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What Causes Brain Fog,muscle Stiffness And Pain With Elevated Vitamin D Level?
Question: I am a 45 year old female. After a sore throat that came up suddenly 5/21 and lasted only a few days, I became very weak and fatigued. Brain foggy, severe muscle stiffness (like constantly tense or contracted) and achiness, an overall tremor throughout my entire body that you cannot see but I saw in my fingers for the first time in a hot epsom salt bath. A strange overall beating or pulsating along with that tremor. I also feel tremor in my intestine and my bowels have been more active but not loose. My head feels very heavy with a "beating" and so do my limbs, with feelings of "drunkiness" (no migraines). Blood had just been tested prior to this and my tsh levels tested normal (2.29 tsh and free thyroxine .89 were what were tested). Everything else normal but Vitamin D elevated from 18 to 29 due to recommendation to take more vitamin D. Upon hearing symptoms the doctor ordered more bloodwork and my wbc was 11.9 and neutrophils 9175 (slightly high). Urninalysis and ekg good also. He suggested I come back a couple days later to monitor and now wbc is in the normal range, other tests for Magnesium, Cortisol, ACTh and metaphrines have not come back yet. In the meantime, I am diagnosed with anxiety and taking .25 alprazolam which helps the tremors a little. I've been relatively healthy (fast paced life but not out of control). Have you heard of Epstein Barr (which I was told many years back I had virus) or Fibromylagia or anxiety causing these symptoms and should I be tested for these? Seeing the tremor so pronounced in a hot bath frightened me and I had expected it to relax me! If all bloodwork comes back normal I suspect they would order an mri to rule out ms or other possible brain anomalies?? I was hospitalized for a brain contusion as a teen and suffered grand mal epilepsy for about 10 years but have been seizure free since. I am currently working and must double check everything I do in this brain fog. Your opinion is appreciated.
Brief Answer:
Hello
Detailed Answer:
Hello,
Good day.
We will surely keep the blood work reports confidential and I would certainly appreciate if you could attach a copy.
Noted your history.
Now, many things can cause this. From hormonal changes at one end, to menopausal sumptoms to anxiety at the other end. Was the metanephrines done in blood or urine? How did they collect it?
I would surely want to know the results of these tests.
Fibromyalgia will cause aches and pains over muscles, but no tremors. Similarly most persons would have had an Epstein barr virus attack in their youth and that has nothing to do with your current symptoms.
I noted your history of epilepsy and do not personally think that is the cause.
Did the symptoms start whilst in a hot shower? Were you worried or anxious for any reasons before these symptoms happened?
Since the symptoms happened soon after an episode of sore throat, infection is top in the list which can cause shivers and tremors. Since these episodes have settled now, please relax. We shall wait for the blood results. In the interim, I would appreciate if you could attach the blood works done so far. ( if you had a urine test, please attach that too)
HAve a great week end
Regards
Binu
Hello
Detailed Answer:
Hello,
Good day.
We will surely keep the blood work reports confidential and I would certainly appreciate if you could attach a copy.
Noted your history.
Now, many things can cause this. From hormonal changes at one end, to menopausal sumptoms to anxiety at the other end. Was the metanephrines done in blood or urine? How did they collect it?
I would surely want to know the results of these tests.
Fibromyalgia will cause aches and pains over muscles, but no tremors. Similarly most persons would have had an Epstein barr virus attack in their youth and that has nothing to do with your current symptoms.
I noted your history of epilepsy and do not personally think that is the cause.
Did the symptoms start whilst in a hot shower? Were you worried or anxious for any reasons before these symptoms happened?
Since the symptoms happened soon after an episode of sore throat, infection is top in the list which can cause shivers and tremors. Since these episodes have settled now, please relax. We shall wait for the blood results. In the interim, I would appreciate if you could attach the blood works done so far. ( if you had a urine test, please attach that too)
HAve a great week end
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The metanephrines, plasma was a blood test and I am waiting for the results. I have had these overall tremors (not outward visible) and symptoms shortly after the sore throat but they did not start in the shower. I only tried to relax and treat my anxiety with a hot bath. For the first time, I saw my fingers shaking last night. I will say the muscle weakness, tremors, brain fog, eye's feeling like popping out of my head, "drunkiness", and beating throughout my body has caused some worrying but I did not feel it was excessive to cause a vicious circle of anxiety. Pulse, blood pressure normal and no fever. So you don't think the Epstein Barr can reactivate as an adult and cause this? Can you get a virus with no fever to cause this kind of symptoms??? I admit, I am nervous of the unknown and the root cause of the tremors. I will attach my blood work to my profile shortly. I suspect new blood work mentioned in our first correspondence will come in soon (I hope) and I will also ask for a copy of the urinalysis.
