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Thank You So Much For Your Reply . I Am

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Posted on Fri, 31 Jan 2020
Question: Thank you so much for your reply . I am a male . So no menopause . I did testosterone test . Waiting results . The blood tests & ultra sound show normal liver & kidney . I have been having this symptom of hot body for a month now . That is why I started doing the tests . I don't have sweating though . Regarding the high hemoglobin , my doctor told me it because of smoking & obesity . I am doing venesection weekly (100 mL) of blood is removed . And I am getting better reading with respect to hemoglobin now but the hot sensation is still present . I don't have stomach pain or deirihia . I have other symptoms sometimes (left reddish eye with water like discharge , I have left back neck pain , left head headache & numbness on left hand , that is only if I sleep on my left side so I wake up with a numbness on the left arm that lasts for a minute , If I sleep on my right hand , there is no numbness ) . I did tests for stroke . No stroke . Heart is ok . That is why I started to think , maybe it is a nerve problem since all the symptoms are happening on my left side . These symptoms are not bothering me as the hot warm sensation does . Do not you think that a nerve can cause this hot feelings in the light of the other symptoms I mentioned ? . Regarding the tests suggested by the other doctor and you mentioned them in your reply , are these normal tests available in labs or they are so specialised (genetic ) ? Cause most of the labs where I live can't do (genetic testing ) and have to send it to Germany which means long time waiting for results & high cost . Do you think a visit to a rheumatologist might be of some benefit ? Or seeing a nerve specialists might give us a clue of what is going on with me ? . Your opinion will be highly appreciated . Thank you in advance .
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Follow up: Dr. Panagiotis Zografakis (0 minute later)
Thank you so much for your reply . I am a male . So no menopause . I did testosterone test . Waiting results . The blood tests & ultra sound show normal liver & kidney . I have been having this symptom of hot body for a month now . That is why I started doing the tests . I don't have sweating though . Regarding the high hemoglobin , my doctor told me it because of smoking & obesity . I am doing venesection weekly (100 mL) of blood is removed . And I am getting better reading with respect to hemoglobin now but the hot sensation is still present . I don't have stomach pain or deirihia . I have other symptoms sometimes (left reddish eye with water like discharge , I have left back neck pain , left head headache & numbness on left hand , that is only if I sleep on my left side so I wake up with a numbness on the left arm that lasts for a minute , If I sleep on my right hand , there is no numbness ) . I did tests for stroke . No stroke . Heart is ok . That is why I started to think , maybe it is a nerve problem since all the symptoms are happening on my left side . These symptoms are not bothering me as the hot warm sensation does . Do not you think that a nerve can cause this hot feelings in the light of the other symptoms I mentioned ? . Regarding the tests suggested by the other doctor and you mentioned them in your reply , are these normal tests available in labs or they are so specialised (genetic ) ? Cause most of the labs where I live can't do (genetic testing ) and have to send it to Germany which means long time waiting for results & high cost . Do you think a visit to a rheumatologist might be of some benefit ? Or seeing a nerve specialists might give us a clue of what is going on with me ? . Your opinion will be highly appreciated . Thank you in advance .
doctor
Answered by Dr. Panagiotis Zografakis (10 hours later)
Brief Answer:
Please read the full answer

Detailed Answer:
Let me start with the easy one... the numbness is normal when you sleep on your arm. Since it goes away really fast, there are no concerns.

Obesity may provide a potential explanation for the high ferritin levels. Sometimes obese individuals accumulate fat in their livers. Too much fat may cause some sort of inflammation, which may trigger ferritin production.

Your current hematocrit should be compared with previous tests. If you had a much lower hematocrit in the past then investigation would be required.

Redness in the eye should be checked by an ophthalmologist. I would expect lateral redness to be something transient but you should check it anyway.

Regarding the headaches I don't have enough information to make a useful comment. Have you seen a neurologist? Do you have a diagnosis for the headaches? Have you done any MRI scans (head and cervical area)?

The tests that the endocrinologist suggested are not genetic ones. They are not common ones either but you should be able to find a lab to do them.

