Immediate follow up, or give it time?

[Emmile]

Hello Everyone,

Thanks for taking the time to view this thread. I am new to the site, but have already seen a number of posts with others who are in Limbo Land and wondering whether or not their strange symptoms could be MS. Unfortunately, I have recently joined their ranks!

On June 1, 2015, I gave birth to our second child. My initial recovery went smoothly, minus some sleep deprivation and exhaustion. Our first two nights home; however, I was overwhelmed my intense panic attacks, one after another all night long. As soon as I would start to drift asleep it felt like I was suffocating, my chest was tight, my mind was racing, body was agitated, I had uncontrollable spasms and shaking in my legs, my arms were weak and tingling, my lips and tongue were numb, I had sweats, hot and cold flashes and felt like I was "going to loose my mind!". I've always been a 'worrier' but have never previously struggles with significant anxiety, and have no history of panic or panic attacks. I called my OB the third day (after two terrible evenings) and he recommended giving it more time as I was breast feeding and the medications would require me to stop.

Thankfully, the panic and anxiety has been improving and I've had no 'full blown' panic attacks since the second evening. At first, the numbness, tingling and weakness in my arms and face would come and go so I didn't pay much attention. But over the last few weeks it some more frequently and in the last week is pretty much always present in varying degrees. Unfortunately, I have remained under some pretty intense stress (struggles with my own health and our new little one's health) and continue to have occasional moments of mild panic or anxiety; which does seem to exacerbate these symptoms.

I am a social worker by training, and I know that panic and anxiety and produce a wide variety of neurological symptoms (that is why I didn't give the symptoms too much thought at first, other than being scary in the moment). However, I have had another autoimmune disorder for nearly 10 years; and there is a family history of MS (both my sister, and paternal cousin). I so desperately want to believe it is just anxiety, for which I plan to discuss medication with my OB again next week as well as starting counseling. The thought of having more health problems on top of the autoimmune issues I already have (which are also flared up since the delivery) makes me feel completely terrified and overwhelmed.

I did see an MD last week for ear infection and mentioned my symptoms, they seemed to want to blame the anxiety but also took blood to test my Vit B, Vit D and Thyroid levels (results still pending). At this point, I am struggling with frequent severe headaches, the tingling has progressed to my left foot, and is pretty much continuously present in my arms and hands and is increasingly painful. The tingling still comes and goes in my lips and tongue.

I know that being so hyper vigilant and worried about my health isn't helping things (I'm trying to avoid Dr. Google), and I am trying to shift my focus. I also know that you all cannot give me a diagnosis. I guess my question at this point is whether or not my current symptoms warrant immediate follow up with my PCP for neurology referral, follow up and additional testing. Or should I give it more time and try treating the anxiety first and see what that does? I guess, the urgency I am feeling is both due to fear related to the symptoms, but also a concern that intervention needs to get started ASAP if I do in fact have MS.

Thanks again for your thoughts and taking time to read this!

[SNOOPY]

Hello Emmile and welcome to MSWorld.

Or should I give it more time and try treating the anxiety first and see what that does?

That would be my recommendation.

Part of the diagnostic criteria for MS is ruling out other possible causes for a person's symptoms. Your anxiety could be a possible cause for symptoms. If your anxiety is treated and you are still having symptoms then you have effectively ruled out anxiety as the cause.

[Seasha]

I guess my question at this point is whether or not my current symptoms warrant immediate follow up with my PCP for neurology referral, follow up and additional testing. Or should I give it more time and try treating the anxiety first and see what that does? I guess, the urgency I am feeling is both due to fear related to the symptoms, but also a concern that intervention needs to get started ASAP if I do in fact have MS.

Thanks again for your thoughts and taking time to read this!

Just my opinion, but think you might want to explore both and why not? (treat the anxiety and get a referral for more testing) Getting closer to an answer will help you mentally!! And congratulations on the birth of your child

[jreagan70]

Hi Emmile:

If it makes you feel better, then you should go ahead and get a referral to a neurologist and start the workup process for MS.

It isn't, though, at all characteristic of MS to present in the way your symptoms initially did. MS isn't known for an initial presentation of 1) panic attacks and 2) hot and cold flashes 3) that coincidentally hit 24 hours postpartum.

It also isn't characteristic of MS to hit very suddenly with symptoms that are widely spread all over the body at the same time. While lesions can occur in more than one place in one attack of MS, they are usually limited to one or two or three distinct places limited to neurological pathways. It isn't characteristic of MS lesions to hit all at one time -- especially within 24 hours postpartum -- in the six or eight places that would be necessary to be responsible for the symptoms you described.

The sudden hormonal changes that occur immediately and after postpartum are very well known for causing all manner of weird symptoms. Those well-known postpartum hormonal effects are at the top of the list for your symptoms.

Your tendency toward worry and anxiety can certainly be aggravated by postpartum changes. And your other autoimmune condition -- which sounds like one that can cause inflammatory damage systemically (perhaps more like lupus or RA and unlike MS) -- can possibly cause those sudden, widespread symptoms on very short notice. (And for anyone else reading this, fibromyalgia can also react quickly to these systemic chemical events and cause body-wide general symptoms, but fibromyalgia is NOT an autoimmune disorder.)

Attacks of MS are known to onset within a few weeks postpartum. So even if the symptoms that occurred immediately after delivery can be counted out, symptoms that onset in the following weeks can be looked at as possibly related to MS.

To count as an attack of MS, symptoms have to be those that are characteristic of a demyelinating event and not just nonspecific, like pain, panic, sweating and shaking. Demyelinating events would be something like loss of vision lasting continuously more than 24 to 48 hours, loss of bladder or bowel function lasting continuously more than 24 to 48 hours, or weakness or paralysis of a limb lasting continuously for more than 24 to 48 hours.

As you've found, worry and anxiety can make EVERY symptom of EVERY condition worse. And that's why it's so important to get worry and anxiety under control while evaluating for other conditions.

But you don't have to eliminate them before looking for other causes. Anxiety can't be responsible for lesions that show up on an MRI, so you can go ahead and look for them now, if you'd like. While MS is almost never an emergency, your non-specific symptoms indicate that you don't have to get a diagnosis or start treatment immediately. Earlier rather than later, but not necessarily immediately. It would depend on what the results of your testing show.

It can be nice to know early whether you have a condition that will have to be followed up on later. So if only for your peace of mind, you can start a workup for MS or other neurological disorder now, while you're working on getting your symptoms evaluated and treated in general.