Brief Answer:
Peripheral Neuropathy is a GOOD PLACE to start

Detailed Answer:
Thank you for your query and information.

What you present certainly does SOUND like a rather classical case of a PERIPHERAL NEUROPATHY which by definition is virtually always going to follow the pattern of a DISTAL (meaning "far away..in feet) point of initiation in the feet and symmetrically ascend over time. It certainly seems to be progressing somewhat rapidly for a metabolic neuropathy such as DIABETES MELLITUS or some other biochemical, genetic, or related pathology. Usually peripheral neuropathies due to systemic disease (involving the sensory systems) progress over many months if not years and do not rise nearly as quickly as what you're illustrating.

However, if you had a nutritional deficiency that included things such as B12, B6, B1, FOLATE, D and if that deficiency somehow ended up aggressively affecting the body in this rising fashion then, your symptoms could be explained....but in this case, it seems as if things were happening at somewhat of a quick pace.

I will almost guarantee that if your B12 levels are adequate then, your folate levels are almost certainly normal or even above normal.

Endocrinopathies such as THYROID DISEASE, ADRENAL GLAND, TESTOSTERONE, PARATHYROID, etc. can also be responsible for a rapidly and progressive type of picture as can DEMYELINATING DISEASES of the brain. You also refer "fatigue, lack of motivation, and poor sleep hygiene" as related conditions. Many of these symptoms can be due to NONORGANIC problems such as depression, anxiety, or personality disorders which can mimic and cause virtually EVERY TYPE OF BODY manifestation. I would of course, leave this differential of causes to the very end after every thing else has been examined and ruled out.

As a neurologist my approach would be to obtain the tightest history on when this all started and how it has evolved over the past 6-12 months. I would listen carefully for any chance at your having suffered not only from metabolic sorts of issues but also whether or not you have had any dietary changes in the past 6 months and if so to try and see if any of the current symptoms were also present long time ago.

I would then, look to get relevant labs and other testing AFTER having doing a detailed NEWUROLOGICAL EXAMINATION that would include tendon reflexes, sensory perceptions over the body such as numbness, tingling, PAIN, etc....especially if the pains are getting worse rapidly. I would look for any evidence of a "kink" in the back, kink in the neck meaning compressed or anatomically compromised nerve roots that could be supplying areas of the body.

Labs and other testing would reflect the MOST COMMONLY discovered problems in such situations and include B12 (you state it's high so no need to repeat), diabetes mellitus (you said you didn't have), HIV and other STD status since those types of INFECTIOUS entities are highly relevant to such a story.

I might consider something like a SLEEP STUDY for possible SLEEP APNEA that should be done DEFINITELY due to the amount of awakening you seem to do at night.

Finally, if nothing in the labs were to fall out that were abnormal then, I would get an MRI of the brain and spinal cord...perhaps even with GADOLINIUM CONTRAST. I would definitely make sure to get a RENAL CLEARANCE before taking the contrast...bad reactions to the XXXXXXX substitution could REALLY give some problems and you don't want those complications as opposed to just getting a simple lab set of CREATININE and ESTIMATED GLOMERULAR FILTRATION RATE (>= 60 ng/ml) to demonstrate the health of the kidneys.

I would not move to do any electrical testing on you since pure sensory symptoms typically do not really show up as anything on such physically invasive studies.

Bottom line, this definitely sounds like some kind of NEUROPATHY of a sensory nature that could emanating from some metabolic disorder to problems with an endocrine gland or a set of glands. It could also be due to the presence of HEAVY METALS so I woulds definitely get a screening done for things such as lead, manganese, elevated liver or kidney enzymes.

BTW, I believe there's a typo in your blood pressure.....could it be you were saying that your blood pressure was 130/70?

If I've provided useful and helpful information to your questions could you do me the favor by CLOSING THE QUERY and taking a moment to provide some kind words of criticism and perhaps even stamp with a 5 STAR rating if you feel inclined? They'll give me either more peanuts in my Lunch pail next shift....OR....let me out an extra 10 minutes to be in the SUNSHINE and make MORE vitamin D! LOL

Do not forget to contact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 32 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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