[34F] With chronic back pain, migraines, and new onset of numbness and hot flashes
Patient Description
A 34-year-old female has been experiencing chronic back pain for years, involving both the lower and middle back. The pain can escalate to the point where it feels like her back locks up, making it extremely painful to move, sit, or stand. Massaging a specific area can cause severe pain. Additionally, she has a constant kink in her neck on the left side, which worsens with head movement and is accompanied by severe migraines and almost daily headaches. Recently, she has noticed numbness in two middle toes on her left foot and numbness in her hands and arms, especially when lying down or performing activities like tiptoeing or driving. She also reports experiencing hot flashes and feeling weak, which has been worsening over the past year and a half. Over-the-counter medications like Tylenol and ibuprofen have not provided relief. She has a history of dizziness and fainting spells, which led to a recommendation to see a neurologist, although she has not been able to do so. The fainting episodes were characterized by dizziness, vision fading to black, and a sensation of spinning or swaying.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, it seems like you might be dealing with multiple issues. Here are some possible explanations:
Chronic Back Pain and Neck Pain
- Musculoskeletal Issues: Chronic back and neck pain, especially with episodes of severe pain and "locking up," could be due to conditions like degenerative disc disease, herniated discs, or muscle spasms. The pain between your shoulder blades and the kink in your neck might be related to muscle strain or cervical spine issues.
- Nerve Compression: The numbness in your toes and hands, as well as the shooting pain, could be due to nerve compression or pinched nerves in your spine or neck, such as sciatica or cervical radiculopathy.
Headaches and Migraines
- Chronic Migraines: Given your history of severe headaches and migraines, it's possible that you have chronic migraines. These can be triggered by various factors, including stress, muscle tension, and possibly the issues with your neck and back.
- Tension Headaches: The daily headaches and the location of the pain (front or top of the head) suggest that you might also be experiencing tension headaches, which can be related to muscle tension in the neck and shoulders.
Hot Flashes and Weakness
- Hormonal Changes: Hot flashes and sweating could be related to hormonal changes. While less common at your age, conditions like early menopause or thyroid issues (such as hyperthyroidism) could cause these symptoms.
- Chronic Fatigue Syndrome: The persistent feeling of weakness and exhaustion, especially if it worsens with activity, might be indicative of chronic fatigue syndrome or another underlying condition affecting your energy levels.
Unifying Diagnoses
- Fibromyalgia: This condition can cause widespread musculoskeletal pain, fatigue, and tenderness in localized areas, which might explain the combination of your symptoms.
- Autoimmune Disorders: Conditions like lupus or rheumatoid arthritis can cause a variety of symptoms, including joint pain, fatigue, and neurological symptoms.
What you can do
Chronic Back and Neck Pain
- Consult a Doctor: It's important to see a healthcare provider for a thorough evaluation. They may recommend imaging studies like X-rays or MRIs to identify any structural issues.
- Physical Therapy: A physical therapist can help you with exercises to strengthen your back and neck muscles and improve your posture.
- Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help, but since they haven't been effective for you, your doctor might prescribe stronger medications or other treatments like muscle relaxants.
Headaches and Migraines
- Neurologist Consultation: Given the severity and frequency of your headaches, seeing a neurologist is crucial. They can help identify triggers and recommend appropriate treatments, which might include prescription medications.
- Lifestyle Changes: Keeping a headache diary to track triggers, staying hydrated, and practicing stress-reducing techniques like yoga or meditation can be helpful.
Hot Flashes and Weakness
- Hormonal Evaluation: A healthcare provider can perform blood tests to check for hormonal imbalances, including thyroid function tests.
- Stay Cool: Wear light clothing, stay hydrated, and use fans or air conditioning to manage hot flashes.
General Tips
- Exercise: Gentle, low-impact exercises like walking or swimming can help improve your overall health without exacerbating your symptoms.
- Healthy Diet: Eating a balanced diet rich in fruits, vegetables, and lean proteins can support your overall well-being.
- Symptom Tracking: Use MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider.
What you should look out for
Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care more urgently include:
- Severe or worsening pain that doesn't improve with over-the-counter medications.
- New or worsening numbness or weakness in your limbs.
- Fainting or severe dizziness.
- Unexplained weight loss or other new symptoms.
Remember, while I can provide some guidance, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment.
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6 mo ago