Treatment for joint pain, back pain, and night sweats?
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Hello, I am 29 yr male, non-smoking, weight 70kg, physically fit (occasional outdoor/indoor sports, have regularly practiced hatha yoga, stopped 1 year ago when son was born), diet - 5 years without meat, although I eat fish and seafood, take supplements of Omega-3, D3 (for a month or two twice a year), no prescription meds. Sedentary work in the office. Currently experiencing mild to moderate joint pain, which used to be occasional and now is present more often. Joints affected are mostly knees, especially after physical activities, even short bike trip or skiing or ice-skating (such activities never gave knee pain before, only during last few years, with pain intensity increasing), also affected are hips, small finger joints, toe joints, shoulders. First experience of joint pains appeared more than 10 years ago, then subsided, reoccurred from time to time. More significant relapses began 2-3 years ago with pain in one joint lasting 1-2 days, pain migrated from one set of joints (e.g. left hip, right shoulder, couple of finger joints) to other set of joints later. Used to have NO back pain besides some fatigue kind of pain when bending for longer periods (possibly after minor injury with lifting weight 10 years ago). It seems, there's some back pain now during this period (for the very first time) - experiencing it when bathing son and now when sitting in the office. Night sweating for many years (possible since very early childhood or birth). ESR, CRP - within norm, RF - not present, HLA-B27 - positive, antistreptolisine-O - norm (52 IU/ml, norm up to 200IU/ml). Other blood work normal (cell counts, HGB, lipid panel, blood glucose) in normal range (there is some slight dis-balance of WBC for many years, lymphocytes having greater part and neutrophils having smaller part of WBC). Urine - everything within norm. Even though it is quite unlikely (same and only partner for 10 years), unless it is STD transmitted via household items, had a consult for STDs very recently - none present (evaluated for all common, e.g. chlamydia). Visited rheumatologist. Sent for radiology consult. X-ray (there might be some translation inaccuracies, as I am not fully familiar with all the terms in English, in our language we might have a bit different descriptions/expressions) Neck: straightened physiological lordosis, insignificant scoliosis to the left, insignificantly smaller gaps between C5-7 vertebrae, a little bit expressed subchondral sclerosis, a bit sharper edges of the vertebrae; Chest: insignificant scoliosis to the left in the lower part, normal gaps, a bit sharper edges of the vertebrae, a little bit expressed subchondral sclerosis, a bit sharper edges of the vertebrae; Hands: joint gaps normal, even surface, no visible bone structure defects Hips: joint gaps normal, even surface, no visible bone structure defects Result: osteochondrosis of neck and chest parts. No visible defects in hands or hips. After the consult rheumatologist decided it is inflammatory spondyloarthropaty and didn't hesitate to prescribe ciprofloxacine for possible infection, sulfasalazine for management of the disease and dexketoprofen (even though I said I don't have a pain which I would need to manage using drugs). I have also said that I was diagnosed with Crohn's disease earlier and it seems that dexketoprofen wouldn't be the NSAID of choice in this case… Anamnesis (earlier) Some issues with liver in early childhood, would have to doublecheck for exact data. ~1993-1995 - couple of episodes of unexpected vomiting, nausea, severe dizziness lasting for a day. Admited to hospital the second time this happend. Later this has been speculated to be possibly related to micro (hemorrhagic) strokes (although nobody has evaluated neurological signs during these episodes) 1996 (12 yrs) - rupture for angioma in the brain, hemorrhagic stroke (all ventricles were full), no residual neurological defects (nor there have been any significant besides some signs during the hemorrhage). Non-operable (close to corpus callosum), speculated possibilites of treatment with gamma knife radiosurgery but this was never performed. Telangiectasia (no bleeding ever) were present on the body, one quite large on the face. Nosebleeds were quite common. Easily got bruises (e.g. after accidental compression of an arm). Blood clotting seemed to be mostly normal and not related to bruises (there were some blood clotting indicators not within norms, but bruising didn't stop even when they were normal for very long time). Currently (2014) all blood clotting indicators (bleeding time, protrombin activity, platelets, etc.) are normal, although bruises still appear easier than for most individuals. Back then there were specullations about Osler-Weber-Rendu syndrome. Later, telangiectasia just dissapeared and never appeared back again (perhaps at around 1998). Nosebleeds stopped at around year 2000-2001. During this period (early teens up until perhaps 16 years) had significantly elevated levels of alkaline phosphatase which then came back to normal in the age of 16 or around. Puberty signs were always delayed compared to peers. ~1997 was perhaps the first time when I experienced moderate to severe abdominal cramps/pain, fever (39C and above). First episode lasted for about 2-3 days and then