Large number of symptoms with no diagnosis

[Calathan]

I'm a 27 year old male, and have been having an increasing number of symptoms over the last 3 months.  I don't know what I should do next or even if my symptoms are all caused by the same thing.

Initially I had what felt like bad indigestion after eating lunch, with pain at the top of my stomach and in the left side of my chest (particularly in a small spot just inside and above my left nipple).  I could feel my pulse on the left side of my chest just in the area that was hurting.  I also felt like I had gas in my stomach and kept belching for about 24 hours.  Those symptoms have at various times since then gotten mostly but not entirely better and then gotten worse again.

About 1.5 weeks after the initial symptoms started, I had pain and muscle spasms starting in one spot on the right upper part of my back.  The pain spread through my right shoulder and into my neck, and then into the right side of my back and into my right upper arm.  After a few days, the pain improved, but it has never entirely gone away.  For a few weeks, I had little pain in my back and neck, but had pain in my upper arms, shoulders, and armpits of both arms (though not each spot all the time).

About 2-3 weeks after the back pain had started, I had what started as a mild headache on one side of my head, but then developed into pain around and behind my eyes, as well as blurred vision.  After a couple days, I also started having pain in the surface of my eyes and sometimes red spots or blood vessles showing up.  I also had a mild sense of being off balance.   For one day soon after the eye pain started, I had a particularly bad headache, and have had milder headaches since then.  A couple weeks later, the sense of being off balance was temporarily worse, but still not so bad that I was falling over or anything like that.  I also started seeing spots or streaks of light move across my vision, which were frequent for two days and have since grown gradually less frequent.  The pain behind and around my eyes continued for a few weeks, and has since recurred on occasion (most recently 2 days ago).  The pain in the surface of my eyes and blurred vision has still occured frequently since then, but not all the time.  My jaws have been popping a lot since the eye pain started, but they have popped for years so I don't know if that could be contributing to my symptoms.

I have also had sore or stiff fingers and toes, as well as pain in my chest where either along the breastbone or where my ribs meet the breastbone.  I had a couple days where I felt very tired and weak, with my fingers and toes particularly feeling cold and sore and my upper arms particularly feeling weak.  During the period of time when I was feeling particularly weak, I also had symptoms of a mild cold (mild nasal congestion, a mildly sore throat), and I have again had symptoms of a mild cold this past week, but in general I haven't had symptoms of a cold during the rest of the time I have been having these other symptoms.  The only times I had any fever was a fever of 99.4 today and a fever of 99.3 when the back pain first started.  The rest of the time, I have had no fever at all.

I have gotten the following tests, none of which have lead to a diagnosis:

I initially had an EKG when I was having chest pain, which a doctor thought might indicate pericarditis.  However, I followed up with a cardiologist and got another EKG and an echocardiogram, which he said were normal (he said I had early repolarization on the EKG, which was mistaken for signs of pericarditis).  An x-ray of my chest was also normal.

I later got x-rays on my back, neck, shoulders, and my chest again after I had been having pain in my back, neck, and shoulders, but all of them were normal.

I got first a CT and then an MRI of my brain after I started feeling off-balance and having headaches, but they were both totally normal.

I had an eye exam from an ophthalmologist when I started having pain around my eyes, and had another eye exam with a visual field test after I had been seeing spots and streaks, but both times he found nothing wrong with my eyes or optic nerves.

I had an ultrasound of my abdomen after the pain at the top of my stomach got worse again, but it was totally normal.

I saw a neurologist and had a EEG, an MRI of my neck, an EMG of my arms, and a nerve conduction study of my arms, all of which were normal except to indicate a slightly pinched nerve in my left arm (I think due to using the computer or playing video games).

I had a blood test for Lyme disease, which was negative, and a blood test for Epstein-Barr, which indicated I have had it at some point but don't currently have an acute infection.  I have gotten numerous other blood tests, including a complete blood count (twice) and a comprehensive metabolic panel (twice), as well an antinuclear antibodies test, rheumatoid arthritic factor test, sedimentation rate test, creatine kinase test, C-reactive protein test, and I think some other blood tests as well.  All of those were normal (one of my cholesterol numbers was a little bad, and my blood sugar was just slightly above the reference range, but I wasn't fasting for the tests).  I also got a stool test for H. Pylori bacteria, but it was negative.

I had slightly high blood pressure a few times (140s over something in the 80s, I forget the exact numbers), but for the last few weeks it has been normal (usually something in the 120s over something in the 70s).  However, today it was up a little again (something in the 130s over something in the 80s).

Anyway, I have no idea what to do next.  My doctor has basically ruled out all the things he thought might be causing my symptoms, and I don't know who to see next.  I'm considering seeing a rheumatologist (even though the blood tests for things like rheumatoid arthritis or lupus came back normal), or a gastroenterologist (since I keep having pain or discomfort at the top of my stomach).  I was also thinking maybe I should see the cardiologist again, since I only saw him when the initial symptoms first started 3 months ago, and have continued having chest pain since then.  If anyone has had anything like this or could at least recommend who I should see next, I would really appreciate it.

