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Are Stiff Neck With Nose And Lower Throat Pain Symptoms Of TMJ?
Question: Hello I am a soon to be 50 year old women up to this last year in what I would call good health. I don't smoke, drink maybe 2 drinks a month of wine. I have had my thyroid removed about 10 years ago do to pre-cancer cells. About a year and half ago I started to notice balance issues and inner ear aches along with a up tick in my migraines (that I have had for about 20 years). I brushed it off to fluid in my ear. After about 6 months I started getting a stiff neck and nose pain and pain in my lower throat. I went to the er one night with one of my migraines lasting 3 days. They said I had allergys. I thought whoo hoo thats it. Took some allergy medicine and it didnt help. Then I thought well maybe its whats left of my thyroid and the problems have come bad. So I saw an thyroid doc who sent me to an ENT. He said I had TMJ and acid reflux. Balance issues, stiff neck and ear pain with TMJ??? So I gave up. About 3 months later I notice I was becoming stiff in the morning and having trouble walking. I sill felt bad and was beginning to also feel pretty tired all the time (not sleepy). Do any activities at times not all the time seemed to be a hassle. I also got pain in the knuckle of my little finger that lasted and is still the same. The stiff neck started making me car sick a lot. I decided to call a neurologist. He did a lot of MRI of the head and neck and found nothing. So he sent me to a balance doctor. Who checked my ears and ran test. Everything came back negative. He sent me to a rheumatologist . Who told me I have Fybromyalgia . I now have shooting pain, dull pain, sharp pain in my arms, legs, toes, fingers, inner ear, legs hip, ribs, wrists ankles. I am hearing cracking sounds in my legs, arms, wrists, ankles, hips. Like little pings. My cholesterol is high, My ALP shot up 40 points since may. It was 124 and now is 165. I have always had blood pressure of 110/70 my whole life and they just put me on blood pressure medicine because I was getting hyperorthostatic blood pressure. It was shooting up to 150, 160, 170, and 180 when standing from a sitting position. I also know that there are days I am going to the bathroom quite often and am feeling extremely thirsty . I still feel like walking is extremely tiring and sometimes I can feel my knees buckling. I also have a pain in my upper left rib cage which no one has said anything when I have stated it. I know I sound like I have to many things going on but something is not right. I feel terrible. Any suggestions.
I forgot I was put on 3 different n-saids that havent helped. Also they did a DEXA Scan and it came back normal.
I forgot I was put on 3 different n-saids that havent helped. Also they did a DEXA Scan and it came back normal.
Brief Answer:
Polysymptomatic
Detailed Answer:
Good evening. I would like to try and help you sort some of your issues out. Because of the multiplicity of symptoms I would like you to sit down and reread the paragraph you wrote and write up a SMALL bullet list of the THREE most troubling physical things (or mental) that are bothering you RIGHT NOW.
In other words, if I had a magic wand that could XXXXXXX you the immediate, complete, and perfect erradication of ANY 3 problems you mentioned above...which would they be? You may rank order them or not...up to you.....but I want 3 problems XXXXXXX ... Everything gets put away.
We will then, use that list to further expand what the relationship between those items might be and anything else going on. THEN, and only then, will we be able to build an effective and logical plan for how to start attacking your symptoms (probably one by one) and NOT HAVE THEM come back! Wouldn't that be nice....oh, it's possible....but I need you to tell me what's MOST IMPORTANT and everything else goes to the back of the pile for later consideration.
All of this is to be kept on a formal PAIN DIARY. If you can do one online and upload it to me on this network...that's fine....If we can get you to keep really diligent notes then, we will have a pretty good idea of at least the most important and most debilitating symptoms and problems.
Please direct more comments or inquiries to me in the future at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 33 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Polysymptomatic
Detailed Answer:
Good evening. I would like to try and help you sort some of your issues out. Because of the multiplicity of symptoms I would like you to sit down and reread the paragraph you wrote and write up a SMALL bullet list of the THREE most troubling physical things (or mental) that are bothering you RIGHT NOW.
