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Having severe body pain, weakness and fever. Found abnormal vitamin d3 level. Right medication?

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Internal Medicine Specialist
Practicing since : 1996
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Hello Sir,
i have sever body aches after some physical excercise. i get fevers many times if i do some long exertion in standing or walking.
this is happenning since 4-5 years..once i get fever, it stays for a week then gets better.
i feel very week and fatigued mostly..
got alot of tests done already, only vitamin d3 was abnormal (7.3)
and polymorphs in blood test were little high. not much
i feel unbalanced and feel like waking on trampolin, if i strain my neck muscles (even lifting my 3 year old kid)
lost around 20 kg in 2 years and then had a hard time gaining it back (have gained 3 kg in lat 1.5 years)
i have discussed my issue with alot of gastroenterologist and diabetologist as well..but no diagnosis
i need your help coz only sympotm i can explain is extreme muscle pains and fatigue following any physical exretion..even sneezing makes my muscles very stiff for 2-3 days..i can hardly breath with tight muscles.
LFT
KFT
Blood sugar
BP
Haemoglobin
candida antibody (coz of gas and constipation issues)
thyroid and anti tpo
vitaminb12
igg
stool analysis (72 hrs)
Posted Tue, 26 Mar 2013 in Medicines and Side Effects
 
 
Answered by Dr. Prasad Akole 3 hours later
Dear XXXXXXX

Welcome and thanks for entrusting your query here at HCM!

I am Dr. Prasad Akole (Critical Care Expert- http://bit.ly/Dr-Prasad-Akole) and am glad to address to your query here.

I cannot see any values of reports you just mentioned in your query. Can repost them or attach all the scanned reports as attachments to Attn: Dr. Prasad Akole to
YYYY@YYYY

I feel you problem is of muscle weakness and pain, fatigue. It can occur with low vitmin D levels and calcium deficiency.

Could you please answer some questions to help me elucidate the problem?
Do you over exercise? Do any gym? Or is it with daily activities?
Do you get reduced urine quantity when you get fever, pains?
Is there any tingling / numbness in the limbs?
Do you have any difficulty reading/ eye muscle weakness?
Can you stand up from sitting position easily and normally?
Do you get breathless? Are there any swellings in the body?
Was CPK, electrolytes, calcium and vitamin B12 levels checked? Any Xray, ECG, urine routine exam?

I would like to have these answers and the lab values of the tests you have already done.
Drink adequate water, avoid any exertion/ exercises and exposure to heat till you get a diagnosis.
I hope you are on Vitamin D supplements.

Will await answers.


Thank you and Good luck!
Above answer was peer-reviewed by
 
Follow-up: Having severe body pain, weakness and fever. Found abnormal vitamin d3 level. Right medication? 1 hour later
Could you please answer some questions to help me elucidate the problem?

Do you over exercise? Do any gym? Or is it with daily activities?
i do gym but i have very less tolerance level..i cant do over exercise..although it make me feel very good at that time but worst a day after exercise..i usually feel muscle pains and fatigue next after exertion.

sometimes i feel strange sensation in legs or arms in night while sleeping if i do overexcercise..like i need to stretch the arms and legs.or press them with weight..this happenns only on hard excercise or overtraining. although my excercises are of moderate levels, still they are hard for me..

i have started exercising since 1 year only..i used to do hard excercise when i was 21-24 years..i left them due to job and my job is a graphic designer (long sitting job)
i used to go to office (50 km everyday) by driving car. i started feeling unreal many times while driving car..it made me panicked alot of time.

my first major dizzy attack came when i drove a bike..i came back home and felt unbalanced on moving my neck.

i started loosing weight and remained panicked due to continuous minor dizzyness..
dizzyness comes only on moving my head spcially..got the examination done by ent for ear issues but nothing abnormal was found in CT scans or other balance tests.

my whole body used to be very tight and doing normal -moderate work could make me feel weak and fatigued for 3-4 days straight..no pain but very fatigue. as if my muscles are over relaxed...

i left job and started doing some excercise..it made me feel much better.
i was little more energetic and comfortable everyday..
now i cant leave excercise for 2-3 days..if i dont do excercise thn my body becomes tight after second day (specially in morning after waking up) and get way too relaxed in afternooon as if my body doesnt want to move (no pain but only weakness)

while working on computer i take extra care of my neck rest..i cant work without neck rest..it makes me very dizzy..but i can work easily if i have neck rested..

_________________________________________________

Do you get reduced urine quantity when you get fever, pains?
no, infact i urinate little more coz i feel cold at that time...
my fever gets better on its own..paracetamol helps relive the symptoms but ibrufen works better. (i dont take much medicines though)

_____________________________________________

Is there any tingling / numbness in the limbs?
i guess yes..mostly just before i fall sleep..

