Question: Good evening.
To provide a general background, I am a 36 year old Caucasian female. Below is a synopsis of the medical concerns in which I'm seeking a professional opinion for.
I have for two to three years experienced an ongoing intermittent localized ache in my thoracic spine. Several x-rays and an MRI have been conducted with only minor findings that are not assumed to be responsible for the discomfort. I am quickly fatigued when standing from this pain and the degree of pain varies from dull to intensely debilitating.
In late spring of 2014 I began experiencing bouts of numbness and a pins and needles sensation occurring bilaterally in both my hands and feet. Again, this occurred quite frequently with varying degrees of intensity and still resurfaces from time to time. Additionally, a sudden painful joint pain occurring in both elbows and wrists will set in. Many nights throughout the summer months I was woken due to my hands feeling numb and the following morning suffered such great pain in both my hands and feet that it often took hours to comfortably function. Over a span of two or three weeks these symptoms too decreased. Perhaps it may be worth noting that I have not been diagnosed with any form of arthritis, only lumbar spondylalosis.
Most recent, beginning this past November, a sudden onset of intense pain was felt in my thoracic spine area that seemed to initiate cramping in my sternum area. It felt as though the cramping moved in almost a wave motion around my back and forward to my chest cavity. I further experienced the development of a burning sensation in my throat with swollen tonsils from time to time (constantly spraying salt water on my tonsils to prevent tonsil stones from forming), a pressure in my chest was felt from minimal physical exertion or if I became over stimulated/stressed from raising my voice (parenting a seven year old), I felt nauseous with or without food in my stomach and was sensitive to touch from just under my sternum area to midway down my torso. As if a power switch had been shut off this past Sunday, all discomfort was nearly absent when I woke minus a lingering sore throat.
Lastly, I experience significant brain fog more frequently than not. A couple years back there seemed to be merely moments of the sensation. More recently the fog reoccurs more frequently, lasting longer, with more intensity, and lingering residuals for hours or days afterwards. Concentrating is nearly impossible, I'm very forgetful and have difficulty putting sentences together. I catch myself stuttering during conversations as if there is a gigantic disconnect in my cognitive functioning. I have an EEG scheduled and have been referred to a memory clinic in XXXXXXX NC. My fear is that unless I am experiencing the fog the cognitive testing will be all for nothing.
I'm recently retired from the military. I feel as though I've lived in my PCM's office in hopes of getting to the bottom of my medical problems. I've had a slew of tests conducted to include; abdomen ultrasound, MRI on my brain, EKG, and a myriad of blood tests (blood cell count, thyroid, pancreas, kidneys gallbladder). I would also like to add that I initially felt like many of these symptoms were instigated during ovulation and my period (I have been using the Mirena for three years). Thus far all tests have returned negative with the exception of low Vitamin B levels which I have began taking a daily multivitamin for approximately six to eight weeks ago.
Unofficially I'm gathering the opinion is that my symptoms are psychosomatic vice true physical complications. Clearly I am not a medical professional yet I am acutely aware that what I'm feeling is nothing short of true physical problems. This is my first visit to a forum such as this seeking medical advice from a professional but I sense I'm soon nearing a dead end in my current approach and am frankly growing quite discouraged. I am aware there are additional testing options which are more sophisticated and can potentially offer more definitive answers though I'm not quite sure why these testing options are not exercised to rule out possible causes. If it is the insurance companies that are responsible for the stall could you provide any insight on how to best combat that monster?
Advice, thoughts, or any sort of miracles that you may be capable of offering regarding what I've described are certainly greatly appreciated.
Thank you for your time.

Good evening Dr Naval,
Thank you for your assistance and responding to my concerns. Below I will provide the additional information your requesting

1. I do frequently feel fatigued and slow to get moving when I wake. Often times when I wake the brain fog is already present. There are days that I feel well but many mornings if I’m not fatigued during the initial onset it will set in rather quickly while standing stationary to get ready (doing my hair and other morning hygiene). Usually the pain begins to radiate from that specific location I described in my thoracic spine (which is located rt about bra line level) kind of traveling down my spine with a feeling of pressure in or around my tailbone.

2. I believe my siblings would describe me as short tempered by nature to be honest in response to question two. I would say that normally I choose to speak what comes to mind. However, there are episodes where I feel that I’m more easily provoked than normal. Over the past five or six months these episodes have been extremely intense. I can once or twice a month feel an escalation of this coming on quickly. I almost look for an outlet (unfortunately my family) to initiate an argument to allow myself to diffuse. During these moments it is as if it is uncontrollable, I know its coming and feel like it has to come out.

3. Absolute yes to your question regarding forgetfulness. My parents always felt as though I struggled a bit in school and had difficult time remembering/retaining information. I would agree. When I reached adulthood and began attending college I sought assistance from a psychiatrist to determine if I may have ADD. I graduated high school in 1997 and began taking prescribed Adderal in 2008. My dose has remained consistent and rather low (15mg ER and early mornings a 10mg IR dose). As these abnormal physical problems began to occur so did my concentration and ability to remember. I have felt for 18 months or so I may have finally developed a tolerance to the medication and that it’s time to talk to the psych about an increase. I have spoken to him and have expressed that the problem may lie outside of his realm of treatment capabilities. He agreed that I should hold off through the duration of medical testing to see if the problem is from an alternate source.

In October/November time frame I ran into a friend of mine in town. During our conversation I felt lost. To reflect on the experience it was as if I watched myself have the conversation vice being a part of it. I couldn’t remember my friends last name, her son’s name… even driving home that afternoon I felt as though I was too disconnected to function if the symptoms worsened. And then, like clockwork, a day or so later the feeling dissipated. My current doctor passes this off as anxiety but I know how I feel physically when I have anxiety. What is happening is anything but anxiety related. I know when to look for medication to assist with stress. This is something else I just don’t know what.

4. I’m not sure I know what bowel opening is Dr Naval. I don’t have a history of medical complications so these things are rather bizarre for me to be experiencing. I’ve had one child (vaginal delivery) and breast implants in 2009. In 2010 I developed capsular contractors and the surgeon corrected this. That has been my extent of medical visits/complications ever.

In July of 2014 I believe I experienced my first episode of constipation and used a suppository after a couple days of discomfort. Around then I would periodically feel a hardening or cramp in my lower abdomen (perhaps hip level). I was still on active duty during this time and a Navy Medicine technician explained it was a muscle spasm. What I do know is that what I was experiencing (non painful cramping) was not musculoskeletal, what I felt was deeper inside. Those cramps increased over the months and the hardening I felt seemed to extend along the inside of my hip around my abdomen however not as low as where my ovaries are located. Periodically bowel movements were difficult and when my menstrual cycle would begin there may be a day or two where I would have softer stool.

5. Yes, on and off to your frequent urination inquiry, or at least the sensation of needing to do so. Occasionally this will also occur during the day though minimal comes out in my attempts. The feeling is much like a UTI without the burn.

6. My stress levels have varied. There have been several occasions of significant time spans were indeed I would admit my anxiety is greater than the average person’s, but as of lately (8-10 weeks) I feel somewhat leveled out. I do have Xanax prescribed to take as needed in a very low dose. On average I may take 4-6 doses a month. My senses feel very peaked at times. I’m sensitive to noise and occasionally my face will be sensitive to touch, almost like a burning feeling that randomly may occur.


*Also to note I receive quarterly steroid injections in my lumbar spine.
*Current medications:
Adderall, Xanax (as needed)
Tramadol (as needed)
Horizan
Celabrex
Ambien