Should I Watch and Wait?

​Here is My Question:
Hi- Looking for advice on how to proceed. Symptoms for years that were initially attributed to "other things" then left thumb went numb which triggered a doctor visit. Year down the road and still being passed off from one specialty to the next and watched by neuro. Besides fatigue, which is constant all symptoms are intermittent. CT 1 year ago. EMG when left thumb was numb an that was normal. Evoked potentials auditory and visual this year normal. Brain MRI 1 yr ago, non specific white matter lesions differential of migraine, vasculitis or demylenating disease. Spine MRI clear. New MRI 1 week ago. Again non specific white matter lesions "mostly in frontal lobes" increased in number. Same differential.

Also had MRA which was normal. My ANA is negative, my ANCA is negative, all blood work is normal besides High cardiolipin and beta 2 immunogloulin but no embolisms, thrombosis etc. Symptoms included numbness in thumb x 3 months (resolved) right food 2 mod (resolved), intermittent numb/tingling mostly fingers sometimes feet, vertigo, left eyelid twitching, Raynauds, spatial issues, see floaters in shower/when hot, personality changes when hot (extremely irritable), off balance when hot, idiopathic allergic reactions, joint pain (constant left thumb since June), intermittent knees, muscle pain (times when back/neck muscles are so tight nothing helps including massage and chiropractic and meds, high NSAIDS), choking when drinking (on and off for years), then this month choked x 2 when eating. More but to keep it condensed….Should I go along with the watch and wait theory or do I push for a more aggressive plan? Help.

Answer:
WIthout knowing more about you, I would have to agree with the "watch and wait" approach with aggressive symptom management. Remember, we often don’t require a diagnosis to manage symptoms.

Spinal fluid analysis is very useful in cases like yours; the vast majority of people who have or will develop MS, have spinal fluid abnormalities that persist all the time regardless of the activity of the disease.

Good luck

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego