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Q: I have developed a muscle weakness in my upper arms and a sensation of heat on my face. I've also had episodes of tingling and mild pain in my left arm, plus severe headaches, sometimes with visual disturbances, and a sensation of losing my balance. The most recent problem has been weakness of my eyes.

A visit to my HMO doctor was unproductive, with an unenthusiastic referral to a neurologist. I'm a stay-at-home mom with two small children, and making and keeping appointments are a problem. Can you tell me what could be causing these symptoms so I can be better informed when I next approach my physician?

-- J.R., Orlando, Fla.
A: You certainly seem to have a lot on your plate. Let's see if we can sort through your problems.

Knowing no more than what you've told me, I have to agree with your doctor that one or more neurological problems are causing your symptoms. I don't know why the doctor is unenthusiastic in his referral -- perhaps it's just concern that you will not get much help.

For example, there are a group of neurological disorders called primary demyelinating diseases, of which multiple sclerosis is the best known. For these diseases, there are no cures and treatment provides only limited benefits.

Nerve fibers in and out of the brain are wrapped in an insulating myelin sheath, somewhat like the insulation around an electrical wire. When the myelin sheath is damaged, nerves don't send impulses properly.

This destruction of the myelin sheath can be caused by infection, inflammation, immune or metabolic problems, poisons and some drugs, including alcohol. Often, the cause is unknown.

As you might expect, damage to the myelin sheath can result in many symptoms, including the ones you described. Classic symptoms include muscle weakness, balance problems and dizziness, tiredness, numbness and tingling, and a variety of visual problems. Some or all of these symptoms can show up, then disappear for years, or become worse within weeks.

These demyelinating disorders are usually seen in young adults, more commonly in women and, for unknown reasons, more often in people who spend the first 10 years of their life in temperate climates. Heredity may also play a part, especially in multiple sclerosis.

A definite diagnosis is sometimes difficult because of the wide variety of possible symptoms. No one test is diagnostic, but an MRI is probably the most sensitive technique. Some lab tests can help distinguish between these disorders and others.

Corticosteroids like prednisone have been used for decades to relieve acute symptoms, but they do have some side effects. If you have multiple sclerosis, two types of drugs have been introduced in the last few years that decrease progression but also have some side effects.

All this is not to say that you have multiple sclerosis, but only that you should check it out. There are other conditions that cause your symptoms and more than one may be at work here.

When next you see your doctor, I recommend that you bring a detailed written description of your symptoms with answers to the following:

Are the symptoms episodic or continuing?

How long have you had which symptoms?

Are there times when the symptoms are better or worse?

Are the symptoms progressive, either in degree or length of episode?

Update on contraception: The FDA has just approved a "morning after" pill for the prevention of pregnancy. Studies have shown it reduces the chance of pregnancy following unprotected sexual intercourse from 8 percent to 1 percent.

It has to be taken within three days and reportedly will not terminate an existing pregnancy. It has much fewer side effects than previously approved pills used to block pregnancy after unprotected sex.

It should not be used as the primary method of birth control and does not prevent the spread of sexually transmitted diseases.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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