In other words, if I had a magic wand that could XXXXXXX you the immediate, complete, and perfect erradication of ANY 3 problems you mentioned above...which would they be? You may rank order them or not...up to you.....but I want 3 problems XXXXXXX ... Everything gets put away.
We will then, use that list to further expand what the relationship between those items might be and anything else going on. THEN, and only then, will we be able to build an effective and logical plan for how to start attacking your symptoms (probably one by one) and NOT HAVE THEM come back! Wouldn't that be nice....oh, it's possible....but I need you to tell me what's MOST IMPORTANT and everything else goes to the back of the pile for later consideration.
All of this is to be kept on a formal PAIN DIARY. If you can do one online and upload it to me on this network...that's fine....If we can get you to keep really diligent notes then, we will have a pretty good idea of at least the most important and most debilitating symptoms and problems.
Please direct more comments or inquiries to me in the future at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 33 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
Triaging of Problems
Detailed Answer:
Let's take a look at these 3 problems as a focus to other things that may be going.
1. If your headaches are continuous and unremitting then, you should consider seeing a HEADACHE SPECIALIST. In terms, of information that you could take to them would include your symptoms (which can be documented on a diary or log which is something I give to all my headache patients) and can represent information that will help the doctor determine whether or not you are suffering from TENSION, TYPE of HEADACHES, MIGRAINE TYPES, a mixture of the two, or something completely different. Depending upon the type of headache, how often you get them, and the different symptoms you're having you may be prescribed medications that can either PREVENT them from coming on such as propranolol or nortriptyline. Or you could be prescribed abortive medications which can range from high dose NSAID's to Sumatriptan or other drugs similar.
2. As far as extreme fatigue is concerned there are a mountain of causes and medical problems in which FATIGUE is a common symptom. These could range from INSOMNIA to SLEEP APNEA, to CHRONIC DAILY HEADACHES or even metabolic issues such as HYPOTHRYOIDISM, HYPERTHYROIDISM, low adrenal gland functioning, low hormonal levels functioning due to your approaching the menopause perhaps (if that's relevant in your case). Other causes of fatigue include erratic eating schedules which could cause HYPOGLYCEMIA, MEDICATIONS which can cause fatigue as a secondary effect, and then, of course, the syndrome after which it is named which would be mostly treated by a rheumatologist called CHRONIC FATIGUE SYNDROME.
3. Thirsty all the time which is referred to POLIDIPSIA is a condition which in normal individuals (in other words those without overt metabolic issues such as diabetes mellitus, or some other medical condition) is caused by anxiety, medication induced, or straight out dehydration. Most Americans do not drink enough daily fluids or if they do they flush them out by drinking things (such as alcohol and caffeine) which causes them to lose fluids they are ingesting. And so these factors must be examined. And there are a whole list of other causes. I will list just a few possibilities which you can review with your doctors:
•A recent salty or spicy meal
•Bleeding enough to cause a large decrease in blood volume
•Diabetes mellitus
•Diabetes insipidus
•Medicines such as anticholinergics, demeclocycline, diuretics, phenothiazines
•Loss of body fluids from the bloodstream into the tissues due to conditions such as severe infections (sepsis) or burns, or heart, liver, or kidney failure
•psychogenic polydipsia (which is a constant sense of thirst even though the body has more than enough fluids).
Please direct more comments or inquiries to me in the future at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 123 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Triaging of Problems
Detailed Answer:
Let's take a look at these 3 problems as a focus to other things that may be going.
1. If your headaches are continuous and unremitting then, you should consider seeing a HEADACHE SPECIALIST. In terms, of information that you could take to them would include your symptoms (which can be documented on a diary or log which is something I give to all my headache patients) and can represent information that will help the doctor determine whether or not you are suffering from TENSION, TYPE of HEADACHES, MIGRAINE TYPES, a mixture of the two, or something completely different. Depending upon the type of headache, how often you get them, and the different symptoms you're having you may be prescribed medications that can either PREVENT them from coming on such as propranolol or nortriptyline. Or you could be prescribed abortive medications which can range from high dose NSAID's to Sumatriptan or other drugs similar.
