EMG) to test nerve conduction.

There are people who respond well to significant dietary changes, as food sensitivities can cause similar symptoms and flares, whether it’s true celiac disease (which my mother and brother have) or reactions to things that one is sensitive to. I’m in a group where people do elimination diets and then gradually add back one ingredient at a time to find out what they react to. Some of them also follow specific anti-inflammatory or auto-immune diets, and claim this puts them in remission. While I do find that I seem to flare with some foods, they are not the ones that are listed as typically being problematic. I seem most sensitive to food additives, so I try to eat mostly organic, minimally-processed foods. Because there seems to be so much variability, I believe that doing the elimination diet is the best way to identify one’s unique triggers – I’m just not that disciplined.

Finding a good rheumatologist is the tough part. Autoimmune disorders are a hot topic in the health care industry, but many Rheumies are stuck in the past (this has been my problem, despite being a few miles from a large medical school and teaching hospitals). A lot of people have good success with functional medicine practitioners, but those are usually out-of-pocket and pricey.

Feel free to contact me if you have any questions. I hope you get answers and effective treatment soon!

I’m a recovering hypochondriac myself so I guess you know not to get on the internet. I would simply talk to your doctor just like you did in your description. If he thinks you are a hypochondriac then fire him and get a second opinion.

I’m kind of the opposite of a hypochondriac. I’m more likely to convince myself I’m gonna live forever without medical help…

Sad thing is I have a running 100% accuracy rate for self-diagnosis when I actually do ask for help…

@Seek I know how you feel. I still have not figured out how to deal with being perceived as a hypochondriac when I pretty much always avoid going to the doctor if I can, will wait weeks hoping something will just pass on it’s own, and almost never think a pain or bump is going to kill me. Chronically ill patients get tested like crap all too often, especially when there is no clear diagnosis.

If you want to ensure the doctor does the rheum panels @hearkat is right, a rheumatologists is your best bet. A GP might, hard to know. GP’s are all over the map in my experience.

Here’s the thing, I firmly believe in my heart discovering my vitamin D deficiency probably prevented me from developing a rheum problem, or maybe pushed it off into the future. If you have a gut feeling, and want to ensure those tests are done, you should consider going straight to rheumotology if you can. They certainly can do the D, B12, iron, and TSH I suggested.

I had been diagnosed with fibromyalgia, but I ignored it, because the diagnosis didn’t make sense to me. Not that I don’t believe that syndrome exists, I do, but it didn’t fit me in my opinion. It was my endocrinologist that diagnosed my D definiciency and that has been one of the most significant thing that has helped me.

Definitely go to a doctor. There might be an easy fix for at least some of your symptoms. I believe there is, and so you might be suffering for nothing.

Make sure you get a copy of the results. The law changed this year that you can actually get results from the lab. I get my blood drawn at Quest Labs and have their app on my phone. I can log in and see all my blood test results, Pap smear, everything. It’s great. I assume other labs have similar tools.

Yes, @Seek , definitely get and keep copies of all your lab results so you can follow the changes and ask questions appropriately. Sometimes the doctor will miss something that you’ll catch.

I can’t think of actual questions you need to be asking. I’d be more likely to go over all of the symptoms and blurt out, “Am I gonna die???” But then, I overreact to things…

Seriously, though, please keep us updated. I hope you and your doc can get it sorted out.

Ignore the Internet. Be precise and accurate in your symptoms description.

Thanks Doc, good advice to ignore others symptoms and focusing on what is going on with YOU.—

I think @Rarebear has given you the best answer you can possibly get. And I hope your doctor really listens to what you are saying and asking and doesn’t simply brush your concerns away. If he does, take them somewhere else, you obviously need and want answers so don’t let anyone make little of your concerns Seek.

Update:

Saw the doctor today, after finally convincing myself to go in.

They took blood and will be running an arthritis panel, as well as checking b12 and folic acid. He also says he’ll likely end up referring me to a neurologist and a rheumatologist.

He has this meek, quiet bedside manner that makes me really uncomfortable. I’m considering asking my friends in the area which doctors they absolutely hate, and going to see them. I wish Dr. House was real.

Did he run the vitamin D?

What about TSH?

I’m glad you went to the doctor.

Hope it’s all good news.

Half joking: if you want someone to swoop in, poke and prod, half listen, and then tell you exactly what they’re thinking, visit an ER. I think “teaching hospitals” tend to be a little more shoot from the hip as well.

I know costs are always a concern, and the ER isn’t cost effective at all, but maybe it leads to a better fit.

@funkdaddy The ER cares you don’t die that day on their watch. Then they tell you to follow up with your doctor.

