Please read my self -assessment below and symptoms Question- Could this be some type of autoimmune problem that is attacking myelin of my nerves, from a possible viral infection? (shingles or Covid 19 – was not tested for either one) Question 2- If I did have Covid 19 back in January and the acute pain is subsiding (after Months) would there be a way to test my nerves for damage? (Never tested for Covid because this was before the announcement of US cases in March. Did not seek any treatment at first because waiting for Cobra insurance to start. I did consideri going to the hospital several times.) 52 yr old woman. Nurse for 18 yrs, worked 12 hr shifts, prone to heavy lifting of obese patients. Recent stresses over last year, selling house. Contract fell through, gypsy lifestyle for 6 months. Staying with children, lots of travel and lack of sleep. Weight 194lbs (had fluctuations recently high 207 down to 172 then back up to 194.) Not working since Feb Hx Diabetic x10 yrs – poor control blood sugars in the 200s and below. Humalog and Lantus Hypertension – Amlodipine Losartan 130-140/ 80s with meds Hyperlipidemia Herniated cervical discs x2 – surgical intervention (no fixation) (6yrs ago) Copper IUD- removed in JuLy 2019 (? Copper deficiency) Post menopause (no period for 1 1/2 yrs) Muscle cramps- calf muscles – mostly at night x1 yr plus Sciatic nerve pain- occasional bout with r sided sciatic nerve pain- Pain in hip and down right thigh- lasted about 3weeks to a month each time. Pain level 4/10 (1 yr) Cataract surgery – question Lantus Induced- Lens replacement 3yrs ago WBC – consistent elevation 10-12 for a few yrs Teeth – abscess issues, gum dx and teeth loss Rash sacral area and left buttock- rash was small maybe 2 inches – small tiny blisters, itchy, then gooey, then crusted over. Had a couple large pimple sized lesion on Left buttock with the same qualities (question shingles?) (sept/oct of 2019). Cholecystectomy – 2000 Births- 4 children- 3 births- rare monoamniotic twins, c-section x 2 Significant factors: January 2019- Children went on a cruise. Everyone in the household sick with cough for at least 3 weeks. I developed a dry cough that lasted over 4 weeks, severe headache, low grade temp (physician diagnosed allergies and treated as such. 2 separate visits because symptoms did not improve.) (question Covid?) Closed on home in January. moved and left job in February. (no insurance at first). Developed severe leg pains and unusual right flank numbness- (started in January). More severe at night at first) Unusual Numbness sensation at sacral level from spine, wrapping around Right side to belly button (band of numbness) lasted about 1-2 weeks (? Transverse myelitis) Severe Leg pain- More severe on Left side- Sacral Back, both hips, Thighs and low pelvic floor pain (No Numbness or tingling below knees) Unable to pinpoint origin of pain. Could not lie on either hip. Flip flop from side to side trying to find a comfortable position. (lying and sitting worse than standing and walking). Description- Gnawing, deep continuous pain down to the bone 24/7 pain. 9/10 (at least 3 months). Significant weakness – Unsteady on feet Lack of Balance Possible Muscle atrophy – felt like muscles were getting smaller (attributed it to recent post menopause) Numbness and tingling- Legs and hips – significantly greater on left side Burning sensation – most prominent on anterior thighs (Left side significantly greater than right side) Hot to touch- Upper Left Lateral Hip and Thigh. Significant skin temperature change on touch- No visible color change or lesions (would rule out cellulitus). (Question Inflammatory process. Question demylenation). Annoyance to light touch- could only wear light clothing that did not constrict skin, any rubbing against skin would create annoying discomfort. Feeling that muscles were continuously contracted – strangling pressure around torso and upper legs Other symptoms: Severe Fatigue – unable to sleep more than 2 hrs a day. Only fell asleep from severe exhaustion. Woke with severe pain. Shots of electrical pain from mid back down to toes on occasion (originating in different areas). Headache – constant with degrees of intensity Hyperglycemia (Highly elevated