Doctors Lounge - Rheumatology Answers
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Forum Name: Rheumatology Topics
|GHolmes - Tue Dec 23, 2008 6:06 pm||
Thank you for the opportunity to ask my question. For five years on and off I have experienced unexplainable pains throughout my body. They originate in either my shoulder blades, hips, calves or thighs and radiate. The only way I can describe the pain is as a pulling pain that feels like when I was a child and I had "growing pains." The pain is not usually severe; but it is persistent, sometimes lasting nearly a week without reprieve and then it will suddenly go away. No medicine, exercise or posture change will alleviate it. However, movement is often more tolerable than sitting or lying still when I have the pain. I can have it in one of the areas described only, or several at the same time. In the past I have attributed the pain to various dietary issues - sugar, aspartame, etc. but eliminating these never seems to do the trick. I thought it only occurred when I was sedentary but I am very active now and it still occurs occasionally. Happily, in addition to not being severe, the pain is also not regular and I am without it much more than I am with it.
My gastrointerologist scheduled me for a colonoscopy after symptoms of my previously diagnosed small intestinal bacterial overgrowth (SIBO) resurfaced a few months after treatment. When I began the prep for the procedure the day before I had the pain that I described above, but it was very minor and only in my left calf. I began to drink the Golytely solution and about an hour into drinking the pain intensified and spread to all of the areas I mentioned so I was effectively in pain from my shoulders to my ankles. It was excruciating. Only my torso and arms were not in pain. The pain lasted through the night and into the next day and until I was put out for the procedure. My gastro suggested dehydration. He told me he would give me electrolytes to drink after the procedure but I think he and I (being anesthetized) forgot. I left with no pain, but the anesthesia wore off and the pain came back. My husband had to walk me screaming and crying to our nearby health center. The doctor who saw me in urgent care was dismissive. I explained about the procedure and my gastro's suggestion of dehydration. She said that I could not possibly be in such pain from dehydration. She asked about stress at home and made me an appointment with a neurologist and a urologist and sent me home. After the doctor sent me away, the nurse pulled me aside and told me that I was most likely suffering from an electrolyte deficiency and to go home and drink water. I am fairly sure that he was right. I looked up my symptoms after they went away and assumed that I might have had mild hypokalemia. I drank electrolyte water and I also ate potatoes, which I do not usually eat as I keep a low carb diet to manage my SIBO symptoms.
When I saw the neurologist he expressed concern that the urgent care doctor did not test me for serum calcium, serum magnesium, and phosphorous. He also ordered a thyroid panel, Chem 24 and ESR (SED-RATE) However, he thought that having me take any of these tests would be useless if I was not presenting with symptoms. So we are waiting until the pain comes back and then I will go in for the lab work. Of course I do not want the pain to come back at all and I am afraid we missed a unique window of opportunity to find out if there is a preventable solution to avoiding this pain again. Is there any reason why the original doctor did not perform any tests and is the neurologist correct in setting me up with so many labs? Are there any other tests that I should ask for when I see a doctor who isn't dismissive? Thank you.
|Tom Plamondon PA-C - Wed Dec 31, 2008 1:40 pm||
The differential diagnosis for polymyositis (multiple muscle pain/inflamation) is broad and certainly includes electrolyte disturbances.
Doing electrolyte count, thyroid screen, and sed rate are all indicated. And I can see the reasoning behind doing the electrolyte and sed rate count during time of pain.
I would also add CPK (increase with inflammatory muscle conditions), ANA and rheumatoid factor.
Do you have any muscle weakness, skin rashes, dry eyes, joint pain or inflammation? Any history of blood clots? Fever? Weight changes? Fast heart rate? Fluttering of the heart?
Review of medicine is important e.g any statin drug use to treat high cholesterol.
These are all important historical questions.
All the best to you and keep us posted.
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