Difficult case, several diagnosis, no solution yet

Posted by stumpjumper @stumpjumper, Jan 15, 2019

Hi everyone

As I have been ill for more than 3.5 years and have already applied for an appointment at Mayo clinic, I would still try to give mayo clinic connect a try. Maybe someone has a clue as to what might be going on with me. It is always good to use the experience and expertise of people around the world when it comes to finding solutions for seemingly difficult cases (I can't get rid of the feeling that my case is not so difficult after all, we just haven't found the piece that is linking it all yet). Moderators, please feel free to move this topic into another subgroup if you think it isn't in the right place. So here we go:

I am 30 years old, male, from Switzerland and considered myself healthy all my life. I was building a career, did lots of sports, travelled the world and we where ready to get married in 2017 – when in June 2015 my symptoms showed up to stay. I’d like to give you a short overview on how this illness developed over time, on my current symptoms and on what medical testing has been conducted so far.

General course of development:

At first things deteriorated gradually. Everything started in 2015 when I was recovering from a few days of having the flu and went back on my road bike, which went fine. A few days later, I had this sudden onset of fatigue. I woke up in the morning and thought that something is really wrong. I've already had episodes where I felt sick and very tired during the 12 months before June 2015 with symptoms similar to what I was about to experience later on. But these episodes usually subsided after a few days and at that time it was still possible to exercise as the tiredness would usually go away a few minutes into training. Everyday life was never really affected at that point.

In June 2015, this changed dramatically. Endurance sports were not possible anymore but I was still able to play a little bit of tennis if I pushed through and to go for short walks. Working was still possible even though it needed a huge effort from my side. I was ultimately forced to completely stop working in May 2016 after gradually reducing my workload beforehand.

So over the following months I slowly started developing all the other symptoms mentioned in more detail below: Ear ringing and sleep disturbances were the first to arrive apart from the extreme exhaustion. Brain fog showed up. My fatigue and malaise started getting worse and worse. I then developed all the muscle aches and pains. Episodes where I felt like having the flu with general malaise but without a fever started arriving more frequently. At first they came for a few days every month and then increased to several days a week where I felt like this. Then the digestive symptoms came along. It was as if my whole body had started to break down and more and more systems were getting involved. Medical testing that was done by my family practitioner during that time did not render any conclusive results.

I was then diagnosed with Hashimoto's in 2016 by thyroid ultrasound (very small thyroid volume of 4ml total, hyper-perfused tissue, free T-values in the low normal range, no antibodies). I was started on synthetic T4 but thyroid medication did not bring any relieve. I experimented with hormone brands and types from T4-only, T4&T3 synthetics, T3-only and finally ended up on a combination of synthetics and NDT. Most symptoms are still persisting and did not even improve much. Thyroidectomy performed in October 2018 relieved local symptoms but the systemic ones have persisted so far.
I tried different diet changes as well. I have been gluten-free for almost two years now and even experimented with an autoimmune protocol diet for more than 3 month. Neither that nor any supplements did bring about any change.
A short trial with Prednisone (5mg daily) in order to see whether this may calm down inflammation had strong adverse effects. I ended up with panic attacks and hypoglycemia.

Symptoms overview:

I am mostly exercise intolerant. Even 20 minutes of easy walking triggers fatigue. It is as if someone pulled the plug on me and I could literally fall asleep at the side of the road. I used to do several hundreds of kilometers on my road bike. It feels like this fatigue isn't muscle, cardiovascular or respiratory related, it rather seems like my central nervous system would go haywire. Within the last 7 months I have at least been able to reintegrate some light strength workout into my daily routine again (push-ups, sit-ups and core exercises in moderate quantities). Also, I have been able to go for short strolls but I rarely feel well while doing it - my brain seems to get fogged and fatigue creeps in.

Then there is this feeling of malaise, like having the flu but without a fever although the doctor I saw recently measured 37.9 degrees Celsius within my ear (slightly elevated temperature). This feeling is not here every day but comes and goes in waves. When it gets bad, the only thing I can do is to lay down and rest.

