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What Causes Joints Pain, Muscle Pain And Stiffness In Shoulders And Neck?
Question: Concerned I may have an autoimmune disorder. I'm 32 years old, female 5-7" tall weight is 145 lbs. I do have diagnosed HSV-2 and HPV. I am on Zoloft for Depression, some symptoms I realize may reflect that. I am on NO other medications of any kind currently. I have been given antibiotics for repeat sinus infections over the past few years, as well as for vaginitis, UTI, yeast infection and a vaginal bacterial infection (all at once). I have also developed a slight allergy to the z-pack in the last year.
Symptoms- I have joint pain, muscle pain and stiffness mostly in my shoulders, neck and back constantly. Blood in stools, chronic hemorrhoids/fissure. I am being treated for this. Constant lethargy/fatigue/exhaustion and virtually no short-term memory for names or items. Dry mouth and skin (again Zoloft). My body is cold (particularly my feet) after an intense workout. My fingers and toes are sort of shrively/pruney. I get nasal polyps. My menstrual cycle has become erratic the past 3 months with extremely heavy periods (1 super tampon per hour) and I feel anemic during that week including dizzy.
Also any specialists in the L.A. Area that you can suggest?
Symptoms- I have joint pain, muscle pain and stiffness mostly in my shoulders, neck and back constantly. Blood in stools, chronic hemorrhoids/fissure. I am being treated for this. Constant lethargy/fatigue/exhaustion and virtually no short-term memory for names or items. Dry mouth and skin (again Zoloft). My body is cold (particularly my feet) after an intense workout. My fingers and toes are sort of shrively/pruney. I get nasal polyps. My menstrual cycle has become erratic the past 3 months with extremely heavy periods (1 super tampon per hour) and I feel anemic during that week including dizzy.
Also any specialists in the L.A. Area that you can suggest?
Brief Answer:
please provide more details, progression & investigations
Detailed Answer:
Hello,
Thank you for asking at HCM.
I went through your history and would like to know more about you like:
a. Please give detailed history of your all different problems, i.e., how they appeared and progressed. Sequence of development of different problems is very important to know your problems better.
b. Do you have nose symptoms like sneezing, nose obstruction, running nose, etc repeatedly? Have you been tested for allergies?
c. From your history, I am getting impression that vaginitis (bacterial), yeast infection, UTI were all at the same time - within a single episode. Am I correct? Please correct if I didn't get you.
d. What is your occupation? How significant is stress for in your life? Does stress worsen your symptoms?
e. Do you have digestive complaints like constipation, repeated stomach pain, gastritis, etc? How is your digestion in general?
f. What are your diet habits? What is the cause of chronic hemorrhoids/fissure?
g. Have you ever had shortness of breath? Wheezing?
h. Apart from Zoloft, which medications do you take frequently/regularly? Do you use pain killers or oestrogen pills regularly?
i. What were your all investigations so far?
j. Do you have any skin problems like rashes?
k. Have you been investigated for any micronutrient deficiencies? Have you been suggested any vitamin/mineral supplements in past?
l. How is your sleep? Do you have sleep disturbances?
m. What is the cause of menstrual disturbances? What is opinion of your Gynecologist? Have you undergone ultrasonography of abdomen?
Above details would help me to know your complaints better and therefore to make suggestions for you more specifically.
At present, from your provided details, I would like to make suggestions for you as follows:
1. You have multiple system complaints. As systems are connected with one another, I want to know how the things progressed.
2.Such symptoms could be due to autoimmune but could also be due to chronic stress or multifactorial so called, life style disorders.
Please provide above details on follow-up. It will be humble pleasures to help you with best of my knowledge and experience.
Wish you the best of the health ahead.
Thank you & Regards,,
Dr Parin N Parmar
please provide more details, progression & investigations
Detailed Answer:
Hello,
Thank you for asking at HCM.