subsided by itself. Could be it was accompanied with diarrhea (no data on this). Episodes repeated 1-2 times per year. No other signs or symptoms of cold or similar. Usually always accompanied with diarrhea. During high school years I always recall complaining about how tired (fatigue) I felt occasionally without any known reasons. Sometimes feel this now. ~2000 onwards started noticing occasionall joint pain of short duration (few hours), don't recall which joints exactly, must have been various (small, large) 2003 - went to Ocean City, MD, US (indicating this for climate) for summer job as a programme for students. Small finger joints were painful during all the summer. When came back to Europe, pain was gone. ~ 2004 - admitted to hospital (diagnostic facility) after episode of severe abdominal pain and fever 40.4C. Colonoscopy performed, biopsies taken. Initial diagnosis - ulcerative colitis, later after biopsy results received - differentiated to Crohn's disease. Possibly have uveitis of one eye then, no diagnostic tests, just observation. Some treatment with mesalazines after diagnosis was made. Noticed, that during every flare up with fever, CRP goes to ~50 or above. ~ 2005-2006 - participated in study of Crohn's disease, colonoscopy performed. Intestinal epithelium described as completely healthy, no erosions, biopsies taken from healthy tissue didn't indicate anything. Diagnosis changed to IBS. 2010 - Shigella Sonnei infection after visit to India. Treated with ciprofloxacin until it appeared that this strain is resistant to it. Switched to Chloramphenicol (sensitive). Episodes of severe abdominal pain and fever very rare in later years. Improvement seems to coincide to yogic practices, stress management. All later episodes seem to be related to stress. Family: Grandmother (mother's line) - ulcerative colitis Grandaunt (grandmother's sister) - RA Father - unexplained severe abdominal pain, blackouts, diarrhea during years served in army and later, episodes disappeared in his thirties Mother - ulcerative colitis, HLA-B27 positive, joint pains (mostly fibromyalgia-like during examination), suspected systemic lupus erythematosus (ds-DNA antibodies discovered couple of times, no conclusion made yet, lack of signs), restless-leg syndrome Questions: What are possible conditions having in mind all background? Maybe there is one genetic issue behind all of it? How likely it is for my son to develop the same issues, what are likely triggering factors which enable the genes which might play a role here? Any comments, overview very welcome.
Posted Wed, 12 Mar 2014 in Ayurveda
Answered by Dr. Munish Sood 14 hours later
Brief Answer: Rheumatic Disorders Detailed Answer: Dear XXXX Thanks for contacting Ayurveda with your health concern and going by your Medical History I have come up with following suggestions. A. going by your systemic complaints: i. peripheral arthritis ii. young age of onset iii. negative test for rheumatoid factor iv. familial predisposition and strong association with HLA-B27 v. skin and mucosal lesion [telangiectasia], bowel complaints [IBS], eye involvement [uveitis] Thus possibly it is a group of : "Seronegative Spondyloarthropathy" [SPA] under which one has to look out for the following diseases for differential diagnosis: . Ankylosing Spondylitis [since X-ray neck shows changes thus could be included] . Reiter's syndrome/Reactive arthritis: since joint pains are there thus has to be ruled out] . Arthropathy of inflammatory bowel disease [Crohn's disease, Ulcerative colitis (UC)]: family history of UC is there. B. According to European SPA Study Group [ESSG] Classification which has 86% sensitivity and 87% specificity following is the Criteria for SPA 1. Inflammatory spinal pain 2. Positive family history [present] 3. Psoriasis 4. Inflammatory bowel disease [present] 5. Alternate buttock pain [present +fleeting joint pains] 6. Uveitis, acute diarrhea [present] 7. radiographic sacroilitis [present] PS. 1. please make sure that your attending Physician carry out necessary examination [ Gaenslen's sign/patrick test] and Investigations [X-ray of sacro iliac joints and later with CT/MRI] for possible Involvement. 2. Since there is chest involvement make sure to go for PFT [pulmonary function tests] C. The chances of your child developing the disease in the long run range from 5% to 20% . PS. .If mother is HLA-B27 +ve, children have a higher chance of inheriting & developing i.e. 38% as compared with 8% of HLA-B27 +ve fathers . Even if child is HLA-B27 positive, it is not necessary that he/ she may develop the disease, However, if your child ever has pain/ swelling in any joint/ persistent backahe, see a Rheumatologist immediately. Hope I've given due consideration in taking up your case, any suggestions/ concerns are welcome. Dr. Munish Sood Consultant & physician Naimittika Clinic
Follow-up: Treatment for joint pain, back pain, and night sweats? 13 hours later
Dear Dr. Munish, I am amazed by how much effort you have put in explaining everything, really appreciate it. I forgot to add that I occasionally have ulcers in my mouth since childhood. Does this contribute to AS diagnosis? Also, what most natural treatment/management could you suggest? Any hints which are not very widespread? :) (I.e. besides exercise). Special diet? Any ideas how Omega-3/Omega-6 ratio could play a role in inflammation here? Thanks!
