body aches/pains, extreme fatigue, and known low B12

I'm a 31 year old female weighing 198 lbs.  I use the NuvaRing for birth control, and I take a multi-vitamin daily.  I have low B12, and I'm on weekly B12 injections.  This was diagnosed back in Sept. 2010 with a level of 203. In Dec. it had gone up to 408.  At the end of Jan. 2011, I had a lot of life complexities that prevented me from getting my B12 shots (sick husband, driving kids, etc.).  I started back on my shots 4 weeks ago.  Before I started treatment again with the shots, my B12 level had gone down to 340 even though I was taking a multivitamin daily.  Tomorrow will be my 5th shot.   I have days where I'm feeling okay and have energy to do things.  However, I have more days where I'm just so sleepy, that I cannot do anything but sleep.  I'm also seeing a cardiologist to rule out heart issues.  ECHO and 48 hour Cardiac Holster came back normal.  Here's a complete list of my systems - not sure which ones are related:

- Extreme fatigue - sleeping 10+ hours every day and still feeling like I can't function.  I take naps at every opportunity and go to bed shortly after I get the kids in bed.

- Inability to focus and concentrate - particularly with work (I'm a business systems analyst and my job requires a lot of thinking and analysis.)

- Stress -- mainly because I feel like I'm not able to perform my job like I have in the past.

- Full body aches - feels very flu-like.  This symptom comes and goes.  

- Joint pain in hands/fingers/knuckles - In the past, this was tied to my low B12 because I had extremely painful hands where I couldn't even dress myself or open doors.  45 minutes after my first B12 shot, the pain subsided and my hands went to a more manageable tingly feeling.  This comes and goes (pain, tingle, no pain/tingle) depending on my B12 level, I suspect.

- Problems with coordination - I don't know if this is related to my body aches, but I seem to drop things more frequently these days.  Or I hit things inadvertently.  (ie. setting my son's glass down on the table, I hit the napkin holder).  I do seem to have minor stability issues when standing/walking, but that was present even as a kid.  My dad even called me "Miss Clumsy" as a kid.  

-Pains in my calves - well on the side of my calves and behind my knees.  These pains come and go and sometimes lasts only minutes and other times hours.  I usually only have leg hurting at a time (typically my right leg). Frequently, but not always, a few minutes after the pain disappears in my right leg, I feel a pain in my left shoulder for a few minutes.  The leg pain has been going on for months.  I typically experience it about 3 times a day.

- Chest Pain - I've had 3 scary situations that have all happened within the last month.
     a.  Driving home with the kids, my heart begins racing and pounding.  I get lightheaded and dizzy.  My chest feels heavy.  I cough (once), and I feel better.  Episode lasted about 30 seconds.
     b.  Sitting on the couch next to my husband, my chest starts hurting.  I sit up straight and grab at my chest.  I get slightly dizzy.  Episode lasted about 30 seconds.
     c.  Started at the around 3pm, start feeling very aware of my heart beat.  Several hours later (around 6pm), my breaths seem to be restricted by a "wall" when I breath in.  I cannot breathe past the wall.  I want to go to the ER, but my husband tells me it's probably stress and lie down and relax. I go to bed around 6pm.  I lie awake until about 9pm when I finally fall asleep with the chest wall symptom.  I wake up the next morning able to breathe normal.

- Frequent low grade fever 99.2-100F.  Frequently, I get chills and feel sick.  I take my temp and I have a low grade fever.  However, I know this is not my normal temp.

- Viral illnesses every 4-5 months with temps 102+F.  Doc even joked that I should get my tonsils yanked out.

- Upper back pain just left off of my right shoulder blade.  The pain seems to be deep.  This pain has been around for months, but the intensity varies.  Some days, it's so bad that I take Motrin to try to help it, not sure it helps. Other days, I can only feel it if I press on the area.

I'm currently being treated with an antibiotic for a cyst on my back (upper left side).  I started the antibiotic yesterday, and now I think I have a yeast infection.

