Seeking Guidance on Neurological Symptoms: Which Specialist to Consult?

Could you please help me with a preliminary assessment of the necessary outpatient services and specialties I might need? Thank you so much!

Dear: Hello! I have been troubled by several ailments for a long time.
I would appreciate it if you could help me with a preliminary assessment of the necessary outpatient departments and specialties, so I can seek treatment.
I have not seen significant improvement from the local family clinics and traditional Chinese medicine practitioners.
The clinic doctors have also suggested that I visit a larger teaching hospital for better outcomes.
Thank you very much for your expertise and kindness.

Personal Information: Male, 33 years old, unmarried, 178 cm, 75 kg, blood type O.
Over the past ten years, I have not had any major illnesses or surgeries, and my health check-ups have not shown any abnormalities.
I have not been diagnosed with any statutory communicable diseases.
Since August 2003, I have experienced the following symptoms without improvement or clear diagnosis:
(Consultation 1) In recent months, from August 2003 to February 2004, I occasionally experience sudden episodes, particularly when I lower my head, turn my body, or during moments of contemplation.
My left eye's vision becomes unclear, and I feel dizzy (not blurred vision, but rather that my left and right eyes cannot focus normally together, resulting in overlapping images).
When I close my right eye and look straight ahead with my left eye, the image appears normal.
When I close my left eye and look ahead with my right eye, it also appears normal.
However, when both eyes are open, the target object appears overlapped.
This condition usually takes about 10 to 20 minutes to return to normal.
The occurrences are irregular and sudden, happening while lying down, sitting, or standing, particularly affecting my ability to discern images while walking or driving, which is very dangerous.
Additionally, I often feel discomfort and pain in the left side of my head, and my left limbs exhibit muscle weakness, with my left hand experiencing slight tremors and a sense of weakness.
The community clinic doctor diagnosed it as neuropathic pain and muscle pain, while the ophthalmologist suggested fatigue and advised more rest.
This condition has been evident since last August and has become more frequent.
I wonder if it is due to excessive pain medication leading to tolerance or worsening pain.
I would greatly appreciate your professional opinion on the necessary outpatient departments.
(Consultation 2) Occasionally, I experience a black shadow in my left eye, usually accompanying the symptoms mentioned in Consultation 1, followed by dizziness.
My right eye has not experienced these symptoms.
Additionally, I sometimes feel pain in the left side of my chest near the heart or in the upper back near the heart, as well as in the neck area near the hairline and between the shoulder blades.
The pain is always localized to one area at a time, never affecting multiple areas simultaneously (the pain is felt within the muscles, not on the skin surface).
My breathing, heart rate, and blood pressure are normal, and it usually takes about 10 to 20 minutes to return to normal.
The occurrences are irregular and sudden, happening while lying down, sitting, or standing.
Changing positions during pain does not alleviate it; the pain remains (again, felt within the muscles, not on the skin surface).
I am uncertain if this could be due to internal organ issues or vascular blockage causing the pain.
I would greatly appreciate your professional opinion on the necessary outpatient departments.
(Consultation 3) In August 2003, I noticed a granular lymph node in my right neck, which is still present.
Recently, I have also felt a hard lump in the upper back of my neck, which is noticeable to the touch.
Sometimes, there is pain in this area, and it usually takes about 10 to 20 minutes to return to normal.
The occurrences are irregular and sudden, happening while lying down, sitting, or standing.
Changing positions during pain does not alleviate it; the pain remains (again, felt within the muscles, not on the skin surface).
I would greatly appreciate your professional opinion on the necessary outpatient departments.
Thank you very much!

David, 30~39 year old female. Ask Date: 2004/02/29

Dr. Lai Lunxiang reply Neurology

1.
Based on your description, your condition may be "orthostatic hypotension." Please drink plenty of water and do not restrict salt intake excessively; a normal amount is sufficient.
There are many causes of orthostatic hypotension, and if it cannot be managed, you should seek treatment at a teaching hospital.
2.
The left chest pain accompanied by the aforementioned symptoms may be "sympathetic nerve pain." I personally recommend taking an appropriate amount of sedatives.
3.
The symptoms you described are likely to occur during periods of overwork and insufficient hydration (this is my personal speculation).
This may be due to inadequate lymphatic circulation, so I suggest drinking more water, approximately 2500 mL per day.

Reply Date: 2004/02/29

More Info

Based on the symptoms you've described, it seems that you are experiencing a complex array of neurological and possibly psychological issues. Given the nature of your symptoms, it is crucial to approach this situation methodically and seek the appropriate medical specialists who can provide a comprehensive evaluation and treatment plan.

Recommended Specialists
1. Neurologist: Given your symptoms of visual disturbances, dizziness, muscle weakness, and pain, a neurologist is the most appropriate specialist to consult first. They can conduct a thorough neurological examination, order necessary imaging studies (like MRI or CT scans), and perform tests to evaluate your brain and nervous system function. Your symptoms, such as the overlapping vision and left-sided weakness, could indicate a neurological condition that requires further investigation.

2. Ophthalmologist: Since you are experiencing specific visual symptoms, such as difficulty focusing and seeing overlapping images, an ophthalmologist should also be consulted. They can rule out any underlying eye conditions that may be contributing to your visual disturbances.

3. Pain Management Specialist: If your pain is chronic and not responding to standard treatments, a pain management specialist may be beneficial. They can offer alternative pain relief strategies, including physical therapy, nerve blocks, or other interventions that may help alleviate your discomfort.

4. Psychiatrist or Psychologist: Given the psychological aspects of your symptoms, such as anxiety or stress related to your health concerns, consulting a mental health professional could also be beneficial. They can help you manage any anxiety or depression that may be exacerbating your physical symptoms.

Additional Considerations
- Comprehensive Evaluation: It is essential to have a comprehensive evaluation that considers both your physical and mental health. Chronic pain and neurological symptoms can often be intertwined with psychological factors, and addressing both aspects is crucial for effective treatment.

- Medication Review: Since you mentioned concerns about medication tolerance and potential dependency, it would be wise to have a healthcare provider review your current medications. They can help determine if adjustments are necessary or if alternative treatments should be considered.

- Lifestyle Modifications: In addition to seeking medical advice, consider lifestyle changes that may help improve your overall well-being. Regular exercise, a balanced diet, adequate sleep, and stress management techniques (such as mindfulness or yoga) can all contribute positively to your health.

- Follow-Up: After your initial consultations, ensure you have a follow-up plan in place. Chronic conditions often require ongoing management, and regular check-ins with your healthcare providers can help track your progress and make necessary adjustments to your treatment plan.

Conclusion
Your symptoms are complex and warrant a thorough investigation by multiple specialists. Start with a neurologist for your neurological symptoms and follow up with an ophthalmologist for your visual issues. Additionally, consider consulting a pain management specialist and a mental health professional to address the multifaceted nature of your condition. Remember, it is essential to advocate for yourself and seek the care you need to improve your quality of life.

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