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Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

I have frustrating problems no one can seem to identify.

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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3278 Questions

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Posted on Fri, 1 Feb 2019 in Headache and Migraines
Question: I have frustrating problems no one can seem to identify. As a layperson I think it may or may not be one issue.
What is known so far:
1. Spine problems include severe lumbar stenosis, spondylothesis, desicated discs in lumbar, thoracic and cervical areas. MRI on lumbar and cervical says no nerve impingement.
2. Pain Management: I have been through normal pain medications but am ultra sensitive to most drugs so take 2.5 mg hydrocodone as needed.. usually a couple times a day unless i do anything active like try to walk to my mailbox. Anxiety treated with 30mg Temazam at night to help with sleep. Occassionally I get daytime panic attacks and 5mg diazapam for that.
3. Symptoms: Low back pain for years then I got sick with what seemed to be a flu that didn't go away. that coincided with moving to a new house. I moved out and symptoms cleared. (4 months of migraines, coughing, fatigue, etc) The coughing made my back worse. The fatigue did worsen and I landed in Endo where I was diagnosed with Hashimotos disease. Synthroid did not help. Armour did. Now Armour doesn't work and Synthroid has horrible side effects and seems to make current symptoms I will describe worse.
4. Two years later my job moved to a new building and withing weeks I was sick again. It started as the office cold and then moved to pneumonia. Total time until it was resolved was about 5 months.
5. Several months after that I had something i thought might have been a stroke. I work up with worst migraine of my life, thought I heard thunder but weather was clear. My right eye looked a little droopy and the right side of my face seemed a little droopy. I went to urgent care, had a CT and other tests. no evidence of stroke.
6. I started getting symptoms consisent with my lumbar problem.. twitching, muscle cramping, etc They have worsened over time. The slighest movement sometimes induced horrible cramping below the waist (any/all muscles seem to be involed)
7. This moved up. The first thing I noticed was a weird feeling in my arms. It feels like a blood pressure cuff on each arm Then I started having the tingling and twitching in my forearms and hands and occasiona muscle spasms usually just triggered by a small motion, never just at rest. Doctors have attributed this to carpal tunnel and cubital tunnel but treatment was not effective.
8. twitching and muscle cramping moved to lower abdomen and now also occurs on sides of abdomen and mid back.
9 MIgrains can last for weeks. Relpax works, wears off and the headache returns. The biggest trigger is fragrance.
10. Neuro has identified demylination in left leg, something about possible small fibers (two docs disagree on that one). I have had 3 brain MRIs, there are enhancing areas but teaching hospital said they are not consistent in location with MS and that doctor said "we don't want to go down the MS road" EEG = "sharp brain waves" Angiogram= OK
2017 MRI:
TECHNIQUE:
Multiplanar MR imaging has been performed without and with 20 cc of Detorem from a 20 cc syringe. Examination performed on a 1.5 Tesla MRI.
Diffusion imaging has been performed.
COMPARISON:
MRI brain 27 September 2018 and MRI brain with contrast 18 October 2017.
FINDINGS:
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma. Stable as compared to previous study.
There is no evidence of hemorrhage or acute stroke.
No evidence of diffusion restriction.
The ventricles, sulci, and cisterns are within normal limits. Some minimal deep white matter ischemic changes are identified. Stable findings. Occasional prominent CSF space is noted. There is no evidence of mass-effect or midline shift. There is no evidence of intraparenchymal hematoma or subdural hematoma. No midline abnormalities identified. There is no evidence of Chiari malformation. Vascular pattern demonstrates no evidence of aneurysm or arterial venous malformation. No enhancing lesions are identified. There is no evidence of intra or extra-axial tumor. The mastoids and orbits are unremarkable. The sinuses demonstrates no evidence of sinusitis.
IMPRESSION:
Stable MRI brain.
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma.
Stable as compared to previous study.
Some stable chronic deep White matter ischemic changes are again identified.
2019 MRI:
TECHNIQUE:
Multiplanar MR imaging has been performed without and with 20 cc of Detorem from a 20 cc syringe. Examination performed on a 1.5 Tesla MRI.
Diffusion imaging has been performed.
COMPARISON:
MRI brain 27 September 2018 and MRI brain with contrast 18 October 2017.
FINDINGS:
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma. Stable as compared to previous study.
There is no evidence of hemorrhage or acute stroke.
No evidence of diffusion restriction.
The ventricles, sulci, and cisterns are within normal limits. Some minimal deep white matter ischemic changes are identified. Stable findings. Occasional prominent CSF space is noted. There is no evidence of mass-effect or midline shift. There is no evidence of intraparenchymal hematoma or subdural hematoma. No midline abnormalities identified. There is no evidence of Chiari malformation. Vascular pattern demonstrates no evidence of aneurysm or arterial venous malformation. No enhancing lesions are identified. There is no evidence of intra or extra-axial tumor. The mastoids and orbits are unremarkable. The sinuses demonstrates no evidence of sinusitis.
IMPRESSION:
Stable MRI brain.
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma.
Stable as compared to previous study.
Some stable chronic deep White matter ischemic changes are again identified.

