Mind or body? What's up with these symptoms?
November 15, 2012 7:43 PM   Subscribe

YANMD, but what could be causing these bizarre health issues in a previously (fairly) healthy twenty-year-old female? Snowflake details inside.

For the past eight or nine months, I have been having strange, unexplained symptoms that don't seem to have any particular trigger other than one panic attack in March of this year. I've been to three different doctors since then and had various tests run but no one seems to have any explanation.

First, some quick background details about my health. As I said, I'm 20-years-old and female. I'm 5' 2" and weigh around 135 pounds. I have a history of anxiety disorders and more recently some depression (the depression coinciding with the aforementioned panic attack and these symptoms). The most serious issue I've had with my health is a strange skin rash occurring on and off from around 2007 until 2011 involving flaky skin patches, redness, oozing, scabbing, and itching. This skin disorder was never completely diagnosed and was treated unsuccessfully with steroid cream before disappearing. I suspect psoriasis, but I'm not a dermatologist. I have also had problems with my joints (pain and aches), especially my right knee which partially dislocates every month or so. The only medicine I am on is generic Ortho Tricyclen. I have been a social smoker on and off for a few years.

After my panic attack in March during which I was convinced I was having a heart attack, I have had chronic chest pain on the left side of my chest. It comes and goes but has never stayed gone more than a few weeks. Two days after the panic attack I went to the doctor after getting an inaccurately super high blood pressure reading at Walmart. My blood pressure was checked (during a complete meltdown it was 138/80 or something around there) and I requested an EKG which was normal. The doctor prescribed me a low dosage of Celexa and I went on my way.

After discovering that Celexa made me feel insane, I stopped taking it (with my doctor's permission) and was fine for a few months. Over the summer, however, I started feeling anxious and the chest pain returned along with fatigue. I went to a different doctor who did blood tests for thyroid disorders and possible other problems, all which came back clean. He suspected depression and anxiety but was not prescribed medication.

Most recently I have been having strange sensations in my abdomen, back, and legs. My legs will ache occasionally when I'm trying to sleep and I can't stand to keep them still. They also fall asleep very easily and my left leg occasionally gets this seemingly nerve related shooting tingle. I know that's a poor explanation but it's the only way I can think to describe it. I have pain in my left shoulder and in my left side, next to my bellybutton. I also have "ice pick pain" right above my left ear, sometimes falling into a dull headache. I had another physical at my gynecologist on October 8 and my abdomen was palpated, blood pressure and heartbeat checked, etc. Nothing was out of place. My blood pressure is checked daily and runs anywhere from 100/60 to 120/75.

The chronic pain I'm experiencing is driving me crazy and I'm not sure what could be causing it. I feel like it could all be in my head from the anxiety and depression, but if it isn't I'm terrified that there is something seriously wrong with my body that I'm attributing to my mind. Has anyone experienced/heard of anyone experiencing symptoms like this? What type of doctor should I see?

Thank you in advance for reading this novel of a post, and for any advice you can provide.
posted by sarahgrace to Health & Fitness (28 answers total) 2 users marked this as a favorite
Talk with a gyno about the fact that you smoke even occasionally and are on that specific BC. Nerve issues in tandem with smoking and BC use could be bad news bears.
posted by These Birds of a Feather at 7:47 PM on November 15, 2012 [5 favorites]

One possibility to ask about: if you're vegan/vegetarian, or even if you're not, get checked for possible low B12. Ask for an actual B12 test if they say a normal blood count didn't show anemia. It is possible to have neurological issues, including anxiety/depression, without having the anemia (something to do with folate supplementation in the food supply -- folate masks the anemia).
posted by pie ninja at 7:57 PM on November 15, 2012 [4 favorites]

It is very, very possible the pain and symptoms are tied to your anxiety issues. That does not mean the pain is in your head though. Pain that is not caused by physical injury to tissues is still real pain. It is your nervous system having a physical reaction to something with a psychological basis. Of course, the bitch of it is you get a feedback loop where your anxiety manifests in pain which cause more anxiety which causes more pain . . .

