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Severe Sleep Apnea, Torn Miniscus, Had Pneumonia, Word Slurring, Dizziness. Has Arthritis In His Sternum. What Now?
Question: Hello, my husband is a 38 y/o white male, 6'1, 235lbs but in very good shape and currently has 48inch shoulders and 38inch waist now but he's gained 20lbs in the last 4 months so his waist has gained 4 inches in that time. He smokes a pack a day for 20 years. Does not drink alcohol at all. No drug use. No DM. He's active military - Navy Chief.
Hx: He has severe sleep apnea [diagnosed 2 weeks ago, CPAP on its way], tennis elbow, another torn miniscus, constant severe pain in both knees and both hips [multiple xray and MRI have both come back clean and hisdoctors are dumbfounded]. He has had knee surgery for torn miniscus 3 years ago, has had pneumonia 5 times, food poisoning on the boat 7 times and the "Mystery XXXXXXX Flu" that apparently everyone on the XXXXXXX XXXXXXX gets 10-30 days afterboarding the ship [but he hasn't been on the XXXXXXX for over a year and a half. He said he's had the weird tingling for several years but it usually "comes and goes" lasting about 5-15 minutes but now, there is swelling which has never happened before. He has been ruled out for CHF, RA, SLE, MS. His family has NO Hx of CHF, CVA, cardiac problems, no arthritis, no DM. He complains of constantly being exhausted and occasional spouts of feeling "high" [for like of a better description] where he feels he has a head full of wool, like feeling like being REALLY drunk but knowing he shouldn't feel that way, the low cognitive skills, word slurring, dizziness. His mother did tell me that she has had the same tingly/prickley sensation in her right arm so I don't know if there's a genetic factor. He sporadically gets ocular migranes [he can have none foryears then about 10x a month to 4 a day in a month] His cholesterol is normal, he does not have high BP, no fevers [other than the pnuemonia and foodpoisoning, he's never sick, no fevers, no rashes, no swollen lymph nodes, no bilateral pain, no seizures, no strokes, etc.
He has been complaining of many things but the real complaint is the major pain in his right arm. His right arm is swollen [shoulder to finger tips], and the swelling has been ongoing for about a month. He described the feeling in his arm as 3 stages: stage 1, desensitizing sensation that starts in the tip of his thumb, then goes to the first finger to the pinky o the had. Stage 2: cold tingling/prickely sensation tstarts to rapidly spread to his entire hand. Stage 3: the tingling sensation spreads to his entire arm almost instantly and his entire arm up to his shoulder and then the entirearm feeling like it is on fire along with numbness and tingling. The tingling and burning is reported on a 10/10 pain scale continuing for about a month. The doctors have done extensive EKG's, full blood panels, XXXXXXX panels, thyroid panels... they've pretty much ruled out many possible diseases/syndromes but noone can tell us wha he's got. His shrink thinks he also has sjogren's syndrome because he's always drinking something otherwise his lips dry out and he feels like his eyes are full of sand.
Meds: He has been Rx'd Motrin,and Vicodin for the pain but he rarely takes the vicodin. Prior, he was Rx'd Celebrex because he had pain in his back, knees, and 2 nuckles but his MD took him off of it after a month because that's when we estimate the symptoms started and she wasnt sure if his symptoms may have been caused by Celebrex. Now, a month off of Celebrex, his symptoms continue.
Currently, he's in constant pain ranging 7/10 to 10/10 constantly. His Rheumatologist has ruled out OA and RA but said he has arthritis in his sternum [I'm not a doctor but it's the first timeI heard that one], and his 3rd and 4th right fingers, along with tennis elbow in this right arm. He is fatigued all the time, he now has mood swings because of the constant pain, and all his doctors don't know what's wrong with him other than the 90% chance he has Sjogrens.
All his doctors are out of ideas. What can it be? What other info can I offer/questions I can answer?