[Calathan]

Sorry to not post anything for a while.  Anyway, so far most of my symptoms have not gone away, though each of them has at various times improved and then gotten worse again.  I went to see a rheumatologist who had me get more blood tests, and then diagnosed me with a vitamin D deficiency due to the blood tests.  She prescribed me a high dose of vitamin D to take once a week for 8 weeks, but so far after 4 weeks I haven't had any improvement of my symptoms.  In fact, some of the symptoms that had previously gone away have now come back (though almost all of the symptoms have at various points gone away and come back previously, so I don't think them coming back is due to the vitamin D).  I'm not sure if the vitamin D deficiency was causing any of my symptoms, or might have been caused by the fact that I have not been playing sports much for the last several months due to feeling bad and thus getting less sun exposure.  I was also thinking that the Prilosec could have caused me to not absorb vitamin D well.  I stopped taking the Prilosec at least a month ago now and have not seen any improvement of my symptoms since then.

My doctor also had me try taking Sertraline in the hopes that it would improve my symptoms, but I stopped taking it after 5 days because it was giving me a lot of side effects (stomach pain, insomnia, inability to ejaculate) and not helping any of my symptoms.  The morning of the second day after stopping I had a very bad bought of anxiety which I think was due to starting and then stopping the Sertraline.  I have had a few bouts of anxiety since my symptoms started, but all the previous ones were less severe and occurred only when I had new symptoms.  In this case, I logically knew nothing was wrong, but felt so anxious that I ended up going to the ER.  Anyway, my doctor gave me Xanax to take just if I have anxiety (I haven't had any bad anxiety since then though), and I also saw a psychiatrist.

The psychiatrist had me try taking Cymbalta mainly because my regular doctor had tried having me take Sertraline.  I realize now that there really was no indication that I should take either, and I probably shouldn't have agreed to take the Cymbalta.  Like the Sertraline, the Cymbalta gave me insomnia and made me unable to ejaculate (though I didn't have any stomach pain with it, perhaps because my body had started getting used to SSRI effects while I was taking the Sertraline).  It helped with the mild pain I had been feeling in my chest (though that was one of the least annoying of my symptoms), but not at all with the pain in my neck, back, and shoulders, my eye problems, or the soreness, stiffness, and cold feeling in my fingers.  I ended up taking it for almost a month before I finally decided that the side effects were much worse than any benefits I was getting from it.  However, by then my doctor had given me samples of Ambien to try to help with the insomnia that was caused by the Cymbalta, which had helped slightly but then left me with significant rebound insomnia after only 7 days of taking the Ambien. I went from about 3-4 hours sleep with the Cymbalta, to 5 hours sleep with Ambien while on the Cymbalta, to no sleep at all if I didn't take a sleeping medicine, both while I was on the Cymbalta and for a couple weeks after I stopped.  Eventually, the rebound insomnia went away, but it has made me not want to take Ambien (or Cymbalta) ever again.

Unfortunately, my doctor has decided that anxiety must have been the cause of all of my problems, even though I have assured him that all of my symptoms started before I had anxiety (i.e. the long period of increasing symptoms with no diagnosis caused me to have anxiety, not the other way around).  I haven't had any significant anxiety for about 8 weeks now, but I am still feeling all of the same symptoms.  I not sure if I should keep seeing the same doctor or find a new doctor, as I no longer really trust my doctor's opinion and the last time I saw him (maybe about 6 weeks ago), he didn't seem willing to believe anything I told him.  Part of the reason I saw the rheumatologist is that I didn't think my doctor would be willing to order any more tests, even though there were some things (such as vitamin levels) that I hadn't been tested for at that point.

Anyway, I am still having a sore neck, shoulders, and upper back, cold, sore and stiff fingers and toes, and some eye irritation (though the eye problems haven't been quite as bad as they were a few months ago).  I have also had a couple periods where the front of my neck, in the area of my Adam's apple, had discomfort.  My doctor didn't think it was a thyroid problem, as I had a blood test for thyroid problems (though that was before I had much irritation there), and also because he didn't think the area felt enlarged.  I thinking it could be a muscle problem related to the neck pain, as this time it started about a week after I had started having soreness in my neck muscles, and the last time I seem to remember the soreness also progressing from the back and sides of my neck to the front in a similar way.  I've also felt like I had a lot of mucus in my throat for a few weeks now, though I haven't really had a sore throat (on the inside) or a stuffed up nose, or anything else indicative of a cold.

I'm still trying to decide what to do next.  I don't know if my symptoms might improve after I finish the vitamin D treatment, or if the fact that they haven't improved so far (half way through the treatment) indicates that there is something else causing the symptoms.

Also, I just want to mention that I feel confident that Multiple Sclerosis has been ruled out.  My brain MRI was viewed by someone at the location where I got the MRI, by a doctor at my primary physician's office (not actually my primary physician, who was on vacation then), and by a neurologist, all of whom said they so nothing wrong.

[Dr. Kokil Mathur]

Hi

Thanks for keeping me posted! Hope you are better now?

Well all your symptoms can be easily explained by Multiple Sclerosis. It will be worthwhile to seek a second opinion.