Please keep in mind that unusual or atypical symptoms may often be attributed to anxiety - after a careful investigation of course.

Please let me know if you'd like to discuss this further. I'll be back in a few hours and I'll be glad to answer any questions you may have.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Panagiotis Zografakis (0 minute later)
Brief Answer:
Please read the full answer

Detailed Answer:
Let me start with the easy one... the numbness is normal when you sleep on your arm. Since it goes away really fast, there are no concerns.

Obesity may provide a potential explanation for the high ferritin levels. Sometimes obese individuals accumulate fat in their livers. Too much fat may cause some sort of inflammation, which may trigger ferritin production.

Your current hematocrit should be compared with previous tests. If you had a much lower hematocrit in the past then investigation would be required.

Redness in the eye should be checked by an ophthalmologist. I would expect lateral redness to be something transient but you should check it anyway.

Regarding the headaches I don't have enough information to make a useful comment. Have you seen a neurologist? Do you have a diagnosis for the headaches? Have you done any MRI scans (head and cervical area)?

The tests that the endocrinologist suggested are not genetic ones. They are not common ones either but you should be able to find a lab to do them.

Please keep in mind that unusual or atypical symptoms may often be attributed to anxiety - after a careful investigation of course.

Please let me know if you'd like to discuss this further. I'll be back in a few hours and I'll be glad to answer any questions you may have.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (5 hours later)
Thank you so much for your reply .

1)-I attach here some blood test done last March 2019 & another RECENT one done this month 2020 regarding hematocrit . I am seeing a hematology doctor regarding this elevation of rbc . I have done some test (EPO & JAK2) , but still waiting results ... as I mentioned before , specialized tests are sent to Germany , and results take 4 weeks to come back . I asked about the tests (5-HiAA, ....etc) , these tests must be sent to Germany . So you can imagine the time & cost involved .

2- As I mentioned in my questions , the other symptoms I have (headache , watering eye , ... etc ) are mild and do not bother me much . My real problem is the hot body parts particularly the neck which radiates the heat up to the neck .

3- I did CT scan for the brain , and it is clear with no abnormalities found .

4- Could not do MRI cause of obesity .

5- abdominal ultrasound is also clear with normal size of liver , kidney and prostate & enzymes of these are ok as revealed in the blood test .

6- I noticed something I d like to mention , evening , when I lay down on sofa or on bed , the hot/warm feeling disappear and the body feels normal temperature quickly . Again , when waking up the hot body sensation starts again .

7- After doing venesection , the ferritian gone down to 403 from previously 533 .and I am watching my food nowadays with respect to iron reach food .

8- I have not seen an eye doctor nor a nerve doctor yet .

9- ESR &CRP is little elevated , but the rheumatoic factor is negative .

10- the headache is mild and always and on the left side only just above the ear .




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Follow up: Dr. Panagiotis Zografakis (0 minute later)
Thank you so much for your reply .

1)-I attach here some blood test done last March 2019 & another RECENT one done this month 2020 regarding hematocrit . I am seeing a hematology doctor regarding this elevation of rbc . I have done some test (EPO & JAK2) , but still waiting results ... as I mentioned before , specialized tests are sent to Germany , and results take 4 weeks to come back . I asked about the tests (5-HiAA, ....etc) , these tests must be sent to Germany . So you can imagine the time & cost involved .

2- As I mentioned in my questions , the other symptoms I have (headache , watering eye , ... etc ) are mild and do not bother me much . My real problem is the hot body parts particularly the neck which radiates the heat up to the neck .

3- I did CT scan for the brain , and it is clear with no abnormalities found .

4- Could not do MRI cause of obesity .

5- abdominal ultrasound is also clear with normal size of liver , kidney and prostate & enzymes of these are ok as revealed in the blood test .

6- I noticed something I d like to mention , evening , when I lay down on sofa or on bed , the hot/warm feeling disappear and the body feels normal temperature quickly . Again , when waking up the hot body sensation starts again .

7- After doing venesection , the ferritian gone down to 403 from previously 533 .and I am watching my food nowadays with respect to iron reach food .