2. As far as extreme fatigue is concerned there are a mountain of causes and medical problems in which FATIGUE is a common symptom. These could range from INSOMNIA to SLEEP APNEA, to CHRONIC DAILY HEADACHES or even metabolic issues such as HYPOTHRYOIDISM, HYPERTHYROIDISM, low adrenal gland functioning, low hormonal levels functioning due to your approaching the menopause perhaps (if that's relevant in your case). Other causes of fatigue include erratic eating schedules which could cause HYPOGLYCEMIA, MEDICATIONS which can cause fatigue as a secondary effect, and then, of course, the syndrome after which it is named which would be mostly treated by a rheumatologist called CHRONIC FATIGUE SYNDROME.
3. Thirsty all the time which is referred to POLIDIPSIA is a condition which in normal individuals (in other words those without overt metabolic issues such as diabetes mellitus, or some other medical condition) is caused by anxiety, medication induced, or straight out dehydration. Most Americans do not drink enough daily fluids or if they do they flush them out by drinking things (such as alcohol and caffeine) which causes them to lose fluids they are ingesting. And so these factors must be examined. And there are a whole list of other causes. I will list just a few possibilities which you can review with your doctors:
•A recent salty or spicy meal
•Bleeding enough to cause a large decrease in blood volume
•Diabetes mellitus
•Diabetes insipidus
•Medicines such as anticholinergics, demeclocycline, diuretics, phenothiazines
•Loss of body fluids from the bloodstream into the tissues due to conditions such as severe infections (sepsis) or burns, or heart, liver, or kidney failure
•psychogenic polydipsia (which is a constant sense of thirst even though the body has more than enough fluids).
Please direct more comments or inquiries to me in the future at:
bit.ly/drdariushsaghafi
I would be honored to answer you quickly and comprehensively.
Please keep me informed as to the outcome of your situation.
The query has required a total of 123 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I realize that these are generic symptoms and can be involved in many illnesses. You asked me to create a pain diary. I thought about that for a moment and have come to the conclusion that everyday is exactly the same other than the migraines and the frequent urination (dehydration feelings 3 or 4 days a week). The inner ear, bridge of nose, sore throat and joint pain are intermittent all day long. It never leaves and seems to be getting worse with each month. It has moved from starting in my fingers, toes, and heals to my ankles, wrists and now has moved into my arms, shoulders, pelvis, ribs and back and knees. Fatigue, balance issues, gate, stiffness and walking are also a daily issue. Walking up stairs is painful with no problem walking down stairs. I recently just noticed I am getting a sore in my nose. I am wondering if I am cartilage issues. I had my thyroid out 10 years ago because of pre-cancer cells but I also have Homochmitos Thyroid also. My ALP XXXXXXX 40 points in the last 3 months up from 124 in May to 165 in August. I am thankful for any incite you may have. This is not Fibromyalgia, it cant be its moving quickly. From just a finger, my heals and stiffness in February to now everywhere. Without sounding to over-reactive if it keeps on I wont be walking soon. thank you XXXX
Also I wanted to add I do not or never have suffered from depression. I am happily married with children and granddaughters. My husband, my sons and I own our own business. We are self pay medical at this point. I have paid out of pocket for all of the test I have had. I have a good life and always have been active and happy. This has been taking over my life the last few months and has seemed to come out of no where. Although it is not easy to help anyone to understand the discomfort factor or whether it is my dwelling or a real problem. I can tell without a doubt it is a real problem. I do not feel that taking a few blood tests and a few x-rays are enough to come to the conclusion that I have Fibromyalgia . I have been telling my husband for months something is wrong and I have to get it figured out because I am worried something bad is going to happen. I don't want to be sick. I don't have the need to be sick. But something is wrong. I am at the end of what to ask for from my doctors. I asked for the last blood test. I checked my vitamin D, calcium, parathyroid, alkaline phosophatase. I have been checked for RH, lupus all negative. I had a DEXA scan and an MRI of my pelvic bones, Negative. I assumed I was tested for all autoimmune but am not sure. I am wondering about Relapsing Polychondritis only because of the sore in my nose, joint pain, Vestibular issues. Even thought I was cleared of having any problems with my ears, their is still inner ear pain everyday in both ears. They are popping sometimes, ringing and I am loosing sound sometimes for a few seconds. Not to mention the balance issues, clipping door ways, stiff neck and car sickness. No redness on the outside of my ears though. I have what they said is ruflux, because of the burning in my throat. But I have a dry cough and I dont bring up acid but the pain goes down to my breast bone. That comes and goes. I lost my voice for a month last year. If its not arthritis, what affects the nose, ears, throat, joints, pelvis, back, ribs, and causes me to have trouble walking up stairs or raising or using my arms and hands. Sorry for the long paragraph, I just though detail might be in order. Not analytical I know. :)
