Autoimmune diagnosing problem
I don't know what to do at this point. I'll give some of back my story, up until I got extremely sick in October 2014, I was completely healthy and what I considered normal. I rarely went to the Doctor for anything, rarely got sick and I was always on the go. I'm a 32 year old female, married with 2 kids. In October 2014 I came down with some sort of virus. I was extremely sick for about a week. Within 2 days of feeling better I started having pins and needles only on my left side in my arm, hand, leg and foot; my left leg also started falling asleep. I just thought all that was weird and went on with my life, not seeing a dr or anything. Starting in January of 2015, my symptoms started getting worse. I was walking through a parking lot when I lost complete feeling of my left leg and fell. It lasted about 30 mins or so before I started getting feeling again. By this time my pins and needles were staying constantly, the numbness was becoming more frequent, and now my left side was extremely weak. After visiting my primary she confirmed the weakness, ran a bunch of lab work and referred me to a neurologist in my area. Fast forward to December 2015, I had 2 mri's, completed physical therapy and been seen by 2 neurologists, both of which told me they didn't want to spend the time to help figure anything out. My pins and needles had now migrated to the right side, and my face; I lose complete feeling in my left and right legs, more on the left, as well as in my left hand; My bladder started giving me issues retaining and releasing; I frequently become so extremely tired I can't get out of bed for days, sleeping the entire time; my balance is so out of whack that there are days I'm walking and I look like I'm drunk because I can't walk well; started having memory issues, as well as word finding issues. Because of the random dead leg, and balance issues, I fall frequently. So I decided to come to Mayo Clinic.
They have done numerous tests and blood work. I have had a full spinal and brain MRI, EMG (x2), spinal tap, skin biopsy, audiology testing, balance testing, ARS, QSTAT, BAER, VER, SSER, Nystagmography Tests, Tilt table testing, dynamic posturography tests, urology testing, and I'm sure some others I can't think of right now and all have come back clear except a few small issues, but don't offer any insight to my issues. I came back positive for small fiber neuropathy, I failed all six stages of my balance testings but because I didn't need assistance the dr said he won't consider it failed and nothing was done, they found mild bilateral hearing loss, and my tilt table came back slightly abnormal.
I've seen consultative med, hematology, neurology, urology, integrative medicine, and psychiatry. No one can figure out what's going on but my life has changed so much that I need to figure out what's going on so I can either treat it or figure out how to deal with it. I have a hard time staying awake, my balance is completely off, I randomly lose feeling in places and fall, I'm weak on my left side and have issues standing for long. I was going to school full time and had a 3.85 GPA until this now it's dropped to a 2.75. I can't keep up with anything and I don't know how I'm going to work when I can't tell when there will be days I can't wake up or get up. Or when My balance is so unstable I can't walk with out help.
I was referred to neuromuscular and saw the Dr this morning. He said I won't treat anything until we know more, which is fine because I want to know more. But told me to have a great day and didn't tell me what to do next or where to go from here. He just said send me a message of it gets worse. I don't have any other appointments or outlook on what to do now. I'm not out seeking, looking for, or even asking for medications. I just want to figure out some sort of normal. I don't know how I'm supposed to help support my family or work of I can't even do anything. But not knowing I don't have many options, can't get medical help or anything.
I'm so frustrated and feel like everyone's brushed me off. What I wouldn't give to just feel normal again or at least have an answer.
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Sorry to hear of your travails. You've had to endure a lot.
So how was the adrenal insufficiency diagnosed? There are several ways to test for it so did you get the full suite including ACTH? Was it diagnosed as primary, as in Addison's, or secondary? Why hasn't it been treated since that could make a massive difference?
Likewise with a firm SLE diagnosis. If it was diagnosed, and the tests that drove the diagnosis can be replicated, any worthwhile clinician would treat it. Not treating it is taking a big chance. Yes, the meds are scary, but the prognosis of the illness progressing unchecked is scarier.
My 2 cents is that your primary physician with all of these reported issues should not be a chiropractor, it should be an experienced rheumatologist for starters. If the chiropractor gives you some relief, fine, but as far as med consults, not so much.