Brief Answer:
Hi
Detailed Answer:
Hello,
Good day.
EB virus infection can come back later in life again. What i meant was that, your childhood EB virus infection has nothing to do with current episodes. Virus infection usually cause fever, but many viral infections can present with just muscle pain, tiredness, shivers etc. These incidents follwing a sorethroat attack could be due to a viral infection itself. Your doctor did all the blood tests to rule out an adrenaline excess by doing a plasma metanephrine test. This is rare and unlikely, but not impossible.
Anxiety can cause these symmptoms too. Please relax while you wait for the blood results.
Regards
B
Hi
Detailed Answer:
Hello,
Good day.
EB virus infection can come back later in life again. What i meant was that, your childhood EB virus infection has nothing to do with current episodes. Virus infection usually cause fever, but many viral infections can present with just muscle pain, tiredness, shivers etc. These incidents follwing a sorethroat attack could be due to a viral infection itself. Your doctor did all the blood tests to rule out an adrenaline excess by doing a plasma metanephrine test. This is rare and unlikely, but not impossible.
Anxiety can cause these symmptoms too. Please relax while you wait for the blood results.
Regards
B
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I know that is what I need to do. I will update my profile as we learn more. Thank you Dr. XXXXXXX
Brief Answer:
Best wishes
Detailed Answer:
Wish you a speedy recovery
Best wishes
Detailed Answer:
Wish you a speedy recovery
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have posted additional bloodwork but there is an end note that says metaphrines test not performed -not suitable speciman received. I am unclear where the cortisol and acth test results are and if mine are normal. I see my physician this afternoon. I am going to ask if they are open to testing my progesterone levels-she may run the metaphrines test again. I had no idea anxiety could cause such problems. I now have blurred vision in my left eye but at least less tremors and not quite so dizzy-still a little uncordinated though. I still feel the need to rule out other seriuos problems before just treating anxiety.
Brief Answer:
Hello
Detailed Answer:
OOps. I didnt get any test reports. Please try attaching it again. You may also mail a copy to YYYY@YYYY
The sample might have lysed and thats why it was not suitable for metanephrine test. I hope the sample for ACTH was collected in the morning fasting and it was covered in ice bags before it was transported to lab.
Yes, you are right. Anxiety is a diagnosis off exclusion. We should always rule out other serious disorders before we label it as anxiety
Regards
Binu
Hello
Detailed Answer:
OOps. I didnt get any test reports. Please try attaching it again. You may also mail a copy to YYYY@YYYY
The sample might have lysed and thats why it was not suitable for metanephrine test. I hope the sample for ACTH was collected in the morning fasting and it was covered in ice bags before it was transported to lab.
Yes, you are right. Anxiety is a diagnosis off exclusion. We should always rule out other serious disorders before we label it as anxiety
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The metaphrines test is still not back but I am responding well to Clonazepam .5mg twice a day. The only thing that is confusing is I did not think I was going thru a stressful time and blindsided by 3 weeks of frightening symptoms. I have attached my hormone levels but what do you think of estrogen dominance and do you believe as our progesterone drops that our anxiety can be more easily triggered (due to less sedative effects of GABA when less progesterone). Progesterone/estrogen ratio can be calculated and they (well what I read) suggest at least a 300:1 ratio of progesterone/estrogen. I realize they are measured in different units and when I do the conversion, I am still getting a very low ratio of 1.786:1 . While I am responding to benzos isn’t it better to treat the root cause and not the symptoms? Or should I not treat with progesterone and just accept this is what a woman’s body naturally does as she approaches menopause. Please double check my calculation and give your opinion on estrogen dominance (or refer to another doctor?). Results below:
Progesterone .3 ng/ml or multiply by 1000 to get 300 pg/ml
Estrogen: 168 pg/ml or divide by 1000 and .168 ng/ml
Regardless of which units used in ratio, I get 1.786 : 1 Progesterone Estrogen ratio
300 pg/ml = X (progesterone)
168 pg/ml 1 (Estrogen)
I'm thinking that must be wrong but I used an example posted and understood how they calculated but this seems way off. Anyhow, The FSH is hard to read but looks like 0.6 mIU/ml but if that doesn’t sound right, I will call the office and ask because I do not see where .6 falls in range. I was fasting. Did test 6:30 am in the morning. I was interested in the progesterone/estrogen ratio (estrogen dominance) but of course this .6 fsh seems very low.