Hx: He has severe sleep apnea [diagnosed 2 weeks ago, CPAP on its way], tennis elbow, another torn miniscus, constant severe pain in both knees and both hips [multiple xray and MRI have both come back clean and hisdoctors are dumbfounded]. He has had knee surgery for torn miniscus 3 years ago, has had pneumonia 5 times, food poisoning on the boat 7 times and the "Mystery XXXXXXX Flu" that apparently everyone on the XXXXXXX XXXXXXX gets 10-30 days afterboarding the ship [but he hasn't been on the XXXXXXX for over a year and a half. He said he's had the weird tingling for several years but it usually "comes and goes" lasting about 5-15 minutes but now, there is swelling which has never happened before. He has been ruled out for CHF, RA, SLE, MS. His family has NO Hx of CHF, CVA, cardiac problems, no arthritis, no DM. He complains of constantly being exhausted and occasional spouts of feeling "high" [for like of a better description] where he feels he has a head full of wool, like feeling like being REALLY drunk but knowing he shouldn't feel that way, the low cognitive skills, word slurring, dizziness. His mother did tell me that she has had the same tingly/prickley sensation in her right arm so I don't know if there's a genetic factor. He sporadically gets ocular migranes [he can have none foryears then about 10x a month to 4 a day in a month] His cholesterol is normal, he does not have high BP, no fevers [other than the pnuemonia and foodpoisoning, he's never sick, no fevers, no rashes, no swollen lymph nodes, no bilateral pain, no seizures, no strokes, etc.
He has been complaining of many things but the real complaint is the major pain in his right arm. His right arm is swollen [shoulder to finger tips], and the swelling has been ongoing for about a month. He described the feeling in his arm as 3 stages: stage 1, desensitizing sensation that starts in the tip of his thumb, then goes to the first finger to the pinky o the had. Stage 2: cold tingling/prickely sensation tstarts to rapidly spread to his entire hand. Stage 3: the tingling sensation spreads to his entire arm almost instantly and his entire arm up to his shoulder and then the entirearm feeling like it is on fire along with numbness and tingling. The tingling and burning is reported on a 10/10 pain scale continuing for about a month. The doctors have done extensive EKG's, full blood panels, XXXXXXX panels, thyroid panels... they've pretty much ruled out many possible diseases/syndromes but noone can tell us wha he's got. His shrink thinks he also has sjogren's syndrome because he's always drinking something otherwise his lips dry out and he feels like his eyes are full of sand.
Meds: He has been Rx'd Motrin,and Vicodin for the pain but he rarely takes the vicodin. Prior, he was Rx'd Celebrex because he had pain in his back, knees, and 2 nuckles but his MD took him off of it after a month because that's when we estimate the symptoms started and she wasnt sure if his symptoms may have been caused by Celebrex. Now, a month off of Celebrex, his symptoms continue.
Currently, he's in constant pain ranging 7/10 to 10/10 constantly. His Rheumatologist has ruled out OA and RA but said he has arthritis in his sternum [I'm not a doctor but it's the first timeI heard that one], and his 3rd and 4th right fingers, along with tennis elbow in this right arm. He is fatigued all the time, he now has mood swings because of the constant pain, and all his doctors don't know what's wrong with him other than the 90% chance he has Sjogrens.
All his doctors are out of ideas. What can it be? What other info can I offer/questions I can answer?
Hello,
Thanks your posting a query and giving detailed history.
From the pain description it seems he has a sort of radicular/ radiating pain in right upper limb. I have few specific questions for you:
- did he ever complained of neck pain
- did this pain goes to till shoulder or neck region
- I am not sure how are his upper limb XXXXXXX tendon reflexes? This helps to understand the nature of lesion and the possible sites.
- At any time whether an MR of spine/ radiculopathy.? May I get access to the reports?
He has right tennis elbow also concomitantly which can sometimes give rise to this sort of pain after exertion / lifting weights. I am not sure how the diagnosis of arthritis 3rd and 4 th finger was thought off ? What were the investigation and local findings on examination.? So I think I need at least scanned copy of the prescriptions which can contain the other doctor's examination findings.
As far as Sjogren's is concerned there are few tests which may help rule out like schirmer's test. A biopsy for looking out minor salivary glands which your rheumatologist can guide you. These test raises the possibility. Chest arthritis are rare entities where only a Rheumatologist can comment. I do not see them in our day to day practice.
If the above evaluation is already done or comes negative I would consider a possibility of chronic fatigue syndrome. It is a clinical diagnosis with supportive clinical features. A neurophysician's appointment can give out some more clues.
Best Wishes
Dr. Neeraj Baheti
Thanks your posting a query and giving detailed history.
From the pain description it seems he has a sort of radicular/ radiating pain in right upper limb. I have few specific questions for you:
- did he ever complained of neck pain
- did this pain goes to till shoulder or neck region
- I am not sure how are his upper limb XXXXXXX tendon reflexes? This helps to understand the nature of lesion and the possible sites.