I have had enough drugs tried on me to have the bottles fill a large garbage bag. Every type of anti-seizure medication produced more side effects than benefits. In the middle of all this I changed endrinologists and he took me off armour thyroud and put me on 200mc of Synthroid and cytomel (I don't remember dose). That made everything severly worse and I went psychotic. All docs now agree that was an extreme dosage. I went completely off all thyroid meds and my biggest comlaints now are super dry skin that cracks and chronic fatigue. I tried to go back on synthroid but 50mc produced extreme aggitation and inability to sleep. Endo will not listen to me about dosage so I am awaiting a consultation with another doctor in hopes of finding a lower dose that will help without making things worse.

Side notes:
- I seem to be hypersensitive to a lot of drugs. SSRIs are the worst.
- I may be experiencing personality changes. It's hard to determine that myself. I find I anger easily (usually dealing with paperwork and approvals not being done correctly with insurance or after waiting an hour for a doctor in a hard chair when I can barely sit upright in a soft chair!)

I have a lifetime problem with anxiety disorder. Not knowing makes that 10 times worse. (I can process information and make rational choices but not without data!)
default
Follow up: Dr. Erion Spaho 0 minute later
I have frustrating problems no one can seem to identify. As a layperson I think it may or may not be one issue.
What is known so far:
1. Spine problems include severe lumbar stenosis, spondylothesis, desicated discs in lumbar, thoracic and cervical areas. MRI on lumbar and cervical says no nerve impingement.
2. Pain Management: I have been through normal pain medications but am ultra sensitive to most drugs so take 2.5 mg hydrocodone as needed.. usually a couple times a day unless i do anything active like try to walk to my mailbox. Anxiety treated with 30mg Temazam at night to help with sleep. Occassionally I get daytime panic attacks and 5mg diazapam for that.
3. Symptoms: Low back pain for years then I got sick with what seemed to be a flu that didn't go away. that coincided with moving to a new house. I moved out and symptoms cleared. (4 months of migraines, coughing, fatigue, etc) The coughing made my back worse. The fatigue did worsen and I landed in Endo where I was diagnosed with Hashimotos disease. Synthroid did not help. Armour did. Now Armour doesn't work and Synthroid has horrible side effects and seems to make current symptoms I will describe worse.
4. Two years later my job moved to a new building and withing weeks I was sick again. It started as the office cold and then moved to pneumonia. Total time until it was resolved was about 5 months.
5. Several months after that I had something i thought might have been a stroke. I work up with worst migraine of my life, thought I heard thunder but weather was clear. My right eye looked a little droopy and the right side of my face seemed a little droopy. I went to urgent care, had a CT and other tests. no evidence of stroke.
6. I started getting symptoms consisent with my lumbar problem.. twitching, muscle cramping, etc They have worsened over time. The slighest movement sometimes induced horrible cramping below the waist (any/all muscles seem to be involed)
7. This moved up. The first thing I noticed was a weird feeling in my arms. It feels like a blood pressure cuff on each arm Then I started having the tingling and twitching in my forearms and hands and occasiona muscle spasms usually just triggered by a small motion, never just at rest. Doctors have attributed this to carpal tunnel and cubital tunnel but treatment was not effective.
8. twitching and muscle cramping moved to lower abdomen and now also occurs on sides of abdomen and mid back.
9 MIgrains can last for weeks. Relpax works, wears off and the headache returns. The biggest trigger is fragrance.
10. Neuro has identified demylination in left leg, something about possible small fibers (two docs disagree on that one). I have had 3 brain MRIs, there are enhancing areas but teaching hospital said they are not consistent in location with MS and that doctor said "we don't want to go down the MS road" EEG = "sharp brain waves" Angiogram= OK
2017 MRI:
TECHNIQUE:
Multiplanar MR imaging has been performed without and with 20 cc of Detorem from a 20 cc syringe. Examination performed on a 1.5 Tesla MRI.
