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Suggest treatment for sharp pain in spine and shingles

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Posted on Wed, 31 Dec 2014
Question: Long story i will try to hit highlights.
I have reason to believe I had my left diaphragm partially paralyzed as result of several severe bouts of shingles. In July I had sharp pain in left lumbar spine & w/in minutes I couldn't expand my ribcage to take a deep breath. Thought I needed chiropractic adjustment but Two days later a shingles rash presented. About 4weeks after another round of shingles rash my breathing/ribcage relaxed again & breathing became a bit easier but I began having great difficulty breathing lying supine. Next i had a very dry& unproductive cough for about 2 weeks followed by my head "exploding" w/ 2horrinle days of headaches & what felt like severe sinusitis. A few weeks later a "mysterious flow" of mucusy fluid began constantly flowing down my throat, it feels like coming from sinuses but sometimes feels like it's flowing up from diaphragm region. Having pretty severe pain in back around ribcage/lumbar spine, mostly left sided. Still can't sleep supine have to elevate, still flowing mucus.
Have taken Famciclivir & Valtrex for shingles.
Taken amoxcycillin & AZithtmyacin ZPac, along w/Flonase & nothing has made any difference.
Is this what one would expect w / a paralyzed diaphragm "coming back to life " so to speak? My lungs don't feel compromised iat this point, I'm actually feel better when moving around, walking etc. but this mucusy flow is what seems to be making breathing difficult. Almost like choking on my own fluids but really only on the left side.
Live in small, rural town and no Dr. I've been to knows anything about any of this? Please help to ease my mind, at times I feel crazy from this flow & pain. Any insight will be most appreciated.
doctor
Answered by Dr. Olsi Taka (7 hours later)
Brief Answer:
Flow not related to diaphragm.

Detailed Answer:
Hello. I read your query carefully and I understand your concern. I also read your previous exchange with my esteemed colleague Dr. Saghafi and I understand the stress these bouts of shingles have put you under.

Regarding your current question, I don't think that mucous discharge is coming from your diaphragm. The diaphragm is a muscle which while helping the breathing process has no communication with the airways itself, no outlet from which fluid could come from. Phrenic nerve involvement by shingles wouldn't cause any fluid formation in the diaphragm anyway, only a bacterial infection process would cause that (that would be a serious condition with many more components to your clinical picture so no reason to dwell on that).

In an indirect way a paralyzed diaphragm could be a predisposing factor for lung infections, which in turn could cause sputum discharge, but since you describe your breathing situation not being compromised and improving, I doubt that is the case, if a concern you might discuss it with your doctor whether he has noticed any signs on physical exam and whether tests like x-ray are necessary (although I suspect they might already have considered that possibility). Back pain can be investigated if it is still present.

Your symptoms are compatible with sinusitis (which I am assuming has been confirmed by physical exam and imaging tests) with the fluid being as a result of the draining of the accumulated fluid in your sinuses, it is part of the process. If the sinus infection is persistent then despite treatment with antibiotics predisposing factors for chronic sinusitis should be investigated by an ENT specialist (factors like nasal polyps, septum deviation or other nasal abnormalities, allergies etc).

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Olsi Taka (17 hours later)
Thank you for your reply, it's quite informative & appreciated however I am still searching for answers to this perplexing & painfully ever present condition. Yes, I did have an excellent experience w/your very highly esteemed (in my eyes) colleague Dr Saghafi & would have spoken to him again except can't get the direct link he sent me to work.
If these things may be helpful, I have hiatal hernia w/symptoms diagnosed 2010, I am hypothyroid (also diag. 2010) which was off in the midst of all this & we increased my synthroid amount to .88.
Now, the rest of the story..,
The mucusy flow seems to flow more when there is pressure on my occipital/suboccipital area & upper back ie: sitting back in recliner or in my car supported by seat & headrest. After this flow happens for awhile in these positions I often experience weakness in my upper left arm and left leg, sometimes heart palpitations, followed by need to urinate frequently, as though flushing something. I am also waking w/headaches in same occip/suboccipital area & neck. I have had, back several weeks ago, quite a few times that I wake up gasping hands/feet tingly and it's as if my brain forgot to tell my lungs to breathe in. I have been constantly constipated , since the beginning in July, I had gone several weeks without bowel movements at that time & which has now improved to about 1x per week, if I'm lucky. I have described this whole experience to my husband as "it feels like everything from my bowel to my sinuses on my Left side have been paralyzed, or at least severely compromised? Sounds crazy I know but Its uncomfortable at best, painful at its worst, and sometimes frightening.
Could all of these, what seem to me to be neurological symptoms be simply allergies? I have no outward signs of allergies, ie: sneezing, watery eyes, etc. and no history. Could it possibly be an infection of my spine? If so, how do I find out? Thanks for your time and your help.
doctor
Answered by Dr. Olsi Taka (8 hours later)
Brief Answer:
Thyroid function tests and MRI recommended.