I went through your history and would like to know more about you like:
a. Please give detailed history of your all different problems, i.e., how they appeared and progressed. Sequence of development of different problems is very important to know your problems better.
b. Do you have nose symptoms like sneezing, nose obstruction, running nose, etc repeatedly? Have you been tested for allergies?
c. From your history, I am getting impression that vaginitis (bacterial), yeast infection, UTI were all at the same time - within a single episode. Am I correct? Please correct if I didn't get you.
d. What is your occupation? How significant is stress for in your life? Does stress worsen your symptoms?
e. Do you have digestive complaints like constipation, repeated stomach pain, gastritis, etc? How is your digestion in general?
f. What are your diet habits? What is the cause of chronic hemorrhoids/fissure?
g. Have you ever had shortness of breath? Wheezing?
h. Apart from Zoloft, which medications do you take frequently/regularly? Do you use pain killers or oestrogen pills regularly?
i. What were your all investigations so far?
j. Do you have any skin problems like rashes?
k. Have you been investigated for any micronutrient deficiencies? Have you been suggested any vitamin/mineral supplements in past?
l. How is your sleep? Do you have sleep disturbances?
m. What is the cause of menstrual disturbances? What is opinion of your Gynecologist? Have you undergone ultrasonography of abdomen?
Above details would help me to know your complaints better and therefore to make suggestions for you more specifically.
At present, from your provided details, I would like to make suggestions for you as follows:
1. You have multiple system complaints. As systems are connected with one another, I want to know how the things progressed.
2.Such symptoms could be due to autoimmune but could also be due to chronic stress or multifactorial so called, life style disorders.
Please provide above details on follow-up. It will be humble pleasures to help you with best of my knowledge and experience.
Wish you the best of the health ahead.
Thank you & Regards,,
Dr Parin N Parmar
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thank you for your response. I have answered below.
a. I have been on Zoloft for Depression/Anxiety since 2005. I have gone up and down from 50-75 to 100 and back down depending on how I am doing. The joint pain, muscle pain and stiffness mostly in my shoulders, neck and back constantly has gotten worse in the past couple of years though it started developing to where it was uncomfortable about 6 years ago. The lethargy/fatigue/exhaustion and virtually no short-term memory for names or items continues to progress. I think I noticed it in relation to the depression/anxiety but while my mood is improved by medication, the other symptoms certainly aren’t. My body is cold (particularly my feet) after an intense workout and my fingers and toes are sort of shrively/pruney, these things I have noticed in the last year. I have detailed durations, etc with the symptoms where you have asked below.
b. I seem to have constant congestion, nasal polyps (6 years) that come and go, and post nasal drip. I always have had these symptoms as long as I can remember. I have not been tested for allergies. I sneeze a lot around flowers and dust at work (both are in the air regularly). I have no pets and don’t seem to be bothered when I’m around them. I have had sinus infections about 5 times which I have been put on antibiotics for over the past few years. Including one that it seems I have just gotten in the past couple of weeks.
c. Yes, when I had my first HSV-2 outbreak XXXXXXX 2014, I had a fever, my rectal symptoms flared up significantly as well as all those the other things going on at the same time including the chlamydia. I was in bed for about 9 days and even lost control of my bowels once. I was put on 3-4 rounds of antibiotics. I have had a UTI once since then but have not had other HSV-2 outbreaks since.
d. I am an Event Planner, it does get stressful. Stress does worsen the digestive and rectal problems. I have not noticed a big difference in other areas due to stress. Nor have I been under more stress in the past few months. I met my boyfriend 2 months ago, and if anything I have been less stressed since then.
e. I have had IBS since I was a kid, and it flares up with stress. I had Acid Reflux which has seemed to go away since I have stopped eating spicy foods and highly acidic foods. My digestion has never been great, but I have periods where it gets better and then it flares up (diarrhea and constipation). I take Metamucil at least once a day. I do get indigestion/bloating, etc but not on a real regular basis. As far as history, my mother had emergency colon surgery a couple years ago due to a blockage (she was 66 at the time). And my father was treated for a fistula in the past. Both have had hemorrhoids.
f. I try to eat fairly healthy, not much fried food, not too many carbs and not too much sugar. I do however have 2 cups of coffee and 2 glasses of wine each day approximately. I do eat processed foods more than I would like because I’m on-the-go so much that I’m not at home to cook much (generally gone 10-12 hours a day). I do notice stress and diet have a good amount to do with the hemorrhoids/fissure. I have had one rectal botox injection and it helped a lot for about 6 months (with the fissure). The colo-rectal surgeon said that the fissure could have been caused by damaging episodes of diarrhea.
g. No shortness of breath, wheezing, etc.
h. No pain killers. Absolutely nothing else, I have tried to stay off of all other medications in the last few years, even birth control. I take cranberry pills, B-complex liquid and the Metamucil.
i. Let me know if I didn’t cover anything between my original summary and in answering your questions.
j. No rashes, though I have always had sensitive skin. I started to feel like I was getting hives when I took the z-pack last, so they had me stop part way through (in the last year). I have had acne flare-ups much more in the past 6 months than in the past 5 years.
k. No I have not.
