Q. Why am I suffering from severe pain that shifts all over the body?
Hello doctor,
I have multiple sclerosis, diabetes, and epilepsy. However, I am usually numb to pain, my bowels function fine, and my temperature is normal. I got two shots of the vaccine for COVID. Hence, over the last three or four weeks, I initially got pain in both kidney areas, but not from them; it was muscular. Then it went to my gallbladder area for one or two days, and now it seems to have shifted for the last two weeks to the left-hand side of my lower abdomen underneath the ribs. So I am taking Co-codomol every day, sometimes twice a day. My weight has reduced, so my trousers are now falling when I wear them. I am having a CT scan next week. Any idea what this is?
Hello,
Welcome to icliniq.com.
I have read your query. I am sorry for such discomfort you are having. Your description of the symptom does not fit the usual suspects. Therefore I would like to ask you a few questions; Do you have any aggravating or relieving factors for the pain in the mentioned area? Also, how is the pain; is it severe or mild? Is it related to a particular type of food? Finally, do you have any tenderness on palpation? Do you suffer from any nausea or vomiting episodes? Do you have a feeling of bloating or excessive gas formation? Any fever or chills, micturition difficulty, burning while micturition? You mentioned your bowel movement is fine, so it is not constipation-related pain. You also said weight loss. Can you approximate the weight loss? Shifting pain from the right lower anatomical area to the gallbladder and now to the left lower abdomen underneath the rib raises one possibility of gas. Diverticulitis occurs on the left side of the stomach. Symptoms include pain, nausea, vomiting, fever, abdominal tenderness, and bowel movement change (constipation or diarrhea), but it does not fit your description. Have you tried taking medication for gas? For example, is tablet Co-codamol (Paracetamol) working? I asked you the above questions to rule out usual suspects. Please reply to the above questions. It is good that you are going for computed tomography (CT) scan of the abdomen next week. Thank you.
Hello doctor,
Initially, for two days, I could not touch those areas without pain. Also, I could not even stand up without pain which is still the case, but it is less intense. I feel nausea after eating almost anything except drinking water. I have celiac and avoid consuming gluten. My weight now has reduced to 123 pounds from 132 pounds about two months ago. Even standing up and sitting down hurts.
Hi,
Welcome back to icliniq.com.
Considering your reply to my questions, it probably points towards the pain of musculoskeletal origin from the back muscles. You can not stand up without pain, and standing up and sitting down hurts supports this finding. I would suggest you take skeletal muscle relaxants medicine to ease your symptom. I suggest you take tablet Ultrazox (Chlorzoxazone 250 mg, Diclofenac 50 mg, and Paracetamol 325 mg) twice daily after food, and tablet Pantoprazole 40 mg empty stomach once a day before food if you have a problem with gas formation. Consult your specialist doctor, discuss with them and take the medicines after their consent. What is more concerning is unintentional or involuntary weight loss and nausea feeling almost eating after anything. Unintended weight loss is defined as the loss of greater than five percent of an individual's body weight over six to twelve months. In your case, there is a reduction of 13 pounds (10 percent) in just two months. One cause could be uncontrolled diabetes. You should visit a local doctor and do the necessary investigation as advised. Follow up is necessary. Thank you.
Hello doctor,
I am not a fan of food since it makes me feel sick to eat it, but my diet has not changed. Weight loss has been within the last three months. My diabetes management is poor. My levels are close to hypoglycemia daily, and I have noticed the pain is sharper when my glucose levels are low.
Hi,
Welcome back to icliniq.com.
Uncontrolled diabetes is associated with glycosuria (excess sugar in the urine) and can cause weight loss. But you mention your blood sugar level is close to hypoglycemia (below average sugar level) daily. Do you take antidiabetic medication? Ask your doctor to adjust the medicine dose and frequency to prevent hypoglycemia blood level. You have had diabetes for how many years? Do you have any kind of depression? First, I will try to summarize possible causes of weight loss based on the medical history you have provided. For example, weight loss can be attributed to multiple sclerosis (MS), diabetes, reduced intake of food, and celiac disease. Initial assessment for weight loss includes comprehensive medical history, physical examination, and panel of tests like complete blood count (CBC), C-reactive protein test (CRP), erythrocyte sedimentation rate ( ESR), renal, liver and thyroid function tests. Based on the medical history, other specific tests can be included or excluded. I am unable to explain at this moment how pain is sharper when your glucose levels are low. Do your glucose levels go below 70 mg/dL? In hypoglycemia, symptoms manifested are fatigue, sweating, increased heart rate, confusion, etc. I suggest you visit your local doctor to address weight loss and nausea symptoms. Regarding pain, if it is of muscular origin, as your above chat point towards it, taking skeletal muscle relaxant medicines would help to ease it. I hope I can guide you. Thanks.
Hello doctor,
I have been a diabetic since 1999. My glucose levels are getting lower and lower, despite not changing my diet, and it gets lower with less insulin intake. I also do not understand, as I know 'hypos' means low glucose levels. Usually, pains are accompanied by numbness, so maybe they are mild in hypoglycemic. I am hypoglycemic, with levels ranging between 2.5 to 3.5 mmol/L.
Hi,
Welcome back to icliniq.com.
This is strange because your glucose levels are getting lower and lower, but you did not have a workup to find its cause. So why do you take insulin injections despite lower glucose levels? Workup for hypoglycemia should be done based on the history you have provided. I have tried to narrow down the causes of your symptoms based on the given history. However, I would suggest you visit your treating physician regarding your symptoms, including repeatedly lower glucose level, and get computed tomography (CT) abdomen done next week as advised by your doctor to rule out any abdominal cause of the pain. Thank you.
Hello doctor,
I understand it must be a common body reaction for patients with hypo-unawareness to become more sensitive to glucose. The MS probably must have caused the unawareness. Thankfully sensors notify me. Thank you.
Hi,
Welcome back to icliniq.com.
Hypoglycemic unawareness occurs more frequently when there is long, tight control of diabetes and frequent episodes of low blood sugar levels. Usually, the body should feel symptoms of low sugar, but there is explained mechanism as to how and why hypoglycemic unawareness occurs in advanced type 2 diabetic patients. So, you need to talk to your treating physician about consistent lower blood sugar levels, plan good diabetic management, and adjust the dose and frequency of medicine to prevent lower levels. I hope I can guide you about your primary initial question and take the suggested medicine for it. Take care. Thank you.
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