8- I have not seen an eye doctor nor a nerve doctor yet .

9- ESR &CRP is little elevated , but the rheumatoic factor is negative .

10- the headache is mild and always and on the left side only just above the ear .




doctor
Answered by Dr. Panagiotis Zografakis (24 minutes later)
Brief Answer:
it's not a typical symptom

Detailed Answer:
Hi,

I understand the difficulty of having to send to tests to another country and with little hope of finding what's wrong because none of your symptoms is specific for any disease.
Regarding the headache, there are certain characteristics that may make a doctor worry about it. These include (but are not limited to) prior history of head injury, a very sudden and severe headache, neurological symptoms (like localized weakness or sensory deficits), etc. Chronic headaches that come and go and last for years are rarely serious in etiology.

The MRI scan provides more details about the brain tissue and may detect diseases like mutliple sclerosis much better than the CT scan.
Having a normal ultrasound scan and being obese is kind of surprising because many overweight (or obese) individuals have fatty liver disease.

The warmth you're feeling on the chest is not a typical symptoms of any kind of disease. Sometimes diseases of the heart or esophagus may present with atypical symptoms but the rest of your story does not fit. Heart problems typically get worse with physical activity and better with inactivity.

Your ferritin levels are still very high despite the venesection. I suppose you've done a bone marrow test. Were the iron stores full or not? Have you done the TIBC test (total iron binding capacity)?

High ESR may be caused by a multitude of disorders, so this is not helpful. It does require investigation though. If you haven't done serum protein electrophoresis, total protein and albumin levels then I suggest you do them too.

The ophthalmologist's examination is essential I'm afraid because it may reveal signs of autoimmune disorders, even if the symptoms are mild.

Finally I should suggest another neurological 'diagnosis' (as an atypical presentation) which is epilepsy. Both multiple sclerosis and epilepsy are diagnoses that have to be discussed with a neurologist.

If you have more questions, please do not hesitate to text me again.

Best Regards,
Dr Panagiotis Zografakis
Internal Medicine Specialist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Panagiotis Zografakis (0 minute later)
Brief Answer:
it's not a typical symptom

Detailed Answer:
Hi,

I understand the difficulty of having to send to tests to another country and with little hope of finding what's wrong because none of your symptoms is specific for any disease.
Regarding the headache, there are certain characteristics that may make a doctor worry about it. These include (but are not limited to) prior history of head injury, a very sudden and severe headache, neurological symptoms (like localized weakness or sensory deficits), etc. Chronic headaches that come and go and last for years are rarely serious in etiology.

The MRI scan provides more details about the brain tissue and may detect diseases like mutliple sclerosis much better than the CT scan.
Having a normal ultrasound scan and being obese is kind of surprising because many overweight (or obese) individuals have fatty liver disease.

The warmth you're feeling on the chest is not a typical symptoms of any kind of disease. Sometimes diseases of the heart or esophagus may present with atypical symptoms but the rest of your story does not fit. Heart problems typically get worse with physical activity and better with inactivity.

Your ferritin levels are still very high despite the venesection. I suppose you've done a bone marrow test. Were the iron stores full or not? Have you done the TIBC test (total iron binding capacity)?

High ESR may be caused by a multitude of disorders, so this is not helpful. It does require investigation though. If you haven't done serum protein electrophoresis, total protein and albumin levels then I suggest you do them too.

The ophthalmologist's examination is essential I'm afraid because it may reveal signs of autoimmune disorders, even if the symptoms are mild.

Finally I should suggest another neurological 'diagnosis' (as an atypical presentation) which is epilepsy. Both multiple sclerosis and epilepsy are diagnoses that have to be discussed with a neurologist.

If you have more questions, please do not hesitate to text me again.

Best Regards,
Dr Panagiotis Zografakis
Internal Medicine Specialist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (1 hour later)
Thank you very much for your quick reply . Thank you very much for being so professional , helpful and friendly . I really appreciate your patient with me . The time & effort you are spending trying to help me indicates how kind you are .