- At any time whether an MR of spine/ radiculopathy.? May I get access to the reports?
He has right tennis elbow also concomitantly which can sometimes give rise to this sort of pain after exertion / lifting weights. I am not sure how the diagnosis of arthritis 3rd and 4 th finger was thought off ? What were the investigation and local findings on examination.? So I think I need at least scanned copy of the prescriptions which can contain the other doctor's examination findings.
As far as Sjogren's is concerned there are few tests which may help rule out like schirmer's test. A biopsy for looking out minor salivary glands which your rheumatologist can guide you. These test raises the possibility. Chest arthritis are rare entities where only a Rheumatologist can comment. I do not see them in our day to day practice.
If the above evaluation is already done or comes negative I would consider a possibility of chronic fatigue syndrome. It is a clinical diagnosis with supportive clinical features. A neurophysician's appointment can give out some more clues.
Best Wishes
Dr. Neeraj Baheti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello doctor,
He has had XRAY's of right shoulder, neck, spine [lumbar, thorax, and cervical], both knees, right elbow, and right wrist - all reports stating "no significance" and 3 doctors and a chiropractor all say there's no evidence of abnormalities.
He had MRI to Right shoulder, neck, spine [cervical and thoracic], both knees, and right ankle - all findings came back as "no evidence of abnormalities"
Rheumatologist ruled out OA, RA, SLE with XXXXXXX panel, RH factor was 14, XXXXXXX tendon reflexes are normal, the fingers - he has had consistant pain, swelling, and can't hold a wrench for more than 10 minutes when working on planes or cars.
They have him scheduled for next week. The rheumatologist said he had arthritis in his sternum after pressing different spots on his chest and pinpointing the spots that really hurt. Regarding neck pain, he said he always had someneck/backpain for the last 15 years but MRI's and Xrays always come back clean. The pain extends only tohisshoulder and does not reachthe neck. No pinched nerves or slipped disks. The pain in his arm is not brought on by exercise but it worstened by lack of motion. He says the pain gets better if he stands up and raises his hand and shakes it for several minutes [for some reason, sitting down and shaking his arm doesn't help.
Please let me know if there's any otherinfo I can provide.
Thank you
He has had XRAY's of right shoulder, neck, spine [lumbar, thorax, and cervical], both knees, right elbow, and right wrist - all reports stating "no significance" and 3 doctors and a chiropractor all say there's no evidence of abnormalities.
He had MRI to Right shoulder, neck, spine [cervical and thoracic], both knees, and right ankle - all findings came back as "no evidence of abnormalities"
Rheumatologist ruled out OA, RA, SLE with XXXXXXX panel, RH factor was 14, XXXXXXX tendon reflexes are normal, the fingers - he has had consistant pain, swelling, and can't hold a wrench for more than 10 minutes when working on planes or cars.
They have him scheduled for next week. The rheumatologist said he had arthritis in his sternum after pressing different spots on his chest and pinpointing the spots that really hurt. Regarding neck pain, he said he always had someneck/backpain for the last 15 years but MRI's and Xrays always come back clean. The pain extends only tohisshoulder and does not reachthe neck. No pinched nerves or slipped disks. The pain in his arm is not brought on by exercise but it worstened by lack of motion. He says the pain gets better if he stands up and raises his hand and shakes it for several minutes [for some reason, sitting down and shaking his arm doesn't help.
Please let me know if there's any otherinfo I can provide.
Thank you
Hello,
Thanks for providing details of investigation and examination findings.
If everything else is normal, nerve conduction study will help us and give a clue. Also meanwhile discuss with your rheumatologist for further work-up on lines of sjogrens as suggested in my reply.
I personally feel even nerve conduction may come normal.
Does he have multiple tender spots over the body? Is he depressed? How's his sleep? He most like has Chronic fatigue syndrome a detailed evaluation by neurophysician may help you to reach to diagnosis.
Hope this answers your query
Best Wishes
Dr. Neeraj Baheti
Thanks for providing details of investigation and examination findings.
If everything else is normal, nerve conduction study will help us and give a clue. Also meanwhile discuss with your rheumatologist for further work-up on lines of sjogrens as suggested in my reply.
I personally feel even nerve conduction may come normal.