L. I sleep very soundly and fall asleep quickly unless I am in a place I’m not familiar with (such as when traveling). I also don’t sleep well if I have had alcohol close to bedtime.
m. I went to the OB/GYN five times in 2014. I am not too impressed with my gynecologist… when I was diagnosed with all the things going one in unison, he tested my blood for STD’s (onsite) and did not run any other panels even when I asked about that. The only procedure done (twice) was a colposcopy. The last one was in late 2013, and my pap 1 year later came back normal.
I have not been back in the past 3-4 months since I have started having such menstrual abnormalities… no idea the recent menstrual disturbances. I went to have a blood panel done a couple days ago elsewhere and figured that would be a better start before going to the OB/GYN once again.
I forgot to mention, I have started feeling much more thirsty, started craving salt, and had mild discomfort in the lower right part of my back by the rib cage in the past 6 months.
a. I have been on Zoloft for Depression/Anxiety since 2005. I have gone up and down from 50-75 to 100 and back down depending on how I am doing. The joint pain, muscle pain and stiffness mostly in my shoulders, neck and back constantly has gotten worse in the past couple of years though it started developing to where it was uncomfortable about 6 years ago. The lethargy/fatigue/exhaustion and virtually no short-term memory for names or items continues to progress. I think I noticed it in relation to the depression/anxiety but while my mood is improved by medication, the other symptoms certainly aren’t. My body is cold (particularly my feet) after an intense workout and my fingers and toes are sort of shrively/pruney, these things I have noticed in the last year. I have detailed durations, etc with the symptoms where you have asked below.
b. I seem to have constant congestion, nasal polyps (6 years) that come and go, and post nasal drip. I always have had these symptoms as long as I can remember. I have not been tested for allergies. I sneeze a lot around flowers and dust at work (both are in the air regularly). I have no pets and don’t seem to be bothered when I’m around them. I have had sinus infections about 5 times which I have been put on antibiotics for over the past few years. Including one that it seems I have just gotten in the past couple of weeks.
c. Yes, when I had my first HSV-2 outbreak XXXXXXX 2014, I had a fever, my rectal symptoms flared up significantly as well as all those the other things going on at the same time including the chlamydia. I was in bed for about 9 days and even lost control of my bowels once. I was put on 3-4 rounds of antibiotics. I have had a UTI once since then but have not had other HSV-2 outbreaks since.
d. I am an Event Planner, it does get stressful. Stress does worsen the digestive and rectal problems. I have not noticed a big difference in other areas due to stress. Nor have I been under more stress in the past few months. I met my boyfriend 2 months ago, and if anything I have been less stressed since then.
e. I have had IBS since I was a kid, and it flares up with stress. I had Acid Reflux which has seemed to go away since I have stopped eating spicy foods and highly acidic foods. My digestion has never been great, but I have periods where it gets better and then it flares up (diarrhea and constipation). I take Metamucil at least once a day. I do get indigestion/bloating, etc but not on a real regular basis. As far as history, my mother had emergency colon surgery a couple years ago due to a blockage (she was 66 at the time). And my father was treated for a fistula in the past. Both have had hemorrhoids.
f. I try to eat fairly healthy, not much fried food, not too many carbs and not too much sugar. I do however have 2 cups of coffee and 2 glasses of wine each day approximately. I do eat processed foods more than I would like because I’m on-the-go so much that I’m not at home to cook much (generally gone 10-12 hours a day). I do notice stress and diet have a good amount to do with the hemorrhoids/fissure. I have had one rectal botox injection and it helped a lot for about 6 months (with the fissure). The colo-rectal surgeon said that the fissure could have been caused by damaging episodes of diarrhea.
g. No shortness of breath, wheezing, etc.
h. No pain killers. Absolutely nothing else, I have tried to stay off of all other medications in the last few years, even birth control. I take cranberry pills, B-complex liquid and the Metamucil.
i. Let me know if I didn’t cover anything between my original summary and in answering your questions.
j. No rashes, though I have always had sensitive skin. I started to feel like I was getting hives when I took the z-pack last, so they had me stop part way through (in the last year). I have had acne flare-ups much more in the past 6 months than in the past 5 years.
k. No I have not.
