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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Medical
Satisfied Customers: 53639
Experience:  Medical Doctor Trained at a Top Academic Institution
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History: 37 year old male. Generally healthy with no known

Customer Question

History: 37 year old male. Generally healthy with no known diseases or conditions. I've had a bit of autoimmune type stuff in the past (irritable bowel, persistent pityriasis versicolor). Family history of autoimmune has lupus, father possible rheumatoid arthritis. Grandfather died of a connective tissue disease. I've also had some bloodwork that was a bit off....high ALT, elevated uric acid, slightly positive rheumatoid factor, elevated calcium, low vitamin D....results were generally just out of range with the exception of the vitamin D which was quite low. A neurologist put me on vitamin D and low grade nortriptyline (30mg) for migraines. Chronic history of migraine; headache pattern changed about six months ago, eventually had MRI with contrast that was all clear. No longer on the nortriptyline and headaches have improved.
I've had back pain for the past six weeks or so. It's there everyday and resembles sort of a dull ache. There are a couple tender points right on my spine. I don't remember injuring it and it is never a sharp pain or positionally or movement related. Worse at night when lying flat and though it doesn't wake me up, if I am awake I notice the pain. Sleeping position doesn't seem to make a difference. My wife is a physical therapist and she's given me some exercises and I've tried ice and heat. It involved my lower back a bit but seems to be concentrated on my mid-back. No other symptoms as far as weight loss or fevers, night sweats, etc. Am experiencing some fatigue but it's not horrible.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Phil, MD replied 1 year ago.
Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.
Thanks for this question
two thoughts come to mind
1)ankylosing spondylitis
Ever been checked for these?
Customer: replied 1 year ago.
No I haven't, my wife is a physical therapist and actually mentioned ankylosing spondylitis. What are the tests for that?
Expert:  Dr. Phil, MD replied 1 year ago.
you need a very good rheumatologist to do a good exam Plus, you need xrays of the spine. It will show a "bamboo spine". This is a specific radiological finding that the doc reading your xrays can tell Also, a blood test called an HLA B27 can be suggestive. It is in the spectrum of autoimmune diseases that run in your family