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Flu like symptoms, heavy legs sensation, pain in eyes. No MS, tumors,cancer,diabetes,do have chronic sinusitis. Is it Polymyalgia Rheumatica ?

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Neurologist
Practicing since : 2001
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Hello Doctor,

I'm a male, 39 years, pretty good health (with the exception of my undiagnosed symptoms)...no cancer, heart problems, diabetes or any other known diseases. I do not drink, smoke or use illicit drugs. I do have chronic sinusitis.

The symptoms and concerns are as follows...

I get these horrific flu-like symptoms whenever I get a viral infection such as the flu or a sinus infection or sometimes with no apparent illness at all. Much worse than anyone I've ever known. This goes back to my youth, but I notice that it gets worse as I get older, especially within the last 5 years or so. Of all the flu-like symptoms I get, the sporadic body aches are the worst. They're unbearable. The last few times I've gotten these "attacks" I've had to go to the ER. This last episode really scared me, as even morphine didn't ease the pain. In addition to this, I begin to hyperventilate and I start becoming incoherent. Now, these seemingly neuromuscular pains happen at anytime, any day, anywhere throughout my body, but mainly in my legs. They're sharp, needle-like pains in my muscles that may only last for seconds at a time, but may hit a particular area in body over and over again for several minutes, such as my thigh or arm.

Another symptom I get is a "heavy legs" sensation. This started about 10 years ago and occurs sporadically. A number of things can trigger it... walking for long periods, jogging, working out, an illness such as the flu or a cold, stress or sometimes with no apparent triggers at all.

At its worst, it renders me incapacitated. It begins mildly, and then worsens to the point where I can’t walk at all. This symptom happens frequently and can last for an hour up to weeks at a time. This, in-and-of-itself, is not painful, but physically draining and interferes with daily functioning. When this leg fatigue or heaviness happens, my gait is also affected. I'd like to note that I do indeed maintain muscle strength in my legs at all times even during these episodes. However, when I try to walk, it feels like I'm toting around concrete slabs on each side of my leg.

Lastly, I now have been experiencing eye troubles within the last 6 months. Very often, my eyes feel very heavy and sometimes sleepy. It scares me to drive, as I don't want to fall asleep at the wheel. I've come close several times. Even when I get 8 hours or more of sleep, it still occurs. In addition to the heavy eyes, I'm now experiencing pain inside my eyes. It's a throbbing, muscle pain XXXXXXX in my eyes, sometimes in the left, sometimes the right. Even, looking in a certain direction can cause pain. It’s a similar pain to the pain I felt when I had Lasik surgery many years ago, sitting in post-opt as the pain drops began wearing off.

I'm not sure if any of these symptoms have anything to do with one another, but I do know for a fact that as I get older, my symptoms are happening more often and with more severity.

I've seen many doctors, including neurologists, to find out what’s going on. They've ruled out MS, Hypokalemic Periodic Paralysis, Lupus, Lime Disease and brain tumors. The latest doctor suspects it may be Polymyalgia Rheumatica. However, I don't have any pain in my shoulders or hips and this has been going on since childhood, just not as severe.

Sorry for the lengthy details. I figured I'd be as thorough as possible. I realize without lab studies or scans, it’s probably impossible to detect what it could be, but any theories, thoughts are suggestions would be most appreciated. Thank you so much for your help.
Posted Mon, 21 May 2012 in Bones, Muscles and Joints
 
 
Answered by Dr. Shiva Kumar R 6 hours later
Hello

Thanks for the query

From the details provided to me to put it shortly it looks to me like you have severe muscular pains, stiffness and weakness of the limbs which increase on exertion and probable ptosis (sleep eyes) all suggesting the possibility of a neuromuscular disorder in you. Diseases of both the muscle and neuromuscular junction can present with problems similar to your problems, but presence of pain points more towards muscle disease.

I personally feel you are not suffering from Polymyalgia rheumatica. I would like to know if you have lab values of CPK and LDH which indicates muscle damage in you. ENMG of the muscle would be required to look for myopathic changes suggestive of muscle disease. Repetitive nerve stimulation (RNS) test to look for the possibility of NM junction disorders.

So I personally request you to provide me these details before I conclude about your problem.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question I would be happy to address them.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
Follow-up: Flu like symptoms, heavy legs sensation, pain in eyes. No MS, tumors,cancer,diabetes,do have chronic sinusitis. Is it Polymyalgia Rheumatica ? 15 hours later
Thank you, doctor. I have requested my recent blood work from my doctor for you to see. Hopefully, I will recieve it soon. In the meantime, I have had an EMG performed on me about 8 months ago on my legs and arms and the results were fine. Is the EMG the same as an ENMG and RNS?
 
 
Answered by Dr. Shiva Kumar R 9 hours later
Hello

Thanks for the follow up query

EMG performed on you is same as ENMG as mentioned by me earlier. Normal EMG excludes many muscle disease but not all. I am interested to see what your blood report says. If muscle enzymes are normal then I would recommend you to XXXXXXX a Neuromuscular specialist to consider other possibilities of myopathy. If the suspicion of the muscle disease is high you may require muscle biopsy to exclude certain possibilities.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question I would be happy to address them.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
Follow-up: Flu like symptoms, heavy legs sensation, pain in eyes. No MS, tumors,cancer,diabetes,do have chronic sinusitis. Is it Polymyalgia Rheumatica ? 2 days later
I just recieved my recent blood test. Please find the attached blood results. I took this test toward the end of a respiratory infection, so my neurologist wants me to redo the blood testing in a month or see if my recent illness had anything to do with the raised CRP level.

I've been doing some research on Fibromyalgia and right now, this seems to be the only thing that makes sense in light of my symptoms.

Here's re-cap of my symptoms

-periodic heaviness of legs, difficulty walking
-random, sporatic needle-like pains in my muscles from head to toe, mainly in legs.
-constant fatigue
-heaviness of eyes, tired eyes (not visibly noticable)
-random pain in both left and right eyes
-lower back pain, hurts to bend over

Please note, the pains are exacerbated and unbearable during an illness/fever.

I've had an MRI of the XXXXXXX legs and lower back and everything's come back unremarkable.

Thanks again for your feedback..
 
 
Answered by Dr. Shiva Kumar R 12 hours later
Hello

Thanks for the follow up query

From the information provided it looks like the muscle enzymes are normal. Raised CRP levels is due to recent respiratory infection. As we have excluded the possibilities of muscle and NM junction disorders, fibromyalgia looks a possibility at this point of time.

So I request you to see a Rheumatologist for a consultation to looks for the possibility of fibromyalgia.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate. If you have any additional concerns regarding your question I would be happy to address them.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
Follow-up: Flu like symptoms, heavy legs sensation, pain in eyes. No MS, tumors,cancer,diabetes,do have chronic sinusitis. Is it Polymyalgia Rheumatica ? 44 minutes later
Thank you, doctor. I will make an appointment with a Rheumatolgist.
 
 
Answered by Dr. Shiva Kumar R 2 hours later
Hello

Thanks for the query

Wishing you good health.

Sincerely,

Dr Shiva Kumar R
Consultant Neurologist & Epileptologist
Above answer was peer-reviewed by
 
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