Family, Internal Medicine, General Medical Questions/Any ideas?


QUESTION: I have asked you some questions previously about some things that are going on. I understand that sometimes a diagnosis takes awhile and may take many different steps before it is achieved. I was wondering if you could tell me what your next step would be in my case?

In July of 2012 I had a migraine for 9 days. This was by far the longest the I had ever had a migraine and my imitrex didn't even touch it. In addition to pain I was sensitive it light, sound, smells, and had speech disturbances. I had to go in and have a shot to break the pain cycle, all symptoms were relieved except for the speech disturbance. My PCP took me off imitrex and put me on topomax as a migraine preventative, he also referred me to a neurologist because of the lingering speech disturbance.

In October I finally had an appt with a neurologist. By this time I was also having other problems. RLQ pain (mild to moderate) and tingling in my hands, feet, and face. The neurologist performed his exam and sent me for a blood test, he found that my B12 level was 169 and my Folate was 277. So I have started to take folic acid and monthly B12 injections.

As for my stomach I have had an ultrasound to check my gallbladder, it was normal. I have had 2 CT scans that show that my appendix is larger than normal and that I have an ovarian cyst on the left ovary. I have had blood tests that show that I have no infections or inflammation. I had a pelvic in November which was normal and non painful. And I just had a colonoscopy this week which was normal.

I have RLQ pain. Its mild to moderate, sometimes stabbing sometimes burning. It feels like I have cramps all the time just not in the right area. I feel bloated I don't like pressure on my stomach, I have no energy, and my appetite is almost non existent.

Your thoughts?



ANSWER: this is a complicated history over the last 6 months.....   You didn't ask specific questions, so I will just throw out a couple of ideas....

B12 was quite low and if you didn't have symptoms directed related to that, you would, eventually.... you need to have B12 injections, lifelong.... they are cheap and easy......

The tingling is probably secondary to topamax.  The speech disturbance, that you didn't specify is worrisome.... most migraine symptoms should resolve.

You didn't say how often your migraines were but if frequent, then keep looking for prevention medicines.   It is ok to continue topamax if it is causing tingling as long as you don't mind it.  

---------- FOLLOW-UP ----------

QUESTION: I have started the B12 injections,I've had 2 of the so far. I have noticed that I do feel a lot better a few days after the injection but that it doesn't seem to last for a full 30 days. The B12 injections and the topamax seem to be working. I've had a significant drop in migraines, in any type of headache for that matter; and the tingling and speech disturbance seem to respond to the B12 injections.

My biggest concern right now is my stomach pain and the fact that there doesn't seem to be any reason for it. This in addition to my extreme lack of energy which is making my life difficult. I've lost 30 lbs since the end of August, 15 lbs has been in the last month. I know it's not my gallbladder, appendix, or colon. So I guess my question would be with the tests already performed what's left?


the question is do you have a "chronic appendicitis" which is some low level inflammation in it, or is this pelvic pain (from female organs).  I assume they eliminated the possibility of a urine infection with a urine check.  

Typically we load B12 with a shot a week for a month then monthly.... a cc of B12 gives you so much, that it takes at least a month to dwindle down to normal, but initially, your stores were so depleted that it may not last a month.  It should eventually last a month......

Family, Internal Medicine, General Medical Questions

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Robert Borucki


I am an expert in Family Medicine and Emergency Medicine.


I am trained and boarded in Family Medicine and have also worked extensively in emergency medicine for over 10 years.

BA in Natural Sciences; MD in 1986\borucki

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