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What Does The Following Test Result Indicate?
Question: Hi,
I am 28 years male. I have no history of any disease, expect hair loss. One of the hair loss doctors in Bangalore(Dr, XXXXXXX Shamsher) asked to get my Vitamin D, thyroid and serum ferritin assessed. This was in XXXXXXX 2012. below were my results:
Thyroid: Normal
Vit D: 7 ng/ml
serum ferritin: 41 ng/ml
MEAN CORPUSCULAR VOLUME 70 fL
MEAN CORPUSCULAR HEMOGLOBIN 21 pg
MEAN CORP.HEMO.CONC 31 %
HEMOGLOBIN: 14.5
RED CELL DISTRIBUTION WIDTH (RDW CV): 16.4 fl
TOTAL RBC: 6.79 X 10^6/μL
He prescribed me calricol XXXXXXX for 3 months and Dex Orange Iron capsules.
I again went for a re evaluation after 6 months and my Ferittin was 50 ng/ml and Vit D was 25 ng /ml(as of Dec 2012)
Then In Dec 2013 I started feeling mild shoulder and chest tingling with mild breathlessness while climbing stairs. I went for a ECG and 2D echo and results came normal. Doc suggested anxiety.
Then in May 2014, I went for a basic checkup with my family doctor and he prescribed a X ray of neck and he told arm tingling and shoulder pain is due to cervical. He suggested he some exercises.
Then Recently in Bangalore(Oct 2014) again I started feeling very mild breathlessness specially while exposed to atmosphere, not in a room or gym.I went to doctor and he suspected allergy from XXXXXXX climate. He suggested a Lungs X ray, allergy tests and Vit b12 asessment.following were my result.
ABSOLUTE EOSINOPHIL COUNT : 250 cells/Qumm
TOTAL IGE- IMMUNOGLOBULIN-E: 77 IU/ml
Vit B 12: 202pg/ml
Lungs X ray: normal.
He told breathlessness is due to B12 deficiency and suggested me Nurokind 1000 mcg injections for a period of year ,initially 7 shots in 7 days, then weekly for month and then monthly. I already took 9 injections.
but still sometimes I feel very mild breathlessness from nose while exposed to outside atmosphere (Like the one felt when in excitement and anxiety) and mild pain in neck and shoulder (due to cervical).
Its not that serious that I feel weakness and fatigue, but it makes me uncomfortable.When I am rest, I have absolutely no problem. I also use to go to gym and run on treadmill, there also I didn't felt any major issue. but its mostly when I go out and walk in atmosphere.
I am confused as even doctors dont have a concrete answer. Please suggest me what to do?
Does Vit B12 injections takes time to fill up the deficiency? I am also taking dex orange and calcirol(once /month) to fill out my Iron and D deficiencies. I am also doing cervical expercises.
I am 28 years male. I have no history of any disease, expect hair loss. One of the hair loss doctors in Bangalore(Dr, XXXXXXX Shamsher) asked to get my Vitamin D, thyroid and serum ferritin assessed. This was in XXXXXXX 2012. below were my results:
Thyroid: Normal
Vit D: 7 ng/ml
serum ferritin: 41 ng/ml
MEAN CORPUSCULAR VOLUME 70 fL
MEAN CORPUSCULAR HEMOGLOBIN 21 pg
MEAN CORP.HEMO.CONC 31 %
HEMOGLOBIN: 14.5
RED CELL DISTRIBUTION WIDTH (RDW CV): 16.4 fl
TOTAL RBC: 6.79 X 10^6/μL
He prescribed me calricol XXXXXXX for 3 months and Dex Orange Iron capsules.
I again went for a re evaluation after 6 months and my Ferittin was 50 ng/ml and Vit D was 25 ng /ml(as of Dec 2012)
Then In Dec 2013 I started feeling mild shoulder and chest tingling with mild breathlessness while climbing stairs. I went for a ECG and 2D echo and results came normal. Doc suggested anxiety.
Then in May 2014, I went for a basic checkup with my family doctor and he prescribed a X ray of neck and he told arm tingling and shoulder pain is due to cervical. He suggested he some exercises.
Then Recently in Bangalore(Oct 2014) again I started feeling very mild breathlessness specially while exposed to atmosphere, not in a room or gym.I went to doctor and he suspected allergy from XXXXXXX climate. He suggested a Lungs X ray, allergy tests and Vit b12 asessment.following were my result.
ABSOLUTE EOSINOPHIL COUNT : 250 cells/Qumm
TOTAL IGE- IMMUNOGLOBULIN-E: 77 IU/ml
Vit B 12: 202pg/ml
Lungs X ray: normal.
