Age: 24.0
Sex: M
Vaccine: ANTH
Symptoms: Arthralgia, Diarrhoea, Epistaxis, Fatigue, Hypoaesthesia
Clinical narrative: Pt is a 25-year-old male with the following complaints: 1.Shock sensation in back: he began to notice this in mid Feb 2003 between AVA # 2 and # 3 a shock like sensation in his back. He describes this as involving his entire back as if someone was hitting him and feeling like all nerves got pinched at once. He states that only his skin is involved and that his muscles feel ok. Each episode lasted approx 20 seconds. He stated this happened 2-3 times before AVA #3. He noticed increased shock in his back after his AVA # 4. He reports he is ok in the hot tub and when he goes to bed and he is all relaxed he gets a shock in his back. He does not notice this feeling with activity, only with relaxation. No history of muscle spasm or back injury. Denies urinary incontinence, no saddle anesthesia. His left leg falls asleep about 3 times a month and he is unable to associate this with any activity. He states that this only occurs when he is sitting and is relieved when he stands up and moves around. 2. Eye twitching: After his third anthrax he developed twitching in his left eye that he had never experienced before. He noticed it 1-2 times per wk for a period of 4 wks while he was overseas March 03. He stated he had 5-6 episodes of twitching in the past year. In a follow up conversation on 03 Jun 04 he states that it has not bothered him for the past month.  3. Fatigue: He states he works from 6:30-2:30 goes home and naps for 15 min and then works at his second job form 4:30-9.  He then goes to bed between 10-11 pm and wakes up at 6 am. His day job is that of an air traffic controller and his pm job is answering the phone. He reported that he slept for 12 hrs while he was deployed and that he remained tired. He states he usually falls asleep in about 15 min after going to bed and that he sleeps through the night. States that when he wakes up in the morning he continues to feel tired for about 2 hours before he is fully awake. He reports no worsening of fatigue after AVA #4.  4. Diarrhea:  He reports that after he eats a "good" meal his body would shake and that he can feel the food rushing through him. He reports occasional diarrhea approx 1-2 times per week. Reports stools are brown and at times he notices steaks of blood. He denies abdominal pain. He began to notice these symptoms while deployed. There was no worsening after AVA # 4.In a follow-up call 03 Jun 04 he is now reporting abdominal cramping in the morning with slight relief after urination or defecation.  5. Left knee pain: he reports that after he returned from deployment in June 03 he began to notice, at times, left knee pain when he bends his knee. He describes this pain as a sharp pain like something being pulled and it increases when he jumps. He denies any history of injury. He has had no medical evaluation or x-rays. He stated that he has increase pain after jumping. He stated he tried to tell it to his doctor but his MD just dismissed this concern.  6. Wrist pain: he reports that he gets pain in his wrist when he swings a bat, or other motions that are similar, but states that he can swing a golf club without any problems. Pain is associated with activity only. No changes during the past year and also noticed the pain upon his return from deployment. 7. Left foot cramps: states he gets cramps from his foot up calf and to the knee area. He states that it looks like his veins and muscles are going to pop out and that he also gets occasional cramps in his rt foot. He states that when he feels a cramp coming on he can usually control it by walking around and that they only occur while he is at rest.  This happened about 4 times a week from Jan to June last year and since then they only occur once or twice a week. No increase with receipt of AVA #4.  8. Arm numbness: when he raises his arms up over his head he gets numbness in his fingers that resolves when he lowers his arms. Occurs most often when he is working on stuff above his head but no problems when reaching for a glass. He reported that holding a phone to his ear for a prolong period will reproduce the numbness. He began to notice this last July. He denies any neck or shoulder pain and reports no problems with moving his shoulder. No increase in symptoms after AVA #4.  9. Bent left pinky: he states that he wakes up in the morning with his left little pinky in a "weird" position. He noticed it 4 times since mid Nov. 04. His finger then feels like it has been sprained for the next 2-3 days. He also reports a sprain feeling in his right pinky but no deformity is noted.  He said he gets the feeling in both fingers at the same time.  10. Nose bleeds: he reports that that he gets at least 1 nosebleed a month. Each episode lasts approx 5 min and stops when he inserts tissue into his nostril. Does not feel blood going down the back of his throat. He denies any sinus problems. In June 04 he reported an increase incidence of nose bleeds occurring approx 1-2 times per week.  11. Vision disturbances: Since returning from the desert he sees specks floating around about every 10 days. Does not interfere with activities and only notices it when he is home relaxing. No increase with AVA #4.