I’ve had several episodes of sudden hypoglycemia within the last 3 years. When measuring blood sugar levels, they then tend to be around 2mmol/l and the typical symptoms of shakiness, weakness, cold sweat, dizziness, extreme sugar craving, etc. appear. I cannot link them to anything, sometimes they seem to be reactive to meals, sometimes they happen late at night. Apart from that blood sugar levels seem normal. They have certainly never been elevated.

I get spells of ocular migraines (without pain so just the aura) that usually last for 20-30 minutes. I don't know what triggers them (hormonal fluctuation as the usually happen first thing in the morning?) but I do have them about 2-3 times a month, sometimes a few in just a few days, sometimes just one and a few weeks pass until the next one.

I get days where my vision gets blurred and my eyes are clotted with a yellowish substance in the morning. It does not seem to be related to the fit of my contact lenses I wear for my Keratoconus as these episodes usually pass after a couple of days.

I am having mouth sores quite often (usually 2 or three at the same time) that are really big and hurting badly. They tend to stay for about 2 weeks. They also seem to come and go in waves (see pictures attached). I was able to establish a link to fluctuations of thyroid hormone levels. Usually my ulcers are a good indicator that levels are shifting.

Furthermore, my tongue has a thick white coating and pimples, all of it mainly in the back half of the tongue. Also, my tongue always has teeth marks in it at the edges.

My voice often seems to be "covered" with a slimy substance after meals that I have to cough off.

I experience constant high-pitched ear ringing. Also I get spells of sudden hearing loss that recover after a few minutes (mostly just on one ear, but not always on the same ear) and dizziness that goes away after a few seconds or minutes. This also happens randomly.

My sleep is disturbed (non refreshing, light with episodes of vivid and bizarre dreams) and I feel hung over and poisoned upon waking in the morning.

I get muscle pain all over my body (mainly leg, back and neck, feels like the pain I had when I was growing as a kid or after an intense workout).

My skin is extremely dry and I get rashes out of nowhere (Urticaria like itchy bumps, exclusively in my face but without being able to identify the triggers).

My thinking is impaired as well as I am struggling with brain fog all the time. Feels like everything is far away and perceived through a thick fog.

I am mostly constipated with severe bloating and gas and sudden episodes of diarrhea that cannot be linked to food triggers (except very specific ones like grilled Tuna who gives me cramping and diarrhea within 30 minutes).

Overview of testing performed:

2015: I have been thoroughly checked for any heart diseases (ultrasound, normal- and stress-electrocardiogram) with no results.

2017 & 2018: I had gastrointestinal ultrasound and stool sampling with no conclusive results. Calprotectin, Alpha1-Antitrypsin and Eosinophilic Protein X were ones slightly elevated. Colonoscopy did not show any abnormalities.

2017: I have been diagnosed with leaky gut, candida overgrowth and SIBO by functional medical doctors and a gastroenterologist.

2015-18: Different Endocrinologists did extensive testing with no abnormalities apart from my thyroid (Hashimoto's) and testosterone deficiency compared to healthy males of my age.

2016 & 2017: Brain MRIs showed some abnormalities. The doctors saw several small, round, non-specific T2w/FLAIR-hyperintense white matter lesions (bi-frontal, subcortical mainly in Gyrus frontalis superior. With regards to differential diagnosis Microangiopathy seems unlikely, most likely these were caused by the ocular migraines I am experiencing.

2015-2018: Neurological examinations (the ordinary type of testing every doctor does when thoroughly examining a patient fort he first time) did not render any abnormalities either.

2018: I was extensively tested for infectious diseases. Everything came back negative (including Lyme, EBV, Bartonella, CMV, Tuberculosis, Rickettsia, Coxiella, etc.) except for Parvovirus B-19, which was IgG positive. Extensive stool testing for parasites (also rather exotic ones) was negative. CRP was tested on several occasion and always normal. Hence, acute infectious disease of any kind was excluded. I was also tested for Autoantibodies (ANA, ANCA) which all came back within the normal range as well. So are my Immuneglobulins IgG and IgE.

2015 & 2016: I even went to see psychologists and psychiatrists in order to rule out any possibly hidden stress-related conditions, although they have never made sense to me in the first place – again no results.

2017: I was put on different kinds of functional medicine treatments after different kinds of testing: e.g. IV-therapy, acupuncture and infrared-fever-therapy, the latter of which led to severe adverse reactions presenting as severe cramping, paralysis and paraesthesia which all resolved after heat was reduced. None of them improved my condition while some made me even worse. After 3 months of trying we put a halt to this.