Are you receiving any treatment for your anxiety at this point? Any therapy? Have you considered consulting with a psychiatrist to try different medications?

Outside of that, regularly employing meditation and CBT methods (as in Feeling Good) may help you get on top of the anxiety, which may lead to a relief of some of your symptoms.

I'm sorry, this is a hard road to be on and one without much sympathy from physicians.
posted by schroedinger at 7:58 PM on November 15, 2012 [2 favorites]

You need to see a doctor who is not a gynecologist about your current symptoms. This is obviously not a gynecologic problem and so they really aren't in a position to evaluate you for it. See your primary care doctor about it. Having recurrent chest pain (or high blood pressure) with panic attacks is not unusual, but these new symptoms you are having could be completely unrelated to that episode, and so you really haven't had any workup for it.

Consider restless leg syndrome for the leg issues, but get checked out by an internal medicine or other general practitioner to evaluate what else might be going on. IANYD.
posted by treehorn+bunny at 8:00 PM on November 15, 2012 [2 favorites]

I should add that psychiatric causes of pain are considered 'diagnoses of exclusion' - there certainly can be mental/psychiatric reasons for pain, and your pain could be related to that, but other physiologic causes need to be ruled out first.
posted by treehorn+bunny at 8:02 PM on November 15, 2012 [1 favorite]

You should see a very good rheumatologist, preferably one connected to a local medical school or major research institution. Arthritis is not always just sore joints--sometimes it's connected to a larger physical autoimmune problem.

To be honest, though, all of this sounds like it could be explained as normal or normal-ish. For example, mild knee dislocation is pretty normal for a young woman who is more flexible than average. Headaches are pretty normal.

Besides a rheumatologist, you need to see a good psychiatrist who can work with you on your anxiety. Anxiety can make minor aches and physical sensations seem horrible and abnormal. It feels very real and very scary, so I'm not discounting that at all. I'm sorry you're dealing with this.

Good luck!
posted by the young rope-rider at 8:06 PM on November 15, 2012 [4 favorites]

Oh and yes if you don't have a good GP then I suggest getting one before going to specialists, if possible.
posted by the young rope-rider at 8:08 PM on November 15, 2012

I am a 23 year old woman and social smoker with anxiety issues on Levora (HBC) who has most of these exact same symptoms. I'm not saying you shouldn't get them checked out-- definitely get them checked out-- but it is possible for anxiety to manifest itself in some freaky ways. Still, definitely get them checked out.
posted by stoneandstar at 8:41 PM on November 15, 2012

If you haven't had it ruled out, make sure you get checked for stress induced acid reflux. When the stress ratchets up for me, I find myself cutting back on caffeine and foods that are greasy, spicy or ice cream to get the pain in check. If it gets really bad, that's when I go see a doctor for Tagament, Pepcid, or whatever it is that they want to prescribe to me this year.
posted by Nanukthedog at 9:05 PM on November 15, 2012

Restless legs syndrome is characterized by the need to move one's limbs, and people with RLS frequently also have depression and anxiety. Agree that you should see a rheumatologist.
posted by Wordwoman at 9:07 PM on November 15, 2012

See your primary doc, be sure to mention the skin symptoms and the joint symptoms, as a couple things can present with both of those together. Come prepared to answer questions about autoimmune disease in your family. Based on those and other questions, she will hopefully either have it figured out or refer you to rheumatology or elsewhere.
posted by The White Hat at 10:23 PM on November 15, 2012

Find a local massage therapist with a good reputation and get on her table for at least an hour at a time. It will be money well spent.
posted by flabdablet at 2:04 AM on November 16, 2012

In the throes of untreated anxiety and on hbc, I experienced several of these symptoms, most significantly the chest pain and tingling leg. Follow up with your doctor about treatment for anxiety and depression. If you're not on hbc for health issues, ask your gyn about non-hormonal bc; the majority of my chronic health/pain issues, notably constant fatigue, abdominal pain and headaches, stopped when I stopped hbc.
posted by peacrow at 3:17 AM on November 16, 2012

My first thought was something autoimmune too like rheumatoid arthritis. Go straight to a rheumatologist if your GP isn't taking this seriously.
posted by dawkins_7 at 4:40 AM on November 16, 2012

Yeah, sounds like you should see a good rheumatologist. Could be fibromyalgia, which is unfortunately another disease of exclusion.

