Mounting Pain, Fatigue, Joint weakness and bruising...

I am an 18 year old female who has been suffering from a number of symptoms that I would like to sort out. They include fatigue, weakness, migraine headaches, mysterious bruising, bags under the eyes and joint pain coupled with "crunchy" sounding joints. I maintain a very healthy diet and sleep the recommended eight hours, but still tend to get sick often. I am on a low-dose birth control pill.

I've been experiencing mild to moderate fatigue for over four years, and have been variously prescribed/recommended amphetamines, antidepressants, vitamins and exercise. Last year I was diagnosed with Mono, which my pediatrician deduced had been lingering for at least two months. I took a week off from school to rest, but my energy level remained low. Prior to taking a week off for the mono, I developed dark bags under my eyes that will not go away.

Three months ago I was in a low-speed car accident. I got mild whiplash, which I am in therapy for. My chiropractor is treating the whiplash and the migraine headaches, which have come as a result of the whiplash and the subsequent displacement my c2 vertebra. Since the crash my wrists, elbows and shoulders have become weak and painful. They do not appear swollen, but minimal motion causes them to crack and pop. I am a piano player, and the pain is interfering with my ability to practice.

Over the past two weeks I have been getting bruises around my left and right wrists and elbows. The bruises occur in exactly the same spots on both sides and are tender to the touch and brown in color. My arms, particularly my left arm, are becoming weaker, to the point that holding a pizza with one arm is almost impossible.

My joint pain, fatigue and headaches tend to get worse as the day goes on. My pediatrician, chiropractor and gyno each attribute the symptoms to different things. Should I consider another opinion?

[Kevin Pho, MD]

A referral to a rheumatologist can be considered to evaluate the fatigue and joint pain.

It is possible that the discomfort can stem from the injuries you have suffered.  However, I would do blood tests for diseases like lupus or rheumatoid arthritis - including an ANA level and rheumatoid factor.  Other tests to consider would be a blood count (to evaluate for platelet dysfunction that can lead to bruising) as well as markers of inflammation (i.e. a sedimentation rate or C-reactive protein).  

If the rheumatology evaluation is non-revealing, a referral to a neurologist can be considered to evaluate the weakness.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[shancal]

Thank you very much. I will discuss your suggestions with my pediatrician. My mother had rheumatic fever and was bedridden for much of her childhood. Is there a genetic factor to rheumatic fever and other rheumatic disorders?

[myproblem]

I can't begin to tell you how much you sound like me at your age. All of the symptoms are so similar. The difference is that I spent years with no medical insurance, so count yourself lucky. I am also a musician, and primarily play piano and classical guitar. I have given up, or cut back on many of my former talents/hobbies because of my health and pain issues. I definately agree that you should have a workup done for autoimmune (rheumatological) diseases. ask your Dr. to test for Rheumatoid Arthritis & Lupus. The panels for these will giveyour Dr. further direction depending on the results. There are many autoimmune diseases, and many overlap. Some can be very hard to distinguish without the help of an experienced rheumatologist.
In my case the symptoms started just as I neared puberty, with my first memories of joint pain being about a year before my period started. autoimmune diseases are most common in women, and a hormonal link is strongly suspected. By 18 I felt like I was 100, and had to quit my job due to the extreme fatigue. I also caught every germ that blew my way, and was sick all the time. In fact I have quit working 3 times because of my illnesses. It took until I was 25 to even get a Dr. to listen to me, and until the week I turned 30 to get a label of "Mixed Connective Tissue Disease". This is an overlap of autoimmune symptoms, primarily Scleroderma, and Lupus. There are many treatments avilable once you get a Dr. who takes you seriously, and once you get a diagnosis (even if it's just "ballpark" like mine). I am now almost 31, and have found some medication that slows the progression of the disease, and impoves my symptoms. I am pregnant right now though, so I just have to suffer, because it is not safe during pregnancy or nursing.
It is very important to be presistent. It sounds like your Mom is a good suport for you. (I did not have that luxury.) Take her to all your appontments if you can. Two heads are better than one. Good luck, and post back if you have more questions.