L. I sleep very soundly and fall asleep quickly unless I am in a place I’m not familiar with (such as when traveling). I also don’t sleep well if I have had alcohol close to bedtime.
m. I went to the OB/GYN five times in 2014. I am not too impressed with my gynecologist… when I was diagnosed with all the things going one in unison, he tested my blood for STD’s (onsite) and did not run any other panels even when I asked about that. The only procedure done (twice) was a colposcopy. The last one was in late 2013, and my pap 1 year later came back normal.
I have not been back in the past 3-4 months since I have started having such menstrual abnormalities… no idea the recent menstrual disturbances. I went to have a blood panel done a couple days ago elsewhere and figured that would be a better start before going to the OB/GYN once again.
I forgot to mention, I have started feeling much more thirsty, started craving salt, and had mild discomfort in the lower right part of my back by the rib cage in the past 6 months.
Brief Answer:
Detailed suggestions
Detailed Answer:
Hello,
Thank you for your follow-up.
Thank you for your detailed history which certainly helped to know your complaints better.
Personally I would summarize your health as follows: Main issues - nose-sinus issues and digestive issues, with menstrual problems & neck-shoulder stiffness, complicated/aggravated by stress & depression. But you don's have repeated fevers, skin problems, etc.
At present, I would like to make suggestions for you as follows:
1. For nose & sinus issues:
a. I would suggest allergy testing for common air-borne allergens such as house dust mite, pollens, molds, insect proteins, animal dander, etc. This will help you to identify the substances causing allergies to you as well as to know the measures to avoid them.
b. In general, please avoid exposure to dusts, smokes, fumes, strong odors and air pollution as much as possible, particularly if they aggravate your symptoms. They are not allergens but direct irritants for nose/sinus.
c. For symptom control, I usually suggest my such patients intranasal corticosteroids (fluticasone propionate or mometasone furoate for at least 2-4 weeks depending upon response.
d. Regular nasal saline washes and steam inhalation will also help you in a long run.
e. If above treatment do not improve nose/sinus symptoms, I would suggest you to consult an ENT surgeon who will examine nose cavities from inside, may suggest you some investigations to know the status of sinus.
f. Please have adequate amounts of liquids during day to maintain hydration.
2. For your digestive complaints, I would like to know the root cause of your problems. It could be simply long standing constipation with complications like hemorrhoids/fissures or irritable bowel syndrome or autoimmune conditions like Crohn's.
a. I would like to know whether any investigations done for diagnosis of your digestive complaints. If not, my suggestion would be consulting a gastroenterologist who will take detailed history of your digestive symptoms, will examine you and may suggest some investigations/endoscopy if he/she feel appropriate.
b. As you are taking metamucil fiber supplements, I would like to make sure that please take plenty of fluids during day. Fluids are very important for fibers to be effective. If you are not taking adequate fluids, fiber intake can worsen digestive complaints on the contrary.
c. I usually suggest my such patients probiotics supplements which improve IBS and digestive complaints.
d. If your digestive complaints worsen after particular food, I would suggest allergy testing for that particular food only.
e. In general, please follow simple healthy diet rich in vitamins & minerals. Small frequent meals are better than 2-3 large meals. Please make sure you are eating only according to appetite.
3. Neck-shoulder stiffness are most often due to postural defects rather than autoimmune disorder. Long time sitting against computer/at desk, stooped posture, and excessive stress can lead to such neck-shoulder strains.
If any of the above factor is important for you, please try to correct that.
Regular relaxation and meditation may help you in a long run.
4. I would suggest you to consult your Gynec doctor for menstrual problems.
5. Life style changes and stress reduction will help you in combating depression also.
6. At present, I would especially suggest you probiotic supplements, folic acid vitamin B12, vitamin D, and a good multivitamin-multimineral supplement for at least 2-3 months.
7. If you have not been investigated, I would suggest you basic investigations like complete blood counts, ESR, CRP, serum SGPT, serum proteins, serum total IgE, blood sugar (fasting and post prandial), serum ANA, stool examination, urine examination, ultrasonogram of abdomen.
Complete blood count will help to know hemoglobin as well as will give clues to some other disorders, ESR & CRP will be highly elevated in chronic inflammatory diseases or autoimmune diseases. Ultrasonogram of abdomen will give clues both towards intestines and gynec complaints. As you have mentioned increased thirst, I would like to know blood sugar to know whether you have diabetes mellitus.