1) I attached here the CT scan report I got for the brain .
2) I also attached the ultrasound for the abdominal . Yes it shows fatty liver , but I was told there is nothing to worry about . This fatty liver I had also in an old abdominal test ultrasound done 1 year ago .
3- For the iron tests , please see attached results . I have done iron serum & ferretin .
4- For the hemoglobin and rbc , I ordered something called JAK2 mutation and EPO . These tests are to exclude polytheism vera . Results not yet arrived .

5- One of the GP doctor I have seen suggested that the hot body might be due to low T- hormone (testerionne) . I have done the test and results might be ready after tomorrow .

6- Some internal medicine , suggested that the hot body is due to high red blood cells . But after the venesection , the hemoglobin went down but I still have the same feeling of hotness . I have bought a hemoglobin monitoring device at home and I am checking . I am getting lower reading than before (16.7) .

7- I don't think elipsey is my problem . Why ? I have a close family member who has elipsey and I see the seizures and other symptoms that appear . (Memory problem /difficulty understanding /.....etc) I don't have any of these .

Kindly see the attached . Might help in advising me what test more necessary and which specialist I might need to see in order to figure out the problem .
Once again thank you for your time .

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Follow up: Dr. Panagiotis Zografakis (0 minute later)
Thank you very much for your quick reply . Thank you very much for being so professional , helpful and friendly . I really appreciate your patient with me . The time & effort you are spending trying to help me indicates how kind you are .

1) I attached here the CT scan report I got for the brain .
2) I also attached the ultrasound for the abdominal . Yes it shows fatty liver , but I was told there is nothing to worry about . This fatty liver I had also in an old abdominal test ultrasound done 1 year ago .
3- For the iron tests , please see attached results . I have done iron serum & ferretin .
4- For the hemoglobin and rbc , I ordered something called JAK2 mutation and EPO . These tests are to exclude polytheism vera . Results not yet arrived .

5- One of the GP doctor I have seen suggested that the hot body might be due to low T- hormone (testerionne) . I have done the test and results might be ready after tomorrow .

6- Some internal medicine , suggested that the hot body is due to high red blood cells . But after the venesection , the hemoglobin went down but I still have the same feeling of hotness . I have bought a hemoglobin monitoring device at home and I am checking . I am getting lower reading than before (16.7) .

7- I don't think elipsey is my problem . Why ? I have a close family member who has elipsey and I see the seizures and other symptoms that appear . (Memory problem /difficulty understanding /.....etc) I don't have any of these .

Kindly see the attached . Might help in advising me what test more necessary and which specialist I might need to see in order to figure out the problem .
Once again thank you for your time .

doctor
Answered by Dr. Panagiotis Zografakis (1 hour later)
Brief Answer:
the reports are not diagnostic

Detailed Answer:
Thanks for the additional information!

1- The CT scan is absolutely normal although (as implied in my previous answer) it's not 100% certain. The MRI scan may be necessary to diagnose various disorders, including multiple sclerosis.

2- The US scan and fatty liver disease may explain - at least partly - the high ferritin levels. There's nothing in the report to explain your symptoms. And polycythemia is very unlikely with a normal liver and spleen size.

3- Serum iron and ferritin can - sometimes - be misleading. The TIBC may complement the other tests and bone marrow examination is the most definite way to make sure that a patient has enough iron.

4- The gene tests would be helpful if positive.

5- I can't say whether it's the testosterone or not. Some men experience hot flushes that resemble the symptoms of menopause.

6- Some individuals have high hemoglobin values (as high as yours) without any symptoms or medically justified concerns. Comparing your current levels with older reports (months or -better- years) would be very helpful.

7- Epilepsy doesn't have to manifest with blatant symptoms. The seizures occur mostly in grand-mal epilepsy. There are too many forms of this disease and some of them may only manifest with an abnormal sensation. You should discuss this subject with a neurologist.

I've checked all the tests you've uploaded. I can't contribute anything more than what I've already said. If (or when) you have more information I'll be glad to comment on that too!
In the meantime, I would suggest visiting an ophthalmologist and a neurologist for further assessment as the first step of this investigation.

Kind Regards!