Conclusion:

Apart from my diagnosed Hashimoto’s, there is nothing to put a finger on that could explain my current state of health. There are several pieces to the puzzle that in my opinion must all be somehow related. As a matter of fact, I have been incapacitated for more than 3 years now without really knowing what’s going on. This goes beyond frustration. I know that all of these symptoms are real. They are not in my head. And it truly is time to get my life back. Or at least for me to know what I am battling against and to get a chance to eventually conquer it.

So any ideas you might have, I am happy to hear. I have recently stumbled across mast cell activation, which could be a possible explanation. Any experience on that would thus be helpful as well.

Thanks for reading this and helping me improve!
Stumpjumper

Interested in more discussions like this? Go to the Autoimmune Diseases Support Group.

@suecreader

@stumpjumper: Like several other answers you have had above, some, but not all, my symptoms match yours. I was diagnosed with fibromyalgia about 18 years ago by a rheumatologist, and she was helpful in initial treatment with medications that took away some of the pain involved. This was at a time when fibro was still considered to be a "dumping ground diagnosis" (i.e. "not a real thing, but doctors give that diagnosis when they can't find anything wrong with you" - or a variation on that theme that I heard from several people, including one of my bosses). Right now, I take Celebrex (which is an NSAID) that she prescribed (but then moved away from our area - which is in SD - and we have yet to have another doctor to replace her) which is continuing to be prescribed by my primary care MD. I made an appointment in Rochester with Mayo in June 2015, mostly due to problems with restless legs syndrome, but I also listed in my top concerns (on a form they send you) the fibromyalgia. My first set of appointments was to a Sleep Center doctor, a Fibromyalgia Doctor, a psychiatrist, to a gastroenterologist, and a pharmacist (since I have had many negative reactions to several pills, AND, I wanted to make sure the supplements I was taking were doing some good and/or not reacting negatively with the prescriptions I was taking). I had excellent care and feedback from each department. All of those appointments occurred within a three-day period of time, and at the end, I had a plan of action and appointments to come back to the doctors who saw problems that were ongoing and need to be addressed. So, I encourage you to pursue the Mayo route as others have said. Especially, if you, like me, have been going to this doctor and then doctor or specialist, and feel like none of your symptoms are being addressed as a whole person.
I also wanted to add what I learned about fibro: the doctor I saw indicated that the current theory is that fibromyalgia is the result of several 'insults to the system . . . . and by insults that can be a surgery, a traumatic event, an accident, or anything that impacts the body in an intense way or has a significant impact.' When he said that, I could trace by the beginning of my symptoms to a year when I had finished school & had no job, was a single mother, and needed to have two surgeries in three months: a hysterectomy and a cervical fusion. Also,after my surgeries, a long-term relationship ended due to impatience with my ongoing hospitalizations, so in addition to worry about finances, there was this additional emotional component involved. I add all this additional information since it sounds like you may have symptoms of fibromyalgia, and possibly Chronic Fatigue . . . . it turns out that I had some of those same markers to justify a second diagnosis of chronic fatigue along with fibro. I also attended classes while a Mayo which spanned a 2 1/2 day period of time that spoke to exercises, medication, etc. I found it very helpful and affirming. I notice that John has referred you to another group that may provide you with support and ideas. Another issue that you mentioned that I also struggle with is the sleeplessness which is primarily due to my restless leg diagnosis. I don't believe you also have that condition; however, my Sleep Center doctor has told me that going long periods without sleeping (and I have had months and years where I have only been able to sleep two hours per night because of the intensity of the leg issues) can create insomnia alongside the reason for not sleeping. There is a Cognitive Behavior Class (CBT) that is offered at Mayo for people with insomnia - it is possible you could get some ideas from that. I do know that not sleeping exacerbates all kinds of other issues.
Good luck - I hope you find ALL the answers you need - don't give up though since I believe the answer is out there. Hopefully at Mayo.