If you have been investigated any of these investigations previously, please let me know them on follow-up. If not, please consult your doctor before going for investigations. In general, your symptom profile does not guide towards a particular autoimmune disorder from my view point. More specific autoimmunity investigations can be suggested after knowing some basic investigations suggested above.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Detailed suggestions
Detailed Answer:
Hello,
Thank you for your follow-up.
Thank you for your detailed history which certainly helped to know your complaints better.
Personally I would summarize your health as follows: Main issues - nose-sinus issues and digestive issues, with menstrual problems & neck-shoulder stiffness, complicated/aggravated by stress & depression. But you don's have repeated fevers, skin problems, etc.
At present, I would like to make suggestions for you as follows:
1. For nose & sinus issues:
a. I would suggest allergy testing for common air-borne allergens such as house dust mite, pollens, molds, insect proteins, animal dander, etc. This will help you to identify the substances causing allergies to you as well as to know the measures to avoid them.
b. In general, please avoid exposure to dusts, smokes, fumes, strong odors and air pollution as much as possible, particularly if they aggravate your symptoms. They are not allergens but direct irritants for nose/sinus.
c. For symptom control, I usually suggest my such patients intranasal corticosteroids (fluticasone propionate or mometasone furoate for at least 2-4 weeks depending upon response.
d. Regular nasal saline washes and steam inhalation will also help you in a long run.
e. If above treatment do not improve nose/sinus symptoms, I would suggest you to consult an ENT surgeon who will examine nose cavities from inside, may suggest you some investigations to know the status of sinus.
f. Please have adequate amounts of liquids during day to maintain hydration.
2. For your digestive complaints, I would like to know the root cause of your problems. It could be simply long standing constipation with complications like hemorrhoids/fissures or irritable bowel syndrome or autoimmune conditions like Crohn's.
a. I would like to know whether any investigations done for diagnosis of your digestive complaints. If not, my suggestion would be consulting a gastroenterologist who will take detailed history of your digestive symptoms, will examine you and may suggest some investigations/endoscopy if he/she feel appropriate.
b. As you are taking metamucil fiber supplements, I would like to make sure that please take plenty of fluids during day. Fluids are very important for fibers to be effective. If you are not taking adequate fluids, fiber intake can worsen digestive complaints on the contrary.
c. I usually suggest my such patients probiotics supplements which improve IBS and digestive complaints.
d. If your digestive complaints worsen after particular food, I would suggest allergy testing for that particular food only.
e. In general, please follow simple healthy diet rich in vitamins & minerals. Small frequent meals are better than 2-3 large meals. Please make sure you are eating only according to appetite.
3. Neck-shoulder stiffness are most often due to postural defects rather than autoimmune disorder. Long time sitting against computer/at desk, stooped posture, and excessive stress can lead to such neck-shoulder strains.
If any of the above factor is important for you, please try to correct that.
Regular relaxation and meditation may help you in a long run.
4. I would suggest you to consult your Gynec doctor for menstrual problems.
5. Life style changes and stress reduction will help you in combating depression also.
6. At present, I would especially suggest you probiotic supplements, folic acid vitamin B12, vitamin D, and a good multivitamin-multimineral supplement for at least 2-3 months.
7. If you have not been investigated, I would suggest you basic investigations like complete blood counts, ESR, CRP, serum SGPT, serum proteins, serum total IgE, blood sugar (fasting and post prandial), serum ANA, stool examination, urine examination, ultrasonogram of abdomen.
Complete blood count will help to know hemoglobin as well as will give clues to some other disorders, ESR & CRP will be highly elevated in chronic inflammatory diseases or autoimmune diseases. Ultrasonogram of abdomen will give clues both towards intestines and gynec complaints. As you have mentioned increased thirst, I would like to know blood sugar to know whether you have diabetes mellitus.
If you have been investigated any of these investigations previously, please let me know them on follow-up. If not, please consult your doctor before going for investigations. In general, your symptom profile does not guide towards a particular autoimmune disorder from my view point. More specific autoimmunity investigations can be suggested after knowing some basic investigations suggested above.
Hope above suggestions will be helpful to you.
Should you have any further query, please feel free to ask on follow-up.
Wish you the best of the health ahead.
Thank you & Regards,
Dr Parin N Parmar
Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
Answered by
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