Doctors Lounge - Rheumatology Answers
provided on www.doctorslounge.com is designed to support, not
replace, the relationship that exists between a patient/site
visitor and his/her physician."
Back to Rheumatology Answers List
- Fri Sep 26, 2008 9:32 am
My partner is 46, male, and has always been in good health. Since June of 2007 though, his mobility and sense of well-being have been deteriorating consistently. Several tests have been done, medications and other treatments have been attempted, all without success or a firm diagnosis. His doctors do not seem to be very proactive in trying to investigate the cause for the symptoms so that they can be treated accordingly. We are trying to find someone who can help point us in the direction of the proper specialist to consult so that we can finally begin to learn what is really going on and obtain the proper treatment. Here is a summary of the symptoms:
Tightness/stiffness in hands - back of hands and tops of feet - a feeling that the muscles/tissues are not stretching as they should for movement
Extremely tight hamstrings - they do not stretch as necessary for movement
Overall tightness and stiffness in legs with pain in the muscles
NO pain in the joints of fingers, legs, or feet
Joint pain does occur in the knees when he takes stairs, to be expected
Lower back pain
The tightness is usually worse in the morning, however it does not ever subside completely, and muscle pain is present most of the time day or night.
Several years ago he began experiencing symptoms of gout, for which labs confirmed high uric acid levels. An anti-inflammatory would usually relieve the pain when he had an attack until last year. That is when he first sought treatment; received x-rays on his feet and blood work revealed uric acid level was high (9.0+). He was referred to a rheumatologist who prescribed colchizine to knock it out, then on a regular dose of allopurinol. His uric acid was tested again in the fall and it was down to normal levels and the allopurinol discontinued. However, by this time, even though the gouty symptoms in his feed had subsided, he was suffering from widespread symptoms - those listed above. He was tested for RA and it was negative; the doctor did not seem to think he had any osteoarthritis either. (no x-rays were specifically done to check, and there is not any pain in his joints, per se) No more blood work was done and the rheumatologist seemed unconcerned. After a few more months of suffering from pain and tightness that was increasing, my partner again contacted the rheumatologist, who had labs done to test Vitamin D levels. Although we did not see the results, he said that it was low and prescribed an 8-week course of Vitamin D (prescription dosage). To no avail. The tightness continues to increase. My partner decided to give chiropractic a try, since it had helped me greatly with my lower back problems after an injury. He received numerous treatments and massage over a period of 4-6 weeks, and began working on a gradual stretching regimen as well. As of today, the symptoms remain, and appear to be consistently getting worse with continued attempts to stretch (he is not overdoing the stretching, rather, focusing on the gradual).
A couple of days ago, after experiencing four days of extreme fatigue, intermittent nausea, labored breathing and some blood pressure elevation, we took him to the ER. Labs came back "normal" they told us, with the exception of a slightly elevated uric acid again; chest x-ray was normal, and his lower back x-ray showed only "minor degenerative changes". We obtained a copy of his labs that show in fact that several things are elevated:
MCH - 31.1
MCHC - 36.4
Absolute Neutrophils - 7.7
Glucose - 108 (not fasting, although draw was done appx. 2 hrs after toast w/peanut butter)
Uric Acid - 8.2
Noting that the Absolute Neutrophils count is high, I should also note that his WBC was well within normal range - indicating that the white blood cells swimming around are switched on for infection fighting, but there is no infection. He is slightly overweight, 5'11" and 230 lbs. Physical activity consists generally of yard work (which is fairly involved); we try to walk in the evenings but he cannot go very far because of the pain. His work is not physical other than walking through facilities. His alcohol intake is generally on weekends with an occasional weeknight, although it is substantial during those times. He has a previous history of using cocaine although it has been two years since last used. He does not smoke.
Could any of those lab results be connected in some convoluted way to the symptoms he is having? Could a drug (prescription or otherwise) he took in previous years have led to what he is experiencing now? Would his alcohol intake have an effect on what is happening? Basic liver function tests in the CBC are well within normal levels. What additional types of testing should we be pursuing, and what kind of specialist would be the best to employ for doing so? We are not convinced that rheumatology is the avenue we should be pursuing at this point.
Any suggestions (or evaluation from an MD) would be SO appreciated. This is progressively getting worse to the point that it is affecting his ability to do ANYTHING remotely physical and we can't seem to get anyone to take it seriously enough to look deeper. We know that we need to be looking under rocks, but it would certainly help to know which rocks to start with.
Thanks for your help.
| Tom Plamondon PA-C
- Thu Dec 18, 2008 9:02 pm
Thanks for your patience and thank you for the well written case.
The values for the hemoglobin concentrations (MCH and MCHC) are high end of normal and do not cause alarm. Glucose looks fine. ANC (neutrophil count) is a shade high.
Does he have tremors? muscle weakness? facial paralysis or droopy eyelids? loss of sensation in limbs? Respiratory problems? These are questions regarding the differential for ALS, Myasthenia Gravis.
A thorough physical is important. I would include an EMG and consider referral to physiatrist.
Alcohol use is an important consideration with high uric acid levels and gout. Alcohol will make gout worse.
Let us know how it goes.
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit
Ask a Doctor Teams: Respond to patient questions and
discuss challenging presentations with other members.
Doctors Lounge Membership