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Panagiotis Zografakis (0 minute later)
Brief Answer:
the reports are not diagnostic

Detailed Answer:
Thanks for the additional information!

1- The CT scan is absolutely normal although (as implied in my previous answer) it's not 100% certain. The MRI scan may be necessary to diagnose various disorders, including multiple sclerosis.

2- The US scan and fatty liver disease may explain - at least partly - the high ferritin levels. There's nothing in the report to explain your symptoms. And polycythemia is very unlikely with a normal liver and spleen size.

3- Serum iron and ferritin can - sometimes - be misleading. The TIBC may complement the other tests and bone marrow examination is the most definite way to make sure that a patient has enough iron.

4- The gene tests would be helpful if positive.

5- I can't say whether it's the testosterone or not. Some men experience hot flushes that resemble the symptoms of menopause.

6- Some individuals have high hemoglobin values (as high as yours) without any symptoms or medically justified concerns. Comparing your current levels with older reports (months or -better- years) would be very helpful.

7- Epilepsy doesn't have to manifest with blatant symptoms. The seizures occur mostly in grand-mal epilepsy. There are too many forms of this disease and some of them may only manifest with an abnormal sensation. You should discuss this subject with a neurologist.

I've checked all the tests you've uploaded. I can't contribute anything more than what I've already said. If (or when) you have more information I'll be glad to comment on that too!
In the meantime, I would suggest visiting an ophthalmologist and a neurologist for further assessment as the first step of this investigation.

Kind Regards!


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Panagiotis Zografakis (4 hours later)
Thank you very much for the detailed reply . It was really helpful . I 'll visit ophthalmologist and a neurologist as advised . Hopefully nothing serious will be the outcome . Once again , thank you very much for your time & effort trying to help me . It was of great help getting your opinion on my case . I 'll be in contact once I get the results of the gene tests . I hope you don't mind .
Thank you again .
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Follow up: Dr. Panagiotis Zografakis (0 minute later)
Thank you very much for the detailed reply . It was really helpful . I 'll visit ophthalmologist and a neurologist as advised . Hopefully nothing serious will be the outcome . Once again , thank you very much for your time & effort trying to help me . It was of great help getting your opinion on my case . I 'll be in contact once I get the results of the gene tests . I hope you don't mind .
Thank you again .
doctor
Answered by Dr. Panagiotis Zografakis (43 minutes later)
Brief Answer:
You're welcome!

Detailed Answer:
You're welcome!

And yes, please do keep me posted!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Panagiotis Zografakis (0 minute later)
Brief Answer:
You're welcome!

Detailed Answer:
You're welcome!

And yes, please do keep me posted!
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

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Thank You So Much For Your Reply . I Am

Thank you so much for your reply . I am a male . So no menopause . I did testosterone test . Waiting results . The blood tests & ultra sound show normal liver & kidney . I have been having this symptom of hot body for a month now . That is why I started doing the tests . I don't have sweating though . Regarding the high hemoglobin , my doctor told me it because of smoking & obesity . I am doing venesection weekly (100 mL) of blood is removed . And I am getting better reading with respect to hemoglobin now but the hot sensation is still present . I don't have stomach pain or deirihia . I have other symptoms sometimes (left reddish eye with water like discharge , I have left back neck pain , left head headache & numbness on left hand , that is only if I sleep on my left side so I wake up with a numbness on the left arm that lasts for a minute , If I sleep on my right hand , there is no numbness ) . I did tests for stroke . No stroke . Heart is ok . That is why I started to think , maybe it is a nerve problem since all the symptoms are happening on my left side . These symptoms are not bothering me as the hot warm sensation does . Do not you think that a nerve can cause this hot feelings in the light of the other symptoms I mentioned ? . Regarding the tests suggested by the other doctor and you mentioned them in your reply , are these normal tests available in labs or they are so specialised (genetic ) ? Cause most of the labs where I live can't do (genetic testing ) and have to send it to Germany which means long time waiting for results & high cost . Do you think a visit to a rheumatologist might be of some benefit ? Or seeing a nerve specialists might give us a clue of what is going on with me ? . Your opinion will be highly appreciated . Thank you in advance .