Also I wanted to add I do not or never have suffered from depression. I am happily married with children and granddaughters. My husband, my sons and I own our own business. We are self pay medical at this point. I have paid out of pocket for all of the test I have had. I have a good life and always have been active and happy. This has been taking over my life the last few months and has seemed to come out of no where. Although it is not easy to help anyone to understand the discomfort factor or whether it is my dwelling or a real problem. I can tell without a doubt it is a real problem. I do not feel that taking a few blood tests and a few x-rays are enough to come to the conclusion that I have Fibromyalgia . I have been telling my husband for months something is wrong and I have to get it figured out because I am worried something bad is going to happen. I don't want to be sick. I don't have the need to be sick. But something is wrong. I am at the end of what to ask for from my doctors. I asked for the last blood test. I checked my vitamin D, calcium, parathyroid, alkaline phosophatase. I have been checked for RH, lupus all negative. I had a DEXA scan and an MRI of my pelvic bones, Negative. I assumed I was tested for all autoimmune but am not sure. I am wondering about Relapsing Polychondritis only because of the sore in my nose, joint pain, Vestibular issues. Even thought I was cleared of having any problems with my ears, their is still inner ear pain everyday in both ears. They are popping sometimes, ringing and I am loosing sound sometimes for a few seconds. Not to mention the balance issues, clipping door ways, stiff neck and car sickness. No redness on the outside of my ears though. I have what they said is ruflux, because of the burning in my throat. But I have a dry cough and I dont bring up acid but the pain goes down to my breast bone. That comes and goes. I lost my voice for a month last year. If its not arthritis, what affects the nose, ears, throat, joints, pelvis, back, ribs, and causes me to have trouble walking up stairs or raising or using my arms and hands. Sorry for the long paragraph, I just though detail might be in order. Not analytical I know. :)
Brief Answer:
Headache diary very useful in treating headaches
Detailed Answer:
Thank you for your return information. Just so you know what type of specialist I am- I am an adult neurologist with subspecialization in Headache medicine. Headache diaries are the central core of my headache clinic and I spend quite a bit of time educating and teaching our patients how to detail their headaches in written format which though a bit tedious to begin with becomes much smoother and greatly appreciated by patients who go through the rigor of learning the technique. I commonly have patients who initially say the same as you do that they really don't see the point since all their headaches are identical. However, that type of perception has been studied and what's been found is that there are many reasons for why people think or feel that's the case. It is a typical response from anybody who has chronic headaches so you're not alone in your thinking. But what the studies have continually revealed (and much to the XXXXXXX of all participants who were certain that all their headaches were unwavering) is that in fact, headaches are as unique as fingerprints. No 2 are every the same and not even in the same patient. I am happy to send you a typical log that we use in the clinic and although it is not entirely intuitive because there are some definitions that have to be explained it may provide a basis for you to have a discussion with your doctor so as to look at that particular entity which I believe occupies an important part of your scope of problems. Again, I recommend you seek out a headache specialist since family physicians and internists by and large don't have too much experience or interest in such diaries or journals and would not be able to guide you as a headache specialist would....and I'd go so far as to say even general neurologists would likely not easily jump on board to help you with something like this...it really is the territory of a subspecialist's.....BUT IF YOU FILL THEM OUT I CAN TELL YOU THAT IN THE HANDS OF THE RIGHT INDIVIDUAL THERE IS SOOOO MUCH INFORMATION that can be gleaned and uncovered that it will absolutely astound you. It can point to the best treatments and classes of medications as well as pointing you away from treatments which may be a mistake for you to try. Quite different from what the majority of physicians and patients are used to doing which is, "Try one...doesn't work...try another...doesn't work....try another...." And pretty soon "I've tried every medicine there is doc and Nothing Works On me!"
