Brief Answer:
You are probably having 'Chronic Fatigue syndrome'

Detailed Answer:
Dear Sir

From the symptoms you have described you are probably suffering from 'Chronic fatigue syndrome'. This is typically characterized by fatigue, sore throat, muscle and bone pains, unrefreshing sleep etc. The exact cause is not known but certain viral infections can lead to this problem.

Lots of medications have been tried for the disorder but they generally don't work. The best treatment for this is 'Cognitive behavioural therapy' with graded exercise program. I would suggest you to consult a local therapist with experience in Cognitive behavioral therapy for the same and you will see good results with this form of treatment.

As far as hormonal problems are concerned, I would advise the following tests for you in addition to what you have already done:

1. Serum testosterone (fasting, between 8:00 am - 9 am)
2. Serum LH level (8 am)
3. 24 hour urinary cortisol
4. Free T4 and TSH

Please get back to me with these reports. Since you vitamin D is low, I would advice you to take Vitamin D sachets. Typical brand in XXXXXXX is Calcirol XXXXXXX and it is given 60,000 units once a week for 8 weeks followed by once a month. You can talk to your local physician to write you a prescription for vitamin D.

Since your blood pressure is on the higher side, I would advise you to take blood pressure medications after consultation with you physician. You may also need cardiovascular assessment considering your mildly elevated blood pressure. I would advice you to take low salt intake for the same.

Hope this was useful. You can revert back with the hormonal investigations which I have advised.

With Regards
Dr. Om J Lakhani, MD.

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Brief Answer:
You MRI adds to the diagnosis of 'Chronic Fatigue syndrome'

Detailed Answer:
Hi. Let me answer both you questions

1. I agree with your doctor. You had a mild elevation of Prolactin. Such mild elevations are commonly seen with medications. They are especially common with medications used in treatment of Gastrointestinal conditions like dyspepsia or peptic ulcer. Nothing needs to be done per se for this problem.

2. Muscles spasms are common in patients with 'Chronic Fatigue syndrome' , the diagnosis I proposed in the previous post. The cervical problem may not be related to ALL the symptoms that you have written, but may be related to SOME of the symptoms. You can take a pain killer with a muscle relaxant and some passive physiotherapy after consultation with your local physician / orthopedician for the same. Nonetheless, presence of a muscle spasm contributes to the diagnosis of 'Chronic Fatigue syndrome' and that seems to be the working diagnosis for you at present.

I hope I answered both of you follow-up questions.

Regards
Dr. Om J Lakhani

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Brief Answer:
Detailed below:

Detailed Answer:
Let me answer your questions:

1. I understand from what you're saying is that there are still some symptoms that are not attributed to the muscle spasm. Would you please specify those symptoms and suggest what are their probable causes.

Like I said all the symptoms including muscle spasm are explained by ' Chronic fatigue syndrome'

2. Do I still need to do the blood tests that you have mentioned previously? can we eliminate them all? or can we eliminate some of them after we figured out the muscle spasm problem?

Yes, you need those tests to rule out other problems.

Regards
Dr. Om Lakhani.

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