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Treatment for AUTONOMIC NEUROPATHY, ACHALASIA, OSTEOPOROSIS.

Resolved Question:

47 yr. old male active and healthy until diagnosed with severe osteoporosis in 2008. I had multiple rib fractures which led to the BMDS. T-Score lower spine -3.1
Past three years old patientsuffered from chronic nausea. Two months ago diagnosed with
acid/reflux, achlaysia type 1 (my esophagus was stretched open surgically), fructose malabsorption and low oxygen levels during nighttime oximeter test (not sleep apnea) and
two QSART neurological tests showed autonomic neuropathy. However, my G.I. and Neurologist believe that these diagnoses are symptoms of an undiagnosed disease. Two weeks ago my Neurologist ordered the following tests but we have not spoken yet as we await paraneoplastic antibody results. Two weeks feels like a lifetime when sick so any insight would be helpful. I'm hopeful yet prepared for any diagnosis so please be frank.

Platelet increase from 288 in 2011, 330 in 2012 and 442 August 2014
Increasing Protein total serum, now 8.5 g/dL
MPA IgG serum 1400 mg/dl
MPA IgA serum 239
MPA IgM serum 85
MPA Kappa serum 1140 mg/dl
MPA Lambda serum 656, K/L ratio 1.74
No M protein identified
Lactate 0.5 mmol/L
TP 8.2 g/dl
All other blood tests (WBC, RBC, etc. were normal)

Should I see a Hematologist and if so, should I see a specialist? What further testing would you recommend? Thanks.

Category: Hematologist

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Category: Hematologist
 21 Doctors Online

Hello,
Thank you for your query at DoctorSpring.com
With the background of multiple bone problems and elevated proteins, I would suggest to rule out a plasma cell disorder, most commonly multiple myeloma.
Please ask your physician if he can order an electrophoresis study and bone marrow evaluation.
Kindly revert back after doing all investigations. Also can you send me all the scanned reports?
It will help me in getting a better picture.
Regards.


Patient replied :

Thank you for your reply. I will upload my reports later when I can get to work for a scanner. It appears that my Total Protien along with the IgG and Lambda are only slighly elevated. The IgA is elevated but just barely and the IgM is on the low end of normal. Platelets have increased slowly over three years old patientfrom 288 to 442. Am I over-reacting by wanting to see a hematologist or do these readings warrant an appointment? Based on the limited information I gave you is Amyloidosis a possibility? Can plasma cell abnormalities cause nausea, G.I. issues and Autonomic Neuropathy? I should also mention that I have had cubital tunnel surgery (ineffective) and that I have tingling in both forearms and hands. Thanks


Hello,
I could guess few probable diagnosis but need a complete review all reports , present and past , before I comment further.
Also, I need complete clinical information. I need your entire clinical detailed history. How long were you having carpal tunnel syndrome ?? Did they stain any specimen ?
Please send all reports for reviewing to help you better .
Regards


Patient replied :

I understand that making a diagnosis via chat is problematic.. A neurologist ordered the tests listed above but based on the results I would like your opinion on if I should see more of a specialist like a hematologist or an oncologist? Also, can plasma cell abnormalities cause G.I. issues and autonomic neuropathy?. I will see whomever you suggest and this is my last question. Thank you and I await your reply.


A hematologist is a better person to consult in your case. You need some more investigation for finalizing your diagnosis
Regards.


Dr. Prasad Eswaran
Category: Hematologist
Experience: 
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

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