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Ask Dr. Gott 3/22
Wait-and-see approach to unexplained pain
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    DEAR DR. GOTT: Like most of your fans, I would like to start with a compliment. You always seem to have the answer to the questions that many of us have but believe are too insignificant or unimportant to ask our doctor. You never respond in a manner that belittles the person asking, and for that I say thanks.
    Now, my question. It is a bit complex, but I will try to be concise. In 2005, I started developing symptoms of peripheral neuropathy. After a consult with my family practitioner and a few preliminary tests that were negative, I was referred to a neurologist. While waiting for the appointment, I discontinued my Zocor and a mild antidepressant to see if symptoms declined. (One of Zocor's side effects is neuropathy.) Within a few weeks to a month, the symptoms declined somewhat. The neurologist continued with more tests. Most of them were normal. The milder neuropathy symptoms were and still are present but intermittent.
    When the results of my protein studies came back, including the paraneoplastic panel, my striated muscle levels were elevated. Because of this, my neurologist ordered a lung scan, which was negative. At that point, I was told to just wait and see if I had any symptoms that might suggest lung cancer.
    Since I am proactive in my health care, I did my own research online and found that small-cell lung cancer can be preceded by peripheral neuropathy before the onset of the disease. Several existing studies suggested that regular follow-up testing was advised because waiting for symptoms can result in poor prognosis if covert cancer is present. I reviewed this information with my family physician, who agreed with the wait-and-see approach of the neurologist.
    I had a repeat paraneoplastic panel one year later (2006), and the striated muscle portion was still elevated but lower than the first test.
    Is there anything you would recommend? Should I ask for a referral to a different specialist? I am not looking for trouble, but on the other hand, I do not want to ignore a problem if there is something I should or could be doing.
    DEAR READER: Your physicians have addressed your problem using excellent medical care. I agree with the wait-and-see approach, especially given the fact that your blood test improved during 2006. I do not know the cause of your neuropathy (nerve malfunction). If your symptoms are stable or improving, I would not worry too much. If you feel uncomfortable, speak with your neurologist or ask for a referral to another doctor for a second opinion. If your symptoms worsen, see your neurologist, who should order more tests and address possible issues, including treatment options.
    Continue with your yearly monitoring and follow your physician's advice. Good luck, and let me know how this turns out.
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