I hope you will take my advice and choose to learn the art of documenting headaches as this is really the only way treating them or expecting that they be successfully confronted can have a rate of success.
I fear you may have misunderstood my including psychological/psychiatric choices as possible explanations to your symptoms. I do not have nearly enough information (nor am I qualified as a specialist) to make the call as to whether you are or are not suffering a mood disorder. Frankly, I don't think anybody can do that unless they can be absolutely sure all other medical causes, contributing causes and risk factors for some medical condition(s) has been adequately ruled out. I mentioned these entities merely as a way of being COMPLETE in the identification of the major possible causes for the rather broad and nonspecific symptoms you've presented. I'm glad to hear that you have a happy marriage. That is HUGE when it comes to having a solid support system that can help you cope and address some of these health issues. Very different when someone has to face all these problems alone vs. with a loving and caring family. Hopefully, your medical team is as supportive and will take the time and due diligence that can piece your symptoms together into a coherent constellation of problems which could fit together to form either a syndrome or perhaps 2 or 3 separate problems.
In terms of ruling or out fibromyalgia this is essentially territory best tread, in my opinion, by a good rheumatologist who is knowledgeable in the textbook procedures needed to approach the patient in terms of the tests that need to be done to rule out other diseases but also who has the patient base in order to recognize when variations on a theme are likely afoot. As you correctly stated, fibromyalgia is not able to be diagnosed by way of a single or even multiple blood tests. Nor can the condition be 100% ruled out by doing the same. Instead there is a lot of clinical acumen that must go into reading such patients, their histories, and then, having educated hunches that feel right or wrong when coming down with that diagnosis.
I can tell you that in my particular case of at least going through a preliminary screening of patients who I believe may have FM...first I do go through some routine blood and urine tests....I can't tell you how many people over the years have had numerous other problems from thyroid to adrenal to Vit. B12 or Vit. D anomalies and who have resolved when properly treated.....so that is tantamount to the process. However, assuming that there is no obvious cause preliminarily I subscribe to a method of screening patients by assessing them on basically 2 fronts. One is called the WIDESPREAD PAIN INDEX measure and the other is the SYMPTOM SEVERITY score. I use a set of questions which are considered the latest accepted guidelines and represent modification of the 2010 and 2011 criteria. If my patients score in these areas and it appears almost certain then, that they may have FM then, I look to verify that finding by referring my patients to a good rheumatology colleague I have in this area. By the same token I think you may be well to see if your doctor would be willing to do the same for you.
Have you had a good solid neurological examination? You mention losing hearing, imbalance issues. Have you had an MRI of the brain? I don't know if it would truly be warranted in this case since my preference would be to be able and examine you physically before just ordering more tests....especially if you are self pay....MRI's are very expensive. Although your doctor may be able to speak to an imaging center and depending upon the pull he's got with them work out a reasonable price they could charge a self pay patient. Here in XXXXXXX for example, I have an agreement with my local radiology facility for MRI's of $350.00 for self pay patients. That same scan will be billed out to the tune of about $2000-$3000.00. While I agree that finding something heretofore unknown in you that is based in the brain or spinal cord at the TENDER YOUNG AGE of 49 is slightly lower chance....but on the other hand if you never look....you'll never find.