Other possibilities are pancreatitis due to some autoimmune disorder. An autoimmune disorder too can cause several mixed symptoms like in your case.

And last but not the least your symptoms could also be rare side effects of Prilosec, infect all of them. Please refer: http://gerd.emedtv.com/prilosec/prilosec-side-effects-p2.html

I am glad you thought of mentioning that you are taking Prilosec. Stopping the medication should solve your problems if this is the case.

Hope this helps! All the best! Do keep me posted.

[Weesy68]

This may be of interest too.  I found it while looking up Vitamin D deficiency which can cause this.

Laryngospasm
In medicine, laryngospasm is an uncontrolled/involuntary muscular contraction (spasm) of the laryngeal cords. The condition typically lasts less than 30 or 60 seconds, and causes a partial blocking of breathing in, while breathing out remains easier. It may be triggered when the vocal cords or the area of the trachea below the cords detects the entry of water, mucus, blood, or other substance. It is characterized by stridor and or retractions. Some people suffer from frequent laryngospasms, whether awake or asleep. In an ear, nose and throat practice, it is typically seen in people who have silent reflux disease. It is also a well known, infrequent, but serious post-surgery complication

[Weesy68]

I had some symptoms in common with you and recently found out that I have Anemia and severe Vitamin D deficiency.  Anemia is tested by checking Ferritin levels which is the only iron test that can verify iron deficiency anemia because Hemoglobin and Hematocrit can be perfectly normal, and it is considered the most severe form of anemia.  The doc is right that you should have the  B12 as well and I would get a Vitamin D test too as that can cause pain in the areas you describe and quite a few other problems, including heart.  If it is GERD it may be causing absorption issues or you may have a malabsorption issue that seems like GERD. I am being sent for a study to see if I have gastroparesis after having been diagnosed with GERD and been given Prevacid for six months twice a day with minimal help.  Don't discount the importance of the Vitamins.  I've done that and am now realizing just what that deficiency can do.  Those vitamin deficiencies can also cause neurological symptoms when you are deficient and Vitamin D in particular is found only in a few foods and exposure to the sun so if you aren't supplementing it's not that difficult to fall low on that one.  They checked me for MS as well and showed nothing.  You may also want to check the accuracy of the stool test for H-Pylori because the breath test is actually the most accurate test.  I had that test as well, ha ha.  I also had heart tests and they were normal, but I noticed that you did not have the treadmill test which actually studies your heart while it's under stress because some symptoms will occur more often when your heart is under stress so that is really important.  The things you are seeing in your eyes could be an aura which will usually precede a migraine headache and once in a while I can get an aura without a headache but that's rare.  Anemia does cause headaches and various other symptoms because your body is not getting enough of the oxygen to various different parts of your body so the lower your iron goes, the more symptoms will appear. My fingers and toes got very cold and still are as I only started the iron which was an RX not OTC medication specifically for anemia.  In hindsight, had it occurred to me that I had anemia, all I would have needed to do was to put my hand next to someone with a similar coloring and it was obvious that I looked pasty white while they had pinkish hues.  If it is anemia you might notice that when you put your hands under warm water your hands go red pretty quickly.  Happens with your toes as well.  There were times where I had four toes completely white and the baby toe all red.  Weird, but true.  I did notice in the very beginning a mottled look to my skin as well.  Look up mottled because it's hard to explain.  Get your Ferritin checked.  There are underlying disorders that can cause Iron deficiency anemia, but your symptoms are very similar to mine.  Mine just happened to follow a case of mono.  You can read my post regarding my symptoms if it will help you.  My BP also went up initially then it started to slowly get lower I guess as I became more anemic, and migraines that I had not experienced for about three years now were now coming back and worse than before and closer together.

[Calathan]

Thanks for the help.

I think the two MRIs I got were to rule out Multiple Sclerosis and cervical disk problems, so I don't think I have to worry about those anymore.  I also don't use alcohol, and I get a lot of vitamin B12 in my diet.

I'm really thinking a hiatal hernia seems like a good explaination for my initial symptoms.  I was belching for about 24 hours when the symptoms start, which seems like it could have caused a hernia.  However, could a hiatial hernia or GERD be the cause of all of my other symptoms, or would that be unlikely?

Also, my doctor has had me taking Prilosec (actually the generic equivalent), since he initially thought my symptoms were caused by GERD, but then I developed the back pain and then the headaches and eye pain.  Is there any chance that the Prilosec could have caused the other symptoms, or is that not likely?

[Dr. Kokil Mathur]

Hi

Thanks for the detailed post.

I can see that you have been investigated for a number of problems. Others which you can take into consideration are GERD or gastroesophageal reflux disease, hiatal hernia, also called a diaphragmatic hernia, cervical disk that may irritate the nerve roots going to the chest wall or thoracic outlet syndrome.

Thyroid problems, excess use of alcohol, Vitamin B12 deficiency, associated hyperventilation syndrome, fibromyalgia, stress etc should also be looked into.

You should also seriously consider Multiple Sclerosis.

I think you should discuss these possibilities with your doctor. This needs a more detailed investigation. It is difficult to comment beyond this without examining. Please let me know if there is any thing else and do keep me posted. Take care!