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What Causes Hiatus Hernia With Involuntary Shaking,muscle Pains,nausea And Weakness

Posted on Wed, 19 Feb 2014

Question: I am a 24 year old healthy female. Last October, all of a sudden I started experiencing extreme nausea, vomiting, heavy headedness, chest pain and fatigue. After two ER visits and several doctors visits, they had done lots of blood work that had all come back normal including checking my gall bladder and heart. I ended up having an endoscopy done and it was discovered I have a hiatus hernia that is causing heartburn and acid reflux. In early December I was prescribed 40mg of prilosec once a day. Since then I have been better, no stomach pain and not much heartburn but I still have occasional bouts of extreme nausea. I also do not feel back to 100%. I have no energy (I feel worn out after driving to work). When I had all the tests done, it was discovered that my vitamin D was 21. My doctor prescribed 50,000ui three times a week. I started taking these last week. I took the first one monday night and felt okay. I took the second one the next wednesday night with dinner. After 15 min, I started vomiting and dry heaving unable to stop. Also, my whole body started shaking and couldnt stop. It lasted for about 30 minutes. It was horrible. The last few days I am again having my original symptoms of extreme nausea, NO energy, fatigue. I am also having extreme muscle pain, first in the chest, then my right bicep, now my left bicep. I'm also having eye pain/blurry vision, anxiety (which could be from feeling like I am dying all the time). I went from 100% healthy to not being able to function when I have these "episodes" as I've started calling them. My doctor seems stumped and guessing.

Answered by Dr. Dr. Prasad J (8 hours later)

Brief Answer: Metabolic parameters need to be tested... Detailed Answer: Hi, I went through your post with diligence. You suffered with symptoms of Hiatus Hernia which seem to be responding with medical treatment and I am happy with that. Besides Hiatus Hernia you also developed some new symptoms of involuntary shaking, muscle pains, nausea and weakness as you are being corrected for vitamin D deficiency. These new symptoms may be part of already diagnosed condition or those still unknown. If you were to be my patient, I would investigate you further to exclude other undiagnosed condition. Those include: 1. Hypocalcemia: A low calcium level is sometimes know to cause involuntary muscle spasms 2. Hypomagnesemia: Low magnesium level is associated with low calcium. 3. Vitamin B12 deficiency: Other vitamin Deficiency is suspected if there is a single vitamin deficiency. 4. Creatinine Kinase (CPK): Creatinine kinase is elevated when some one has involuntary muscle spasms. They get metabolised gradually; however untill they remain associated muscular aches is commonly seen. 5. Ongoing viral infection may be responsible for recent onset muscle pain, weakness, nausea. Shivering may be a sign of fever. Therefore I would order complete hemogram, vitamin b12 check, serum calcium, serum magnesium as well as CPK check up before attributing to anxiety. Your treating doctors will know about these tests. Hope this helps. Let me know if you need clarifications. Regards

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

Follow up: Dr. Dr. Prasad J (2 days later)

Thank you for your response. I had all of this blood work completed on Monday. Everything came back normal. Monday night I had a bad episide of extreme nausea, chest pain and shaking. I ended up in the ER where they confirmed that my heart is fine and not causing my problems. I went back to the doctor today and she is stumped. They drew blood to check antibodies for celiac disease and if that comes back okay she wants me to have some kind of gall bladder emptying test. (The gall bladder ultrasound was normal). Today I am still experiencing nausea, dizziness, blurry vision and muscle pain which is mostly in my left upper chest and left arm. Still searching for answers. I feel awful .

Answered by Dr. Dr. Prasad J (9 hours later)

Brief Answer: Digestive issues may or may not be related... Detailed Answer: At this point of time, I would say that perhaps all your complaints may be from the digestive tract or may be they are from other sources. 1. Hiatus hernia is a chronic condition which can only be brought under control with medicines. The curative treatment is through surgery alone. Your should include dietary changes along with proton pump inhibitors for better results. I recommend my patients small and frequent, less spicy food along with regular medicines. I hope you are following these dietary changes too. 2. Gall bladder and liver function also add to digestive functions. I would definitely include tests on gall bladder and liver functions since hiatus hernia treatment has not fully solved your treatment. You should proceed with gall bladder tests. Discuss if you need to also get your liver functions assessed (if it wasn't tested yet). 3. Celiac disease and malabsorption conditions present with fairly long history. Since you have no features of anemia and other vitamin deficiency, I would chance malabsorption conditions lowest. You can wait for the results. 4. If all tests yield negative result, my last consideration would be fibromyalgia wherein these symptoms are unexplainable. Off course your doctors should complete all the tests before venturing to this possibility. Without an opportunity to physically examine you and review test findings, your case is definitely challenging to me. But keep me posted after your test results and I shall try my best to assist you online. Regards

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

Follow up: Dr. Dr. Prasad J (12 hours later)

Thank you for the quick response. I got my HIDA scan on my gall bladder scheduled for next tuesday. Is it common for there to be problems with the gall bladder even if the ultrasound is okay? Also, I have been eating pretty clean and small amounts. I dont know what could be causing this horrible chest pain.

Answered by Dr. Dr. Prasad J (11 hours later)

Brief Answer: HIDA scan is a functional test Detailed Answer: Hi, Ultrasound scan are able to pick to structural pathologist such as stone, inflammation or abnormal growth. It is of little help if I would like to know how well the bladder is pumping secretions. The bile secretion has important digestive role and if it isn't pumping well, most surgeons opt to remove the gall bladder out. The XXXXXXX used during HIDA scan will help your doctor analyse the pumping function of gall bladder. I wish the doctor are able to pick up few clues after HIDA and celiac evaluation. Good luck!!

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