Brief Answer:
Need to get a solid history and PHYSICAL EXAMINATION

Detailed Answer:
In a perfectly and otherwise healthy 34 year old man I would begin with a solid history of childhood to the present and discover what if any challenges or problems this person had growing up; both physical and mental/psychological if appropriate. Are there are any breaks in these symptoms....in other words, do they come and go or are the symptoms there constantly after awakening from sleep?

I would also get a full complement of laboratory analyses to include thyroid parameters, inflammatory markers such as ESR and CRP, and then, make the patient fill out a headache diary that he can bring back on the next visit to decide on next steps.

I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload images if you'd like.

Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 73 minutes of time to read, research, and respond

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Brief Answer:
Recommendations as they are- Why does he have PELVIC PINS in hips?

Detailed Answer:
Unfortunately, the information above doesn't really help me give you a diagnosis and you will need to check with the doctor taking care of the patient in order to see if they may be willing to undertake any of the tests that I've outlined for you. With those results in hand it will be much easier for me to interpret the symptoms that the patient is experiencing.

If you'd like here is a list of suggested lab tests that can be obtained:

1. Vitamin B12 in serum (If Below 350-400) then, include the following tests:
a. Homocysteine in urine and serum
b. Methylmalonic acid in serum
2. Folate
3. Free T4
4. TSH
5. Vitamin D, D2, and D3 in serum
6. Urinalysis
7. Magnesium in serum
8. ESR
9. C- reactive protein

I hope this list better allows you to have a discussion with your doctor and of course, based upon the patient's known history some of these tests may or may not be indicated or appropriate. His doctor will know.

I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY since this is the end of the month and will allow for all previous responses to be processed in a timely fashion for both yours and my benefit.

Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like once your doctor decides on which tests to get and you have the results.

Many thanks for using this service to ask your questions. Be well.

This consult request has taken a total of 89 minutes of time to read, research, and respond

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