(PS, that link has almost every symptom you described.)
posted by kellybird at 4:42 AM on November 16, 2012

Also, it's not all in your head. You are pretty much spot on for fibromyalgia, and should try to find a doctor who specializes in it. Like many diseases that predominantly affect women, the medical establishment is not yet caught up to treating it and you are really not going to get relief unless you see a top specialist. Your GP, gyno, or any sort of standard rheumatologist will not help here. 2nding to look up university hospitals.
posted by kellybird at 4:50 AM on November 16, 2012

My sister had a bunch of your systems starting in her teens (skin problems, joint pain, knee dislocation, and chronic pain). She also happened to be a smoker, and I think she was on hormonal BC. After years of misdiagnosis, she finally got a real diagnosed about 5 years ago at age 30. She has some sort of arthritis (it has aspects of psoratic and rhuematoid, but doesn't clearly fit one or the other), and is now taking Enbrel, which has improved her quality of life to an amazing degree.
posted by kimdog at 6:45 AM on November 16, 2012

You need to see a Rheumatologist.

Psoriasis is an auto-immune disease and combined with the joint issues you complain of is pretty classic actually.

Enbrel started as a cure for Rheumatoid Arthritis (which affects the heart) and is now used for psoriasis as well.

It's very typical for these symptoms to start in the early twenties.

It can be serious and dammage can be permanant. Get to a Rheumatologist instantly!
posted by Ruthless Bunny at 7:53 AM on November 16, 2012

I'd just like to point out that the OP is not necessarily talking about joint pain. She mentioned pain in her legs (presumably, the muscles because she also described them 'falling asleep'), left shoulder - possibly in the joint, the abdomen, and next to her ear. Most of the pain, it seems, is not in the joints.

Yes, you could go to a rheumatologist, but remember that when you have a hammer, everything looks like a nail. That is why going straight to a rheumatologist is only going to screen you for rheumatologic diagnoses. There are plenty of other reasons why you could have abdominal pain or headaches than because of a rheumatologic problem (in fact, abdominal pain and headaches are not typical of rheumatologic problems, except maybe fibromyalgia). This is why starting with a primary care physician is a good idea. Fibromyalgia is difficult to diagnose in part because it is a clinical diagnosis associated with a constellation of nonspecific symptoms.

Trying to diagnose yourself with fibromyalgia at home or over the internet is a recipe for not being taken seriously at your physician's office.
posted by treehorn+bunny at 8:28 AM on November 16, 2012 [1 favorite]

People are talking about psoriatic arthritis. My rheumatologist thinks that I might have this. It is mild and by no means disabling. The reason why I say that she thinks that I might have it is because it is very, very difficult to diagnose many autoimmune disorders. That is why you should not assume based on what we're saying that you definitely have one thing or another. If you go in to the doctor thinking "I have X and I have to convince them so I can get treatment" you will find it really, really frustrating. It can be years before these things are convincingly diagnosed. In the meantime, you want a doctor who will listen to you and take your symptoms seriously, keep an open mind, and help work with you to keep you as comfortable and happy as possible.

People with chronic health conditions often suffer from depression or anxiety at the same time, so it is very important that you also get the mental health support you need. Even if it's not "just" anxiety, whatever is happening is making you anxious and you deserve support for that aspect of your health as well.

