Neurologist report

Here's the report from a Neurologist on my case to whom I was referred to by an Internist. It's a good summary of my history (although with some minor mistakes in his interpretation and timing here and there). It shows how complex a case like this can become and how patients can be made to go in circle from specialist to specialist who fail to see the big picture (no unifying diagnosis).

Neurophysiology
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Electromyogram (EMG)
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The electrophysiologic study showed:

1. Normal left median motor conduction between elbow and thenar eminence.

2. Normal left ulnar motor conduction between distal humerus and hypothenar eminence.

3. Normal left median nad ulnar sensory conduction across the wrist.

4. Normal needle EMG of left deltoid, vastus medialis, extensor indicis propruis and triceps.

Interpretation
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The above study was normal.

Clinical Consultation
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This 38-year-old right-handed man, who works as a system administrator for a research laboratory at *********, was seen at the request of Dr.W***** in the EMG Laboratory on June 1, 2010. He was referred due to a finding of a syrinx on his MRI and fasciculations and sensory symptoms.

Mr. *TicksSuck*'s history dates from Sept. 2008. While camping in the Kingston area, he had a tick bite. He notes that he found a picture of the tick, which was the tick related to Lyme disease. He subsequently developed a rash. Following that, in Dec. or Jan. 2009, he noted a white object in the periphery of his eye, which lasted three months. His eye was examined during this time and, evidently there were no findings. He, in addition, developed tinnitus. Subsequently in the spring, he developed right knee pain and left elbow pain. At times the pain was so severe that he had difficulty flexing his elbow. He noted twitching in his limbs and occasionally in his face. He was seen by Dr.C****** in the Infectious Diseases Clinic in July 2009, and completed a course of Doxycycline. He was further investigated for a number of infections including syphilis, HTLV, hepatitis a, B and C, along with HIV. Rheumatoid factor and ANA were negative. In addition, he had B12, folate and glucose levels, which were normal.

Subsequent to the course of Doxycylcine, he notes that he did not feel better. He does note, about 1-1/2 years ago, (before any treatment), a feeling of a surge in his neck, which he describes as a sensation as if liquid were moving up into the head. Subsequently, he had numbness in the left fingertips and toes, which lasted about one month and resolved. He has subsequently had tingling, which involved the whole body. The pain in the left elbow, and occasionally the right elbow, continued along with the right knee. He no longer has sensory symptoms. He does note widespread fasciculations. He has had a rash under his eyes and on his nose. He has taken some pictures of it with his iPhone. The pictures demonstrated a well-circumcised, flat, erythematous area just under the eyes and on the right side of the nose.

In 2009 he went to Dr.M******** in Plattsburgh, New York. He was treated with Amoxicillin, Probenecid, Metronidazole, Minocycline and Nystatin. He notes however that he did not complete all the courses of these drugs. Dr.C********* did demonstrate a vitamin D deficiency, and he has been taking vitamin D since that time. He does not feel he has improved.

There was no relevant past history.

He did have a MRI scan of the cervical spine done at the ********* Hospital, which demonstarted a small syrinx from T2 to T4. this syrinx had a maximal diameter of 2mm. There was no expansion of the cord or suggestion of another lesion accompanying the syrinx. He had a normal CT scan of the head done.

On examination, this was an alert, generally well-appearing man. His neurologic examination was normal. He had normal tone, bulk and power. Reflexes were normal and symmetrical and his gait was normal. Sensory examination was unremarkable. He did not have any phenomenon with neck flexion.

Assessment
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In summary, this 38-year-old man has had a number of symptoms since a tick bite in 2008. With regard to the specific questions posed in the referral, I do not feel that the syrinx is symptomatic. It would not explain widespread fasciculations. These fasciculations, in the face of a normal clinical and EMG examination, suggest benign fasciculations. I have discussed this with him. Mr. *TicksSuck* is understandably concerned about his condition and feels that the investigations that he has had have not helped in resolving his symptoms. He feels quite strongly that he has serologically negative Lyme disease. I have told him that I am not an expert in this area, nor in vitamin D deficiency, and these questions are best posed to Dr. W*********. He has had a number of antibiotics used without success. This would seem to mitigate against a diagnosis of Lyme disease. Nevertheless, I cannot pose a unifing neurologic diagnosis for his joint symptoms, rashes and other symptoms. The fasciculations in this setting do fit with benign fasciculations. With regard to tinnitus, I do not find evidence that this was investigated in the past. I would suggest a referral to ENT for audiogram and evaluation of the tinnitus. I shall leave this to the discretion of Dr. W*********. If there are other neuromuscular concerns, he could be re-evaluated in the EMG laboratory.

Dr. S*******, MD, FRCPC
Dictated date: 2010 Jun 01

Another day with an "unidentified" tick borne disease

Today, I think, is the start of another daydream-feeling period. I've been having those periods for the last year or so. They usually last for about a week and come back almost exactly one month after, with sometimes small relapses in between. I've been keeping a log...

Today, I woke up feeling fine. Nothing out of the ordinary. I had noticed stronger than usual fasciculations in the front of the left tight while trying to wake up. It lasted for maybe 10 sec. I drank my coffee while checking my emails and reading the news. I noticed that my left cheek felt a bit painful. The tinnitus in my left ear has been a bit more for the last few days. Later in the morning, after I parked my car at work, I noticed this dream-like state happening again. It's feeling as though I'm noticing movements in a delayed manner. This feeling is not constantly there, but lasts for periods of ~15min to hours. Today, it lasted for maybe 1h. In the afternoon, I started feeling numb on the left side of my face again. This too as happened before. Now, after more than a week feeling fine, all these things are coming back at once.

Is it Lyme disease? I did get bitten by a tick two years ago. Only noticed the tick after it was fully engorged. It most likely was after I came back from a camping trip in a region that's been shown endemic. I also did get multiple bruise like rashes in my back and around where I was bitten. As these events were not thought related at first, I did not get treated in time, but much later... About 6 months later with 6 weeks of doxycycline.

About myself: How I got Lyme (or whatever this TBD is)

I have contracted a tick borne disease back from a Camping trip at Charleston Lake, Ontario in the summer of 2008.

The reservation email confirms the date I was there:
"RESERVATION DETAILS:

Park Name: Charleston Lake Provincial Park
Reservation Date: Sat, Aug 16 2008
Arrival Date: Sat, Aug 30 2008
Departure Date: Sun, Aug 31 2008 before 2:00 pm
Site: 364
Site Type: Non-Electrical Campsite
"

Then, on Sept 8, 2008, I stayed home with a very bad pain in the lower right back area. This email sent to my boss dates it:

"Hello sir,

I woke up with a very bad pain in the back and I could barely move. I stayed in bed until now for it to pass... I must have slept in a bad position since I was fine yesterday.

Anyhow, it seems to be going away now, so I'll be coming to work shortly.
"

After this, I am not sure of the date since I did not pay much attention when it happened but, I had removed something from my left armpit. I didn't know what that thing was until much later, months after getting unexplained neurological symptoms... I did then easily recognize what this thing was, from looking at pictures of fully engorged nymph Ixode ticks.

At some other time later, I developed large elongated oval red rashes on the lower left back and side, with purple centers. They looked like bruises even though I did not recall getting hit there and they weren't painful to the touch. I found it weird that they were not painful, but I did think they were simple bruises at the time.