Are your diagnoses right? Can't answer that here but if you have concrete test results that conform to guidelines to diagnose a particular condition you can probably assume that they are. Sounds like you need to do a reset and bring all of this to a highly reputable rheumatologist to review your records and do the needful. I say rheumatologist because of your remarks about SLE which kind of trumps the rest. The TPO is a little high but could be much higher. An endocrine panel is probably a good idea too since autoimmune thyroid disease and other autoimmune disorders are in many cases joined at the hip.
Here is a good site that speaks to lab tests for autoimmune disorders, by illness. Its not meant to dwell on, just a good reference.
https://labtestsonline.org/understanding/conditions/autoimmune/
Hope this helps.
Hi @alysebrunella, thank you for moving my post to a relevant discussion. I appreciate the welcome!
Hi @johnwburns, thank you for your thoughts and the test link. Prednisone 5mg is one of my 20 meds. I got diagnosed with adrenal insufficiency only based on cortisol level in the morning-level of less than 1 both times. I was suspect for Secondary or Tertiary Adrenal Insufficiency. I was also tested for Graves disease- TSH, Thyroglobulin,
TPO, etc.
How would they treat adrenal insufficiency? I was told to take 2-3x my current Prednisone if I get flu, stomach bug etc and adrenal prep before surgery. But no ACTH test, which I wish they would do-they expect I have had so much steroid over historic treatment that is the cause...80 mg solumedrol with my benlysta infusions over the years....over last year 6 or so injections in my spine.
They used c3/c4 complement as basis to take me off all immune suppressants except plaquenil. They consider my lupus inactive.
But my joints are not happy, I have fatigue, i have some areas on my head that are truly thinning (I had a chunk come out behind my ear). I asked for celebrex and that helped hugely.
I stopped infusions back in October because my doctor went out of network and my infusions would be over $1,000. All organs were checked and look good. My lungs are consistent with restrictive disease but otherwise are normal.
CRP was normal back in Feb so again, indicators looked okay.
So my prednisone and plaquenil and nifedipine for Raynauds are used to manage Lupus....and vitamin D2.
This is so hard as my prior rheum treated me with infusions for 5 years and I went to teaching hospital and meds were unwound, and yet I still have 20 meds. Made me wonder what did I let happen to me over last 5 years at pther rheum.
My chiro is not my primary care, but truly concerned that I keep on deteriorating.
4 falls in month of July is bad. Fracturing sacrum, having herniated disc. Having significant numbness/neuropathy in my feet. And leg weakness. Eye blurriness, orbital swelling and slight eye bulge. Obstructive and central sleep apnea. These are very recent additional diagnoses. My list of diagnoses grows.
Going to see neurologist next week for EMG...he thought I may have lupus CNS, but also noted significant weakness, nystagmus of my eyes, etc...
Maybe he can put some lieces together.
I moved my care back in February to a teaching hospital as my autoimmune GI issues cam unded cpntrol and I hoped other specialties could help.
Somethings have gotten better, but even with rest, I am still at a loss. i am encouraged to exercise but my balance is bad and I am accident prone. Right now I am not even okay for pool exercise. i see a Physical Therapist next week for assessment.
I have filed for disability but the process is so slow. I am running through my retirement while waiting.
I need to get better fast so I can work again. I worked so hard to finally have a house. I could end up losing everything come this fall if I am not physically functional.
Bottom line, my chiro is encouraging me to pursue more expertise to get me showing signs of improvement instead of worsening that he sees week by week.
Thank you for writing.
Just curious but are there multiple prescribers for these 20 meds? If yes there is a pretty good chance that you have some collisions going on, or will.
Diagnosing adrenal insufficiency based on a couple of morning cortisol tests doesn't sound right, however low. Does your blood pressure run very low. Do you faint? Hard to know whether 5 mg of prednisone is an adequate dose since the diagnosis isn't clear. Even 5 mg of prednisone is not innocuous. Could mess with bone density, blood sugar, mood. I don't know what the threshold is for shutting off your own adrenal function but its something that should be monitored.
Here's a link re adrenal issues:
https://www.niddk.nih.gov/health-information/health-topics/endocrine/adrenal-insufficiency-addisons-disease/Pages/fact-sheet.aspx
I'll stick to what I said earlier, do a reset on the conditions and meds. Too much going on to try and parse it out point by point. If the neurologist is at a center of excellence maybe you can use him to link to other high quality providers so you get all of your care under one roof. At this point the meds may have become half your problem but arbitrarily cutting them off is not a good idea.
