Which Medical Specialty Should I Consult for My Symptoms?

Q: Which Medical Specialty Should I Consult for My Symptoms?

Hello Ms. <br>Wang： The symptoms you mentioned are diverse, primarily including pain around the eyes, tightness and numbness in the head and neck, muscle twitching, tinnitus, shoulder pain, and dizziness. <br>First, we need to check if your blood pressure is within the normal ran

Which specialty should I see?

Hello, since January, I have been experiencing numerous health issues, particularly discomfort in my eyes and head/neck area.
I have undergone OCT, dilation, and fundus photography, which showed a red area in the right eye on the OCT, but my vision is normal (although my myopia fluctuated by one diopter).
One doctor mentioned that my optic disc might be naturally more prominent.
Currently, I have mild pain around my eyes, and I also experience pain when moving my eyeballs.

Initially, I had pain in the occipital region that prevented me from sleeping, and sometimes I experience sharp pain (on the left side).
Now, I have involuntary muscle twitches in various parts of my body at unpredictable times, especially at night when I feel something jumping or twitching in my head and neck.
Occasionally, I also experience tinnitus, and I cannot sleep on my side or stomach because it exacerbates the pain in my head, neck, and shoulders.
My left hand makes a cracking sound when I move it, and it feels like there is some misalignment or friction in my back.

Sometimes, I feel tightness and tingling on the left side of my head and neck, and both arms' outer sides also feel numb.
Additionally, I experience tingling in both big toes.
Mild dizziness has persisted for a month, particularly on the left side, which feels like I might float away.
I previously visited a rehabilitation clinic where an X-ray revealed mild cervical spondylolisthesis, and a neurosurgeon indicated that I have cervical degeneration.
However, a brain MRI performed by a neurologist showed no issues, and my eye examinations have also been largely unremarkable.

Given that neurological issues have been ruled out, which specialty should I consult next? Thank you.

Wang, 20~29 year old female. Ask Date: 2018/04/17

Dr. Chen Bozhang reply Family Medicine

Hello Ms.
Wang: The symptoms you mentioned are diverse, primarily including pain around the eyes, tightness and numbness in the head and neck, muscle twitching, tinnitus, shoulder pain, and dizziness.
First, we need to check if your blood pressure is within the normal range (100-130/60-85 mmHg).
Secondly, we should determine if there is any cervical spine displacement or degeneration that may be compressing the cervical nerve roots.
Have you undergone carotid ultrasound and electroencephalogram (EEG)? How did the physician interpret these tests, including MRI? This part may require clarification from a neurologist regarding your symptoms.
Additionally, it may be necessary to perform blood tests to check for abnormalities in hemoglobin, electrolytes, and endocrine function.
You can ask a physician in neurology or general internal medicine to order these tests to investigate potential physiological causes comprehensively.
Furthermore, some individuals experience these types of symptoms as psychosomatic manifestations, where internal stress and anxiety convert into physical symptoms.
If physiological causes do not sufficiently explain your condition, you may consider consulting a family medicine or psychosomatic medicine physician to explore whether these are manifestations of psychosomatic symptoms.
I hope this information is helpful to you.
Dr.
Chen Po-Chang, Department of Family Medicine, Keelung Hospital, Ministry of Health and Welfare.

Reply Date: 2018/04/17

More Info

Based on the symptoms you've described, it sounds like you're experiencing a complex interplay of issues involving your eyes, head, neck, and possibly neurological symptoms. Given the range of symptoms, including eye discomfort, neck pain, muscle twitching, and numbness, it can be challenging to determine the most appropriate medical specialty for consultation.
1. Ophthalmology: Since you have ongoing eye issues, including discomfort and changes in vision, continuing to consult with an ophthalmologist is essential. They can help rule out any underlying conditions that might not have been detected in previous examinations. If your symptoms persist despite normal findings, you might want to seek a second opinion or consult a specialist in neuro-ophthalmology, who focuses on visual problems related to the nervous system.

2. Neurology: Given your symptoms of muscle twitching, numbness, and headaches, a neurologist would be a crucial specialist to consult. They can evaluate for any neurological conditions that might be causing your symptoms, especially since you mentioned MRI results were normal but still experience significant discomfort. Neurologists can conduct further tests, such as electromyography (EMG) or nerve conduction studies, to assess nerve function and muscle activity.

3. Physical Medicine and Rehabilitation (PM&R): Also known as physiatry, this specialty focuses on restoring function and improving quality of life for patients with physical impairments. Since you have neck pain and potential cervical spine issues, a physiatrist can help develop a comprehensive rehabilitation plan that may include physical therapy, pain management strategies, and exercises tailored to your condition.

4. Rheumatology: If there is a suspicion of an underlying autoimmune condition or systemic issue contributing to your symptoms, a rheumatologist may be helpful. They can evaluate for conditions such as fibromyalgia, which can cause widespread pain and discomfort, or other inflammatory conditions that might affect your muscles and joints.

5. Pain Management: If your symptoms are significantly affecting your quality of life, consulting a pain management specialist could be beneficial. They can provide interventions such as medication management, nerve blocks, or other therapies aimed at alleviating chronic pain.

6. Psychiatry/Psychology: Chronic pain and discomfort can lead to psychological distress, including anxiety and depression. If you find that your symptoms are affecting your mental health, it may be worthwhile to consult a mental health professional. They can provide support and coping strategies to help you manage the emotional aspects of living with chronic symptoms.

In summary, it would be prudent to start with a neurologist for a thorough evaluation of your neurological symptoms, while also maintaining follow-up with your ophthalmologist for your eye issues. Depending on the findings, you may then consider referrals to other specialists such as a physiatrist or rheumatologist. It’s essential to communicate openly with your healthcare providers about all your symptoms, as this will help them make the most informed decisions regarding your care.
Lastly, keep in mind that managing complex symptoms often requires a multidisciplinary approach, so don’t hesitate to advocate for yourself and seek the care you need across different specialties.

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