Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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How Do I Make Sense Of Seemingly Unrelated Symptoms?

Thursday, 08 Jul 2010 03:09 PM

Question: I am a 49 year old female who has severe leg pain. I have degenerate disc disease in my neck (C-3-6), but my lower back MRI looks good, with a very minimal bone spur (between 4-5). I am anemic, and take Cozzar for blood pressure. I had a colonoscopy and an endoscope looking for a reason for my anemia, and both looked good. I am not able to sleep because of the pain. I also have severe tingling and burning sensations in my feet and toe nail (my glucose test are normal), and I have a sciatica pain. What can I do?

Dr. Hibberd's Answer:

You describe a combination of conditions all of which can be associated with symptoms in your feet. You need to establish whether this is related to pressure or to a metabolic, circulatory or drug effect. You need to see a neurologist and let him perform some simple nerve conduction and EMG studies to pinpoint and verify the cause of your symptoms. Then with the guidance of your trusted family physician and the results obtained from your neurologist, you will be able to establish a reasonable diagnostic and treatment recommendation.

Your family physician should be the "conductor" of your investigation and be the one to refer you to specialists. He or she should guide you through multiple consultants if necessary, and be responsible for prioritizing the information obtained.
Your situation is very common, and emphasizes the importance of establishing a relationship with a family physician or internist who can serve as your "medical home.” Individual self-referral to subspecialty consultants by patients is rarely an efficient way to manage your health, and is usually much more time-consuming than professional referral.

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