Diffusion imaging has been performed.
COMPARISON:
MRI brain 27 September 2018 and MRI brain with contrast 18 October 2017.
FINDINGS:
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma. Stable as compared to previous study.
There is no evidence of hemorrhage or acute stroke.
No evidence of diffusion restriction.
The ventricles, sulci, and cisterns are within normal limits. Some minimal deep white matter ischemic changes are identified. Stable findings. Occasional prominent CSF space is noted. There is no evidence of mass-effect or midline shift. There is no evidence of intraparenchymal hematoma or subdural hematoma. No midline abnormalities identified. There is no evidence of Chiari malformation. Vascular pattern demonstrates no evidence of aneurysm or arterial venous malformation. No enhancing lesions are identified. There is no evidence of intra or extra-axial tumor. The mastoids and orbits are unremarkable. The sinuses demonstrates no evidence of sinusitis.
IMPRESSION:
Stable MRI brain.
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma.
Stable as compared to previous study.
Some stable chronic deep White matter ischemic changes are again identified.
2019 MRI:
TECHNIQUE:
Multiplanar MR imaging has been performed without and with 20 cc of Detorem from a 20 cc syringe. Examination performed on a 1.5 Tesla MRI.
Diffusion imaging has been performed.
COMPARISON:
MRI brain 27 September 2018 and MRI brain with contrast 18 October 2017.
FINDINGS:
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma. Stable as compared to previous study.
There is no evidence of hemorrhage or acute stroke.
No evidence of diffusion restriction.
The ventricles, sulci, and cisterns are within normal limits. Some minimal deep white matter ischemic changes are identified. Stable findings. Occasional prominent CSF space is noted. There is no evidence of mass-effect or midline shift. There is no evidence of intraparenchymal hematoma or subdural hematoma. No midline abnormalities identified. There is no evidence of Chiari malformation. Vascular pattern demonstrates no evidence of aneurysm or arterial venous malformation. No enhancing lesions are identified. There is no evidence of intra or extra-axial tumor. The mastoids and orbits are unremarkable. The sinuses demonstrates no evidence of sinusitis.
IMPRESSION:
Stable MRI brain.
The previously described 5 mm extra-axial lesion is again identified most consistent with a meningioma.
Stable as compared to previous study.
Some stable chronic deep White matter ischemic changes are again identified.

I have had enough drugs tried on me to have the bottles fill a large garbage bag. Every type of anti-seizure medication produced more side effects than benefits. In the middle of all this I changed endrinologists and he took me off armour thyroud and put me on 200mc of Synthroid and cytomel (I don't remember dose). That made everything severly worse and I went psychotic. All docs now agree that was an extreme dosage. I went completely off all thyroid meds and my biggest comlaints now are super dry skin that cracks and chronic fatigue. I tried to go back on synthroid but 50mc produced extreme aggitation and inability to sleep. Endo will not listen to me about dosage so I am awaiting a consultation with another doctor in hopes of finding a lower dose that will help without making things worse.

Side notes:
- I seem to be hypersensitive to a lot of drugs. SSRIs are the worst.
- I may be experiencing personality changes. It's hard to determine that myself. I find I anger easily (usually dealing with paperwork and approvals not being done correctly with insurance or after waiting an hour for a doctor in a hard chair when I can barely sit upright in a soft chair!)

I have a lifetime problem with anxiety disorder. Not knowing makes that 10 times worse. (I can process information and make rational choices but not without data!)
doctor
Answered by Dr. Erion Spaho 43 hours later
Brief Answer:
A reevaluation of your diagnoses and treatment should be done.

Detailed Answer:
Hello and welcome to "Ask a Doctor" service.

I have read your query and here is my advice.

Low back pain may be exacerbated by anxiety, hypothyroidism, and prolonged infections, but there is a need for treatment if severe stenosis and spondylolisthesis, was found in MRI.

Even if MRI shows no nerve impingement if symptoms are found to be severe, surgery may be necessary.