He told breathlessness is due to B12 deficiency and suggested me Nurokind 1000 mcg injections for a period of year ,initially 7 shots in 7 days, then weekly for month and then monthly. I already took 9 injections.
but still sometimes I feel very mild breathlessness from nose while exposed to outside atmosphere (Like the one felt when in excitement and anxiety) and mild pain in neck and shoulder (due to cervical).
Its not that serious that I feel weakness and fatigue, but it makes me uncomfortable.When I am rest, I have absolutely no problem. I also use to go to gym and run on treadmill, there also I didn't felt any major issue. but its mostly when I go out and walk in atmosphere.
I am confused as even doctors dont have a concrete answer. Please suggest me what to do?
Does Vit B12 injections takes time to fill up the deficiency? I am also taking dex orange and calcirol(once /month) to fill out my Iron and D deficiencies. I am also doing cervical expercises.
Brief Answer:
A possible psychological somatic complaints.
Detailed Answer:
Hi,
Thanks for the query. I understand your concern.
From the complaints and the investigations you have undergone, it appears that you have generalized feeling of fatigue, shoulder radiating pain in cervical region and mild vitamin D deficiency, for which you were taking calcitriol XXXXXXX And have also taken vitamin B12 neurokind doses.
Despite all your investigations are normal.
Well,
Firstly these investigations was needed as to rule out any organic or medical pathology. Vit. D deficiency is very common in our nation therefore not a surprising finding. Vit. B 12 levels being low again is a very common finding as Indians are predominantly vegetarians. Therefore nothing wrong majorly with the above two findings. Rest all tests are unremarkable.
Therefore, we have discovered that despite non organic or medical pathology you persist to have symptoms.
It strongly appears to me a case of psychological somatic complaints with a possible underlying depression like features.
Cervical pain and tension headache are most common presenting somatic complaints found in this case. An associated fatigability and sleep problem are also common.
I suggest you consult a psychiatrist, he may consider adding SSRI and probe for depression causes.
Dr Pankaj Borade
A possible psychological somatic complaints.
Detailed Answer:
Hi,
Thanks for the query. I understand your concern.
From the complaints and the investigations you have undergone, it appears that you have generalized feeling of fatigue, shoulder radiating pain in cervical region and mild vitamin D deficiency, for which you were taking calcitriol XXXXXXX And have also taken vitamin B12 neurokind doses.
Despite all your investigations are normal.
Well,
Firstly these investigations was needed as to rule out any organic or medical pathology. Vit. D deficiency is very common in our nation therefore not a surprising finding. Vit. B 12 levels being low again is a very common finding as Indians are predominantly vegetarians. Therefore nothing wrong majorly with the above two findings. Rest all tests are unremarkable.
Therefore, we have discovered that despite non organic or medical pathology you persist to have symptoms.
It strongly appears to me a case of psychological somatic complaints with a possible underlying depression like features.
Cervical pain and tension headache are most common presenting somatic complaints found in this case. An associated fatigability and sleep problem are also common.
I suggest you consult a psychiatrist, he may consider adding SSRI and probe for depression causes.
Dr Pankaj Borade
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thanks for your answer and patiently reading my concern.
yes, I am a vegetarian. I also keep thinking that my Vit D, Ferritin , Vit B12 is low all the time. I also feel that I only had ECG and 2D echo, should I go for a TMT also to rule out anything serious??
I also have basic life stress like career and future(which everybody has). I need my body to be in 100% healthy state to so that I can proceed with my career plans without any hindrance and make big in life. thats why I am so particular on my health
having said that, I think I am pretty rational on my mild breathlessness while exertion and it is not caused by any kind of stress or psychological stuff.
Does Cervical radiating pain can also can mild breathlessness?
Does it takes time fill up Vit b12 deficiency after starting injection treatment?
Is Iron 45 ng/ml low enough?
Thanks for your patience.
Regards,
XXXX
yes, I am a vegetarian. I also keep thinking that my Vit D, Ferritin , Vit B12 is low all the time. I also feel that I only had ECG and 2D echo, should I go for a TMT also to rule out anything serious??
I also have basic life stress like career and future(which everybody has). I need my body to be in 100% healthy state to so that I can proceed with my career plans without any hindrance and make big in life. thats why I am so particular on my health
having said that, I think I am pretty rational on my mild breathlessness while exertion and it is not caused by any kind of stress or psychological stuff.
Does Cervical radiating pain can also can mild breathlessness?
Does it takes time fill up Vit b12 deficiency after starting injection treatment?
Is Iron 45 ng/ml low enough?
Thanks for your patience.
Regards,
XXXX
Brief Answer:
Iron not low, cervical pain can't cause breathlessness.
