[57F] Experiencing weakness, trouble walking, and other symptoms

Patient Description

A 57-year-old female presents with a several-month history of progressive weakness and difficulty walking, described as severe and constant, affecting daily activities. She has also experienced significant muscle mass loss in her legs. Concurrently, she reports longstanding insomnia, characterized by an inability to sleep for more than an hour at a time, unrelieved by various medications. Additionally, she experiences frequent urination at night, occurring hourly for several months. The patient has noticeable shakiness in her legs and right hand, also present for a few months. She suffers from a stiff and painful neck on the right side, extending from the base of the skull to the shoulder, rated as severe in intensity. She has a history of constant migraines and recent changes in vision, noting blurry vision and the need for new glasses, along with short-term memory loss. Her medical history includes Fibromyalgia, Chronic Migraines, Carpal Tunnel Syndrome, and Bell's Palsy. Her current medications include baby aspirin, topamax, clonidine, Gabapentin, Lithium, Trileptal, Amlodipine, trazodone, Magnesium, potassium, calcium, and occasional Tylenol and ibuprofen. She reports being allergic to many substances.

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Arora's Assessment

What might be happening

Based on the information you've provided, several conditions could be contributing to your symptoms:

  • Fibromyalgia: This is a chronic condition characterized by widespread pain, fatigue, and cognitive difficulties. It can also cause sleep problems and frequent urination. Your history of fibromyalgia may be contributing to your current symptoms.

    • Treatment typically involves a combination of medications, exercise, stress-management measures, and healthy lifestyle habits.
  • Dehydration: Frequent urination and weakness can sometimes be signs of dehydration. It's important to drink enough fluids, especially water.

    • Treatment involves rehydration with fluids. In severe cases, hospitalization and intravenous hydration may be necessary.
  • Neurological conditions: Difficulty walking, muscle weakness, shakiness, and neck stiffness could be signs of a neurological condition, such as Parkinson's disease or multiple sclerosis. However, these conditions would typically present with other symptoms as well.

    • Treatment varies depending on the specific condition and may include medications, physical therapy, and in some cases, surgery.
  • Sleep disorders: Insomnia and frequent nighttime urination could be signs of a sleep disorder, such as sleep apnea or restless legs syndrome.

    • Treatment may involve lifestyle changes, medications, or devices to assist with breathing during sleep.
  • Side effects of medication: Some of the medications you're taking can cause side effects that might be contributing to your symptoms. For example, Gabapentin can cause muscle weakness and tremors, and Clonidine can cause dry mouth which might make you drink more water and urinate more frequently.

What you can do

  1. Make an appointment with your doctor to discuss your symptoms. They may want to adjust your medications or refer you to a specialist for further evaluation.
  2. Keep a symptom diary. Note when your symptoms occur, what you're doing at the time, and anything that makes them better or worse.
  3. Stay hydrated and maintain a healthy diet. This can help manage symptoms of fibromyalgia and prevent dehydration.
  4. Practice good sleep hygiene. This includes going to bed and waking up at the same time every day, keeping your bedroom dark and quiet, and avoiding caffeine and large meals before bedtime.
  5. Stay active. Regular physical activity can help manage symptoms of fibromyalgia and improve sleep.

What you should look out for

Seek immediate medical attention if you experience:

  • Sudden worsening of your symptoms
  • New symptoms, such as slurred speech, difficulty swallowing, or loss of balance
  • Severe headache or neck stiffness
  • Fever or other signs of infection

Please remember that while I strive to provide accurate information, I'm not a doctor and this advice should not replace a consultation with a healthcare professional.

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11 mo ago

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People Also Ask


What are the common symptoms of fibromyalgia and how can they be managed?

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, and cognitive difficulties. Management typically involves medications, regular exercise, stress management, and maintaining a healthy lifestyle.


How can dehydration contribute to muscle weakness and frequent urination?

Dehydration can lead to muscle weakness due to electrolyte imbalances and can cause the body to conserve water, leading to frequent urination. Rehydration with fluids, especially water, is essential to address these symptoms.


What are the potential side effects of Gabapentin and Clonidine that could affect my symptoms?

Gabapentin can cause side effects such as muscle weakness and tremors, while Clonidine can lead to dry mouth, potentially increasing water intake and urination frequency. Discussing these side effects with a doctor can help manage them.


What lifestyle changes can help improve sleep quality for someone with insomnia?

Improving sleep quality can involve maintaining a consistent sleep schedule, creating a comfortable sleep environment, avoiding caffeine and large meals before bed, and engaging in relaxation techniques before sleeping.


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