@JLeslie – it was a joke. I mean if you could find an ex-ER doc, or one who also serves in another function elsewhere (many are contracted anyway), that might be a better fit. They are not meek.

my wife is an ER nurse, in a hospital and at a private ER

Yes. I understand that most people are sensitive and like to be hand held good or bad news… but I would love to have a doctor that was completely clinical and factual.

A robot, really. A robot doctor. That would be great.

@JLeslie – I only glanced at the paperwork. There were lots of letters, I don’t recall whether TSH was among them.

It sounds like this is just the first round for you. Unlikely you get a clear cut answer I think. If nothing shows up, you go to a specialist. If something shows up, you go to a specialist. If it is something like B12 then you would obviously treat that and see how it goes before next steps.

Blood work all came back normal.

They left a message with my husband, and that’s all they said.

I looked up the results on the patient portal, and according to that my B12 is on the low end of normal, and there’s a note saying that can cause symptoms in 5–10% of people. So that’s something to look up at least.

Otherwise I’m at a dead and, and my doctor seems less than concerned about it.

The rheumatoid factor came back as 9, and the note there said anything below 14 is normal. :: Shrug:: I guess I just get to be in pain now. Whatever.

Did they test your vitamin D? And TSH?

Something to note about B12 some countries have changed the normal range. Depending on how your lab measure normal might be say 200–1000 and under 400 they suggest treating, but some countries the low end of normal is 500. I try to keep mine above 500. My sister feels it’s best to be above 700 from what she has read.

I really can’t emphasize enough the vitamin D. I know I sound like a broken record. I just know so many people who cured pain with it, including myself, and now my husband’s plantars fasciitis.

Have you tried one of These?

sorry, just trying to lighten the mood

Mine was 369, and it said 200 – 1100 was normal.

@Rojo – gods, I wish.

Mine is below 400 without supplements. The b12 drops have been the most effective for me. I don’t see a huge improvement from getting my B12 up, but basically all the medical establishment agrees B12 is an important nutrient to keep in normal range.

The establishment does not agree about D and that is why many doctors don’t take it seriously. More and more are.

Just for another data point, and I know it’s all anecdotal, so take from it what you want.

My wife had a number of medical issues (not at all related to yours), vitamin D deficiency was the only thing bloodwork found for her. She started supplementing and found a lot of her symptoms went away. She also did a number of other things, so again take from it what you want.

It’s a cheap fix to try, and doesn’t really have a downside.

As mentioned, there are people who have seronegative autoimmune disorders, so the bloodwork isn’t the definitive test. I would recommend that you still follow-up with the Rheumatologist.

I also mentioned that many people do well by performing an elimination diet and then gradually adding back various ingredients into their diet to see which items seem to trigger inflammatory symptoms. I’m getting to the point where I think that may be necessary to me, because I am starting to notice changes after eating some things, but it is really hard to pin-point specific ingredients.

I have also found that being well-hydrated makes a noticeable difference for me. I was chronically dehydrated for several years and in the past year have made an effort to drink more water. It’s not so much that I feel noticeably better; but it’s how noticeably worse I feel on the days when I don’t get as much fluid in me that makes me know the difference.

I can totally relate to your wants from a physician. I found a physician who started his career as an engineer, then at around 40 decided to do to medical school! My son and I have each been to him once and we both like him. He is our new primary after about 5 years without one.

@Seek What was your TSH?

Go for the simple if you can. My rheumatologist diagnosed me with fibromyalgia, but my symptoms didn’t all fit in my opinion. It was my endocrinologist who diagnosed the D deficiency. Thank goodness my rheumatologist was loathe to dope me up with drugs. I either would have had to be a noncompliant patient, or eventually I probably would have tried some of the drugs and been torn about it, and possibly dealing with side effects.

Another thing, my red blood cell stuff was always slightly below normal. Taking iron fixes it, and it is a drastic difference for me in energy level and strength. My iron level can be in normal range, but I show low RBC stuff, although sometimes I am so deficient the iron number is low too. Doctors didn’t tell me to take iron for years, and then finally one did. World of difference. Even now, sometimes I skip taking, or cut down on iron for a few weeks and the test will be low, and doctors say nothing. When I asked for the result (now I don’t have to ask thank goodness) they say, “don’t worry about that your fine.” I’m not worried dammit! I need to know so I go back to taking more iron. Even when the number is normal, I need to know, because the only reason it’s normal is because I’m supplementing. I need to know where I am at.

I tell you this story mainly so you check your CBC results yourself, because maybe iron would help too (only if you need it). It’s also another demonstration of how doctors might dismiss something important.