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Undiagnosed Symptoms (Expert Forum)
Mystery Symptoms
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Undiagnosed Symptoms forum are answered by Dr. Kevin Pho. Topics covered include breathing difficulties, feeling cold, cough, diarrhea, dizziness, fainting, fever, indigestion, itching, nausea, numbness, pain (chronic), paralysis, rash, sweating, swelling, urination problems, and vomiting.
Mystery Symptoms
by ott70, May 31, 2008 06:25PM
Part I
So it's been a crazy three months for myself:
38 years old, male, 180 lbs., 6’ 2”
Symptoms (major -- or what I consider bothers me the most): Palpitations, abdominal pain, back pain (lower, sometimes just below ribs), numbness/tingling in legs and sometimes in fingers and face (both sides), chest pain, joint pain (changes), fatigue
Symptoms (minor): Low-grade headaches, occasional night sweats, changing bowel movements, indigestion, frequent urination, chills, hot "feeling" on skin (no fever), giant papilliary conjunctivitis, epididimititis, flushing, lightheadedness, vision changes (comes and goes), throbbing in left leg (back thigh, can be sharp), ringing ears, possible TMJ (at least some jaw pain), swollen submandibular glands (they’ve been that way for years, but it seems the right side has increased a little mote lately)
*Note on the symtoms, they are over the range of three months. Lately, a lot of the symptoms has subsided or lessened.
Doctors seen: Primary, ER and urgent care docs, cardiologist, urologist, neurologist, gastroenterologist, eyes-ears-nose doctor, alternative medicine
Tests: Blood work (numerous times), chest X-ray, chest CT, echo/stress, holter monitor, head MRI, urine samples, unltrasound on thyroid, heart cath, upper GI, lumbar x-ray, abdomen CT
Findings: Low potassium (back up), low vitamin D (abnormally according to primary), moderate acid reflux in esophagus, mild gastritis in stomach, kidney cysts (one in each kidney), 5 mm non-calcified non-fatty nodule in right lung, high bilirubin
Meds: Inderal 40 mg (but now going with 20 mg half-tablets), Mirtazapine 15 mg, Protonix 40 mg, Pataday and Alrex eyedrops
So it's been a crazy three months for myself:
38 years old, male, 180 lbs., 6’ 2”
Symptoms (major -- or what I consider bothers me the most): Palpitations, abdominal pain, back pain (lower, sometimes just below ribs), numbness/tingling in legs and sometimes in fingers and face (both sides), chest pain, joint pain (changes), fatigue
Symptoms (minor): Low-grade headaches, occasional night sweats, changing bowel movements, indigestion, frequent urination, chills, hot "feeling" on skin (no fever), giant papilliary conjunctivitis, epididimititis, flushing, lightheadedness, vision changes (comes and goes), throbbing in left leg (back thigh, can be sharp), ringing ears, possible TMJ (at least some jaw pain), swollen submandibular glands (they’ve been that way for years, but it seems the right side has increased a little mote lately)
*Note on the symtoms, they are over the range of three months. Lately, a lot of the symptoms has subsided or lessened.
Doctors seen: Primary, ER and urgent care docs, cardiologist, urologist, neurologist, gastroenterologist, eyes-ears-nose doctor, alternative medicine
Tests: Blood work (numerous times), chest X-ray, chest CT, echo/stress, holter monitor, head MRI, urine samples, unltrasound on thyroid, heart cath, upper GI, lumbar x-ray, abdomen CT
Findings: Low potassium (back up), low vitamin D (abnormally according to primary), moderate acid reflux in esophagus, mild gastritis in stomach, kidney cysts (one in each kidney), 5 mm non-calcified non-fatty nodule in right lung, high bilirubin
Meds: Inderal 40 mg (but now going with 20 mg half-tablets), Mirtazapine 15 mg, Protonix 40 mg, Pataday and Alrex eyedrops
Doctor's Answer
by Kevin Pho, MD, Jun 02, 2008 08:25AM
, Jun 02, 2008 08:25AM
You have had a comprehensive workup, with multiple tests and specialist referrals. It is unlikely that I will come up with something over the internet that hasn't already been thought of.
The cardiac workup has been complete, and would exclude many of the major heart conditions.
The abdominal pain can further be evaluated with a colonoscopy, which can evaluate for any masses or colitis. Otherwise empiric treatment for irritable bowel syndrome can be considered.
The tingling can be further evaluated with a nerve conduction study. Metabolic conditions can also be excluded by testing the thyroid, B12 levels and excluding diabetes.
Another opinion can certainly be sought, preferably at a major academic medical center.
This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
www.kevinmd.com
The cardiac workup has been complete, and would exclude many of the major heart conditions.
The abdominal pain can further be evaluated with a colonoscopy, which can evaluate for any masses or colitis. Otherwise empiric treatment for irritable bowel syndrome can be considered.
The tingling can be further evaluated with a nerve conduction study. Metabolic conditions can also be excluded by testing the thyroid, B12 levels and excluding diabetes.
Another opinion can certainly be sought, preferably at a major academic medical center.
This answer is not intended as and does not substitute for medical advice - the information presented is for patients education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
www.kevinmd.com
Supplements / Vitamins: Potassium 100 mg, Vitamin D 2000 IU, multi-vitamin, herbal tinctures (adrenal glands, thyroid, immune, lymph/detox, kidney/bladder)
Negatives: On just about everything it seems. Heart is fine, arteries to the heart are clear, blood work checks out fine, none of the major autoimmune diseases, thyroid is fine, no concerns about gland in throat.
Conclusion: So I’m going nuts, right? Stress and anxiety and hypochondriac? The doctors seem to state stress and anxiety. I can agree that stress led to some of the symptoms, but I know my body well enough that something happened to it. The only doctor that has seemed to help is the alternative medicine fellow. His findings so far were a “virus” in my system and a staph infection. Honestly, his tinctures have seemed to help the most out of everything done for me so far. I don't want to be one of those Health channel medical shows where it took years to find out what was ailing me.
I’m not convinced I’m past whatever it is. I would like another opinion but I’m not sure who to go see. Another primary? An endocrinologist? My insurance allows it, but the endocrinology department wants a referral from my primary (who probably thinks I’m nuts by now). I have also thought about a doctor who specializes in chronic “diseases” like CFS and fibromyalgia.
Any suggestions? Any of the above findings I should follow up on? I would like to think that the gamut has been run on me that nothing serious has been overlooked and maybe just something that is chronically minor. I have actually been feeling better lately with less fatigue, so I hope that would mean it’s unlikely something serious is going on (?) Thanks in advance.
All of symptom seem due to neck trouble known as "Sympathetic cervical spondylosis"
It's symptoms as fellows:
1 head symptoms: headache