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Suggest Treatment For Fibromyalgia, Headache And Difficulty In Breathing

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Posted on Tue, 19 Sep 2017
Question: I have been experiencing several symptoms and can't seem to get any answers as to what is wrong with me. Most doctors have said that I have fibromyalgia and leave it at that. I am getting worse with even more symptoms and don't really know where to turn. I am having headaches, migrains, muscle spasams, difficulty breathing without it hurting on my left side of my spine into my head.
doctor
Answered by Dr. Ishu Bishnoi (4 hours later)
Brief Answer:
Differential diagnosis and need more information

Detailed Answer:
Hi XXXXXXX wells, thanks for asking from HealthcareMagic.


I can understand your concern. You mentioned that doctors have made the diagnosis of "Fibromyalgia". Please note that the fibromyalgia is a diagnosis of exclusion. It means when every other possible cause has been ruled out by clinical examination and investigations, then it is suspected.

Please let me know:

- What all investigations have been done yet?

- What is the duration of symptoms?

- Is there any such family history?

- Are there any trigger points (specific points over body which cause pain on pressing or pain occurs at those points only)

Answering these questions can help me to reach some conclusion. Now coming to probable diagnosis as per your symptoms, it could be

- A migraine with cervical spondylosis

- Noncompressive myelopathy due to B12 deficiency, post viral infection.

- Peripheral neuropathy

- Multiple sclerosis

Hope you will understand my point. If you are having any doubts, please do let me know.

Thanks. Take care.



Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Ishu Bishnoi (47 hours later)
I have had numerous blood tests that usually come up normal or in the low/normal or high/normal range for example the thyroid tests all come back within the normal range, but either low/normal or high/normal for each test given. I have nogules on both thyroids and a goiter. The endo that i have been seeing for the past 3 or 4 years feels of my neck and says you are okay, come back in a year, without doing blood tests or imaging. I am awaiting blood tests for imflamation, stress and something else that i can't remember right now. The tests should be available tomorrow, Aug 28th, 2017. These blood tests were requested by my current neurologist due to the new symptoms i have been having (debilitating muscle spasms in my neck, shoulders and upper back, as well as having pain in my upper back that shoots between my shoulder blades on the left side up my back, on top of my shoulder and into my neck causing headaches) I have had 3 spinal taps(early 2000's) to rule out ms and other diseases. Although, the mri that was done showed leisions indicitive of ms. Actually, one nurologist at vanderbuilt in TN was going to treat me for ms, but i saw a different neurologist for a second opinion, that said i did not have ms due to the findings on the spinal taps (also at Vanderbuilt, Dr Moses-that specalizes in ms). I have been seeing a chiropractor since XXXXXXX 20th, 2017. He does minor adjustments and i go through about an hour to an hour and a half of physical therapy which includes traction of my head, ultra sound, etc. The chiropractor put me on a special diet that was gluten free, vegan, dairy free and organic. Last monday he told me that i should be showing signs of improvement by now and that he thought my problems were auto immune and that i might have some issues with the adrenal gland. I relayed tjis information to my neurologist and thats when he ordered the tests that i am waiting on for Mon. Aug 28th, 2017. The neurologist also said i had a wedge in the thoracic. So he sent me for an xray and it came back normal. I have had muscle spasms, headaches/migrains since early 2000's, but the pain that runs up my back into my head is new, as well as the joint pain i am experiencing, along with the pain in that same area when i cough, breathe, or sneeze. I had to go to the ER this morning, i had dry heaves and when i did, my chest started burning and hurting, as well as pain running down my left arm. Testing for heart issues came back fine, but the doctor on call said I had costonchondritis and maybe plurisy. I asked him if that would explain the muscle spasms, hurting in my back when i breathe and the pain shooting into my head and he said yes, possibly. My mother had "sick headaches" when she was young, and my father has muscle spasms, they both have arthoritis. In the base of my head(maybe called occipital area) on both sides are painful to the touch, the sides of my neck and middle are painful to the touch and it hurts to move my neck in any direction without shooting pain into my head. There are so many tender spots on the shoulders and shoulder blades that hurt, as well as along my spine. I do have pain in my lower back on each side, i guess you could call it in my hips. The hip pain, as well as the shooting pain down my right side has gotten better with physical therapy(decompression of the lower back). Although pain in my lower back is still present, just not the shooting pain. I hope i have answered your questions .
doctor
Answered by Dr. Ishu Bishnoi (15 hours later)
Brief Answer:
Possibility of Fibromyalgia or MS