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I have Mixed Connective Disease, a rare, overlap disease with some symptoms of Lupus. It is genetic, triggered the same, we think. There is a lab test for diagnosis, but some people just have the symptoms, not the full blown disease. Worth asking for that labwork. For the fibro piece, I find that a non-processed diet, low sugar, avoiding potatoes, tomatoes, dairy, wheat makes a difference. I have other food sensitivities that result in feeling worse the next day. For the RLS, I like leg edema massage, basic yoga cat/cow/child/cobra and other stretches from PT before bed. Daily walks help in the general sense, light massage, hydration, Magnesium citrate and D3 seem to help me, besides the basic meds I take. A good site is mctdfoundation.org.

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@joey808

<p>Feels like I’m dying, autoimmune disease?</p><p>About a year ago I was having symptoms of weak/numb limbs accompanied with headaches and dizzyness that seemed to come and go. Recently in the past two weeks it has intensified with me I’m waking up to feeling very weak, difficulty walking, headaches, pressure in the back of my head and in my ears. I have vertigo and dizzyness and I feel off balance. I have episodes where parts of my body go numb, and my face gets red, I get so weak I can barely standup or move. I’ve been to the ER and unfortunately they couldn’t help as tests came back normal and gave me anxiety medication. I have had brain spine and neck MRIs and blood work but nothing has shown up, does anyone have insight? Thank you</p>

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You said you've had blood work, but do you know if your thyroid was checked? I would assume it has been given the symptoms you are experiencing, however before my thyroid disorder was diagnosed many of these same issues you are having were mine. By the time I saw a doctor who suspected this might be the cause I had progressed to the point that I would actually go from being dizzy to blacking out and momentarily losing eyesight. A thyroid that does not work can cause many, many issues throughout the body. This may not be what is causing your symptoms, but just thought it might be something you may want to have checked out further if your doctors haven't tested you previously.

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@joey808

<p>Feels like I’m dying, autoimmune disease?</p><p>About a year ago I was having symptoms of weak/numb limbs accompanied with headaches and dizzyness that seemed to come and go. Recently in the past two weeks it has intensified with me I’m waking up to feeling very weak, difficulty walking, headaches, pressure in the back of my head and in my ears. I have vertigo and dizzyness and I feel off balance. I have episodes where parts of my body go numb, and my face gets red, I get so weak I can barely standup or move. I’ve been to the ER and unfortunately they couldn’t help as tests came back normal and gave me anxiety medication. I have had brain spine and neck MRIs and blood work but nothing has shown up, does anyone have insight? Thank you</p>

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@joey808 have you been seen by a neurologist? Funny how doctors write off anything they can’t figure out, as “anxiety” - especially if you have a history of anxiety or panic attacks! They look no further! 😬

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@joey808 seems you live in Ontario - it takes several weeks, if not months, to get an appointment with a specialist and even longer during this pandemic since most doctors have cut back their patient load! But you’ve taken steps in the right direction!

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@joey808

<p>Feels like I’m dying, autoimmune disease?</p><p>About a year ago I was having symptoms of weak/numb limbs accompanied with headaches and dizzyness that seemed to come and go. Recently in the past two weeks it has intensified with me I’m waking up to feeling very weak, difficulty walking, headaches, pressure in the back of my head and in my ears. I have vertigo and dizzyness and I feel off balance. I have episodes where parts of my body go numb, and my face gets red, I get so weak I can barely standup or move. I’ve been to the ER and unfortunately they couldn’t help as tests came back normal and gave me anxiety medication. I have had brain spine and neck MRIs and blood work but nothing has shown up, does anyone have insight? Thank you</p>

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I wish I can help you. I have three autoimmune diseases and have been working with this for many years. Getting on too the positive side: There should be more research in this field of medicine. Perhaps a new group of people who are dedicated and can get the funding needed. This is a hard trail to walk on but life can still be enjoyable at times and these times should be cherished. Love yourself and treat yourself with kindness. With all the best Peach

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@rashida

@joey808 seems you live in Ontario - it takes several weeks, if not months, to get an appointment with a specialist and even longer during this pandemic since most doctors have cut back their patient load! But you’ve taken steps in the right direction!

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@joey808 you guessed right! I do live in Toronto, Ontario! 😀 Appointments with specialists take several weeks, if not months, even under normal circumstances but now during the pandemic it can be anyone’s guess! My regular physician cannot give me an appointment sooner than a week or more away under normal circumstances either, and now has cut her patient load during the pandemic too.