If your hearing is affected then, to me an audiology examination may be warranted. There are clinical tests that can be done upon neurological examination that can suggest the presence of a hearing acuity problem which then, would better justify something like an audiological exam.
Generalized arthralgias with reflux, what could be neurological issues with equilibrium, hearing alterations, headaches....certainly things such as FM come to mind, polymyositis could be a possibility and then, as I said just above, looking at the brain for something such as demyelinating disease is always a must in my books when symptoms are really "all over the place." Against the concept of a demyelinating type of disease would be your age, the lack of typical sensory symptoms of numbness and tingling in the extremities, or other BIZARRE sorts of transformations which can be days or weeks in duration and then, entirely DISAPPEAR.
I hope these answers satisfactorily address your symptoms and concerns. If so, may I ask the favor of a HIGH STAR RATING with some written feedback?
Also, this is the THIRD question of the series and therefore, may I ask you CLOSE THE QUERY on your end and reopen it with a new query charge if you wish to continue the discussion with me?
If you choose to continue this discussion with me please use the following web address so that I may be directly tagged for response:
bit.ly/drdariushsaghafi
I would be honored to continue answering more questions, send you a copy of the HEADACHE DIARY I give to all my patients, and look at any lab results you may have available.
I'd love to know the outcome of your situation if you choose to end this discussion here and take some of these ideas in for discussion with your PMD.
The query has required a total of 179 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Headache diary very useful in treating headaches
Detailed Answer:
Thank you for your return information. Just so you know what type of specialist I am- I am an adult neurologist with subspecialization in Headache medicine. Headache diaries are the central core of my headache clinic and I spend quite a bit of time educating and teaching our patients how to detail their headaches in written format which though a bit tedious to begin with becomes much smoother and greatly appreciated by patients who go through the rigor of learning the technique. I commonly have patients who initially say the same as you do that they really don't see the point since all their headaches are identical. However, that type of perception has been studied and what's been found is that there are many reasons for why people think or feel that's the case. It is a typical response from anybody who has chronic headaches so you're not alone in your thinking. But what the studies have continually revealed (and much to the XXXXXXX of all participants who were certain that all their headaches were unwavering) is that in fact, headaches are as unique as fingerprints. No 2 are every the same and not even in the same patient. I am happy to send you a typical log that we use in the clinic and although it is not entirely intuitive because there are some definitions that have to be explained it may provide a basis for you to have a discussion with your doctor so as to look at that particular entity which I believe occupies an important part of your scope of problems. Again, I recommend you seek out a headache specialist since family physicians and internists by and large don't have too much experience or interest in such diaries or journals and would not be able to guide you as a headache specialist would....and I'd go so far as to say even general neurologists would likely not easily jump on board to help you with something like this...it really is the territory of a subspecialist's.....BUT IF YOU FILL THEM OUT I CAN TELL YOU THAT IN THE HANDS OF THE RIGHT INDIVIDUAL THERE IS SOOOO MUCH INFORMATION that can be gleaned and uncovered that it will absolutely astound you. It can point to the best treatments and classes of medications as well as pointing you away from treatments which may be a mistake for you to try. Quite different from what the majority of physicians and patients are used to doing which is, "Try one...doesn't work...try another...doesn't work....try another...." And pretty soon "I've tried every medicine there is doc and Nothing Works On me!"
I hope you will take my advice and choose to learn the art of documenting headaches as this is really the only way treating them or expecting that they be successfully confronted can have a rate of success.
I fear you may have misunderstood my including psychological/psychiatric choices as possible explanations to your symptoms. I do not have nearly enough information (nor am I qualified as a specialist) to make the call as to whether you are or are not suffering a mood disorder. Frankly, I don't think anybody can do that unless they can be absolutely sure all other medical causes, contributing causes and risk factors for some medical condition(s) has been adequately ruled out. I mentioned these entities merely as a way of being COMPLETE in the identification of the major possible causes for the rather broad and nonspecific symptoms you've presented. I'm glad to hear that you have a happy marriage. That is HUGE when it comes to having a solid support system that can help you cope and address some of these health issues. Very different when someone has to face all these problems alone vs. with a loving and caring family. Hopefully, your medical team is as supportive and will take the time and due diligence that can piece your symptoms together into a coherent constellation of problems which could fit together to form either a syndrome or perhaps 2 or 3 separate problems.