[JTD]

Hi, I also feel like you are writting about me. I am 25 & have been diagnossed with Rheumatoid Arthritis. I sufferd all of the symptoms you have & can totally relate to the pizza box thing. I had trouble going to the toilet even because I coul not bend down as my knees had no strength to hold me up, & I would just drop to the seat. Not nice!! Anyway I also had strange bruises & finally after a year of tests took it into my own hands. No one knew what was wrong with me as blood tests shoped slightly elevated Rheumatoid level factor(I think thats what its called) but nothing else wrong. I paid $250 bit the bullet, booked a plane to Wellington & saw a Rheumatologist. He examined me & did bloods & diagnosed me straight away. My rheumatoid factor level & ANA (Ithink its called or ARA) had shot up within 1 month of my last blood test. Apparently the normal range is between 3 & 14. Mine was 298!!  Anyway I guess Im trying to say, sometimes it is best to pay a little more & do a lot of research yourself so you are well equiped before you get to the specialist. I have a feeling that you definatly have some type of autoimmune disease such as rheumatoid or something similar. Keep your head up mate & take it easy. P.s If you can stay off steroids they are great for the pain but hell on the rest of the body.  Keep us posted

[missmellie]

one form of arthritis that is genetic is ankylosing spondylitis, the HLA 27B gene. you will have a 50% chance of inheriting the gene if a parent had it,you will need to find a very good rhematologist for diagnose you, luckily I was diagnoed by a very experienced doctor after ten years of finding him that is, i probably went to every doctor there was, after visting with him twice he found the gene responsible after i had given him by health history, one thing is to tell your doctor your family history, as years ago AS would not have been easily diagnosed as today, i inherited this from my dad, yeah he had a bad abck, took horse pills and laid on a board in his bed, that's what they did back then, gosh i am so glad i found such a fantastic dotor, i htink today i would be going out of my mind as i am in so much pain, bit at least now i know what is causing it, now i just need to go to a lower altitude and warmer climate haha as the cold greatly affects this.  sorry to drag on but i see many posts from people who seem to go through so many tests like i did, i'm only 36. i've had a bum back since i was 17. i was so athletic i just thought gosh i've over done it, just get on with it girl but after it starts not to go away and you have it 24/7 it like wow yeah i've rally got something and it can be so maddening knowing that you are ill and the medical field can not find the casue.. fatiques is a very big part odf AS too, so it can be misdiagnosed with fibro, lupus etc.  keep those blood tests all copies of you medical tests i always had a postive ana, slightly elevated so and so but nothing signifiacnt, until the hla 27B this is an indicater it does not mean that you have AS but if you have a bad back, pin in hips, heels neck rib cage chest wall it quite the red flag. good luck to all and god bless

[missmellie]

ps when ibreathe in my back pops and cracks too

[PlateletGal]

You all may want to check out information on both CFIDS and fibromyalgia. I have a positive ANA titer (1:640) and was diagnosed with CFIDS.


http://www.meactionuk.org.uk/Dr_David_Bells_Symptom_List.htm

http://www.fibromyalgia-symptoms.org/

[PlateletGal]

"autoimmune diseases are most common in women, and a hormonal link is strongly suspected."

This is very true and I wish they would do more research on this. << sigh >>

[countryrose]

Hi I am experiencing the same, but without a diagnosis either. I am being told that I have a anklyosing spondylitis, but I don't have abnormal ana, nor serum protein, etc...nor the gene.
Can one still have AS without the gene or markers?

[missmellie]

i do believe that you have to have the HLA 27B gene to have ankylosing spondylitis, are you sure that you were tested for this?