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....been doing a quick read of all comments and feel like printing out and highlighting many of the conditions i have had, or have.....or might have: thing is no fam. dr. here and cant travel... I am getting more issues by the week or month and this started many years ago with fibro diagnosis, but then concentrated on Norflox antibiotic giving me permanent peripheral neuropathy; then on to Glaucoma diagnosis and too many antibiotics and C.Diff; dr. switching around meds and then physical and mental breakdown of sorts.
Spent most of my days, well all of my days in or on my bed for over two years... now tinnitus is 24/7 and painful ears; had 3 short attacks of "more than dizziness," cant explain, crawled into spouse's bedroom for help, with no control over eyes .. notes from emerge make it look like a "little spell" but it was horrendous... (Meniers? Vertigo? no one knows) have had half thyroid out, cancer 1985, migraines since age 12, ibs-d, fecal incontinence, fatigue, strep throat, and the list, like many others on here, goes on and on. CT scan again next week but last time 2020 just said increase in "white matter" not explained to me. Pressure in ears/noise is high right now, its hard to explain to family members who are tired of listening to me. Temp in C. was 35.9 just now, never seen it that low.... anything scares me now. At 77 and reading what others have had to go through, not sure I can. However, best wishes to all for a diagnosis and good prognosis... you are to be commended for keeping going through all that you have. J.
p.s. I too am in Northern Ontario and takes months to see specialist and then they are often not that interested! Hugs

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Interesting note you give us. Almost everything you mention, except the specific diagnoses, I can relate to because "been there done that". But with the help of some good and some not-so-good labs and doctors and researchers, I have a multi-dimensional diagnosis that seems to be straight. To make it more interesting, I was started down this diagnosis path by a brief article in the Portland Oregonian about 6 years ago. It mentioned a strange disease which that writer (from Johns Hopkins, no less) had heard of, called Amyloidosis, and there were even further steps down the ladder from Cancer to Multiple Myeloma to Amyloidosis, and then to Gelsolin (GSN or AGel). So I started digging. Made a trip to Mayo which only ate up my life savings. But it did give me some clues. I started contacting genetic researchers around the country, and after another 5 years I believe I can prove I have not only Gelsolin, but also Fukatin Limb Girdle Muscular Dystrophy , and a bunch of other stuff, all related to these two. Sequencing.Com says I have over 1500 genes, syndromes, variants, alleles, etc., related to each other under the name Gelsolin, AKA Finnish Amyloidosis, or Meretoja's. I also have about 1600 of these related to each other under Fukatin Limb Girdle Muscular Dystrophy. And this FKTN seems to be directly related to GSN. I have since found about 10 persons who have been tested positive for FKTN, and then tested positive for GSN. I believe a positive DNA test for FKTN from a place like Ambrygen.com or Sequencing.com is also a positive DNA test for GSN. The two are tied together somehow, I am convinced. I got the first hint of this from NIH literature. Anyhow, I suggest you get a full 100% whole genome analysis from one of the better firms such as Nebula or Sequencing or Ambrygen or such, and use Genome Explorer to search for genes, syndromes, etc., for GSN, then for FKTN. I would put my whole lists of genes on here, but there are too many of them. The GSN tears into and disrupts the ACTIN web around the cells, and allow other powers to sneak in. FKTN seems to use this opening to rip into nerve and muscle cells to disrupt their function. There are many other DNA powers that sneak in this way. Ankylosing spondylitis, cardiomyopathy, TSE, RYR1, RYR2, RYR3, PA4, LQT1,RTC1, and such. I have several thousand of these buggers. Every tissue, fluid and electrical pulse in my whole body has been affected. So you are not alone.

