Question: I will try to be brief as possible, but I want to include everything in case it is relevant. Up to last XXXXXXX I was a healthy 35 y/o male, 6’2” 195 lbs, active outdoors and do cardio at least 5 days a week. Five years prior, when I was less active and 20 lbs heavier I was found to have mild high blood pressure and so continued to take 5mg Lisinopril. Other than that, no health issues other than an occasional tension headache. Pretty healthy diet, mostly fruits, vegetables, meats, nuts; few grains and dairy. A glass of wine or a beer once or twice a month. Also take a multivitamin and probiotic (Florastor).

In XXXXXXX 2016 I started noticing an intermittent burning sensation in my throat and nasal passages, random times, but not worse when sleeping or exercising, etc. GERD crossed my mind, but I had actually suffered with that in college (and had to take Prilosec for a while), but this was nothing like that. No indigestion or regurgitation-just a burning sensation. It wasn’t really painful but more annoying and so I reluctantly started taking OTC Prevacid. It seemed to have a minimal impact at best and so after two weeks I made an appt with my doctor. He thought maybe it was LPR and prescribed 40mg Protonix. Again, this had minimal impact and so after two weeks it was bumped to twice a day. At this point my symptoms were mostly, though not completely gone. In mid July I was referred to a gastroenterologist for an upper GI scope which was normal. Since everything was normal I spent the next several months trying to change my diet, eliminate spicy and caffeinated items and step down the medicine. For the most part an OTC PPI would manage symptoms, though never completely get rid of the burning sensation. I even tried no PPIs and just used Tums or Zantac when needed. With this method, symptoms were a bit worse, but not mcuh. During this time blood tests were all normal – CBC, CMP, CRP, Hpylori (negative). The gastro also had me try Trazadone, which I used for 3 weeks with basically no effect.

Around mid November 2016, still dealing with the above as noted, I started also having cramping/aching in my mid back, just to the left of the spine, just below the bottom rib. This wrapped around my bottom rib to my side and often felt like a side stitch you get when running. Occasionally the cramping/tightness would also feel like it went through to my abdomen. This came out of the blue, no injury and was pretty constant. Exertion did not make it worse. I went to my doctor and tried meds for IBS (antispasmodic) and Aleve for the aching. Neither really helped much and so he ordered an ultrasound. This was normal. By late December I was still complaining, again typically more uncomfortable than painful, my doctor ordered a CT with contrast. The only finding was some enlarged mesenteric lymph nodes on the left (up to 9mm). My doctor said nothing showed up that should be causing my symptoms. After another month of constant symptoms he referred me to an orthopedic who did some PT and ordered an MRI of the thoracic spine. While this did find a bulging disc, it found nothing in the area of my complaints. I followed up with the gastro in April and due to ongoing symptoms which now included some nausea. This was the first time he learned of the CT and ordered a repeat test, this time with pelvis. Again, the same findings of mildly enlarged left mesenteric lymph nodes.

The doctors don’t seem to know what else to do, but I hate to accept the fact that I will just have to live like this forever. I also feel like there must be something going on if the lymph nodes are enlarged. The cramping/aching in my back is worse some days than others. Some days it feels like a tightness/burning right on the vertebrae. Other times it is to the side and wraps around my side. Often it is worse when I wake up in the morning, sort of an achy/tightness in the back or back/side. The reason I explained the GERD was because there have now been some times when I am not taking any meds where I get more typical GERD burning that feels like it connects to the pain in my back. I have also noticed some hard smooth lumps under the skin in the part of my back that hurts (which may not be related at all). They are not painful to touch and not growing in size. A dermatologist looked at them but could not identify. Blood tests continue to be normal.

-Please let me know if you have any other suggestions as to possible cause.
-Is it possibly that it could be some sort of chronic parasitic infection?
-Could the lumps indicate some sort of growth or fatty deposit that is causing symptoms?
-Are there any sort of ligament disorders that could be the cause?
-Please let me know if there is any other testing that you would recommend.
-Lastly, is there any further treatment that I should try?

Doctor,

Thank you for your thorough review and extensive answers. You have certainly given me some new treatment ideas to bring up with my doctor. I was curious, if you thought the enlarged mesenteric lymph nodes are incidental or if they could indicate anything.

Also, two symptoms I forgot to mention, though I am not sure they would change your response. First. Over the last few months I have had several instances of my stool being orange or yellow. They were solid and I had no pain, just discolored. This would last a day or two and then return to normal-I don't recall eating lots of carrots or anything that would discolor. The other item relates to my blood tests. Like I said, everything was normal, but on several occasions my ALT was higher than my AST. I have heard that can be indicative of liver issues, but was not sure if the rule applied if both were still in their normal range. Not sure if this changes your opinion, but these were among the reasons I questioned a parasite.

Thanks again,