Pain in bones and on VITAMIN D injections. Blood reports.

Hello,
Thank you for choosing DoctorSpring. Apologies for the delay in reply.

It is true that Calcium and Vitamin D are essential for bone health, but it is unlikely that low Vitamin D will directly cause bone pain. The type pain you have mentioned - which involve large ad small joints, especially after activity could be from the bone or the connective tissues. These symptom pattern is called polyarthralgia and could be from a number of causes. But the good news is that this is a common symptom and could be caused by even a viral infection. This kind of post viral arthralgias resolve on its own after some time.

Since you are having this symptoms for some time now, a few blood tests are warranted. At this onset I would like to know some additional information from you. You can reply as a followup.

1. Is there swelling or redness in any of the joints ? Or just pain ?
2. Is the pain mostly in the joints or all over the bone ?
3. Do you get regular periods ?
4. Is there any recent increase or loss of weight?
5. Any hoarsness of voice ? or any kind of voice change ?
6. Do you find yourself anxious / nervous recently ?

You can reply as a followup. I will suggest additional tests and possible diagnosis based on your replies.

Regards

(with inputs from Deepu Sebastian MD)

Patient replied :

Thank you for the reply. My answers are below the questions.

1. Is there swelling or redness in any of the joints ? Or just pain ? Just pain
2. Is the pain mostly in the joints or all over the bone ? definitely joints, mostly in shoulder, elbow, wrists, fingers, hip, knee,ankle, feet... and if i stay in 1 position for 5 minutes or apply pressure that bones hurts too e.g. say im resting my arm on desk (the bone which goes from elbow to wrist) then that hurts OR if im sleeping and then i change my position, well you can imagine i wake up because everything is hurting alot - so now i make a conscious effort of sleeping straight so everything is laid out evenly on bed. Also note: applying pressure, like cutting an apply... or shampooing my hair... hurts my fingers for 6 hours OR if i crush a piece of paper... the pressure i can apply is good, but i wont be able to open my hand for 3-4 minutes. .
3. Do you get regular periods ? Yes
4. Is there any recent increase or loss of weight? Yes, loss. But not alot. Just 2 kg. I was i think 50 and now im 48kg.
5. Any hoarsness of voice ? or any kind of voice change ? Nope.
6. Do you find yourself anxious / nervous recently ? yes! but not nervous... very very agitated. I lose temper and i find myself using a bad tone when all the time.

This is something i tested out a while back: With my right hand I gripped my own two fingers of my left hand very tightly just to test out the pressure. But when i tried to open my right hand fist i could not and the pain was so much that i couldnt even speak or breathe. But with help of my left hand and quick movement i got my right hand to open. However once i was feeling better and my breathing was restored I noticed that i could now not bring my right hand back to fist position and my hand was still stuck in an open position and slightest movement was causing it a lot of pain. I think in total it took me 20 minutes to get my right hand to function normally. I tested it out on my left hand also, and the result was same. Hope this helps.
Also... Y are you taking soooo long to reply? Your first reply came after 17 hours... and now... its once again well over 5 hours... and nothing. If this process is so slow, i'm going to consider a refund. Plz hurry up about this. And... if you are saying this is Polythingy... then you should refer me to your Rheumatologist, no?

Hello,
Exactly, you need a Rheumatologist opinion too and that is what was causing this delay. I am collating his opinions too. At DoctorSpring the our motto is not to rush through a consult like in a typical Doctors office. Hope your would understand.
So in your case it is wise to rule out a connective tissue diesease. You need to get these blood tests done in consult with your Doctor.
ANA
CRP
RA Factor
TSH
Free T3 and T4
Serum PTH
In addition a thorough physical examination is also required. Will it be possible for you to get back with the above tests results ? Meanwhile you can take an OTC pain medication like Ibuprofen 400 mg twice a day. It is best if you are evaluated by a Rheumatologist. I have gone through the blood test attached. It is normal.
Please note that your symptoms can be well maaged with medications. The diagnosis in most Rheumatological conditions can take some time. So please be prepared for that and do work closely with your Doctor. Please updated me with blood test results. I will keep this consult open so that you can get back to me any time.

Thank you
Dr.Manish Tiwari
Dr.Bimlesh Pandey

Patient replied :

I'm attaching my blood reports you asked along with some extra ones but this website is not allowing me to. You should also know I am not allowed to take Panadol, Brufen, Paracetamol, disprin and asprin and the likes. They either give me asthma OR migraine. Please try to respond within 8-12 hours which is what this service is giving me a guarantee of. Z

Hello,
Thank you for sharing all your reports.
It would have been better if you could also get the following evaluated : CPK LDH, VIT B12 serum ferritin, TIBC, and Serum PTH.
So considering all your reports that you have shared, the most likely diagnosis is fibromyalgia, a widepread musculoskeletal disease also called fibrositis, affecting mostly women between age group 20-55 with an annual prevalence of around 2 % all over the world. In later stages, it starts involving multiple soft tissues and also leads to mood changes. There are multiple tender points all over the body.
Mostly the management of fibromyalgia depends on the severity of the symptoms, and managed with OTC painkillers. However since you mentioned none of them suit you, i will advise the following medicine, which is relatively newer form of treatment and helps alleviate the symptoms to quite an extent.
1) Tab. Lyrica ( Pregabalin ) 100 mg three times daily for 2 weeks.
If the pain is not settling down with lyrica then an additional Tab. Tramadol twice daily after food can be tried.
Kindly take these medicines and update me on your symptoms.
Also it would be good if you can still carry out the other tests asked for.
Regards.

Patient replied :

Thank you for the reply.
May I ask why you say that its likely to be "fibromyalgia".
All my test reports are clear and negative. I even got an xray done for my hands and that seems to be clear as well.
This is my last followup question, so please do tell me why you are saying its fibrothingy? I started the meds but they were not helping me at all.
I didnt get the additional tests done because till now all my blood work is clear and it looks like waste of money.
Regards.

Yes, i have strong reason to say it is fibromyalgia.
Fibromyalgia is a painful condition characterised by generalized pain, poor sleep and mild depression. the workup for arthritis/ connective disorders are negative. in your case I cannot examine you but a clinician will easily find out the painful/tender points.
It is quite a common condition and very difficult to treat, however positive thinking, mild exercise and medicines works well. sometime fibromyalgia is called secondary fibromyalgia if this condition is associated with disease like thyroid, rheumatoid arthritis, connective tissue disorder.
I would strongly recommend you to see a rheumatologist.
Regards.