__________________________________________________

Do you have any difficulty reading/ eye muscle weakness?
alot of problems in eyes..i cant go in sunlight..i feel negative after images..i cant read in bright light..i cant see alot of moving ibject like in mall or road...i cant drive..
if i do anything from above thn i feel unreal and eyes feel numb next day..

ice pack and rosewater in eyes helps alot..i strted wearing antiglare and use sunglasses alot now.
___________________________________________________________

Can you stand up from sitting position easily and normally?
YES
___________________________________________________________
Do you get breathless? Are there any swellings in the body?
breathless yes, swelling no..i get breathless when my chest and stomach muscles are tight dues to sneezing or lifting something..this breathlessness is like unable to take a XXXXXXX breath..if i relax thn i feel better.

i don't feel breathless while running or doing exercise
______________________________________________________
Was CPK, electrolytes, calcium and vitamin B12 levels checked? Any Xray, ECG, urine routine exam?
yes
following tests has been done
calcium test - never done this specifically.
LFT - normal
KFT - normal
sodium and potassium - normal
vitamin b12 - normal
xray of neck flexion - nothing major abnormality
ECG - normal
urine test - normal
thyroid - normal
lipid profile - normal
stool test (72 hrs) - normal
haemogram - normal
ct scan of head - normal
serum insulin - normal
blood sugar - normal
hormon test DHEA - normal
morning cortisol - normal


one more major symptom i have is constipation (i have sorted it out with isapgol now) but ususally after passing satisfactory stool, i feel verrrry relaxed and sleepy..for 1-2 hrs..thn i get better..

as a short story. i feel better when i keep moving my body but i cant do normal things like walking for half n hour without getting very exhausted..i can do thing in break..

i can upload all the reports if needed
 
 
Answered by Dr. Prasad Akole 1 hour later
Dear XXXXXXX
Thanks for the elaborate details. I saw all the reports.

Your vitamin D levels are significantly low. Low vitamin D levels and associated calcium deficiency can explain most of your symptoms of fatigue and aches. Have you been mostly indoors? This is a very common problem nowadays.

Have you been started on high dose Vit D and calcium therapy?
If not, you should immediately start an injection of Vit D and then bi-weekly calcirol sachets for 2 months. Also calcium supplement is needed. Will need months of treatment.
Please be guided by a good physician at a reputed hospital.

Stop any exercises slowly over few days and go for very light aerobics just enough to prevent any symptoms. Avoid any strenuous training/ exercises/ activity. Increase exposure tyo morning sunlight. Eat food XXXXXXX in Vitamin D and calcium (net will give all the info)

I think you should be seen by a good neurologist at a good tertiary care hospital. A good expert physical exam is essential. As you have dizziness on neck movements, imbalance, eye problems, and muscle fatigability, we should rule out cervical myelopathy. (can occur due to osteoporosis from vit D / calcium deficiency).
If clinically a neuro/ myopathy is low on suspicion, you might have to undergo MRI cervical spine, EMG/ NCV (muscle function testing), serum calcium, phosphorus, magnesium levels, CPK (muscle enzymes).

I hope you act on my advice meticulously and get better in a couple of months. (yes, takes 2-3 months to normalize).

If there is no relief with this supplementation, uncommon differentials should be considered.
Myasthenic weakness could be a rare differential, but less likely as per description.
One may rule out any myopathies, uncommon electrolyte imbalances etc. I would also advise an ophthalmology opinion.
Are you on any drugs of abuse (by any chance)? Is there any family history of muscle / nerve disease?

Keep me posted on your progress. Feel free to ask me a direct question on
http://bit.ly/Dr-Prasad-Akole
for any further help.

All the best. Would request for your rating/ review of this answer whenever you have no more immediate queries, before you close the query.
Thanks.
Above answer was peer-reviewed by
 
Follow-up: Having severe body pain, weakness and fever. Found abnormal vitamin d3 level. Right medication? 44 minutes later
Hi sir,
Yes i m usually indoor...2 yrs bak i started taking calcid3 tablet on my own and i felt very relaxed and good after taking..i dont miss the dose everynight it keeps my body much better interms of pains and tightness...
I started taking calcirol sachets recently after d3 test..although i m hesitant in taking large doses so i take approx 30k iu of d3 in a week...devided over small doses everyday..
I hv seen alot neurologists...they all said i had alot of stress and anxiety..but internally i know something was wrong...like d3 levels got checked recently...
I suspect magnesium deficiency as well..
I generally feel better after eating for 2 hrs coz i read insulin makes muscles relaxed...so may be i feel better coz of tht..
And my mom has probl3m of dizziness since 30 yrs...she says her,s is due to sinus..
She has low vitamin d as well as per recent tests...
My both elder sisters has thyroid issues...and my mom also has recently been diagnosed as thyroid disorder..

I will continue taking d3 and calcid3
I recntly ordered magnesium chloride salt for making some magnesium oil and apply it on body for better absorption..
 
 
Answered by Dr. Prasad Akole 18 minutes later
Good to read that you are already on supplements.
One suggestion...
Your levels are very low despite your taking supplements. Sometimes absorption is not good through the gut.
So get a depot injection to begin (in the buttock). It builds up the level fast irrespective of the absorption.
Then take 1 XXXXXXX of calcirol twice a week with milk for 2 months. Then one every week. And increase outdoor sunlight exposure in the mornings.
Do the tests I advised (calcium, magnesium, phosphate levels).
You must feel better with this schedule.

Get your mother also started on treatment, as she is more at risk of fractures and osteoporosis.
Correct magnesium, calcium if levels are found low.

Bye and take care.
Above answer was peer-reviewed by
 
Follow-up: Having severe body pain, weakness and fever. Found abnormal vitamin d3 level. Right medication? 12 hours later
Thanks for the advice doctor, i shall increase the vitamin d 3 intake asap..and will ge the suggested tests done...

Thanks
Bye
 
 
Answered by Dr. Prasad Akole 1 hour later
Ok. That's good.
Keep me updated.

Above answer was peer-reviewed by
 
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