In my opinion, hypothyroidism and anxiety are playing a major role in your symptoms.

Besides these two conditions, fibromyalgia is another possibility that should be considered too.

Regarding brain MRI-s, I think you should not be worried about anything serious, the small meningioma is stable, and chronic ischemic white matter changes besides being stable, also don't have any clinical significance.

Since the SSRIs cause a lot of problems, in your case, SNRI (duloxetine, venlafaxine ) should be considered.

This for two reasons:

1- for the problems with the anxiety,

2- for the neuralgic pain and possible fibromyalgia.

Other treatment modalities in your case should include correct dosing for thyroid problems, behavioral therapy, and, physical therapy with pain medications for the back pain.

I don't see a reason for seizures treatment if there wasn't any seizure.

In conclusion, a reevaluation of your diagnoses and treatment possibilities should be done with consultations by Neurologist, Endocrinologist, Psychologist and Spine Specialist.

Hope you found the answer helpful.

Let me know if I can assist you further.


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Erion Spaho 0 minute later
Brief Answer:
A reevaluation of your diagnoses and treatment should be done.

Detailed Answer:
Hello and welcome to "Ask a Doctor" service.

I have read your query and here is my advice.

Low back pain may be exacerbated by anxiety, hypothyroidism, and prolonged infections, but there is a need for treatment if severe stenosis and spondylolisthesis, was found in MRI.

Even if MRI shows no nerve impingement if symptoms are found to be severe, surgery may be necessary.

In my opinion, hypothyroidism and anxiety are playing a major role in your symptoms.

Besides these two conditions, fibromyalgia is another possibility that should be considered too.

Regarding brain MRI-s, I think you should not be worried about anything serious, the small meningioma is stable, and chronic ischemic white matter changes besides being stable, also don't have any clinical significance.

Since the SSRIs cause a lot of problems, in your case, SNRI (duloxetine, venlafaxine ) should be considered.

This for two reasons:

1- for the problems with the anxiety,

2- for the neuralgic pain and possible fibromyalgia.

Other treatment modalities in your case should include correct dosing for thyroid problems, behavioral therapy, and, physical therapy with pain medications for the back pain.

I don't see a reason for seizures treatment if there wasn't any seizure.

In conclusion, a reevaluation of your diagnoses and treatment possibilities should be done with consultations by Neurologist, Endocrinologist, Psychologist and Spine Specialist.

Hope you found the answer helpful.

Let me know if I can assist you further.


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Erion Spaho 15 hours later
Thank you for your response. I didn't use the system correctly so you may have received a similar inquiry.

That is the most forthright answer I have received. In fact, it is the only answer I have received!

I agree correct dosage on thyroid is important but I have an uncooperative Endocrinologist so I am waiting to see another. Glad I'm on track in that area.

I think the Neurologist tried anti-seizure medication because of the (is it EEG where they attached electrodes to your head and flash lights?) I had 3 of those at different lengths and the doctor said "sharp brain waves". The lights themselves caused me to twitch and twist quite a bit at one point. I'm not sure what that means. I have a friend with epilepsy so I know what her seizures are like. I certainly haven't had anything like that. My memory is shot but I think Vimpat worked to reduce the number, severity and length of migraines but by the time I worked up to the dosage where I got the benefits, I was pretty groggy most of the time.

I am in a pain management program for the lumbar issues. I'm also hypersensitive to narcotic pain meds but it was getting bad enough that the doctor changed me for a while from Norco 3/25 (too much of that will trigger a migraine) to Hydromorphone 5mg. For whatever reason, the stronger pain medication took away all the leg twitching and cramps... but it was too strong and left me groggy and tired so I went back to the low dose Norco.

I will talk to my psychiatrist about the medications you mentioned. Thank you very much for that suggestions.

Fibromyalgia in the USA is tricky. Many doctors don't believe it is real. Can you offer any advice on testing and diagnosis for that? My general practitioner told me Hashimotos is not a real disease too.

Guess what? Behavioral therapy is not available in USA!! Psychiatrists are happy to throw drugs at you but that's about it. It is a very frustrating problem... but I will inquire again!

I do have one nagging point of curiosity and that has to do with this being related to autoimmune system. To me it's clear as day the onset of all the problems beside the old lumbar issue... I had a massive allergic reaction to something.. seemed to get better.... but that seems like the first domino in the chain that got flicked.

