Multiple Sclerosis | Fibromyalgia | Vitamin B12 Deficiency - Which One is it?
When a patient presents at the surgery with complaints of feeling tired and multiple aches and pains it can be very difficult for the doctor to ascertain exactly what the diagnosis is.
There are many diseases and disorders that cause fatigue and general aches and pains but the three we are addressing today are Multiple Sclerosis, Fibromyalgia and Vitamin B12 Deficiency. All very similar in the way they present but very different in mechanism. There are many instances of misdiagnosis because the symptoms of each disorder are so similar.
Multiple Sclerosis or MS often starts in adults aged between 20 & 40 years of age. However; it is possible to begin showing symptoms at any age. No-one will have all of the symptoms listed.
Some early signs of MS are:
- Tingling in extremities
- Weak arm or leg
- Balance problems
- Burring of vision
- Lack of co-ordination
Often some symptoms come and go and others stay. No two cases of MS present in the same way; it is a very unpredictable disease. You may just have one symptom which stays with you and no others for many years. Or your symptoms may become serious in a very short time. Here is a long list of some later symptoms:
- Bladder problems
- Bowel problems
- Brain Fog
- Breathing problems (rare)
- Burning sensation
- Concentration problems
- Diminished sex drive
- Erection problems in men
- Lack of response to touch
- Muscle spasms and stiffness (legs)
- Pins and Needles
- Poor Memory
- Seizures (rare)
- Speech problems
- Stabbing pains
- Swallowing problems in later stages
- Vaginal dryness in women
- Vision problems
- Weak muscles
Symptoms are split into 3 groups. The first group are called Primary symptoms and are caused by a process called demyelination - damage to the myelin sheath. This affects the transmission of signals in the nerves because of the resultant scarring; which in turn causes lack of sensation or impairment of movement or some other action depending on the nerves which are attacked.
The second group of symptoms are the Secondary symptoms. For example, problems with balance can cause the secondary symptom of falling and broken bones.
The third group of symptoms are the Tertiary symptoms and these are the practical problems, psychological and social factors. There may be difficulty holding down a job because of mobility issues.
Is there more than one sort of MS?
There are 4 types of MS. The first type is called Primary Progressive Multiple Sclerosis which affects around 15% of people with the disease. This usually affects people around the age of 40 and men and women are equally susceptible. Primary progressive MS normally leads to disability in a shorter time span and symptoms worsen continually. There is negligible or no recovery at all between attacks, nor does this type of MS generally respond well to treatment.
The next type is Relapsing-Remitting Multiple Sclerosis and approximately 90% of sufferers have this type. Symptoms normally start in a younger age group than the primary progressive type at around the age of 20. The attacks are followed by periods of remission or partial recovery. The progress of the disease is variable as is the nerves affected. The vast majority of sufferers will enter the following stage of MS after a period of 10 - 20 years.
Secondary Progressive Multiple Sclerosis follows on from the previous type and like Primary Progressive MS, will continue to worsen without remission. This type of MS is difficult to live with and some degree of disability will be experienced in most cases. The nerves become less inflamed but degenerate more quickly. Treatments are only partially effective. If someone is older when diagnosed or hasn’t recovered fully from initial relapses the disease tends to become secondary progressive within a shorter time frame.
A rare form of the disease is Progressive Relapsing MS which affects approximately 5% of sufferers. Attacks occur at intervals but symptoms continue to progress.
How is MS diagnosed?
Because it is notoriously difficult to diagnose MS, due to the fact that it mimics so many other disorders; doctors have screen out those other conditions. It may be helpful to keep a record of your symptoms as they come and go as this can help with diagnosis.
MRI Scan of the spine and brain to determine damage to the myelin sheath
Neurological examinations - If reduced nerve function resulting in numbness or abnormal sensation, impaired ability to move one or more parts of the body or abnormal nerve reflexes are seen; the medical professional may suspect Multiple Sclerosis.
Lumbar Puncture to analyse cerebrospinal fluid
Eye examinations can show problems with visual acuity (clarity and acuteness of vision), abnormal pupil reaction, nystagmus (uncontrolled vertical or horizontal eye movements), alteration of the field of vision or various other problems with the optic nerve and interior of the eye.
MS treatment for 82p per day
In the UK controversy rages over a drug which costs just £300 per annum or 82p per day when bought privately. LDN or Low Dose Naltrexin is routinely prescribed in the United States for the treatment of MS and other auto-immune diseases like Fibromyalgia, Crohns Disease and some cancers. In the UK however, it is used as an opoid antagonist at a dosage of 50mg for the treatment of Heroin addiction.