In terms of ruling or out fibromyalgia this is essentially territory best tread, in my opinion, by a good rheumatologist who is knowledgeable in the textbook procedures needed to approach the patient in terms of the tests that need to be done to rule out other diseases but also who has the patient base in order to recognize when variations on a theme are likely afoot. As you correctly stated, fibromyalgia is not able to be diagnosed by way of a single or even multiple blood tests. Nor can the condition be 100% ruled out by doing the same. Instead there is a lot of clinical acumen that must go into reading such patients, their histories, and then, having educated hunches that feel right or wrong when coming down with that diagnosis.
I can tell you that in my particular case of at least going through a preliminary screening of patients who I believe may have FM...first I do go through some routine blood and urine tests....I can't tell you how many people over the years have had numerous other problems from thyroid to adrenal to Vit. B12 or Vit. D anomalies and who have resolved when properly treated.....so that is tantamount to the process. However, assuming that there is no obvious cause preliminarily I subscribe to a method of screening patients by assessing them on basically 2 fronts. One is called the WIDESPREAD PAIN INDEX measure and the other is the SYMPTOM SEVERITY score. I use a set of questions which are considered the latest accepted guidelines and represent modification of the 2010 and 2011 criteria. If my patients score in these areas and it appears almost certain then, that they may have FM then, I look to verify that finding by referring my patients to a good rheumatology colleague I have in this area. By the same token I think you may be well to see if your doctor would be willing to do the same for you.
Have you had a good solid neurological examination? You mention losing hearing, imbalance issues. Have you had an MRI of the brain? I don't know if it would truly be warranted in this case since my preference would be to be able and examine you physically before just ordering more tests....especially if you are self pay....MRI's are very expensive. Although your doctor may be able to speak to an imaging center and depending upon the pull he's got with them work out a reasonable price they could charge a self pay patient. Here in XXXXXXX for example, I have an agreement with my local radiology facility for MRI's of $350.00 for self pay patients. That same scan will be billed out to the tune of about $2000-$3000.00. While I agree that finding something heretofore unknown in you that is based in the brain or spinal cord at the TENDER YOUNG AGE of 49 is slightly lower chance....but on the other hand if you never look....you'll never find.
If your hearing is affected then, to me an audiology examination may be warranted. There are clinical tests that can be done upon neurological examination that can suggest the presence of a hearing acuity problem which then, would better justify something like an audiological exam.
Generalized arthralgias with reflux, what could be neurological issues with equilibrium, hearing alterations, headaches....certainly things such as FM come to mind, polymyositis could be a possibility and then, as I said just above, looking at the brain for something such as demyelinating disease is always a must in my books when symptoms are really "all over the place." Against the concept of a demyelinating type of disease would be your age, the lack of typical sensory symptoms of numbness and tingling in the extremities, or other BIZARRE sorts of transformations which can be days or weeks in duration and then, entirely DISAPPEAR.
I hope these answers satisfactorily address your symptoms and concerns. If so, may I ask the favor of a HIGH STAR RATING with some written feedback?
Also, this is the THIRD question of the series and therefore, may I ask you CLOSE THE QUERY on your end and reopen it with a new query charge if you wish to continue the discussion with me?
If you choose to continue this discussion with me please use the following web address so that I may be directly tagged for response:
bit.ly/drdariushsaghafi
I would be honored to continue answering more questions, send you a copy of the HEADACHE DIARY I give to all my patients, and look at any lab results you may have available.
I'd love to know the outcome of your situation if you choose to end this discussion here and take some of these ideas in for discussion with your PMD.
The query has required a total of 179 minutes of physician specific time to read, research, and compile a return envoy to the patient.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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