Except for the back problem, I was healthy albeit overweight. I ate well, worked out, losta lot of weight, did my first indoor triathalon in my late 40s. I rarely drink. I don't do drugs. I have never smoked and the BLAMMO... whatever made me sick the first time just seems like it triggered something.
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Follow up: Dr. Erion Spaho 0 minute later
Thank you for your response. I didn't use the system correctly so you may have received a similar inquiry.

That is the most forthright answer I have received. In fact, it is the only answer I have received!

I agree correct dosage on thyroid is important but I have an uncooperative Endocrinologist so I am waiting to see another. Glad I'm on track in that area.

I think the Neurologist tried anti-seizure medication because of the (is it EEG where they attached electrodes to your head and flash lights?) I had 3 of those at different lengths and the doctor said "sharp brain waves". The lights themselves caused me to twitch and twist quite a bit at one point. I'm not sure what that means. I have a friend with epilepsy so I know what her seizures are like. I certainly haven't had anything like that. My memory is shot but I think Vimpat worked to reduce the number, severity and length of migraines but by the time I worked up to the dosage where I got the benefits, I was pretty groggy most of the time.

I am in a pain management program for the lumbar issues. I'm also hypersensitive to narcotic pain meds but it was getting bad enough that the doctor changed me for a while from Norco 3/25 (too much of that will trigger a migraine) to Hydromorphone 5mg. For whatever reason, the stronger pain medication took away all the leg twitching and cramps... but it was too strong and left me groggy and tired so I went back to the low dose Norco.

I will talk to my psychiatrist about the medications you mentioned. Thank you very much for that suggestions.

Fibromyalgia in the USA is tricky. Many doctors don't believe it is real. Can you offer any advice on testing and diagnosis for that? My general practitioner told me Hashimotos is not a real disease too.

Guess what? Behavioral therapy is not available in USA!! Psychiatrists are happy to throw drugs at you but that's about it. It is a very frustrating problem... but I will inquire again!

I do have one nagging point of curiosity and that has to do with this being related to autoimmune system. To me it's clear as day the onset of all the problems beside the old lumbar issue... I had a massive allergic reaction to something.. seemed to get better.... but that seems like the first domino in the chain that got flicked.

Except for the back problem, I was healthy albeit overweight. I ate well, worked out, losta lot of weight, did my first indoor triathalon in my late 40s. I rarely drink. I don't do drugs. I have never smoked and the BLAMMO... whatever made me sick the first time just seems like it triggered something.
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Follow up: Dr. Erion Spaho 8 minutes later
I just looked up the drugs. Effexor & Cymbalta. Both have been tried and I had all side effects, no benefits. If I remember correctly, I had a reaction like I had been given amphetamines. I have been through an entire category of drugs and usually I get one of two reactions. It's either like I've been sedated or given an amphetamine.

I was diagnosed with anxiety disorder 20 years ago and spent 5 years fighting taking any drugs. Then I gave in and tried them, and tried them, and tried them. I landed on benzos because they are the only drugs that didn't make things worse.

Four different psychiatric professionals and they are all stumped on why I have such extreme reaction to things.

Heck... even going into the MRI machine will result in full body cramps 4-6 hours after the test!
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Follow up: Dr. Erion Spaho 0 minute later
I just looked up the drugs. Effexor & Cymbalta. Both have been tried and I had all side effects, no benefits. If I remember correctly, I had a reaction like I had been given amphetamines. I have been through an entire category of drugs and usually I get one of two reactions. It's either like I've been sedated or given an amphetamine.

I was diagnosed with anxiety disorder 20 years ago and spent 5 years fighting taking any drugs. Then I gave in and tried them, and tried them, and tried them. I landed on benzos because they are the only drugs that didn't make things worse.

Four different psychiatric professionals and they are all stumped on why I have such extreme reaction to things.

Heck... even going into the MRI machine will result in full body cramps 4-6 hours after the test!
doctor
Answered by Dr. Erion Spaho 15 hours later
Brief Answer:
Multimodal treatment is necessary.

Detailed Answer:
Welcome back.

It is true that the fibromyalgia is a contradictory condition, but still should be taken into consideration in cases of widespread musculoskeletal pain that is not explained by other conditions.

It is a diagnosis of exclusion, in other words, other conditions such as autoimmune diseases, low vitamin B12, low vitamin D3, hypothyroidism, etc. are addressed and treated correctly and symptoms still persist.