Because it is not licensed to treat MS and has not been trialled, NHS practitioners are unwilling to prescribe it; although it has been reported to greatly improve symptoms when taken at a tiny dosage of 3 to 4.5 mg. There are a few enlightened private practitioners in the UK who will prescribe it for the off label usage of treating MS.
There are many testimonials to its effectiveness on the ldnresearchtrust.org website. The LDN Research Trust is a non-profit-making Registered Charity, and everyone is a volunteer. If you are unable to persuade your doctor to prescribe this drug the LDN research trust hold a list of doctors who are willing to use it off label.
Fibromyalgia is a long term disorder which can continue for months or even years. It causes pain and discomfort in the tendons, muscles, joints and soft tissues of the body. The joints are not actually affected but the pain is felt in them. Fibromyalgia is more common in women aged between the ages of 20 and 50 than men. The cause is unknown but it is thought that stress, sleep problems and mental or physical trauma can be factors. The pain, which is often described as aching, burning or shooting can be anything from mild to severe
- Abdominal pain, nausea, bloating and IBS
- Brain fog
- Concentration problems
- Difficulty sleeping/un-refreshing sleep
- Facial pain and tenderness
- Fatigue and lack of energy
- Feeling the cold more
- Food allergies
- Irritable bladder
- Light sensitivity
- Memory problems
- Muscle pain, stiffness or spasms
- Numbness of hands, arms, feet or legs
- Reaction to medication
- Reduced tolerance to exercise
- Sensitivity to smells
- Stiffness after remaining in one position
- Tingling sensations in face or extremities
Tests to determine diagnosis
Blood or urine tests – this will rule out other conditions rather than diagnose Fibromyalgia
There are 18 tender points on the body. To have a firm diagnosis of Fibromyalgia you must have pain or discomfort in 11 of those areas
Is there any treatment?
The aim is to manage, rather than cure the condition by helping the patient to cope with the symptoms, controlling the pain and improving sleep quality. Before prescribing medications other avenues will be explored. Massage, exercise or physiotherapy (be aware that many physiotherapists do not recognise the disorder). If relief isn’t effected by any of these the doctor may consider muscle relaxant or anti-depressant medications. Cognitive behavioural therapy is increasingly being used and there are now approved drugs for the treatment of Fibromyalgia.
Vitamin B12 Deficiency
Vitamin B12 deficiency often occurs in vegetarians and vegans. This is because of the lack of foods containing B12 in their diet. Cobalamin is only naturally present in animal products which some vegetarians and all vegans do not eat. Even if dairy products and eggs are eaten they probably will not ingest enough B12 to meet the recommended daily allowance. Newborns of vegetarian and vegan mums can be deficient in the vitamin. Deficiency also occurs in individuals who for some reason cannot absorb the vitamin. There are a number of conditions which can prevent absorption. Here are 6:
- Atrophy of the stomach lining – Atrophic Gastritis
- Crohn’s Disease
- Coeliac Disease
- Graves Disease
- Pernicious anaemia
What are the symptoms of B12 deficiency?
- Eye Twitches
- Facial pain
- Sharp pains in hands
- Shortness of Breath
- Sores at corners of mouth
- Sore painful tongue
- Tingling of extremeties
- If left untreated B12 deficiency can cause permanent nerve damage which could cause the following symptoms:
- Damage to liver and spleen
- Memory Loss
- Numbness in extremities
- Rapid heartbeat
- Visual problems
- Walking difficulties
How is B12 deficiency diagnosed?
Blood tests and the presence of some of the symptoms above can diagnose the deficiency.
Ensure you eat a balanced diet with sufficient poultry, fish, cheese, eggs and meat. Eat cereals fortified with vitamin B. Take a multivitamin tablet if you feel you are not eating enough animal protein.
B12 replacement by injection will be given to patients who have absorption problems or pernicious anaemia. If this is the case replacement may need to be given for life. For those who can absorb vitamin B, supplements in tablet or nugget form can be effective.
It is easy to understand why it's so difficult to diagnose all of these conditions. There are many others that present with similar symptoms and the only way to work out exactly which disorder you have is by process of elimination and various tests.
A few weeks ago I was completely convinced I had MS as I had almost every symptom. Thankfully it turned out to be my thyroid gland which was out of whack; so there's yet another disorder with similar symptoms!
© Susan Bailey 2013 All Rights Reserved
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