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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 57114
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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Im 22 years old. Over past five years I have had increasing

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I’m 22 years old. Over past five years I have had increasing pain in “joints”. It includes knees, ankles, jaw, elbows, and wrists. This has made me unable to perform exercises including low impact swimming and even walking. Ankles hurt every day. I have seen six doctors including a rheumatologist, orthopedic surgeon, and an orthopedic sports medicine doctor, and two physical therapists. All obvious things have been tested. I had a three phase bone/joint scan with radioactive trace that found anomalies where I felt pain. Scans looked similar to that of a runner or someone who currently engaged in intense physical activities. I sit a lot.The findings are “suggestive of stress reactive changes on the bones where tendons and ligaments attach”. Report said, “There was no evidence of an inflammatory arthropathy to joints. There are stress reactive changes to elbows and wrists and stress related periosteal reactions in mid right foot and in the bilateral tibial tuberosites.” Suggestions?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello from JA
This is a non specific finding...and can not give any specific diagnosis.

What has your orthopedist told you?
Customer: replied 1 year ago.

Only what I wrote. They have no advice. They have never seen such a thing. They have no suggestions or specific diagnosis. They have no referrals.

Expert:  Dr. Thomas, MD replied 1 year ago.
And what do you do for a living, and what type of exercise

Customer: replied 1 year ago.

I am a college student. All I can do is walk to class. Anything else causes pain later. I used to be very athletic but now am sitting. BTW this has been stable for the last 2-3 years but still a major problem

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
And have you seen
a. a rheumatologist
b. a physical medicine MD?
Customer: replied 1 year ago.

A rheumatologist, orthopedic surgeon, and an orthopedic sports medicine doctor, two general practice MDs and two physical therapists

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
The scan is not useful.
Have you had an MRI of any joints?
Of any of the painful areas.
Have you had trigger point testing?
Customer: replied 1 year ago.

The orthopedic doctor said an MRI would not tell him anything useful and it just gave too much information about soft tissue, and so did the bone scan instead.


 


I don't think it is related to trigger points if you are referring to muscle issues as there is some physical problem effecting the connections based on the scan findings.


 


No one seems to know the cause or solution though.

Expert:  Dr. Thomas, MD replied 1 year ago.
What is your height and weight
And have you had thyroid studies, if so, what is the TSH?
Customer: replied 1 year ago.

I used to be 5-8 and 145 but have gotten heavy over the last few years of little exercise and a young person's appetite. Like 180 lbs. Joint problems (knees) first came up when standing behind the ice cream counter for hours in High School and I was in excellent condition.


 


Never had any thyroid studies as far as I know but they did standard blood work.

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
Tendonopathy, which is the only working diagnosis that makes sense, does not have a well defined cause.

One thing we can say.
Stress, physical and mental, and the other postulated factor is toxicity and with weight gain both of these happen.

In addition you have components of fibromyalgia.

If you are hypothyroid, this can contribute to the problem as well.,



Your rheumatologist should have done an ANA panel and a sed rate to make sure there is no indication of connective tissue disease, along with a rheumatoid factor.

if this is clear, and the thyroid is clear [if not it needs to be treated, then the following are needed.

Nutrient dense diet.

The diet, in order of preference in quantity, should look like this
leafy greens
green veggies
other veggies
whole fruit, beans and peas
Whole grains no yeasted breads, dry cereals or anything refined
Seeds and nuts, but cut out seeds if you have any diverticulosis.
A little tofu or tempeh daily
A little high quality soy or coconut milk yogurt

The soluble fiber in this strategy will stabilized colon function in about 6 to 8 weeks, then about 2 or three helpings of animal foods a week, preferably fish, can be added back.
See the book Eat to Live by Dr. Joel Fuhrman, for instructions on this type of diet.


Next a magnesium level needs to be checked. This is a common relative deficiency, especially in the US but everywhere now.
If it is below 2.5, it needs to be supplemented.

Vitamin D needs to be checked, if below 40, supplement [also a common deficiency with multiple effects.


A graduated physical therapy program is needed, and it should be designed by an MD of physical medicine and rehabilitation.

Savella, lyrica or cymbalta can help with the fibromyalgia aspects of your case, but I prefer to start with medical acupuncture.

I suggest you find a practitioner [MD or DO] versed in all of this: that would be here: www.functionalmedicine.org see the find a practitioner link, upper right.


Good luck Robin.
Let me know how it goes.

Please let me know if you have further questions.
Please don’t forget a positive rating.

Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 57114
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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