Answered by Dr. Munish Sood 11 hours later
Brief Answer: Clarifications and Ayurveda Management Detailed Answer: Dear XXXX Thanks for reverting back with your concern A. Since you suffered from IBS and there is positive history of Gastrointestinal disorder, thus probably it could be one reason for your mouth ulcers, moreover make sure you are not gluten sensitive which might be the root cause of mouth ulcers. B. Omega-3 and 6 are called as PUFAs [poly unsaturated fatty acids] and recent studies have revealed that omega 3 helps in reducing inflammation while most omega 6 lowers LDL [bad cholesterol] and reduce inflammation while some omega 6 fatty acids tends to promote inflammation due to increased intake/consumption of vegetable oils [soybean, cottonseed, corn, sunflower, and safflower oil] which disrupts the delicate balance of omega-3 and omega-6 that we need for health, instead use olive oil which is neutral and not rich in omega 6 fatty acids. . Avoid fast / processed food which use vegetable oil, and add food that is rich in omega 3 fatty acids [canola oil, flaxseeds, fish, eggs] PS. So instead of taking omega 6 in oral form, use it in oil form such as evening primrose, black currant oil. [You might have to ask your health care provider about taking omega-6 supplements to determine what form and what dose of omega-6 fatty acids are most appropriate for you.] C. In Ayurveda we consider Rheumatism under ‘AAM’ i.e. disease arising from/due to improper metabolism so treatment and Management is directed towards i. Expelling the already formed AAM, [trifla], methods to prevent further AAM formation [deepan/pachan ] ii. . Avoid: urad dal, curd, fish, jaggery, milk, incompatible and heavy food, suppression of natural urges, anxiety, grief, outdoor activities when sky is covered with clouds, and cold wind. . Take: maize, horse gram, karela, dried ginger, garlic, ajwain,saunf, XXXXXXX marich, saindhav lavan, hing, jeera, old ghee, lukewarm water, castor oil, light walking, sudation, warm clothes, garlic and ginger mixed butter milk. . fry 250 ml ginger juice in 250 ml of til tail, when 250 ml remains [make sure oil doesn't get burn], filter it after cooling and massage. . boil 1 spoon dried ginger in 4 cups of water till 1 cup remains, filter it and add 2 spoon castor oil and drink. Dr. Munish Sood Naimittika
Follow-up: Treatment for joint pain, back pain, and night sweats? 2 hours later
Thank you so much! Could you please give a bit more details on: suppression of natural urges - they should not be suppressed, I understand (just so I don't get it opposite)? Also, is there any possibility that this is also created by dosha imbalance? E.g. vata being too active or something else? Your responses are more than I could expect, I am so pleasantly surprised. Thank you again, Dr. Munish!
Follow-up: Treatment for joint pain, back pain, and night sweats? 6 minutes later
Also, you suggested to add fish (for Omega 3 balance), which I already did couple of weeks ago - increased fish intake (herring, which is very rich in Omega 3 and has little Omega 6), but according to Ayurveda view of the causes of this disease, as you explained, I should not consume fish? Which view is more important here? Will I have enough Omega 3 if I stop eating fish? Does this also include all seafood? Animal products in my diet are limited to fish, seafood, eggs and milk, I have stopped eating other meat 5 years ago. Thanks!
