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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35792
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Symptoms: pain in stomach, generalized body pain, tired,

Resolved Question:

Symptoms: pain in stomach, generalized body pain, tired, weakness, hard to swallow, headaches with pain in ears, chest burning, horseness, sleepliness, gums bleeding, and loss of weight. Please tell me what could be causing these symptoms. Thank you.
Submitted: 9 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 9 years ago.


What are the investigations and blood work done?

What are the specialist you have consulted?

Are you a smoker? Take alcohol?

Any significant past and family medical / surgical history?

Dr. Arun

Customer: replied 9 years ago.
Reply to Dr. Arun Phophalia's Post: Dear Dr. Arun,

The man I wrote you about is the brother to my friend, and here are his answers to your questions:

1. He has had the basic chemistry panel and the basic blood panel. The results were negative for any problems with sugar, kidneys, livber, ptoassium, cholesterol, metabolism, etc.

2. He has seen doctors who specialize in neurology; hormones; infectious diseases; GI; the ears, nose, and throat as well as a psychiatrist.

3. At age 19, he had arrhythmia and at 21 years of age, he was diagnosed with Crohns disease, which is in remission. He has also taken steroids for 30 years and has had gastric reflux.

Please let me know if you need anything else.

Thank you.
Expert:  Dr. Arun Phophalia replied 9 years ago.


The people who are on prolonged steroids, there are always few thing, which need to be considered;

1) The occult infection. These infections are of rare variety and are not detectable by the common cultures. The virus and fungal infection or rare type needs to be considered. The condition is considered as immunocompromised host and opportunistic infection needs to be looked by the infectious disease specialist. A persistent look out in urine, blood, stool, sputum by different cultures would help identify the organisms. Atypical mycobacterium is also a possibility.

2) The second consideration would be looking for the secondary systemic complication of the Crohn's disease. Despite going in remission and main disease being quiescent, the systemic complications can progress and since it is an autoimmune process, can involve other systems.

3) A third possibility to be considered is neuropathy. Deficiency of vitamins B1, B6, B12 can cause all these symptoms. To start with, a serum vitamin B12 levels should be ascertained. A normal level of this should be followed for the other deficiency disorders to looked for. Prolonged steroids and long history of Crohn's disease, both predisposes for the deficiency disorders. Steroid myopathy, and autonomic neuropathy and toxic neuropathy would be other things to be considered by the neurologist.

Hope this helps.

Please feel free for your follow up questions.

Dr. Arun

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