Blood sugars – Highest in the 400s (never been that high) (seemed to directly correlate with pain and stress levels). (highs after 1 month of severe pain and extreme fatigue). Hypertension – Highest 170/90s ((seemed to directly correlate with pain levels). Tachycardia – HR 110s all the time (always had high hr) Lower extremity Weakness, loss of balance and dizziness – felt like unable to keep balance, felt broken Anxiety and extreme stress from continuous pain and fatigue. (and Job search, question if even able to work if job found). Increased urination (urine pale in color- every 1-2 hrs in significant amounts, some burning (did have a e-coli urinary tract infection at one point (attributed to high blood sugars and probably high glucose in urine). (tried to keep up with drinking lots of water but dehydrated probably at some point – urine though was never dark. Vison – maybe some blurriness (attributed to headaches and dizziness) Earache- pain in left ear (attributed to water trapped from many baths). Concentration – difficulty concentrating, fogginess (after starting gabapentin) Nausea – more recent (possible med regimen) Test results Interventions: Hyperglycemia – Increased Insulin dosages (did help some, brought blood sugars down to 200s. Did have some very labile blood sugars and at least 3 episodes of hypoglycemia lowest 57. Pain levels seem to still correlate with higher blood sugars). Treated for suspected Peripheral Neuropathy – Gabapentin prescribed (did have some relief of pain with the drug but never significant relief). Pain though did not start or was ever in feet so question if this is cause. (never had previously before January) Hypertension- Increased Blood pressure meds (still high but lower than before, highs associated with pain levels.) Urinary tract infection – treated with antibiotics but resolved- residual lower abd. And pelvic pain. Earache – treated with eardrops X-ray- did show lumbar spondylosis and degenerative dx Warm baths- 3-4 times a day did help pain slightly Hot and cold therapy- cold when felt the heat sensation (question inflammation) and heating pad when not. PHYSICAL therapy Most significant relief of pain after 1st visit to PT. PT assessment showed limited ROM, decreased reflexes in left leg, muscle contraction. Manual muscle stretching and exercise. Acupuncture done and next day felt a significant release of muscle contraction. Decrease in pain from 9/10 to 6/10 Added deep tissue massage next week- concentrating in Buttocks and legs- all nerve and muscles very tight Currently: pain levels 4-6/10 Still lingering but significant decrease in leg pain, deep gnawing pain subsiding, burning sensation gone, still sensitive to touch or clothes rubbing, Heat on touch less often, Muscles seem to be less contracted, ROM improved with exercises. Pain more centralized. Better ability to pinpoint pain areas now low in sacral area, tailbone, hips, pelvic area, Feels like a wide band of pain wrapped around torso about 8-10 inches from low sacral down to upper thigh (more significant on left side). Muscle relaxers started and finding significant decrease in pain, able to sleep more than 5 hrs, decreased gabapentin hoping to clear up fogginess. Still considerable discomfort but much more tolerable. Continue with physical therapy, evaluated for pelvic floor therapy (will start next week) and continuing deep muscle massage. Having some increased balance issues and dizziness Blood sugars while on muscle relaxers significantly decreased (140s fasting 180 highest post meal. Decreased mealtime coverage from 10 to 6 units Thoughts: Diagnosis Need MRi – possible disc involvement, degenerative, bone spur effecting nerve, Inflammation, tumor Question demyelination dx (could there be an autoimmune component related to possible coronavirus or shingles? (guilliane barre, Post herpatic polyneuralgia, Chronic Inflammatory Demyelinating Neuropathy, MS). Lumbar puncture (would proteins still be elevated after acute stage of demyelinating dx? Corona virus antibody test- confirm if actually had corona Copper insufficiency- related to IUD removal? Peripheral Neuropathy- DM related? Questionable test result – elevated Calcium level (question dehydration, meds or so