Good luck.
posted by the young rope-rider at 8:30 AM on November 16, 2012

treehorn+bunny, I totally agree with you about seeing a good PCP and not self-diagnosing, but I should note that she said she has " problems with my joints (pain and aches)". That is where the rheumatology suggestions are coming from.
posted by the young rope-rider at 8:33 AM on November 16, 2012

At the risk of being pedantic, there is no "cure" for rheumatoid arthritis (or other autoimmune diseases). There are lots of possible treatments and sometimes there is a remission, but there is no cure.
posted by SweetTeaAndABiscuit at 8:45 AM on November 16, 2012

"People are talking about psoriatic arthritis. ... It is mild and by no means disabling."

I'm glad that's the case for you, the young rope-rider, but psoriatic arthritis can be disabling. That's the form of arthritis a close relative of mine had, and it was very disabling for her. The onset was around age 20 as well.

I think it's reasonable that the OP see a rheumatologist.
posted by SomePerlGeek at 9:40 AM on November 16, 2012

Yeah, to be clear it's mild for me but not for everyone. I feel like when you start looking up various conditions on the internet it can get really scary really fast, and I want to make sure that OP knows that you can have a condition like psoriatic arthritis and have it be pretty mild and not interfere with your life overly much, and in fact that is how it goes for most people with that condition. When I first started getting autoimmune stuff diagnosed/treated/"dealt with", I was terrified out of my mind for about a year but it turns out my life is still pretty much awesome.
posted by the young rope-rider at 9:46 AM on November 16, 2012

Do you eat well? Swollen, painful joints and dry skin are a symptom of Vitamin C deficiency.
posted by oneirodynia at 12:03 PM on November 16, 2012

Trying to diagnose yourself with fibromyalgia at home or over the internet is a recipe for not being taken seriously at your physician's office.

Ok sure, but if I were in your place and I had ~every single symptom~ of a disease and was in the right age/gender category for it, and the symptoms had been around for most of a year, I'd still go see a specialist in that thing.

As for not being taken seriously, the contention that this disease is psychosomatic is ridiculous and insulting to those who have it. This is especially obvious if you look at the shameful history of what other diseases have been called psychosomatic, most that predominantly affect women... but it's ridiculous even without considering the history.

Fibromyalgia is thought to be due to genetic mutations in GABA receptors which mediate anxiety, sleep, AND pain, which is why you get that odd constellation of symptoms. There is both genetic research in large studies and brain research that supports the conclusion that there are problems in GABA genetics, and the brain's inhibitory system (which is mediated by GABA). However, this is research of the past 2-5 years, so you need to find a doctor who is up to date.

[And I'll take the opportunity for a mini rant. I, a female, went to a doctor with chronic pelvic pain 10 years ago. I was offered antidepressants. Turns out I had pervasive internal disease that was treated successfully with surgery, that I got diagnosed after visiting ~10 more doctors. So occasionally you might have to shop around to be taken seriously.]
posted by kellybird at 5:53 PM on November 16, 2012

I thought something autoimmune when reading your question as well.

It's worth getting checked out by a rheumatologist. I'd also ask for a blood test to check your vitamin D levels.
posted by guster4lovers at 3:40 PM on November 17, 2012

As for not being taken seriously, the contention that this disease is psychosomatic is ridiculous and insulting to those who have it. This is especially obvious if you look at the shameful history of what other diseases have been called psychosomatic, most that predominantly affect women... but it's ridiculous even without considering the history.

Modern pain research recognizes that ALL pain has a psychological basis, and individual perception of pain is heavily influenced by past experiences. Even when pain DOES have a concrete physiological cause it is still helpful to deal with the psychological underpinnings that may be exacerbating it. People suffering from painful, long-healing injuries (say, bad burn victims) can find some relief through meditation, visualization, and counseling. Similarly, people with chronic pain conditions that have no visible psychological basis often find carefully-prescribed physical therapy and exercise can help. My point is not that she should give up on talking to doctors, but given she has already noted her anxiety and panic attacks it would be useful to pursue that route in tandem as they can only make her pain experience worse.
posted by schroedinger at 10:24 PM on November 21, 2012

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