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Suggest Treatment For Constant Body Pain With Swollen Hands And Rashes On Fingers

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Posted on Thu, 5 Nov 2015
Question: I have had constant body pain for the last few months. All of the tests suggesting auto immune were negative except a positive ana tiger that was 1:40 speckled. My eosinophils also just came back at 8.8. I go to a military base clinic and they only tell me they don't know what's going on. My hands feel swollen and like they've been asleep and I get rashes on my fingers. I have a family history of RA. I also have vitamin D deficiency. But I take supplements for that. What else could it be?
doctor
Answered by Dr. Naval Mendiratta (20 minutes later)
Brief Answer:
Chronic Pain

Detailed Answer:
Thank you for writing on health care magic

I have gone through your history and would like to ask you a few more details to help me localize the origin of pain and the cause. Constant pains are a very difficult to diagnose. ANA positive at 1: 40 doesnt sound too significant. I would like to ask you a few more details before guiding you further:

1. Could you describe me the sites of the pain?? Which all location is it affecting you

2. Is it more on activity or at rest??

3. Do you have any early morning stiffness

4. Any history of backache or any other joint swellings?(Do your rings tighten in the morning)

5. do you experience dry mouth or dry eyes?

6. Any symptoms of constant fatigue/forgetfullness/irrtability??

Do let me know these queries. It will help me narrow down the possibility of inflammatory pain or non inflammatory one

Await your reply

Regards
Dr NAval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Naval Mendiratta (16 minutes later)
1. The pain is in my legs, arms, back, neck and hands.

2. It's all of the time. At rest and with activity.

3. There is stiffness in the morning that is pretty bad. It's hard to move at all.

4. Not really any joint swelling. And no history of back pain

5. I have dry mouth but I also believe it's from Lisinopril. I take it for high blood pressure.

6. I'm always fatigued. It feels like I just can't make it through the day. Even after wAking in the morning I am tired and ready to go back to bed. My co workers have also noticed a mood change in Me. I'm more grumpy than usual. I forget stupid simple things more frequently now as well. Like where I put my keys down that I just had a minute ago. Sometimes even my friends names.

Thank you for your time.
here is a copy of my most recent labs:

Mrs XXXX;

your lab results are as follows:

C-Reactive Protein     Site/Specimen     14 Sep 2015 0806     Units     Ref Rng     
C-Reactive Protein     SERUM     0.2 < i>     mg/dL     (0-0.5)     


Thyroid Stimulating Hormone Sensitive     Site/Specimen     14 Sep 2015 0806     Units     Ref Rng     
Thyrotropin Sensitive     SERUM     2.68 < i>     mcIU/mL     (0.27-4.32)     

Vitamin D, 25-Hydroxy     Site/Specimen     14 Sep 2015 0806     Units     Ref Rng     
Vitamin D, 25-Hydroxy     SERUM     11 (L) < i>     ng/mL     (30-60)     

CBC     Site/Specimen     14 Sep 2015 0806     Units     Ref Rng     
RBC     BLOOD     4.62     x10(6)/mcL     (3.80-5.10)     
Hemoglobin BLOOD     11.3 (L)     g/dL     (11.5-15.5)     
Hematocrit     BLOOD     36.7     %     (34-45)     
MCV     BLOOD     79.5 (L)     fL     (80-98)     
MCH     BLOOD     24.4 (L)     pg     (26.7-33.7)     
MCHC     BLOOD     30.7 (L)     g/dL     (32.5-36)     
RDW CV     BLOOD     15.8 (H)     %     (11.6-15)     
Platelets     BLOOD     372     x10(3)/mcL     (140-420)     
MPV     BLOOD     7.6     fL     (7.0-10.0)     
Lymphocytes BLOOD     24.7     %     (14.0-46.0)     
Monocytes     BLOOD     6.3     %     (3.0-13)     
Neutrophils BLOOD     59.1     %     (38.5-76.5)     
Eosinophils BLOOD     8.8 (H)     %     (0-7.4)     
Basophils     BLOOD     1.1     %     (0-2.6)     
ABS Lymphocytes     BLOOD 1.5     x10(3)/mcL     (0.9-3.0)     
ABS Monocytes     BLOOD     0.4     x10(3)/mcL     (0.2-0.9)     
ABS Neutrophils     BLOOD     3.6     x10(3)/mcL     (1.3-6.3)     
ABS Eosinophils     BLOOD     0.5 (H)     x10(3)/mcL     (0-0.4)     
ABS Basophils     BLOOD     0.1     x10(3)/mcL     (0-0.2)     
WBC     BLOOD     6.1     x10(3)/mcL     (3.6-10.0)     

