In limbo and slightly worried

[sparkles9708]

Hello all!
I am a Physician Assistant Assistant student who has been having multiple odd symptoms since last July.

This all started with my left eyelid twitching since last July and when I first noticed it and asked one of our faculty members about it, she noticed my pupils were unequal sizes and told me to try and get a direct neuro consult ASAP. I also noticed when we would practice suturing and blood draws that I had some slight tremors in my hands. I had noticed it sometimes before, but only before a practical or something like that.

I saw the neuro and I had an EEG, which was normal was normal and I was put on amitriptyline 20 mg to try and control what he thought was migraines and control the tremors. Well I also have noticed my vision becoming more blurry and some cognitive difficulties, but I blamed this on the amitriptyline. I have also felt very tired, but I blamed it on school. However, I had to be taken off of it due to the side effects. He then decided To replace it with Xanax and I sought a second opinion after he refused to listen to my concerns of being put on something that strong and I am about to go out on rotations.

I also decided to seek another opinion when another faculty member said he saw my pupils do e unequal size thing and offered to refer me, there was also a brief period when a friend and I were practicing the eye exam and she thought she saw horizontal nystagmus and he confirmed it.

New neuro ordered a VEP and brain MRI with an w/o contrast. I had the VEP Friday and she said she saw some abnormal waves and asked if I would mind repeating the test on another machine and if I had ever lost my vision completely. My MRI is the 19th. The neuro originally said he thought this was also mostly migraine related,but wanted to rule out some per things with some of the symptoms I was having.

How bad of a sign is it that I think I may have failed the VEP test? While school and this year in general due to personal reasons ( dad diagnosed with stage 4 renal cell cancer, best friend committing suicide, trying to get as many of my rotations as close to home as possible) being more stressful than usual, how likely am I actually facing this as a possibility? I am a 27 year old female. Also they let me choose an open MRI is there a difference between e closed and open?
Thanks!

[Fed Up]

Sparkles; Your symptoms fit a few other disease's too!

it sure sounds like your stress level is off the scale too.

Please be patient, you'll have better answers after your MRI.

Your symptoms could be emotional with all the stress you are under and it could be what you suspect or a few other things.

For your sake, I sure hope this passes and you pass your rotations, too. Be patient, if you need a rest, take some time off. Take care of yourself first!!! fed

[sparkles9708]

I feel like I have dealt prett well for everything I have gone through thus far and at least I trust this neuro a bit more after he said he would never put a Med student on something like Xanax. I am just keeping a positive attitude and thankful thatnatleast this one is at least listening.

[22cyclist]

Hi Sparkles, and welcome to MS World. An abnormal VEP is most likely related to ON. You may or may not have noticed it. I have had it before and not really noticed it other than blurry eye. Nystagmus is a different animal, and a different presentation of MS or some other neurological condition. Have you had any numbness or tingling anywhere? You don't have to have. Many people just present with eye problems. So therefore an abnormal VEP is significant but needs a follow up MRI to assist with diagnosis. If the MRI of brain and or spine is clear, they may do an LP to confirm a diagnosis of CIS (clinically isolated syndrome) and treat you. It all depends on how your testing comes out.

So again how likely is it that you have MS will depend on your MRI and repeat VEP. You can't get diagnosed just with a VEP. You will need more testing, which you are getting.

An open MRI is not as good as a closed one in terms of detecting lesions simply because of its problems with artifact. If you can, I would suggest doing the closed MRI, and take your benzodiazapine to help with the claustrophobia.

I wish you the best. Please keep us updated.

Take care
Lisa
Moderation Team

[sparkles9708]

The only thing I have noticed is the blurry eye, I was starting to notice with exam I would have to stop, rub them or wait till it stopped. I have had some numbness and tingling in my feet and lower legs, but I was having some issues with my legs and was told it was probably due to the amitriptyline.

[Fed Up]

I've had lots of practice with elavil and it doesn't do that to me; doesn't mean it can't to you.

My experience is it totally relaxes my nervous system. It makes my tongue crack an bleed, so I cannot take it more than a few days here and there--it gives me a good nights sleep every now and then. fed

[sparkles9708]

I had sleeping issues in the past tried OTC sleep aids, lunesta, and then found the best solution when I was put on the Leadville at 20 mg, but the other side effects weren't worth it. However, I am now a believer in that drug at low doses for insomnia= I would sleep for a full 8 hours with no interruptions.

[sparkles9708]

Update: Repeat VEP was normal, brain MRI not quite the results I was hoping to hear. Quite truthfully all I remember is hearing him say lesions consistent with a vasculitis or MS if I was having MS like symptoms.

I wanted to give the topamax a little longer to work and see if some of these symptoms were due to migraines/stress. As it turns out my migraines are 100% better and while rotation year is still busy it's not quite the stress filled year didactic was. However the symptoms have not gone away as I had hoped and a fall that happened for no reason, plus my tremors are interfering with my ability to do procedures, will be leading me to make another appointment with the neuro.

[22cyclist]

That is a great idea. There are things they can give you for the tremors. If it is MS, you want to get on treatments ASAP. Come back and let us know what they say.

Take care
Lisa

[sparkles9708]

EMG, is this going to show anything?

I have an EMG test scheduled for next Tuesday for my legs for the numbness/ tingling along with the 3 falls in one month occurrence.

He thinks my tremors are actually better, I really hope I have a nice surgeon for my surgery rotation.

He also thinks the topamax could be causing the numbness/ tingling, but I had this somewhat before I started it. However, if the EMG doesn't show anything he's basically pointing the blame at the medication.

I even tried reiterating the point of this is exactly how I felt this summer when all my symptoms first started and i am not sure if I was listened to. Next rotation I will have longer hours than this one and I am exhausted coming home at 5 pm alone when I get done at 7 or 8 next month.