Progesterone .3 ng/ml or multiply by 1000 to get 300 pg/ml
Estrogen: 168 pg/ml or divide by 1000 and .168 ng/ml
Regardless of which units used in ratio, I get 1.786 : 1 Progesterone Estrogen ratio
300 pg/ml = X (progesterone)
168 pg/ml 1 (Estrogen)
I'm thinking that must be wrong but I used an example posted and understood how they calculated but this seems way off. Anyhow, The FSH is hard to read but looks like 0.6 mIU/ml but if that doesn’t sound right, I will call the office and ask because I do not see where .6 falls in range. I was fasting. Did test 6:30 am in the morning. I was interested in the progesterone/estrogen ratio (estrogen dominance) but of course this .6 fsh seems very low.
Brief Answer:
Hello. Welcome back
Detailed Answer:
Hi,
Happy that your question session is open again.
Hope you read my email regarding the estrogen and progesterone.
The ratio of progesterone to estrogen will change based on the timing of menstrual cycle.
Your estrogen level is 168 pg/ml
Progesterone is 300 pg/ml
P:E ratio is 1.78 : 1
Your FSH level is low ( nearing menopause we expect it to be high).
Were/Are you on any hormonal pills?? This can cause FSH to go down.
May I know why was estrogen and progesterone checked for ?
( ENDOCRINOLOGISTS AND GYNECOLOGISTS REQUEST FOR PROGESTRONE AND ESTROGEN BLOOD TESTS ONLY FOR SPECFIC INDICATIONS )
Please understand that the blood level of progesterone and estrogen is very much dependent on the timing of your menstrual periods.
Few days before ovulation , the estrogen levels peak. But progesterone levels will be minimum then. Once you ovulate, you enter in to the second half of menstrual period called as Luteal phase. In this phase, the progesterone levels peak. ( the peak value around 7 days before next period).
THIS MEANS THAT, PROGESTERONE LEVELS WILL BE VERY LOW IMMEDIETLY BEFORE OVULATION AND LEVELS PEAK AROUND 7 DAYS BEFORE PERIODS.
Good to know that you are responding to clonazepam. VMA is normal and that is reassuring.
Regards
Binu
*** PLEASE CHECK YOUR EMAIL ( I am attaching a photo of the estrogen/progesterone peaks). Again, this holds good only during normal menstrual age. Post menopause, levels of estrogen and progesterone reach a plateau.
Hello. Welcome back
Detailed Answer:
Hi,
Happy that your question session is open again.
Hope you read my email regarding the estrogen and progesterone.
The ratio of progesterone to estrogen will change based on the timing of menstrual cycle.
Your estrogen level is 168 pg/ml
Progesterone is 300 pg/ml
P:E ratio is 1.78 : 1
Your FSH level is low ( nearing menopause we expect it to be high).
Were/Are you on any hormonal pills?? This can cause FSH to go down.
May I know why was estrogen and progesterone checked for ?
( ENDOCRINOLOGISTS AND GYNECOLOGISTS REQUEST FOR PROGESTRONE AND ESTROGEN BLOOD TESTS ONLY FOR SPECFIC INDICATIONS )
Please understand that the blood level of progesterone and estrogen is very much dependent on the timing of your menstrual periods.
Few days before ovulation , the estrogen levels peak. But progesterone levels will be minimum then. Once you ovulate, you enter in to the second half of menstrual period called as Luteal phase. In this phase, the progesterone levels peak. ( the peak value around 7 days before next period).
THIS MEANS THAT, PROGESTERONE LEVELS WILL BE VERY LOW IMMEDIETLY BEFORE OVULATION AND LEVELS PEAK AROUND 7 DAYS BEFORE PERIODS.
Good to know that you are responding to clonazepam. VMA is normal and that is reassuring.