Answered by Dr. Munish Sood 3 hours later
Brief Answer: Ayurveda Concepts and View Detailed Answer: Dear XXXX Thanks for reverting back 1. In Ayurveda we hold 13 non-suppressible natural urges that aid in maintaining the homeostasis of the Tridoshas [Vaat-Pitta-Kapha] of the body , In brief these are: . Vaat [gas] . Vinn: [feces] . Mutra [urine] . Kshav [sneezing] . Trit [extreme thirst] . Kshuda: [hunger] . Nidra [sleep] . Kaas [cough] . Kshram [over exertion] . Jrimbha [yawning] . Ashru [crying] . Chardi [vomiting] . Retas [semen] PS. You may consult an Ayurveda Physician there for better understanding of the same since it requires in depth knowledge about the subject. 2. In long term suppression of natural urges causes vitiation of the humors of the body mainly VATA and further cause accumulation of AMA in the body, hence it is advisable not to suppress these natural urges, thus since I cannot examine you directly but whosoever will treat you will manage you on the line of “AAM avrit VATA”i.e. kapha accumulation resulting in aggravation of Vata. 3. You can limit fish intake to 2 times a week, and take other sources of omega 3 [green leafy vegetables [spinach in particular], walnuts and described earlier. 4. In Ayurveda we hold the theory that Milk, Yogurt and Eggs are incompatible food with fish i.e. these should not be consumed together and since these are included in your daily diet make sure you are not combining them rather taking them separately and solely. PS. No matter what you eat, if the Doctor can optimize your Digestion [JATHARAGNI] which is required for proper production and secretion of digestive enzymes [Enzymes=Jatharagni] we can optimize the function of this multi faceted disease. Dr. Munish Sood Naimittika
Follow-up: Treatment for joint pain, back pain, and night sweats? 3 hours later
Thank you, I keep getting amazed by the depth of your responses :). What is your average prognosis (or range of prognosis) (since you haven't evaluated me directly, so I ask for your general experience with other similar patients) for this condition? In case if it is managed using Western medicine (NSAIDs, immunosupressants, etc.)? In case if it is managed using Ayurveda? Best regards, XXXX
Answered by Dr. Munish Sood 12 hours later
Brief Answer: Immunomodulation Detailed Answer: Dear XXXX Thanks for reverting back with your possible concern(s) 1. since as you already know that Immunosupressants is/are required for treatment purpose and majority of disease are AI [autoimmune] in nature thus it is accepted that this disease is due to some genetic defect and only conservative treatment can be given [since deletion of gene is required]. 2. The course of disease is variable, i.e. some patients progress to spinal deformity and disability whereas other have remarkably little discomfort or disability. [my experience with patients: since disease is AI in nature thus treatment is usually aggressive, long-term and requires regular and careful follow-ups] 3. The main objectives in any system of Medicine are to relieve pain and stiffness and to prevent spinal deformity and disability i. Physiotherapy: Maintenance of erect posture is critical in all activities, including sitting, standing and walking. the patient should sleep in a prone position or supine on a firm mattress with one small or no pillow. Walking and swimming are excellent activities for maintaining joint mobility. ii. NSAID's:no NSAID has documented superiority over another in terms of efficacy and safety. iii. Immuno Suppressants: Neutropenia occurs in 1% to 3% of patients, so monitoring of the white blood cell count is important. iv. IMMUNOMODULATION [RASAYAN CHIKITSA] Rasayana drugs (Rejuvenation/Immunomodulators) should be instituted in your management as part of XXXXXXX (palliative) therapy i.e. which corrects the dysfunction of tissues without disturbing the functions of normal tissues, also Rasayana drugs potentiates humoral antibodies, by increasing serum Immunoglobulin’s such as IgA,IgG and IgM. i. Proteins are essential for antibodies production so milk, egg (white), beans,yogurt,soyamilk,pumpkin,squash,watermelon,peanuts,almonds, if non-vegetarian (meat) are choices ii. Vitamin A: helps to maintain Thymus gland which is a powerful antiviral gland : thus mango,carrots,cantaloupe,egg yolk,apricots,pumpkin,papaya, are ideal iii. Vitamin C: is needed for proper functioning of immune system: amla is best iv. Vitamin E: is a powerful anti oxidant which helps to stimulate antibody production: peanuts, dried apricots, cooked spinach, taro root can be taken v. Vitamin B is important for the activity of phagocytes: eggs, cheese, pistachio, raw garlic, sunflower and sesame oil. vi. Ashwagandha,Mandukparni,Shatavari,Trikatu,Vacha,Guduchi,are best Immunomdulators, you can consult with an Ayurveda Physician there about the same. PS. PROGNOSIS: Most patients who religiously follow an exercise and medication programme are able to lead relatively normal lives with minor adjustment in lifestyle Hope I have undertook the case upto your satisfaction, you may contact me directly on bit.ly/drmunishsood Dr. Munish Sood Naimittika
Follow-up: Treatment for joint pain, back pain, and night sweats? 5 hours later