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July 2021 I read most of very first post not all as not well agaon and must admit glimpsed at many of the many responses.
Re the first I had and have the same except not constipation. I have many of those issues and some different and now at 77 plus and the last 3 years the worst, just not sure I can take any more.
Cancer, fybro, migraines with aura and now memory fog after them (which was my first search today)...migraine with aura since a child with vomiting and head pain now mostly ocular with many ending in brain fog; hypothyroid, right side out, narrow angle glaucoma, tmj, peripheral neuropathy, internal tremors, ibs=d or whatever it really is for many years ... radiated bladder; had c.diff after too many antibiotics for utis in 2018, after over 100 vancomycin permanent fecal incontinnce and lots of bowel pain before that and since; diet bland: tinnitus 24/7 last 18 months or so, just occasional before, internal ear PAIN pressure, fullness, started after 2 bad sore throats never had before now I think I have eustachian tube disfunction but where I live my dog gets better treatment from vet than the ENT who has no interest as cant fix... the pain in ears and around area is for hours every day; extreme fatigue spend most of time on bed rarely leave the house last 3 yrs, and it goes on...
I believe every word of former posters.... add to mine some depression and definite anxiety and life could be worse but it is not the life i used to live or want to live, and it is now affecting my small family. I dont cook, clean, rarely visit, my ipad is my life to the outside world. Goiter on right half thyroid both out 2008, had laser to eyes for vitreous and Iridotomy and use horrible drops like everyone else and these glaucoma and dry eye drops do make it into the body.

Thing is since diagnozed 2018 with narrow angles, it prevented me from taking MANY medications including over the counter for pain etc., such as steroids, as raise eye pressure and I am still worried about that and could be on stronger meds but choose sight.
It started my downhill roll and I haven't really recovered.
I did get bitten in veg. garden around 2012 and very red swollen arm from elbow down and no bullseye rash but could see where some type of bite had been made I thought a spider... could it have been Lyme? We had deer all around lived near the lake, i have photo but colour off and looks overly red, or was it that red, didnt go to dr.

Only reason again listing all this is not in sympathy with others and for comparison, the fatigue is just as the young lady in the first comment.... plus whole body feels out of wack. I feel for everyone with illness especially continuing illnesses which are life changing... add old age and being too sick to even travel overseas to family's funerals etc. over the years and they wonder why I am not coping and really still grieving.

I have had no family dr since fall 2019, GoodDrs clinic in ON. Canada has done their best via video, nurse at clinic and phone calls but just too much, thats not what they are for. Theymade referral to ent as as I cant fravel had to wait a YEAR for a phone call and even then he was moaning about his problems during covid and didnt ask about my ear pain et. Unbelievable but truee.

Take care everyone and lets hope in the future more can be done for people with multiple issues that make dealing with constant pain, discomfort and not living life as we might, especially when tests show nothing and we almost remain labelled as complainers or ???? fill in the gap. Yet talk of my wanting M.A.I.D. in Canada bring comments like; oh you will get better, take this med, take that, ..... meds that will make things worse..... enough is enough but brave are those who continue with no complaint! I even get tired of listening to myself!
It's hard to feel the love and compassion from family gradually fading with each new day, with each new complaints of pain, with each drive to emerge or medical appointment.....so very SAD for everyone. And to think years ago I would complain about the flu... bring it on, I will exchange for all the rest! 💙 J.

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I have come to the conclusion that anyone who has even one or two MD or ER visits without legitimate results should get a Full Genome Analysis from one of the better Genetic Testing Labs. There are several. Sequencing.com, Dante. Mayo is related to one or more. Let me give you an example. 18 months ago I developed red and gray-black patches over my forehead, which spread to my entire face. It hurt like a hornet making a nest in one's ear. Anyway, the lab at the hospital said I had shingles. The doc said I had shingles. However, they could not prove it because they could not find any Zoster in me, as I have never had Chicken pox. So I searched for the answer. In my genetic work, I found I have at least a score of CALR (Calreticulum) versions, which cause just such a thing. I also have JAK2, one version, which can be part of it. The disease is also called "Clarkson's Disease", or "Systemic Capillary Leakage Syndrome", or "Exploding Capillary Syndrome". I found from experience that the best treatment is an OTC salve called "Gold Bond Psoriatic Creme with Aspirin". It not only killed the pain almost instantly, but eventually faded out the red and gray-black areas on my face. Now it is in my hair, back, legs, and I may have to shave my head to put it on, unless I can find it in a thinner liquid form. So you see, without the genetic work, I would probably be dead by now, not just from my exploding capillaries, but from my GSN, FKTN, cardiomyopathy, encephalopathy, various fibroses, and other stuff. A $500-$600 workup is much less expensive than death.

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