My mom's convinced that I need to get tested for Lyme's disease.  I live in Texas - not a high risk state.  However, last summer, I did hike up Sugarloaf Mountain  in Upper Michigan.  Mosquitos were insane.  I don't recall being bit by a tick nor did I have a bulls-eye rash.

My sisters think that I might have a slight Gluten intolerance causing lack of B12 absorbtion

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
Extreme fatigue and many other symptoms you have could be due to hormonal imbalance of PCOD or due to Nuvaring, anemia, diabetes, hypothyroidism, or due to kidney or liver problems. Another possibility is sleep disturbances (like sleep apnea, imbalance of rapid eye and non rapid eye movement sleep etc.). You may sleep your customary 7-8 hours and yet feel fatigued. You need sleep studies to rule this out. Other possibilities are chronic fatigue syndrome, depression, low Vit B12 (this you have), low iron, low calcium, sodium and potassium. Hyperthyroidism too causes increased sweating and tiredness.   Postviral fatigue syndrome is another possibility. Persisting EBV infection or mono can also be the cause.
Low intrinsic factor in gut that hampers absorption of B12, pernicious anemia, parasites in the gut, diet poor in Vit B12, Crohn;s disease, IBS, or poor metabolism by liver are the causes behind low Vit B12. Please consult a doctor to rule these out. Take a diet rich in Vit B12 which should include meat and animal products, cheese, such as beef, liver, salmon, cod, and eggs. Take B12 supplements (this you are already taking as injections) and breakfast cereals fortified with vitamin B12. Finding the cause is important.
Yes, Lyme’s disease and multiple sclerosis too should be tested for.
A comprehensive investigation is required keeping all the points in mind. Do discuss this with your doctor and get yourself examined.
Since I cannot examine you and know other related conditions you may be having, nor is a detailed history possible on net, I have listed the various possibilities that should be looked into. Take care!

[bjm1970]

You have a large amount of symptoms and the fever says to me its not only anxiety,which believe it or not can cause a lot other things,along with the stress and low Vitamin B 12. It cannot hurt to have the Lymes disease test and anything else you can think of.Sometimes we have to push the drs.I do believe you are having some of your issues from the anxiety of the whole situation.Try to do whatever you can to alleviate the stress and if you believe in prayer,talk to God about it.Could be so many things,but could be that you are noticing more due to high anxiety.Good luck,and please let us know what you find out...

[livingtx]

Thanks for your feedback.  I have had my thyroid checked (multiple times) and always comes back normal.  My doctor says that I'm not anemic - as that was checked as well.

Back in Sept. 2010 when my low B12 was found,
Sodium level was 136  (with a 135-146 range).
Potassium 4.5 (with a range of 2.5-5.3)
Calcium 9.4 (with a range of 8.6-10.2)

The blood test did show that I've had mono in the past (but no recollection of it), but it wasn't currently active.

Yesterday, I went to bed at 4:45pm and slept until 8pm.  I got up and ate dinner, and went back to bed at 10pm and slept all night.  Today, I still feel sleepy.  I feel like I'm sleeping my life away.  It's not always this bad.  I sometimes do have good days.

Back in Sept. 2010, when I found out about my low B12, I noticed the breakfast cereal that I had been eating was not fortified.  I made that change right away.  I do eat meat and dairy products (though, no fish.).  

I've made an appt with a Rheumatologist, but it's not until May 25th (first they had available).  I went to the cardiologist yesterday, they used a doppler to try to find any blood clots.  I'm supposed to get the results in a few days, but I'm thinking that's probably going to come back normal -- or else they would have gone to the doc immediately.

I've included my blood test results from Sept. 2010.  However, I know they are hard to read in this format.

Test Name In Range Out of Range Reference Range Lab
Comprehensive Metabolic IG
  Panel w/EGFR
  Glucose 74 65-99 mg/dL

  Urea Nitrogen (BUN) 10 7-25 mg/dL
  Creatinine 0.88 0.58-1.06 mg/dL
  eGFR non-afr. American >60 > OR = 60 mL/min/1.73m2
  eGFR African American >60 > OR = 60 mL/min/1.73m2
  Bun/Creatinine Ration Not Applicable 6-22 (calc)

        Bun/Creatinine ratio is not reported when the BUN and creatinine values are within normal limits.