[strugglinginnc]

I just wanted to say that I too have been very frustrated with the medical treatment I have received.  Nearly 3 1/2 yrs ago I was the front seat passenger in a small suv, we were sitting still when out of no where this lady plows into the rear of us.  They est. she was traveling in excess of 50 mph.  Over the past three yrs. I have had multiple physical theraphy and chiropractic visits and have seen in excess of 15 doctors (in various fields).  I had severe whiplash, nothing I have done seemed to help until I was referred to a physician in Baltimore MD. He diagnosed me with brachal plexus compression - in short my muscles were so tight that they were stopping my nerves and veins from functioning properly.  This cause pain all around my head and neck area.  The left side of my body when I layed down felt heavy (like dead weight) and painful (as though someone where sitting on me); when I layed on my back my chest hurt. So I went to this doc in MD and he diagnosed me and I had surgery to release some muscles in my neck. This has made a difference, because with my left side pain out of the way I can focus on the other symptoms I have (lower & upper back pain, severe pain in my left ear and left side of face, numbness - dull pain in both of my legs).  

The main reason for my comment is to say that sometime we have several symptoms going on and they maybe cause by a couple of different reasons.  Don't give up - don't ever give up on you health care.  It has been so frustrating for me because my injuries came from an auto accident.  Doctor's look at you like you have done something very disgusting. They throw a prescriptions or diagnosis your way just to get you out the door.  I have lower back pain so severe that I can not function at any task with out severe pain.  I had always been an active person at work and at home - Most of the doctors I have seen judge me physically and emotionally without even getting to know some of my back ground first.  

No matter how young or old we are - It is there responsibility as a medical provider to pay attention and listen.  I am a forty yr old wife and mother of two and I live in a very painful 70 yr old body. Still looking for additional relief in nc.

[maxsmom2]

FYI...I do not have the marker gene HLA 27B and am diagnosed  with undifferentiated spondyloarthropathy.  This is one of the sero-negative (ie no bloodwork indicators) forms of arthritis, the worst of which would be AS.  I was incorrectly diagnosed with fibromyalgia until I was seen 4 years ago by a rheumatologist who practices at a large teaching hospital in New York City.

Also, my ck/cpk bloodwork (measures the breakdown of  muscle tissue) was followed when my internist realized that it started climbing from the 200s to the 400s then up to 900s, always rising and falling for no apparent reason. (Cardiac ruled out)

Had 2 EMG tests.  The longer, more comprehensive EMG showed a mild myopathy.  I eventually had a deep muscle biopsy done, again at a teaching hospital in New York City, where the pathology was done by electron microscopy.  The final diagnosis was nemaline rod myopathy-adult onset, a rare genetic neuromuscular disease- with me a mild form.  No treatment or cure but finally an explanation for the erratic cpk levels (which reached 1805 earlier this year but was 455 last month) and the muscle weakness.

My point is, had I not been referred to doctors at large, metropolitan teaching hospitals, I probably would still be improperly diagnosed and more importantly improperly treated.  I take methotrexate, mobic, and Enbrel and now function much, much better than I did several years ago.  At age 60, I feel better most days than I felt 10 years ago.  I am not meaning to dis local doctors but to encourage going to the physicians on the front lines of treatment and research when you seem to be getting nowhere close to home.

[dphillips]

I am a 20 year old male in college. I have lifted weights very seriously for the last 3 years. I was 165 pounds last march and could bench press 250, never had a problem with any joints or health my whole life.  When doing an exercise improperly i pinched a nerve or had a thorasic disc herniation, so lifting was discontinued for recovery over the summer.  Physical therapy had been going on for 3 months now (Sept-).  From march my overall body with exception to my back felt fine and i gave my body time to rest and heal.  In august my left patella came out of alignment so i was also getting treated as well as my back in physical therapy.  Since then both patella, both wrist, both elbows, and both shoulders pop and crunk with nearly every movement.  Every day the popping sound grows loader and more sevear in every joint, and with occasional hip popping.  My question is how does a very healthy 19 year in great physical stature who has never had a problem and never remained idol go to have symetrical and chronic joint popping.  As well with allowing them time to heal, the joints progress with adding more joints in my body to pop and crack.  I am adopted and have no family history, what would be your advise?