There are questionnaires for fibromyalgia diagnosis, besides exclusion of other conditions.

I think that fibromyalgia should be included in the list of possible conditions in your case.

Another possibility to consider is an evaluation for autoimmune diseases such as systemic lupus, rheumatoid arthritis, etc., since there is strong evidence that your symptoms appeared after long infections.

I still think that multimodal treatment with counseling, drugs as needed for pain ( benzodiazepines are okay since they work in your case ), correct thyroid gland function, supplements of vitamins B group, magnesium, etc., physical therapy, spinal injections for your back pain, are necessary in your case.

Hope this helps.

Greetings.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Erion Spaho 0 minute later
Brief Answer:
Multimodal treatment is necessary.

Detailed Answer:
Welcome back.

It is true that the fibromyalgia is a contradictory condition, but still should be taken into consideration in cases of widespread musculoskeletal pain that is not explained by other conditions.

It is a diagnosis of exclusion, in other words, other conditions such as autoimmune diseases, low vitamin B12, low vitamin D3, hypothyroidism, etc. are addressed and treated correctly and symptoms still persist.

There are questionnaires for fibromyalgia diagnosis, besides exclusion of other conditions.

I think that fibromyalgia should be included in the list of possible conditions in your case.

Another possibility to consider is an evaluation for autoimmune diseases such as systemic lupus, rheumatoid arthritis, etc., since there is strong evidence that your symptoms appeared after long infections.

I still think that multimodal treatment with counseling, drugs as needed for pain ( benzodiazepines are okay since they work in your case ), correct thyroid gland function, supplements of vitamins B group, magnesium, etc., physical therapy, spinal injections for your back pain, are necessary in your case.

Hope this helps.

Greetings.
Above answer was peer-reviewed by : Dr. Prasad
doctor
default
Follow up: Dr. Erion Spaho 5 hours later
Wow! I am so glad I found you!

As you might imagine I am a voracious reader. My memory is a whole other issue but generally I retain complex concepts if not minute details. I learned that twitch and cramps can be caused by electrolite imbalances and in particular low magnesium or possible a combination of low magnesium, E and other things I don't remember. Magnesium supplements reduce the severity but I can only take so much. (laxative effect) I also have vitamin E but admit I a not disciplined about it so I will make a point of getting back on track with that.

I tried to talk to my doctor about this being autoimmune because it seems logical. No happy docs when I brought that up. I'm pretty sure I have been tested for Lupus and arthritis. I know I was tested for heavy metal and other toxics as well as parasites.

Spinal injections worked for a while but I guess I can only have so many. I don't know if this is insurance or medical. Norco doesn't work 100% and I can't take very much without side effects but it will take the edge off. The lowest dose availabel of hydromorphone took away the pain completely and I slept well... but stayed groggy too long and couldn't take it during the day so I landed back on Norco.

The vitamin B group is interesting. Oral B-Complex has never done anything except make me burp. However, I quite accidentally ran across an injectable B-complex. I am in Las Vegas and every other block there is a "medical spa" that offers botox and weight loss, facials, etc. They started offering B-12 and B-complex to help with weight loss (under MD supervision) I tried the B-Complex and it worked like I always expected anti-depressants to work. I had a great primary care doctor at the time and he worked with me to get the injections compounded and to find the right dose. It turned out that 2MLs every 3 days was optimum. When I had to change doctors and started having issues I asked my new primary care doctor about going back on the B-complex shots. He scoffed at it. He wasn't comfortable with the ingredients or the dosage and told me a theraputic does was 1ml once a month. I hid a dead end there.

Just two days ago I found a compounding pharmacy that can recreated the magic formula for me but I can't get a prescription. It is the one thing I know works and I have no idea why, why at such a high dose, or why only injectable and not oral. (or if any of this might have actualy caused me harm!)

I was able to get the "trade secret" document from the previous compounding pharmacy because they were no longer going to do sterile injectables. I guess the cost to have the right type of facility to make it is extreme.