Does he have multiple tender spots over the body? Is he depressed? How's his sleep? He most like has Chronic fatigue syndrome a detailed evaluation by neurophysician may help you to reach to diagnosis.
Hope this answers your query
Best Wishes
Dr. Neeraj Baheti
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello again Doctor,
He does not have tender spots, he's not depressed [but everyday our 16 year old drives us both up the walls so stress is pretty much elevated constantly]. As for his sleep, he was diagnosed with severe sleep apnea a couple weeks ago and we are waiting for the CPAP to come. The sleep study came back saying he actually goes into REM sleep for 20-45 minutes total per night so I know that's not helping. The oxygen deprivation at night and lack of sleep is definately taking a toll on him, combined with daily stress of our [very angry and moody] son keeps him in a "not so great" mood. We had a serious open conversation about depression because he has had it in the past and was taking Welbutrin for some time until it sent his BP soaring to 190/110 [I thought hypertensive crisis territory personally but the MD at the Emergency Room diagnosed him with Headache of Unknown Origin and sent him home]. I called his psychiatrist and she weaned him off over a period of 10 days - but this was about 6 months ago. Since he was off that, she put him on Celebrex for the joint pain and Zoloft but then the arm pain started so she was concerned that Celebrex could be causing it so she discontinued the Rx but his symptoms persisted. That's when shetook him off everything, thinking that there is something goingon and we don't want meds masking symptoms that may otherwise be there and this entire diagnosis journey started.
That's the long story that brings me here hoping for some kind of answers and suggestions. He is now scheduled forthe nerve conduction study, then I want him to consult with a neurologist, cardiologist, and as many "ologists" as it takes.
Again, thank you so much for your continued help and advice through all this. Your input is really very helpful.
Our best wishes,
XXXXXXX
He does not have tender spots, he's not depressed [but everyday our 16 year old drives us both up the walls so stress is pretty much elevated constantly]. As for his sleep, he was diagnosed with severe sleep apnea a couple weeks ago and we are waiting for the CPAP to come. The sleep study came back saying he actually goes into REM sleep for 20-45 minutes total per night so I know that's not helping. The oxygen deprivation at night and lack of sleep is definately taking a toll on him, combined with daily stress of our [very angry and moody] son keeps him in a "not so great" mood. We had a serious open conversation about depression because he has had it in the past and was taking Welbutrin for some time until it sent his BP soaring to 190/110 [I thought hypertensive crisis territory personally but the MD at the Emergency Room diagnosed him with Headache of Unknown Origin and sent him home]. I called his psychiatrist and she weaned him off over a period of 10 days - but this was about 6 months ago. Since he was off that, she put him on Celebrex for the joint pain and Zoloft but then the arm pain started so she was concerned that Celebrex could be causing it so she discontinued the Rx but his symptoms persisted. That's when shetook him off everything, thinking that there is something goingon and we don't want meds masking symptoms that may otherwise be there and this entire diagnosis journey started.
That's the long story that brings me here hoping for some kind of answers and suggestions. He is now scheduled forthe nerve conduction study, then I want him to consult with a neurologist, cardiologist, and as many "ologists" as it takes.
Again, thank you so much for your continued help and advice through all this. Your input is really very helpful.
Our best wishes,
XXXXXXX
Thanks for providing further details.
Obstructive sleep apnea can itself lead to fatigue and muscle pain but those joint pains, radiating pains are odds. Fibromyalgia was one more differential at the back of mind hence I asked about tender points.
Chronic fatigue syndrome is a clinical diagnosis as I have already told in my previous reply. For your information, I am giving the criteria for chronic fatigue syndrome.
To XXXXXXX the diagnostic criteria of chronic fatigue syndrome, you must have unexplained, persistent fatigue for six months or more, along with at least four of the following signs and symptoms:
Loss of memory or concentration
Sore throat
Enlarged lymph nodes in your neck or armpits
Unexplained muscle pain
Pain that moves from one joint to another without swelling or redness
Headache of a new type, pattern or severity
Unrefreshing sleep
Extreme exhaustion lasting more than 24 hours after physical or mental exercise
See if he fits in; consult your neurologist/physician.
Hope this answers your query. Should have some more doubts after your nerve conduction study/neurologist consultation, feel free to ask.
Best Wishes
Neeraj
Above answer was peer-reviewed by :
Dr. Shanthi.E
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