Regards
Binu
*** PLEASE CHECK YOUR EMAIL ( I am attaching a photo of the estrogen/progesterone peaks). Again, this holds good only during normal menstrual age. Post menopause, levels of estrogen and progesterone reach a plateau.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I called on the FSH fax and it is 8.6 (sorry fax looks like 0.6) so it appears ok. Because I had done a lot of reading on estrogen dominance (that the P:E ratio was more significant than the values alone), I begged my physician to do the hormone panel since many perimenopause woman have the same symptoms as I had. I have read it comes on because as we age our progesterone drops and that without progesterone, we are more likely to suffer anxiety since the GABA sedative effects cannot do what it is supposed to do with less progesterone. Regardless, as the multiple labs and tests come back normal, this is narrowing down to anxiety. I am just baffled that it came out of nowhere and thought there must be something off or different in my body that needs to be treated. Again, benzos are helping but I wondered if I was treating the symptoms and not the problem (if the problem is low progesterone). And do you think you should treat by using progesterone creams or possibly GABA supplements instead? What is your opinion on estrogen dominance playing a role in anxiety? Some sights suggest a minimum of 300:1 (P:E) ratio but as high as 800:1. Mine was 1.78:1. Is that possibly what triggered the anxiety resulting in tremors, dizzziness, loss of balance, muscle weakness, brain fog and body throbbing? Obviously if this is the cause it seems that benzos treat symptoms and not the true root cause. I don't think my doctor will review P:E ratio or find it signficant but how can so many woman suffer these symptoms without some kind of logical explanation? Is this P:E ratio being the cause of anxiety not widely accepted? I suppose that is enough questions for now. I am thankful to rule out other serious disorders but want to make sure I am treating myself with the best treatment plan (GABA supplements, progesterone creams, or benzos and simply let nature take it's course?). I appreciate your thoughts on this.
Brief Answer:
Hello
Detailed Answer:
Hello,
Good to know that the FSH level is normal. It is not anywhere near the menopausal range. Your estrogen levels are good too. This points that you may not develop menopause very soon. ( atleast one year?).
I mentioned earlier that progesterone levels will be lower during first half of menstural cycle. If you happen to test progesterone during that time, it will be low. There is no much scientific data on P:E ratio and things like that in menopause.
You may find many such things in the internet and i am afraid that internet gives many such misleading informations. You can not find such a thing in standard endocrinology text books or peer reviewed medical journals. Useful menoapuse websites for puublic by FDA etc do not mention anything about it.
Hormones like estrogen and progesterone are present in minute quantities ( pico gram, nano gram etc) and until now, no hormonal assay is perfect to detect them. For the same reason, endocrinologists never ask for these tests unless in specefic situations. ( eg: we may request progesterone test during infertility investgation.. Estrogen is done in delayed puberty, early puberty, male gynecomastia and few situations like that). If you had visited an endocrinologist instead of a phsyician, probably he wouldn't have agreed to your request to do these tests ( for the above mentioned reasons).
Benzos are okay for short term use. ( few weeks). If your problems persists beyond few weeks, then you may need further assessment, relaxation exercises, meditation and possibly non benzo group medications for some time. These newer group medicines will improve the chemical composition of neurotransmitters ( including GABA etc) and wil help to deal with anxiety.
Regards XXXXXXX
Hello
Detailed Answer:
Hello,
Good to know that the FSH level is normal. It is not anywhere near the menopausal range. Your estrogen levels are good too. This points that you may not develop menopause very soon. ( atleast one year?).
I mentioned earlier that progesterone levels will be lower during first half of menstural cycle. If you happen to test progesterone during that time, it will be low. There is no much scientific data on P:E ratio and things like that in menopause.
You may find many such things in the internet and i am afraid that internet gives many such misleading informations. You can not find such a thing in standard endocrinology text books or peer reviewed medical journals. Useful menoapuse websites for puublic by FDA etc do not mention anything about it.
Hormones like estrogen and progesterone are present in minute quantities ( pico gram, nano gram etc) and until now, no hormonal assay is perfect to detect them. For the same reason, endocrinologists never ask for these tests unless in specefic situations. ( eg: we may request progesterone test during infertility investgation.. Estrogen is done in delayed puberty, early puberty, male gynecomastia and few situations like that). If you had visited an endocrinologist instead of a phsyician, probably he wouldn't have agreed to your request to do these tests ( for the above mentioned reasons).
Benzos are okay for short term use. ( few weeks). If your problems persists beyond few weeks, then you may need further assessment, relaxation exercises, meditation and possibly non benzo group medications for some time. These newer group medicines will improve the chemical composition of neurotransmitters ( including GABA etc) and wil help to deal with anxiety.
Regards XXXXXXX
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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