Question
QUESTION: I am 34 y.o female with history of fatigue and pain since just after the birth of second child about 5 years ago.  The pain is mainly in my hands and feet, and comes and goes.  Have had blood levels checked a few times throughout the years but all comes up normal.  Currently my symptoms include pain in the arches of both feet (no change in activity level) and the same type of pain in what feels like the tendons in the palms of both hands running the length of my palms.  I also have Raynauds but this is a very different type of pain and not associated with change in temperature.  I also get occasional swelling in fingers and stiffness.  Occasional wrist pain but comes and goes.  Any advice?  I've tried a steroid in the past but did not notice real improvement.  Was on norpramine for a couple years and saw a bit of improvement I think but nothing drastic, discontinued due to increase in resting heart rate.  Heart rate back to normal ever since.  Only medication now is birth control.  Can you give me some possibilities to look up or speak with my doctor about?  Thanks for your time.

ANSWER: Hi Rachele,

Half way through reading your question Raynauds popped into mind, then further down i read that you have already been diagnosed with it. your present symptoms are in fact consistent with Raynauds. Until something markedly different arises, this is consistent with the present diagnoses. Steroids are basically all that medicine has to offer which offers measurable relief. If an ANA, CRP and anti-dsdna, to name a few, where performed and the results are consistent with your present diagnosis, then I would be comfortable knowing nothing new is undiagnosed. The only advice I can give is make sure ALL blood tests have been performed.

I hope this helps!

Dr. Timothy Durnin

---------- FOLLOW-UP ----------

QUESTION: Thanks for the quick response!  I thought that reynauds only affected the fingers and toes, not the palms and arches.  I am happy to hear that it may just be Raynauds and not something more. My typcial Raynauds symptoms are burning and redness (after blotchy white patches) after change in temperature.  The newer pain feels like it is in my tendons in the arches of both feet and palms of both hands. It's not the typical stinging/achy feeling I get with a raynauds attach.  This new pain is more of an all day thing and not associated with temperature change.  Do you still think it may just be Raynauds?  Can you direct me on good in depth reading about raynauds?  Everying I see on the internet just explains symptoms in fingers and toes, nose, ears, due to cold exposure.  

Thanks so much (agian!)

Rachele

Answer
Hi Rachele,

Raynauds is typically associated with connective tissue diseases,(which effects tendons), this needs to be ruled out. Since all your blood work check out, then it is unlikely there is an underlying disease. I would first make certain that ALL blood diagnostics have been performed, when you say, "all blood levels where normal", I have to be suspicious that something was missed, especially since the onset of new symptoms. Unfortunately, even if it was missed, medicine has little else to offer besides steroids.
Depending on how motivated you are, it might be wise to check for food allergies, mold exposure and other possible causes. I have been surprised throughout the years to find many odd physical manifestations can be traced to these causes. Better safe than sorry.

Getting medical info online can be challenging, loaded with mis-information and outright misleading.

Physicians have a good resource called Merckmedicus.com, the site is presently down but will have everything you want to know about every condition under the sun. It may require a password so if you are unable to access it, I will copy what I can and forward it to you. Please let me know and I'll do what I can.

For the time being, make sure all the blood work performed was comprehensive, leaving no stone unturned. This is done by asking your doctor and getting copies so an outside opinion can review it. If I can see exactly what was performed, I can tell you if it's adequate. let me know if you need any additional help!

Take Care!

Dr. Timothy Durnin