  Sodium 136 135-146 mmol/L
  Potassium 4.5 3.5-5.3 mmol/L
  Chloride 103 98-110 mmol/L
  Carbon Dioxide 22 21-33 mmol/L
  Calcium 9.4 8.6-10.2 mg/dL
  Protein, Total 7.1 6.2-8.3 g/dL
  Albumin 4.4 3.6-5.1 g/dL
  Globulin 2.7 2.2-3.9 g/dL (calc)
  Albumin/Globulin Ratio 1.6 1.0-2.1 (calc)
  Bilirubin, total 0.5 0.2-1.2 mg/dL
  Alkaline Phosphatase 71 33-115 U/L
  AST 14 10-30 U/L
  ALT 16 6-40 U/L
TSH, 3rd Generation 1.05 "> or = 20 Years 0.40 - 4.50 mIU/L
PREGNANCY RANGES:
1st trimester 0.20-4.70
2nd trimester 0.30-4.10
3rd trimester 0.40-2.70" IG

CBC (Includes Diff/Plt) IG
  White Blood Cell Count 6.9 3.8-10.8 Thousand/uL
  Red Blood Cell Count 4.73 3.80-5.10 Million/uL
  Hemoglobin 14.3 11.7-15.5 g/dL
  Hematocrit 42.7 35-45%
  MCV 90.4 80.0-100.0 fL
  MCH 30.3 27.0-33.0 pg
  MCHC 33.5 32.0-36.0 g/dL
  RDW 14.7 11.0-15.0%
  Platelet Count 172 140-400 Thousand/uL
  Absolute Neutrophils 5513 1500-7800 cells/uL
  Absolute Lymphocytes 1042 850-3900 cells/uL
  Absolute Monocytes 311 200-950 cells/uL
  Absolute Eosinophils 7 L 15-500 cells/uL
  Absolute Basophils 28 0-200 cells/uL
  Neutrophils 79.9 %
  Lymphocytes 15.1 %
  Monocytes 4.5 %
  Eosinophils 0.1 %
  Basophils 0.4 %
Vitamin B12 203 200-1100 pg/mL IG

Please Note:  Although the reference range for vitamin B12 is 200-1100 pg/mL, it has been reported that between 5 and 10% of patients with values between 200 and 400 pg/mL may experience neuropsychiatric and hematologic abnormalities due to occult B12 deficiency; less than 1% of patients with values above 400 pg/mL will have symptoms.

"ANA IFA Screen w/ REFL To
Titer and pattern, IFA" IG
*  ANA Screen, IFA Negative Negative
*  Rheumatoid Factor 7 <14 IU/mL
Epstein Barr Virus
  Antibody Panel
  Epstein Barr Virus VCA
    Antibody (IGM) < OR  = 0.90 Index
Index Interpretation
or = 1.10 Positive
"   Epstein Barr VCA
      Antibody (IGG)" >5.00 H index
Index Interpretation
or = 1.10 Positive
"  Epstein Barr Virus (EBNA)
     Antibody (IGG)" >4.85 H index
Index Interpretation
or = 1.10 Positive

INTERPRETATION:  Suggestive of a past Epstein-Barr virus infection.  In infants, a similar pattern may occur as a result of passive maternal transfer of antibody.

[livingtx]

I just heard from the cardiologist's office that my doppler (to check for blood clots) came back mildly abnormal.  Now, I'm supposed to wait until my follow up appt on May 12th to discuss with the cardiologist.  So hopefully, it's not life threatening.

[livingtx]

Well, Chest and Abdominal/leg CT scans came back without any blood clots.  I do have Gallstones, and apparently my lower lungs aren't inflating fully - for unknown reasons - I don't have a cold or anything like that.

I don't know yet if my gallstones have caused any of my symptoms or if I need to get them removed.