@abbyk What I might suggest is an evaluation with a good physical therapist who understands rehabbing spine problems and one who does myofascial release work. When you talk about the carotid area swelling, it might be a muscle spasm causing misalignment of your head, jaw and neck. If you have degenerated spinal discs, they can cause throat pain, and provoke muscle spasms in your neck that can pull up to your ear and jaw. I have that problem myself, and before I found out that I had a bad disc, I thought it was my thyroid as I felt like I was choking and had some unexplained pain. My doctor said the thyroid usually doesn't cause pain. It was a few years later, that my C5C6 disc ruptured, which caused inflammation and bone spurs to grow, and I had surgery at Mayo for that which stopped the throat pain (among others). A spine problem can generate pain anywhere in the body, and it's kind of the last thing someone would suspect. When you get muscle spasms in your neck, it can start moving the vertebrae around and you loose the normal curvature, and with that comes pain from whatever is shifted into a stressful position.

I also have thoracic outlet syndrome which causes my neck to be tighter on one side, and it pulls tightness through my chest and down to my hip, and can even move my hip bone forward or turn it inward. That changes the alignment of the bones in my pelvis which stresses my back. When that was really out, it caused a lot of fatigue and I couldn't walk very far without back and leg pain. For TOS, posture is very important, and I work on releasing the tightness in the fascial layers in therapy. It's like wearing a straight jacket, and I can't move properly or get back into good ergonomic alignment until the fascia is released that is holding the incorrect alignment. MFR therapy really works for me. Having restrictions can affect the esophagus internally as tight fascia can run any direction and it is like a web that binds the body together that recently doctors have called the "interstitium". I get chest tightness and spams from it sometimes. I have to strengthen too so I can maintain a better alignment. You can look at http://www.myofascialrelease.com for information about MFR work and to find a PT who is trained in this treatment. A PT can help advise what type of specialist to see based on what they find physically.

You might want to consult a neurologist and ask if you have thoracic outlet syndrome. It is hard to find places that understand and can treat TOS, but Mayo is a great place for that. It make take a few years of physical therapy to improve TOS, and there is surgery for it, but that can make it worse because of surgical scar tissue. I had neck spine surgery which did make my TOS worse for awhile because of close proximity of the surgical path, but I have improved with PT and am gaining ground again. TOS causes me to breathe improperly because one side of my chest is too tight and doesn't expand correctly, and then I start using neck muscles to breathe and it makes it worse. I also have allergies and asthma that makes it difficult and just recently saw a pulmonologist at Mayo and have better control of breathing. I used to have a lot of sinus issues too, and that is better now too with allergies under control.

What did your ENT say about your sinus issues? Some people have chronic bacterial infections in their sinuses. If no one cultured your mucous, it might be worth asking if that could be a problem for you. It's common to have a staff infection in your nose, and before my spine surgery at Mayo, they had me treat my nose with antibiotic ointment as a precaution.

With an elevated C reactive protein, that is a marker of inflammation that could have many causes. You could start with something simple like dietary changes and see if you feel better. Food allergies can contribute to pain and inflammation. I see an environmental allergy doctor (functional medicine) who understands the biochemistry of the body. I take allergy shots and he has balanced my hormones, and thyroid function, and I avoid a lot of foods that cause allergies and inflammation. This type of doctor looks to prevent disease rather than treat symptoms. They can also test various detox pathways to see if you have a deficit somewhere. Are you taking any medications that might have side effects that can cause your symptoms?

There could be many reasons for fatigue, but sometimes you just have to start somewhere and do what helps and eliminate part of the issues, and then turn to solving other problems. You may have multiple causes for your symptoms. Has any one done imaging or an MRI of your neck and spine? A physical therapist might need to know about any issues before treating you. You can always call Therapy on the Rocks in Sedona, AZ and ask for names of people they trained if there are no MFR therapists near you listed on the website.

Here are some links that may be useful-

Thoracic Outlet Syndrome https://www.mayoclinic.org/diseases-conditions/thoracic-outlet-syndrome/symptoms-causes/syc-20353988
Info on myofacial release http://www.myofascialrelease.com
https://www.mayoclinic.org/symptoms/shoulder-pain/basics/causes/sym-20050696
https://www.mayoclinic.org/diseases-conditions/neck-pain/symptoms-causes/syc-20375581
https://www.mayoclinic.org/tests-procedures/rheumatoid-factor/about/pac-20384800
Academy of Environmental Medicine https://www.aaemonline.org/
Environmental health Center Dalls https://www.ehcd.com/
Papers on Environmental Medicine topics https://www.ehcd.com/books-and-papers-by-doctor-rea/

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