Q: I have a problem that started around 2008 and can’t seem to find anyone to help me with the symptoms I am having. Off and on I have chest burning, abdominal pain, severe headaches, flushing, nausea, tingling in the face/arms/legs, neck pain, lower back and shoulder pain.
I have been to the emergency room no less than four times with chest burning and the doctors there can’t seem to give me an answer. Being a veteran, I have been to VA doctors several times to no avail. I’ve been to a gastroenterologist, physical therapist and a back doctor. Each one I see refers me to someone else. The tests I have had done should have revealed something by now. I have had a stress test, MRI, CT scan, several EKGs, X-rays, a colonoscopy, upper endoscopy and they even sent me to a mental doctor at the VA. I had seven sessions of blood work.
On a daily basis I take Metoprolol tartrate, Levothyroxine, Lisinopril, Simvastatin and hydrochlorthiazide. I’m really getting concerned about all of this. I am a retired 62-year-old male. Other than all the issues I’m having, I seem to be pretty healthy and everyone I have visited doesn’t seem to be concerned.
A: Initially, I’m going to take the easy way out on your symptoms and indicate they may all or in part be directly related to the medications you are taking. For example, while all of the drugs you have been prescribed are well-tolerated by most individuals, Metoprolol can cause chest pain, nausea and headaches. Levothyroxine is associated with headaches, fever and hot flashes. Lisinopril can cause headaches, tingling and fever. Simvastatin can cause muscle pain, nausea and fever. Lastly, hydrochlorothiazide can cause nausea and numbness. I cannot indicate which may be the culprit and, indeed, two or more could cause adverse side effects when taken together. The only way to determine this is with the assistance of the prescribing physician(s) who may be able – based on your medical history – to temporarily or permanently discontinue one at a time to see if any of your symptoms disappear or become less intense. If there is no change with the first (or any medication you currently take), for example, it can either be substituted for another drug in its class or begun with the second being temporarily or permanently discontinued, and so on. Not every drug will affect every person in the same way. We are all different and drug reactions will vary.
Gastroesophageal reflux disease (GERD), cardiac issues, irritable bowel syndrome and other issues appear to have been ruled out; however, has your doctor considered food allergies, kidney stones, Crohn’s disease, ulcers, or gallbladder disease? The latter commonly occurs just after a meal and can present with nausea, vomiting, abdominal or back pain. Perhaps a pheochromocytoma (a rare adrenal gland tumor) or carcinoid syndrome (due to carcinoid tumors) is to blame?
You have already had numerous tests which should have detected abnormalities, but didn’t. As a result, I recommend you request a second opinion from a top notch diagnostician who can categorize your many symptoms and hone in on the most likely causes. Take a copy of your lab work and testing results for his or her review. If deemed necessary, you may have to repeat some of the testing that has already been done.
I am unaware of your insurance coverage, based on the fact that you have been seen by the VA. If you end up back at your nearest VA facility, bring them a copy of my response and ask if you can be seen by someone who can sort things out and get you back on track. Good luck.
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