This is their not so secret recipe to make 5ML vial. They call it "B-Complex Lip-V"
Ascorbic Acid USp fine Poder. .25gm
Thiamine Hyrdorchloride USP .25gm
Riboflavin-5-phposphate sodium USP Dihydrate .025gm
Pyridoxine Hydrochloride USP Powder 0 .025gm
Methylcobalamin Poder) .015gm
Insotol (FCC) Powder 0 .125gm
Choline Chloride USP 0 .25gm
Lidocaine Hydrochloride USP Monohydrate P06 (PC6?) .05gm
Benzyl Alcohol NF Liquid .05ML
Water Sterile for Injection, SP iNJ P 5ML
Methionine (DL) FCC 0 .0625gm
Levocarnitine USP Powder 0 .5gm
Glutamine (L) FCC Powder ) .05gm
Sodium Hydroxide 10% solution 0
Hydrochloric acid (aq) 5% (V/V) Soln )
Filter, 0.22 Micron Hydrophilic Filters Device L
Chromium Piccolinate Dilution 10CG/ML Solut .75ml
Niacinamide USP 0 .25gm
Calcium Pantothenate USP poder 0 .025gm
Mixing:
weight dexpanthanol into beaker
add about 70% of the sterile water
Add benzyl alcohol
Add riboflaving-5-phosphae and cyanocobalain
geometrically, add remaning ingredients
Chck and record the pH, adjust with sodium hydroxide or Hydrochloric acid if necessary. It should be betwee 6.5-7.0. Record ph
QS to final vlume
pass through 0.22 micron filter into sterile syrum vials.

My new primary care doctor popped a cork as soon as he say hydrochloric acid. I'm not exactly a chemist but it looks like a pH adjustment not a suicide attempt!

There's a long wait for Endocrinologists but I have an appointment in three months. I was able to have a long conversation with the pharmacists at the compounding pharmacy. I have also talked to the pharmacists at two regular pharmacies and all have agreed that the normal starting dose on Synthroid is 12.5mc. I was started at 200mc. After discontinuing everything i started on 50mc and that was still way too much. My goal is to get a doctor to start me on a tiny, tiny, tiny dose. I am still not sure why starting really small and working up is so offensive to MDs!

Counseling is not available. There is a shortage of mental health professionals. I was able to get into one practice but could only see an intern. It was more aggrevating than helpful. Her solution was 'try yoga'. (I've done it for years) I will try again with the prescribing clinician again.

When you say physical therapy, what do you mean? The PT office knows me by first name. I've had PT for my back 3 times. PT for my knees when I tore cartilege. Currently starting PT for carpel tunnel. As soon as insurance gets paperwork done I will need to go for rotator cuff tears in both shoulders.

Is there a specific PT for fibromyalgia? If so, I would actually have to get that diagnosis from MDs.
default
Follow up: Dr. Erion Spaho 0 minute later
Wow! I am so glad I found you!

As you might imagine I am a voracious reader. My memory is a whole other issue but generally I retain complex concepts if not minute details. I learned that twitch and cramps can be caused by electrolite imbalances and in particular low magnesium or possible a combination of low magnesium, E and other things I don't remember. Magnesium supplements reduce the severity but I can only take so much. (laxative effect) I also have vitamin E but admit I a not disciplined about it so I will make a point of getting back on track with that.

I tried to talk to my doctor about this being autoimmune because it seems logical. No happy docs when I brought that up. I'm pretty sure I have been tested for Lupus and arthritis. I know I was tested for heavy metal and other toxics as well as parasites.

Spinal injections worked for a while but I guess I can only have so many. I don't know if this is insurance or medical. Norco doesn't work 100% and I can't take very much without side effects but it will take the edge off. The lowest dose availabel of hydromorphone took away the pain completely and I slept well... but stayed groggy too long and couldn't take it during the day so I landed back on Norco.

The vitamin B group is interesting. Oral B-Complex has never done anything except make me burp. However, I quite accidentally ran across an injectable B-complex. I am in Las Vegas and every other block there is a "medical spa" that offers botox and weight loss, facials, etc. They started offering B-12 and B-complex to help with weight loss (under MD supervision) I tried the B-Complex and it worked like I always expected anti-depressants to work. I had a great primary care doctor at the time and he worked with me to get the injections compounded and to find the right dose. It turned out that 2MLs every 3 days was optimum. When I had to change doctors and started having issues I asked my new primary care doctor about going back on the B-complex shots. He scoffed at it. He wasn't comfortable with the ingredients or the dosage and told me a theraputic does was 1ml once a month. I hid a dead end there.

