Monday, October 13, 2008
I am a 44 year old male.
The problem with my hands started about five and a half years ago. I would have occassional pain in my hands. Joints, muscles, all over. No specific spot. Would last a day or so then go away. This would occur about every three or four months. Just thought it was part of my job at the time. I worked a warehouse and delivery truck dealing with wholesale aluminum for pool and patio enclosures. This involved lifting up to 30 feet long bundles of aluminum products weighing over 100 pounds. As time went on, the pain in my hands became a bit more frequent. I just thought it was related to my job.
Memorial Day, 2004, I had a mild case of shingles on the left side my nose and around my left eye, just below and in my eyebrow area.
The middle of 2005, after starting a new job (mixing paint) not requiring as much manual labor, the pain became more intense and a bit more frequent. Approximately two and a half years ago, the pain became a daily part of life. At this point, I sought medical advice about dealing with the pain when I was not able to go to work one morning. I saw Dr. Robert XXXXX in Delray Beach. He did blood work for osteo and rheumatoid arthritis and took X-rays. All of which came back negative. His diagnosis at that point was something "soft tissue" related. Not having extensive health insurance at the time, I couldn't afford to pursue it any further. He prescribed Celebrex and we talked about behavior changes to deal with the pain. I noticed during this time, when my hands became cold, the pain would increase. I started wearing neoprene gloves, especially at work. They helped somewhat. I continued to live with the problem, missing work occassionally. Celebrex and OTC anti-inflammatories offer no relief. I also started having problems at times with simple tasks like typing, openning water bottles, or doing buttons, for example.
Last quarter of 2007, my feet began to noticeably hurt. I tried various inserts to no relief. Purchasing new boots with shock absorbing soles seemed to help somewhat, but my feet still hurt. January 2008, the pain became a daily issue.
My symptoms, at this point in time, are dull, aching pain in my hands and feet. Inexplicably, I am also starting to lose my balance at various times. Hot wax treatments minimize the pain, giving somewhat limited, temporary relief most of the time.
After gaining comprehensive health insurance coverage in March, 2008, I again sought medical attention when the pain became bad enough to keep me from working. After describing the pain and informing the physcian's assistant at the clinic assigned to me as my primary care provider, she prescribed Lyrica. Taking the first dose, after about a half hour, I was able to make a fist with minimal pain for the time in over a year. I was put on 50mg three times a day. I found that each dosage lasted about three and a half hour, then trailed off. As instructed, I called her back and was prescribed 75mg three times a day. This time each dosage lasted about five and half hours. It was upped again to 100mg, three times a day. Now the effects of the Lyrica are lasting about seven and a half hours per dose. She also did blood work that came back negative for any arthritis or diabetes. Not thrilled with having to constantly deal with a PA to get to a doctor to have questions answered, I changed PCP to Dr. Cory XXXXX in Boca Raton, FL.
My new PCP listened to my complaints and again had blood work done in addition to what was completed by the PA, above. Nothing notable came back. The PCP thought a visit to a neurologist was a good course of action and I went to see a Dr Oscar XXXXX in Delray Beach, FL.
Dr XXXXX prescribed physical and occupational therapy, an MRI of my brain and C-spine and did a Electromyography/Nerve Conduction Study of my upper body. My MRI showed no problems in the brain area. The C-spine MRI showed multiple herniated and dehydrated discs (c2-c7), but nothing that would explain the pain in my hands. There was minor stenosis shown, but again nothing that would explain the pain in my hands. The EMG/NCS of my arms and hands came back negative as well. My middle and lower spine were not looked at.
The initial evaluation by the physical therapist showed weakness in my hands, feet and legs. Sharp/Dull sensation in my limbs was also diminished. They had me doing exercises and therapy to work on strengthening my legs and feet and bringing back my balance. The occupational therapist found similar sensation issues in my hands and arms. The occupational therapist thought I might have slight carpal tunnel issues in my hands, in additon to other issues.
I was able to obtain an appointment with Dr XXXXX at the University of Miami, Miller School of Medicine, Neurology Department. After explaining my symptoms, Dr XXXXX did his initial evaluation involving reflex testing, sensation tests, balance tests and review of my medical records. His advice to me at that point was to stop taking any medications, stop the physical and occupational therapy and stop seeing any medical attention, as there was nothing wrong with me other than possible slight carpal tunnel issues. If my symptoms were to get worse, I should let him know. Not satisfied with being told the pain was "all in my head," I went back to my PCP to consult about further treatment.
Thinking the side effects of Lyrica were worse than dealing with the pain, I chose to stop taking the Lyrica unless the pain became severe enough to warrant it.
While showing some signs of improvement with both physical and occupational therapy, both are ended because they cannot show enough change to warrant their continuation.
After the results of the two neurologists, my PCP referred me to Dr David XXXXX in Boca Raton, FL. Dr XXXXX is a rheumatologist who had X-rays of my hands and feet done, as well as a complete rheumatological blood work up done. All of them came back negative with regard to explaining the pain in my hands and feet.
Around the beginning of September, I noticed the outside of my right thigh started feeling itchy or numb. I could scratch the area, but not feel the sensation of my nails on the skin, just the pressure. At times, I also feel what can best be described as an ant crawling up my right leg from the bottom of my right foot, over the inside of my ankle to about mid calf. I also have the same sensation on my left leg starting at the front of my shin just below the knee, around the inside of my knee to the lower front of my thigh. The ant sensation is occassional, the itchy/numb sensation on my thigh is fairly constant.
Today, I am home from work, mainly, because of my feet. I am experiencing generally dull pain throughout my feet, as well as pain shooting up from the bottom of my feet through my ankles when I walk. Also, I have sensitive spots about the size of a penny that move from point to point. All of this is making it difficult to walk. My hands are also bothering me with pain in my wrists, palms and fingers to the point that I cannot make a complete fist or type without pain.
I have pain in my hands and feet all the time, some days its just more severe than others.