Detailed Answer:
Hi xxxxxxxxxxxxx, welcome back.


Thank you for providing me your detailed history. After analysing it, I found that

- You are having asymptomatic thyroid nodules and goiter

- You are having muscle spasms, trigger points and and family history of same

- Your MRI brain had some findings similar to MS. But your spinal tap were normal.

Now if we narrow down your diagnosis, there are two possibilities

- Multiple sclerosis - It can be suspected based on your features and MRI findings. Negative CSF studies can not rule it out. CSF examination is not a good test to diagnose it. MRI brain and spine findings are the main criteria.

So you must ask your neurologist to do nerve conduction studies and electromyography of you. It will rule out nerve damage or demyelination due to MS.

- Fibromyalgia - After ruling out MS, we can suspect fibromyalgia. It can only be suspected after ruling out other organic illness (all blood tests and investigation are normal).

Please send me your fresh reports. If normal, I will tell you what to do about fibromyalgia.
Hope it will help you. If still having doubts, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ishu Bishnoi (27 hours later)
Here are my test results as of Aug 25th,2017
doctor
Answered by Dr. Ishu Bishnoi (6 hours later)
Brief Answer:
Rheumatoid arthritis and low Aldolase

Detailed Answer:
Hi XXXXXXX wells, welcome back.


I have checked your reports. You have two important findings

- RA factor positive - It means you are suffering from Rheumatoid arthritis. It is an auto-immune disorder which involves mainly small joints of body and gradually spread to involve medium joints also. It can cause muscular pain, spasms, generalised weakness, morning stiffness, deformities in limbs.
This is the most probable cause of your symptoms. It can involve other organs also like nerves, skin as it can be associated with other auto-immune disorders.

- Low Aldolase enzyme - Aldolase deficiency is a genetic disease which present with haemolytic anaemia, coarse facial features. Your haemoglobin is 16g%. So I don't think you are suffering from it.

You should consider RA seriously. Consult rheumatologist for management. X rays of your hands, back and feet are needed to know about severity. RA can be controlled by medication like steroids, immune-modulators and painkillers, along with regular physiotherapy.

Hope it will help you. If still any doubts, do let me know.
Thanks. Take care.
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Ishu Bishnoi

Neurologist, Surgical

Practicing since :2007

Answered : 901 Questions

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Suggest Treatment For Fibromyalgia, Headache And Difficulty In Breathing

Brief Answer: Differential diagnosis and need more information Detailed Answer: Hi XXXXXXX wells, thanks for asking from HealthcareMagic. I can understand your concern. You mentioned that doctors have made the diagnosis of "Fibromyalgia". Please note that the fibromyalgia is a diagnosis of exclusion. It means when every other possible cause has been ruled out by clinical examination and investigations, then it is suspected. Please let me know: - What all investigations have been done yet? - What is the duration of symptoms? - Is there any such family history? - Are there any trigger points (specific points over body which cause pain on pressing or pain occurs at those points only) Answering these questions can help me to reach some conclusion. Now coming to probable diagnosis as per your symptoms, it could be - A migraine with cervical spondylosis - Noncompressive myelopathy due to B12 deficiency, post viral infection. - Peripheral neuropathy - Multiple sclerosis Hope you will understand my point. If you are having any doubts, please do let me know. Thanks. Take care.