Detailed Answer:
I read your symptoms carefully and I am sorry you are having such multiple health issues.

You have multiple symptoms which involve multiple body functions and systems. I don't think there is one single condition which can explain all of what you are experiencing.

You are asking specifically about allergies, but while they could explain some symptoms such as the discharge, difficulty breathing they do not explain your other symptoms. There are allergies with intestinal signs but it's usually diarrhea not constipation and accompanied by visible signs like hives, swelling etc.

The signs are not explained by infection of the spine either. While spinal cord involvement can at times manifest with changes in urination and defecation functions, by the time they have been altered it has also several more distinctive signs of neurological deficits with weakness of the limbs, sensory changes.
Of course a physical neurological exam to look for subtle signs would also be useful to definitely put your mind at ease, but I don't think by the evolution it is a case of spinal cord involvement by infection. I understand you have this suspicion due to the recurrent shingles, but shingles involvement of spinal cord apart from being rare includes mostly the signs I mentioned. It also wouldn't explain the mucous flow. (If the neurological exam finds any extra signs, that's another matter, a spine MRI and lumbar puncture would be required).

Your mucous flow as I said before, if confirmed also by physical exam and imaging tests, is better explained by sinusitis. Not related to spine infections or to brain ones for that matter (since you've inquired after them in a previous question).

Regarding what you could do to find out, since you report persistent headache more prominent in the morning and these transitory episodes of weakness of your left limbs I think a MRI of head and cervical region would be advisable to exclude cerebral or upper cervical lesions. It might also give more detailed info on your upper airways and sinuses.

Because constipation is a symptom often encountered in hypothyroidism, I think a reevaluation of you thyroid function and the treatment dosage is required, you might need a higher dose although that should be also guided by the TSH levels.

I am assuming you have had already routine blood panel (complete blood count, blood glucose, renal and liver function, electrolytes). Testing for sistemic autoimmune diseases and Lyme disease is recommended as well.

Also a factor to take in consideration (if everything comes back normal), is also menopause. Menopause due to hormonal changes is related to symptoms like heart palpitation, sleep interruption, headache, digestive disturbances, urge incontinence, tingling in extremities, new allergies. It also is related to anxiety and depression which in turn themselves are related some of those symptoms.

Apart from menopause you have other risk factors related to anxiety and depression such as hypothyroidism and recently post-herpetic neuralgia (of which I read in your previous query).

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Dr. Olsi Taka

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Suggest treatment for sharp pain in spine and shingles

Brief Answer: Flow not related to diaphragm. Detailed Answer: Hello. I read your query carefully and I understand your concern. I also read your previous exchange with my esteemed colleague Dr. Saghafi and I understand the stress these bouts of shingles have put you under. Regarding your current question, I don't think that mucous discharge is coming from your diaphragm. The diaphragm is a muscle which while helping the breathing process has no communication with the airways itself, no outlet from which fluid could come from. Phrenic nerve involvement by shingles wouldn't cause any fluid formation in the diaphragm anyway, only a bacterial infection process would cause that (that would be a serious condition with many more components to your clinical picture so no reason to dwell on that). In an indirect way a paralyzed diaphragm could be a predisposing factor for lung infections, which in turn could cause sputum discharge, but since you describe your breathing situation not being compromised and improving, I doubt that is the case, if a concern you might discuss it with your doctor whether he has noticed any signs on physical exam and whether tests like x-ray are necessary (although I suspect they might already have considered that possibility). Back pain can be investigated if it is still present. Your symptoms are compatible with sinusitis (which I am assuming has been confirmed by physical exam and imaging tests) with the fluid being as a result of the draining of the accumulated fluid in your sinuses, it is part of the process. If the sinus infection is persistent then despite treatment with antibiotics predisposing factors for chronic sinusitis should be investigated by an ENT specialist (factors like nasal polyps, septum deviation or other nasal abnormalities, allergies etc). I hope to have been of help.