Just two days ago I found a compounding pharmacy that can recreated the magic formula for me but I can't get a prescription. It is the one thing I know works and I have no idea why, why at such a high dose, or why only injectable and not oral. (or if any of this might have actualy caused me harm!)

I was able to get the "trade secret" document from the previous compounding pharmacy because they were no longer going to do sterile injectables. I guess the cost to have the right type of facility to make it is extreme.

This is their not so secret recipe to make 5ML vial. They call it "B-Complex Lip-V"
Ascorbic Acid USp fine Poder. .25gm
Thiamine Hyrdorchloride USP .25gm
Riboflavin-5-phposphate sodium USP Dihydrate .025gm
Pyridoxine Hydrochloride USP Powder 0 .025gm
Methylcobalamin Poder) .015gm
Insotol (FCC) Powder 0 .125gm
Choline Chloride USP 0 .25gm
Lidocaine Hydrochloride USP Monohydrate P06 (PC6?) .05gm
Benzyl Alcohol NF Liquid .05ML
Water Sterile for Injection, SP iNJ P 5ML
Methionine (DL) FCC 0 .0625gm
Levocarnitine USP Powder 0 .5gm
Glutamine (L) FCC Powder ) .05gm
Sodium Hydroxide 10% solution 0
Hydrochloric acid (aq) 5% (V/V) Soln )
Filter, 0.22 Micron Hydrophilic Filters Device L
Chromium Piccolinate Dilution 10CG/ML Solut .75ml
Niacinamide USP 0 .25gm
Calcium Pantothenate USP poder 0 .025gm
Mixing:
weight dexpanthanol into beaker
add about 70% of the sterile water
Add benzyl alcohol
Add riboflaving-5-phosphae and cyanocobalain
geometrically, add remaning ingredients
Chck and record the pH, adjust with sodium hydroxide or Hydrochloric acid if necessary. It should be betwee 6.5-7.0. Record ph
QS to final vlume
pass through 0.22 micron filter into sterile syrum vials.

My new primary care doctor popped a cork as soon as he say hydrochloric acid. I'm not exactly a chemist but it looks like a pH adjustment not a suicide attempt!

There's a long wait for Endocrinologists but I have an appointment in three months. I was able to have a long conversation with the pharmacists at the compounding pharmacy. I have also talked to the pharmacists at two regular pharmacies and all have agreed that the normal starting dose on Synthroid is 12.5mc. I was started at 200mc. After discontinuing everything i started on 50mc and that was still way too much. My goal is to get a doctor to start me on a tiny, tiny, tiny dose. I am still not sure why starting really small and working up is so offensive to MDs!

Counseling is not available. There is a shortage of mental health professionals. I was able to get into one practice but could only see an intern. It was more aggrevating than helpful. Her solution was 'try yoga'. (I've done it for years) I will try again with the prescribing clinician again.

When you say physical therapy, what do you mean? The PT office knows me by first name. I've had PT for my back 3 times. PT for my knees when I tore cartilege. Currently starting PT for carpel tunnel. As soon as insurance gets paperwork done I will need to go for rotator cuff tears in both shoulders.

Is there a specific PT for fibromyalgia? If so, I would actually have to get that diagnosis from MDs.
doctor
Answered by Dr. Erion Spaho 19 hours later
Brief Answer:
Graded aerobics and aquatic therapy may help.

Detailed Answer:
Hello again.

I think that if the injectable vitamin B complex is working for you, you should use it.

Levels of vitamins B1, B6 and B12 also should be measured in order to be oriented for the dosage.

I agree with the fact that the smallest working dose of Synthroid should be used.

Graded aerobic exercises and aquatic therapy are found to be helpful in patients diagnosed with fibromyalgia if it's diagnosed with certainty.

Hope I helped you. Feel free to ask further.

Take care.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Erion Spaho 0 minute later
Brief Answer:
Graded aerobics and aquatic therapy may help.

Detailed Answer:
Hello again.

I think that if the injectable vitamin B complex is working for you, you should use it.

Levels of vitamins B1, B6 and B12 also should be measured in order to be oriented for the dosage.

I agree with the fact that the smallest working dose of Synthroid should be used.

Graded aerobic exercises and aquatic therapy are found to be helpful in patients diagnosed with fibromyalgia if it's diagnosed with certainty.

Hope I helped you. Feel free to ask further.

Take care.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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The User accepted the expert's answer

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