Dear Dr. Munish, Thank you so much again. I understand that my questions will not end :), it will be difficult to close this discussion, but I understand that I have to let you go :). There are many many more I would like to ask, I will limit myself to these, if you are still willing to continue this discussion: 1. How long do you think it could take to manage the disease (teaching, guiding of correct way of life) (AS, SPA) by a Ayurveda practitioner up to the level that patient is more or less able to continue by himself? The stage is perhaps quite early (even if began long time ago, there is no significant damage done). 2. Hot bath / ice packs / cold shower in SPA. a) could heat induce more inflammation? It seems to help with pain. b) You mentioned warm weather, clothes, etc. - would ice cause damage? 3. I have been using cold water after each bath, shower, etc., haven't missed a SINGLE instance of when I had contact with water - I always finish with coldest water available (for up to 10 seconds usually) to train my blood vessels + to develop will power. Could this be counterproductive in SPA? 4. What does Ayurveda suggest for pain in SPA/SA? 5. After sleeping on left side, the earlobe becomes painful, only one ear is affected, seems that rubbing the ear is sometimes painful, symptom appeared just 2-3 weeks ago, first time in my life, seems to coincide with onset of more painful joints). Could it be linked to SPA? 6. TCM would perhaps have very much different approach in treating SPA and would potentially use immunomodulators which come/are fungus, like Cordyceps sinensis. I would imaging mushroom and fungus are "not welcome" in Ayurveda? 7. Do rheumatism diseases (the way they are differentiated in Western medicine/alopathy) differ in Ayurveda views? Do these conditions are recognized as different in the same scope? E.g. RA is different from AS and different from SLE/Lupus. Would all these three be viewed and treated differently in Ayurveda. I am just trying to understand if different manifestations of rheumatism as they are seen in Western world have any significance at all in Ayurveda. I know this might be deep topic, please don't worry about detailed answer. Very brief, something close to "yes" or "no" would suffice. I promise I will close this thread after, I will have one more question which I will ask directly.
Answered by Dr. Munish Sood 1 hour later
Brief Answer: Management through Ayurveda & TCM Detailed Answer: Dear XXXX Thanks for reverting back with your concern(s) 1. . When the patient is strong and the disease is weak I suggest going for Panchkarma . When the patient is weak and the disease is strong, I first balance the Dosha to make disease weak and patient strong to undergo Panchkarma, so once Ayurveda practitioner has determine which of your Doshas is most disturbed and also your constitution [Vata-Pitta-Kapha] you will be safely guided to healthy life style and management. PS. Panchkarma is not some magic but it will only ASSIST in healing. In Ayurveda we consider “BASTI” [medicated enema] as the most important purification method, because of the importance of the large intestine in health and disease ‘ सर्वे रोगा: मंदाग्नि” [sarve roga mandagni] since virus first colonizes the colon [ AMA production] and proliferates there before it floods the system [example being Enteric fever, AIDS virus] 2-3. Remember: whenever there is obstruction due to AMA use dry heat [sauna/hot packs, warm towels], wet heat aggravates obstruction and congestion PS. i. Modern Thermography shows that painful areas in the body where there is no INFLAMMATION are usually several degrees cooler than normal. This pain is the result of constricted blood vessels, [Heat therapy will improve joint mobility through increased blood flow, tolerance for pain while Cold therapy reduces stiffness and swelling by causing numbness of the nerves around the joint [which reduces pain and relieves inflammation] moreover cold or hot compression should not be given for more than 20 minutes otherwise secondary effects i.e. vasodilation in case of cold application and vasoconstriction in case of hot application will take place. ii. So whatever bath/pack you use, it will depend upon ‘SAAM-NIRAAM PARIKSHA’ 4. Presently, the medications used to treat most rheumatic diseases do not provide a cure, but rather limit the symptoms of the disease thus your line of treatment in Ayurveda will be ‘AAMVAAT CHIKITSA’: . Langhan: [fasting] . Swedan: [Dry Sudatin/sweating] . Tikta & Kshaya Aushadhi [Bitter & Pungent Herbs/Medicines] . Basti [Medicated Enema] एवं शोथहर चिकित्सा . Shotha har Chikitsa [Anti inflammatory/anti dropsy drug] for pain: Dashmool is the drug of choice 5. It could be TMJ [temporo mandibular JOINT] disorder or middle ear infection, check with concerned doctor. 6. In Ayurveda we classify mushrooms under ‘tamsika ahaara’ [negative food] and used for enhancing vigor and vitality so TCM healer will best guide you for Immunomodulation. 7. In AYURVEDA we consider Allergy [of any type] as hypersensitive reactions of the body to a foreign proteins [vijateeya dravyas] which have not undergone proper metabolism [agni paak] after entering the body thus resulting in 'AMA' [antigen] which causes reduction and prevention of further production of auto-antibodies, as such all Autoimmune disease come under this Allergy/AAM PS. Consultation is my profession by choice and not by chance, so you are free to ask any number of questions you want to I will be more than happy to answer them Dr. Munish Sood Naimittika