Detailed Answer:
I appreciate your concern.
Your normal ECG and 2D echo rules out possibility of breathlessness due to cardiac causes. Going for TMT will hardly yield any abnormality. Besides, your ferritin levels are on lower side but normal, haemogram is normal therefore fatigue and breathlessness due to anaemia is ruled out.
Vit b12 and vit d would have restored by now and it's rare to find breathlessness and radiating pain due to these deficiencies. An X-Ray show no abnormality in cervical spine(you can go for better investigation of MRI spine) therefore no cause there.
Now, why the possibility of psychological cause is because, in certain individuals the psychological stress can manifest into physical symptoms like general fatigue and neurological symptoms(pain in shoulder in your case), it's known as somatization. These conflicts are at unconscious levels in mind, therefore are difficult for an individual to appreciate. It's a diagnosis of exclusion, when all investigations are normal.
A Short course of antidepressant is effective here.
Welcome for further queries.
Thank you
Dr Pankaj Borade
Iron not low, cervical pain can't cause breathlessness.
Detailed Answer:
I appreciate your concern.
Your normal ECG and 2D echo rules out possibility of breathlessness due to cardiac causes. Going for TMT will hardly yield any abnormality. Besides, your ferritin levels are on lower side but normal, haemogram is normal therefore fatigue and breathlessness due to anaemia is ruled out.
Vit b12 and vit d would have restored by now and it's rare to find breathlessness and radiating pain due to these deficiencies. An X-Ray show no abnormality in cervical spine(you can go for better investigation of MRI spine) therefore no cause there.
Now, why the possibility of psychological cause is because, in certain individuals the psychological stress can manifest into physical symptoms like general fatigue and neurological symptoms(pain in shoulder in your case), it's known as somatization. These conflicts are at unconscious levels in mind, therefore are difficult for an individual to appreciate. It's a diagnosis of exclusion, when all investigations are normal.
A Short course of antidepressant is effective here.
Welcome for further queries.
Thank you
Dr Pankaj Borade
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thanks for the detailed answer.
When I move my head left and right I feel radiating pain in neck and shoulder, so there is definitely something related to neck.
I will schedule a appointment with a orthopedic doctor for it.
I have goggled on somatic disorder, and I feel exactly the same mental symptoms as mentioned on internet. I have consulted 2 physicians, never satisfied with any one of them and feel that they are not serious on my symptoms and I feel that I may have some serious disease. since my MCV, MCHC and MCH is slightly low (although hemoglobin is normal) , I feel they ignore this finding.
I will try not to think negative and will not put much attention to breathlessness symptom.
considering my levels of Vit D(25 ng/ml), Vit B12(202 pg/ml) and iron(45 ng/ml), should I continue with supplements of all three?
When I move my head left and right I feel radiating pain in neck and shoulder, so there is definitely something related to neck.
I will schedule a appointment with a orthopedic doctor for it.
I have goggled on somatic disorder, and I feel exactly the same mental symptoms as mentioned on internet. I have consulted 2 physicians, never satisfied with any one of them and feel that they are not serious on my symptoms and I feel that I may have some serious disease. since my MCV, MCHC and MCH is slightly low (although hemoglobin is normal) , I feel they ignore this finding.
I will try not to think negative and will not put much attention to breathlessness symptom.
considering my levels of Vit D(25 ng/ml), Vit B12(202 pg/ml) and iron(45 ng/ml), should I continue with supplements of all three?
Brief Answer:
Continue for another 3 months only, an MRI spine
Detailed Answer:
Thanks or the follow up.
Yes, there could be a possibility of some pathology at cervical spine, I suggest an MRI spine will yield better findings, a chronic inflammation is likely with the presentation of symptoms.
For the vitamin levels, I would suggest to continue the supplements for another 3 months then stop as excess of vit. d and iron can be toxic, though vit. b supplements can be continued for 6 months. The tests can be repeated six months later.
In addition, I would still suggest a psychiatric consultation and consider a short course of SSRI group of medications.
Thanks.
Dr Pankaj Borade
Continue for another 3 months only, an MRI spine
Detailed Answer:
Thanks or the follow up.
Yes, there could be a possibility of some pathology at cervical spine, I suggest an MRI spine will yield better findings, a chronic inflammation is likely with the presentation of symptoms.
For the vitamin levels, I would suggest to continue the supplements for another 3 months then stop as excess of vit. d and iron can be toxic, though vit. b supplements can be continued for 6 months. The tests can be repeated six months later.
In addition, I would still suggest a psychiatric consultation and consider a short course of SSRI group of medications.
Thanks.
Dr Pankaj Borade
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Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
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