ESR     Site/Specimen     14 Sep 2015 0806     Units     Ref Rng     
ESR     BLOOD     13 mm/hr     (0-20)     
doctor
Answered by Dr. Naval Mendiratta (12 hours later)
Brief Answer:
Chronic Pain Syndrome

Detailed Answer:
Good evening

Sorry for the late reply. Was caught up at work

Well, I have gone through your reply and the blood reports.

Your blood reports are quite ok except 25 hydroxyvitamin D3 which is very low. Its defieciency can cause lot of fatigue and generalized muscle ache. We will need to supplement you with it till you reach the normal limit

But I still feel, there is another problem going on which needs to be looked into. The symptoms you have mentioned about and normal lab reports, go more in favor of a disease called Fibromyalgia. It is a disturbance of the pain center , that is more of a central cause than the peripheral one( Joint/muscle/nerve).

I am gonna give you a link. Do go through it and let me know if your symptoms match it( Do avoid google as it can give a lot of mismatch information with worst case scenarios). The treatment part is easy once when we have the diagnosis. Since noone is able to figure it out for you, we can give it a try

XXXX---> Patient education---> Fibromyalgia

Await your reply

REgards
Dr naval
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Naval Mendiratta (11 hours later)
Hi Dr. Naval. Thank you for taking time for me. I looked at the website and information. The symptoms match mine almost exactly. Including the IBS. I didn't realize they could be related. I do get migraines more often now than before. I've had migraines my whole life but they are more frequent. I do not have tmj though. I'm always tired. It never ends. I'm extremely forgetful which is not a good thing in my career. Also sometimes I have issues with an overactive bladder. I just don't make it in time to the restroom. I wasn't aware that all of these things were related and my current dr. Never asked about them. Thank you again.
doctor
Answered by Dr. Naval Mendiratta (12 hours later)
Brief Answer:
Fibromyalgia

Detailed Answer:
Good evening XXXX

Well, yes most of your symptoms do fit into the disease and as long as you are convinced about the diagnosis the treatment part should not be difficult.

The medicines you have to ask your GP to prescribe... I personally favor duloxetine/amitryptilline.

But along with medications, there has to be changes in the life style as well. If we practise both of them together, the results are better and you can go off medications after a while. But minimum 6 months is needed.

As for the life style changes:

1. I would suggest you learn some meditation. 10 minutes in the morning is helpful.

2. Get proper sleeping hours( 6 hours minimum required by your body in the day)

3. Do regular exercises. Initially they may pain but overtime , if you are persistent it will get better

4. Indulge in a hobby. Whatever you always wanted to do.

We have to try combining both and get you out of the disease as it can hamper the quality of your life.

Do visit your GP as you do have a diagnosis and get started on the medications

PS: Dont forget to supplement with Vitamin D as well

Do let me know for more queries. Would be happy to help out

Regards
Dr Naval
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Naval Mendiratta

Rheumatologist

Practicing since :2007

Answered : 754 Questions

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Suggest Treatment For Constant Body Pain With Swollen Hands And Rashes On Fingers

Brief Answer: Chronic Pain Detailed Answer: Thank you for writing on health care magic I have gone through your history and would like to ask you a few more details to help me localize the origin of pain and the cause. Constant pains are a very difficult to diagnose. ANA positive at 1: 40 doesnt sound too significant. I would like to ask you a few more details before guiding you further: 1. Could you describe me the sites of the pain?? Which all location is it affecting you 2. Is it more on activity or at rest?? 3. Do you have any early morning stiffness 4. Any history of backache or any other joint swellings?(Do your rings tighten in the morning) 5. do you experience dry mouth or dry eyes? 6. Any symptoms of constant fatigue/forgetfullness/irrtability?? Do let me know these queries. It will help me narrow down the possibility of inflammatory pain or non inflammatory one Await your reply Regards Dr NAval