Age: 33.0
Sex: F
Vaccine: ANTH
Symptoms: Blood thyroid stimulating hormone decreased, Borrelia burgdorferi serology negative, Burning sensation, C-reactive protein normal, Cardiac monitoring normal
Clinical narrative: Same day as received last AVA, noted sharp, stabbing, burning type pain (not like pain r/t inguinal hernia) ?doubled over, couldn't sleep. Sought evaluation while abroad and received steroid injection. Episodes last from < 1 min, up to 30 minutes. Average pain intensity level  6-7/10. No relief with ice or rest. No pattern - not related to food intake, BMs, general movements, time of day. When doing PT in 2008, certain exercises intensified pain to the point grain pain was a limiting factor with knee rehab. Constant achy pain in right groin area. Pain intensity averages 3-4/10. No associated symptoms. R)-sided hand numbness (whole hand). Noted intermittent right hand numbness, especially in morning. Did not seem to be related to positioning. No relieved by massage or movements. No swelling of hand or change in appearance. Had been evaluated by Neurology. Resolved after about 1 year. RUE shoulder and axillary pain. Stabbing sharp pain that radiates from upper lateral right upper arm to axilla. Seems to be associated with esophageal symptoms. Axillary pain in "burning" in nature. No history of trauma or overuse. Seems to be a precursor of "bad days" when she first awakens. Chronic fatigue. Started in early 2004 with frequency of "bad days" increasing over the years. Feels exhausted ("like after cross country run"). Average energy level (0=bedridden, 100 = baseline energy level): 60% / on "bad" days: 20%. Has about 8 "bad" days per month where fatigue is associated with headaches, fevers, abd pain, chest pain, esophageal spasms) - "bad" episodes usually last x 3 days. Does not feel rested after 8-12 hours of sleep. Does not nap. Went snowboarding for 2 hours and was "wiped" out for a few days / 1 week before back to current "baseline". During a good week, tries to swim x 20-30 min and walk on TM x 30 min 3 days/week. Abdominal pain, cramping, diarrhea and rectal spasms. Abdominal pain described as sharp shooting pain under ribs (R>L) that is worse after eating. Abdominal pain is associated with nausea, but no vomiting. Abdominal cramping at night is usually followed by increased frequency in stools the next a.m. (may have up to 12 yellowish, small, soft formed stools over a 2 hour period). Experiences rectal spasms which awaken her in the middle of almost every night; usually last 5 to 20 minutes; attempts to defecate, unable to have bowel movement. Headaches. Episodes usually associated with "bad" fatigue days. Pressure-type pain behind both eyes, bitemporal, and across frontal area. Usually pain intensity at onset is 5/10 and pain increases to a level 7-8/10 which affects her ability to work. Usually takes TYLENOL which decreases pain to manageable level after about 2 hours. Rarely associated with nausea, but no association with photophobia or visual changes. 1 episode where pain radiated to back of head and neck ?ER and given TORADOL which helped relieve pain. Fevers and lymphadenopathy. Onset around time of onset of fatigue. Chronic swollen glands under chin and right jaw line. Chronic fevers (baseline is now 99, runs temps up to 101). Also has experienced night sweats since around 2003. Chest pain. Sharp, stabbing pain on either side of sternum. Not associated with food or exercise. Intermittent with episodes usually only lasting 5-10 minutes. Pain radiates to axilla. Cardiology evaluations negative; thought to be GI in origin (History of "esophageal spasms" which improve with XANAX, but recently motility study did not show spasms). No change in chest pain with ZANTAC or MYLANTA or XANAX. Always occurs in association with other symptoms (abdominal pain, headaches, fevers, axially pain, esophageal spasms, etc.). Palpitations. Intermittent, brief episodes of irregular heartbeats. Negative cardiology evaluations, including event monitoring. Seems to be related to esophageal spasms. Noted increased palpitations with allergy medications. Memory/cognitive changes. Describes as mental "fogginess".  7/7/09 Lengthy MR received from 2003 to 2008.  Initially presnted in 10/2003 with c/o R groin pain. In 12/2003 ER visits for severe RUQ pain. 1/2004 continued sx. Appy 2005. Consult 6/2006. Pt now reporting night sweats, ENT issues, swallowing and digestive poroblems, abdominal pain and bloating with constipation and diarrhea, L knee pain and other bone, joint and muscle pain, low grade fevers, lymphadenopathy, weight loss and memory loss. No dx made. Neuro consult 10/23/06 for neck and back pain with dx: hx of dural/epidural thoracic angiolipomas malformation with midline cervical and thoracic pain and muscle spasms. Seen 12/2007 for hirsitism and prolactinoma. Dx of functional bowel disorder 4/2008. Extensive testing and diagnostics with multiple dx.  See MR  Follow-up: The results from the requested tests are attached. I can't seem to find the Brucellosis results however I do know that it was negative. Moving forward I wanted to note that I transferred to yet another G.I doctor about 7 months ago. They did get another colonoscopy/endoscopy where they noted that there may be a sign of Celiac disease. They had genetic testing run and I didn't have the serology but I did not have the genetic risk therefore they put me on the gluten free diet. Since being on the Gluten Free diet for about six months my B12 as tripled my vitamin D has doubled, the balance problems, vertigo, and multiple, multiple, multiple bowel movements per day have subsided. Moving forward I still have a little bit of fatigue but fell much better than before. They also did a bacteria overgrowth test (not h-pylori) which was positive and I was put on a series of antibiotics which have been completed and the bacteria re-test was normal. Additional, the hospital had upgraded the esophageal motility test equipment (they said it was the only "new" machine in the world for that testing) so that test was redone. It came back nothing that I do have esophageal motility problems and my lower sphincter isn't working properly. Since that diagnosis, I eat very small bites and drink in between every bite. Due to this practice it can take me about an hour to finish a meal at times however I have been able to reduce and almost eliminate all my chest/esophageal pains which is amazing. So I have made some great improvements in the last six months. The only troubling issue facing me now is the drastic weight loss I've experienced in the past 2 months. This is troubling to me because my esophagus/chest pains have been fine allowing me to eat all my meals everyday (which is a rare because before I could go two or three days a week with out eating due to the pain). I've had some improvements but other setbacks. I've progressed with my verbal ticks to physical ticks and more frequent verbal ticks much like TURRET's syndrome. Additionally, I've lost over 20 pounds and now weigh on average 100 pounds but have been semi-stable since April. However my energy and daily pain have improved. I'm going for another endoscopy next week to determine in my celiac is refractory. Strangely, since going gluten free my fevers have been eliminated. Even when I feel really, really ill I still don't run a temperature.