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Suggest treatment for connective tissue disease

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Posted on Tue, 14 Apr 2015
Question: Trying to get this to Dr. XXXXXXX Rijhwani, follow up information for her. There is a lot to tell. Not sure how detailed I need to get. Don't keep records of reports and labs anymore since my healthcare system loads all information on shared central computer database. I suffer with chronic pain and GI symptoms. chronic constipation since childhood has worsened into adulthood currently unable to have a BM without use of tapwater enema for >6 months. IBS /severe constipation and t/x for GERD began >20 yrs ago. 15 yrs ago back/hip/leg/neck pain with dizziness begin with ^fatigue during work. ALL Symptoms worsened over the next 5 years. 10 yrs ago I Was unable to find acceptable pain Control per GP, steroid injections... IBS symptoms continued (I could go weeks without a BM) 2005 stopped working as night shift RN & joined pain management center to research cause of and find pain control. Diagnosed & t/x for fibromyalgia ,Myofascial pain syndrome and chronic fatigue there. Type II NIDD diagnosed with GP. Have since continued awareness, research and adjunct t/x to add to narcotic pain meds with moderate relief. Over the last year new symptoms developed; Early satiety, nausea with vomiting at times after eve meal, esophageal spasms with rare choking episode, burning sensation to sides of tongue, gastritis. Last year hospitalized for pneumonia believed to be r/t aspiration. Last 8 months diagnosed with gastroparesis per gastric emptying study. Mild salivary stones, provigil for narcolepsy (or hyper somnolence from meds?) chronic irritation to throat with transient painful mouth ulcers, yellow patches back of throat (explained as cholesterol deposits). Enlarged papillae on tongue. Tip of tongue very rough. Continued burning irritation on sides of tongue and spread to top and underside of tongue. Emergent ischemic gallbladder removal full of stones and sludge 6 weeks ago. Have since urinated out pounds of fluid from toxins? Started to feel better all around for a month. Currently very concerned over no improvement in bowel motility. Continued mouth ulcers....Stopped amitiza-side affects. Trying lenseez now with minor side affects so far; heart, kidney,lungs functioning well. CPAP For apnea. Increased blurry vision from dryness per ophthalmologist. Vision improving with artificial tears. Increased irritation to inner ear with ^ inner ear pain in the cold. Neurontin for chronic nerve pain with numbness and tingling to extremities.
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Answered by Dr. Dr. Shruti Rijhwani (8 hours later)
Brief Answer:
Follows.

Detailed Answer:
Dear Madam,

Thank you for reverting back.

Well going through all the history that you have provided there is a strong possibilIty of underlying CTD that is connective tissue disease of which Lupus and sjogrens syndrome remain the main differentials .

I note that you have been labelled as fibromyalgia and chronic fatigue but unless and otherwise we have ruled other organic cause like lupus by serological testing its not appropriate .

Anyways you need to get CBC , ESR , S. albumin, globulin , ANA - IFA , ENA profile , Schirmers test for tear secretion testing . First we will need all these tests , if we have a positive indicator in these then we will advise you for further testing .

Any further queries you are welcome to ask.

Dr. Shruti
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Shruti Rijhwani

Rheumatologist

Practicing since :2008

Answered : 2366 Questions

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Suggest treatment for connective tissue disease

Brief Answer: Follows. Detailed Answer: Dear Madam, Thank you for reverting back. Well going through all the history that you have provided there is a strong possibilIty of underlying CTD that is connective tissue disease of which Lupus and sjogrens syndrome remain the main differentials . I note that you have been labelled as fibromyalgia and chronic fatigue but unless and otherwise we have ruled other organic cause like lupus by serological testing its not appropriate . Anyways you need to get CBC , ESR , S. albumin, globulin , ANA - IFA , ENA profile , Schirmers test for tear secretion testing . First we will need all these tests , if we have a positive indicator in these then we will advise you for further testing . Any further queries you are welcome to ask. Dr. Shruti