Get a medic alert setup for the falls.
Hang in there.
John, thank you so much. I do run low with blood pressure, but I also take calcium channel blockers and beta blockers (Raynauds and migraine prevention respectively). One doc owned most historically, but now pain meds under Primary care, Rheum meds under Rheum, Gastro, Kidney under respective providers. So i keep a list broken down by owner and what each med is used for...I dont like this.
Rheum used to be quarterback...but he checked out, then went out of network and I was left hetting worse. He told me he didnt do well with pain. So I moved. When I called to say I was moving care, ther was no response, so I took it that was what they wanted.
I actually had a diagnosis of dysautonomia in 2005. I had POTS, went thru tilt table test, etc.
I do get faint. BP about 100/60, but has been as low as 89/60. After discectomy and fusion in my neck, it wast 50/30...
My A1C is 5.1-no sign of diabetes.
I am wondering if I have some other disorder altogether. I have muscle fatigue that is unbelievable. I cant handle 2 steps into my house. I have to pull myself in ising the door. If I dont take that prednisone on time I get the shakes and feel faint.
Who knpws what the right amount is. Who knpws if myvadrenals were bad before all my meds-no one ever checked...
I have been thinking going tp Mayo or Johns Hopkins.
I am hoping neurologist may help. He sees how week I am...he doesn't try to ignore
Gotta give a chance...
Thank you lots for thoughts..
@colleenyoung
No problem, we try to help. Priority 1 for you is making a caregiver, friend or relative aware that you fall, and fall often. That is your biggest immediate danger. Second, get those meds reviewed and get them managed by one clinic or group. You are taking drugs that lower your BP and are complaining of fatigue, a known side effect. Don't stop them without supervision by any means. Read the link I sent you about adrenal insufficiency. You may have had Addison's disease before all of this started it is likely that it would have landed you in the emergency room long before now. My 2 cents again. But that is for evaluation by an endocrinologist and it is easily done.
With POTS any meds that effect BP must be managed by a specialist. Make the neurologist aware of this, and your falling as well.
You may not have many problems, you may only have a couple that have not been managed. Lupus is a monster. It is known as "the great imposter" and can make things look like multiple separate illnesses. I'm not saying that's what's going on here, just an fyi.
You said this above: "i have some areas on my head that are truly thinning (I had a chunk come out behind my ear)". What does this mean, that a piece of your skull came out? I certainly hope not and if you have been injured, its a 911 issue and not one for a blog.
Put together a simple plan based on simplifying what seems like an impossibly complicated situation with the help of your doctors and other caregivers. Get enough rest.
Hope this helps.
I appreciate all this feedback lots...and I was talking about hair thinning, but somehow missed being clear-my skull is okay.
I just had a friend tell me "put me first' as emergency contact and send doctor list, meds, wishes...finding a true emergency contact is hard-this friend made it easy..
Yes, I will talk to neurologist about all the falls, etc.
I have a walker because of all the falls-I got it earlier this week.
I am going to read that link you sent on adrenal insufficiency- some of my earlier ER events may have benefited from knowing insufficiency was an issue.I truly feel if I had been tested long ago, this would have been identified.
I have medalert I keep my cell with me always and car has onstar. i have security system with quck paramedic alert. My falls all seem to have had a syncope feel so I will follow-up.
Thank you so much for solid, organized guidance.
Well that's great! Thought so about the hair but had to ask.
Good that the friend stepped up. Hang on to that one.
Remember to ask the neuro about connecting the rest of your care to a single clinic, or 2 at most if possible. Easier to pare down the meds, if possible.
One tipoff re primary adrenal insufficiency is hyper-pigmentation in some areas, hands and elbows I think. You'll see a note about it.
Glad I could help. Good luck and keep us updated.
Thanks again for your reply. I have been on prednisone several times and each time my condition clears up. I am feeling very frustrated right now. I am dealing with some diverticulitis, a mild case, but I have had Levanquin and flaghl added on to the pills I take. I take 10 pills throughout the day. This assures that I have an upset stomach all day. Sorry for the wining.
Please go to Mayo. I cannot say enough about their diagnostic procedures. Mayo's has a team approach so all your concerns and problems would be addressed.