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Dr. Charogat
Dr. Charogat, Doctor
Category: Medical
Satisfied Customers: 1803
Experience:  Licensed in both NYS and NJ with experience in surgery and medicine.
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For the last 10 weeks, I have been suffering muscle cramps

Customer Question

For the last 10 weeks, I have been suffering muscle cramps in many different parts of my body, especially the back, neck and jaw. No cause has been identified, and my blood test came back normal (including sodium, magnesium, potassium levels - calcium was not tested). Shortly before the cramping started, I had a few days where I was feeling wiped out, and just before that I strained a muscle in my thoracic back when rotating. Three days ago, after a long period of steadyish improvement, my cramps have worsened. The most likely aggravating activities seem to have been (a) use of a stationary bike in the gym (15 mins), (b) (especially) 4 minutes of hula hooping. I have been tolerating other gym activities (e.g., cross trainer) well, but I had not been on the bike for a few weeks, and I had not done hula hooping since the problem started.
Is it plausible that these activities have caused cramping in distant locations (e.g., jaw, shoulders, hands, and calves)? Am I likely to have a postviral syndrome or calcium deficiency?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Charogat replied 2 years ago.
Dr.Customer:

Hi,

Dr.Customer:

Actually, I WAS thinking about a post viral syndrome, lyme disease, or fibromyalgia. Have you had any testing done for any of these?

Dr.Customer:

What other medical problems do you have?

Dr.Customer:

What medications do you take?

Dr.Customer:

Have you had any imaging studies to make sure that your spine doesn't have any areas of stenosis?

JACUSTOMER-pg9n9bim- :

No testing, but Lyme disease is unlikely - I haven't been in any areas with ticks. Other medical problems: history of back and neck pain that had been improving over a period of 2 years until this problem started 10 weeks ago (but the symptoms were not cramps). Otherwise I am fit and healthy. No medications.

JACUSTOMER-pg9n9bim- :

I had an MRI of my neck 2 years ago, revealing one small disk bulge, apparently not compressing the spinal cord. Otherwise no imaging.

Dr.Customer:

Lyme disease might be a good thing to test for even in the absence of being in any area of ticks. (I'm assuming you mean that recently - please let me know if I am wrong). Lyme disease can lay dormant for a very long time before starting to cause symptoms. BUT let's put that aside for now and think about other possibilities (just wanted to include it before I forgot).

Dr.Customer:

Do you know what the problem was with your back and neck over the two years? Was there anything suggested besides for the imaging study you mentioned?

Dr.Customer:

What bothers me most is that live it seems that you are quite an active and healthy lifestyle.

JACUSTOMER-pg9n9bim- :

My older back problem improved after manipulating a spinal joint at T6/T7.

Dr.Customer:

you asked about the cramp going to distal muscles... if you are having enough pain to be tightening those muscles then it can cause cramps. Otherwise I don't see how it would.

Dr.Customer:

I know you had normal blood test levels. Were they ever taken right after vigorous exercise?

Dr.Customer:

I wonder if you are not processing the electrolytes properly but are able to come back to a normal level. If you are losing electrolytes too quickly during exercise and need them replaced then....

JACUSTOMER-pg9n9bim- :

Blood test was taken within 24 hours after vigorous exercise, and 2 hours after I'd had severe cramping.

JACUSTOMER-pg9n9bim- :

There isn't any obvious link between when I exercise and when I feel symptoms.

Dr.Customer:

I would probably like to see blood tests shortly after exercise, although honestly I'm not sure if that would make a difference considering when the cramping was in relation to your exersize AND in relation to the time of the blood test

Dr.Customer:

I just want to look something up about this.

Dr.Customer:

Just want to let you know that I'm still with you - my computer is a bit slow.

JACUSTOMER-pg9n9bim- :

That's no problem; I'm still here too.

JACUSTOMER-pg9n9bim- :

You've got me worrying about Lyme disease. I've always been aware of the danger of ticks, and I've never gone into any forested areas uncovered. I've never had anything like the "bullseye" pattern on my skin, and I don't think I've been anywhere there are ticks for at least the past 3 years. Surely I should be safe?

Dr.Customer:

Sorry :( don't mean to make you worry

JACUSTOMER-pg9n9bim- :

I haven't had any of the other more serious symptoms of Lyme disease: I don't think it is that.

Dr.Customer:

Very often that rash never appears. Lyme disease is sometimes called "the great imitator" because it can appear in so many different ways.

JACUSTOMER-pg9n9bim- :

Glad you don't mean to make me worry!

Dr.Customer:

I still am not completely satisfied that this is the answer. It is something that should be investigated as wel?

Dr.Customer:

LOL

Dr.Customer:

Just to make sure I'm not missing this -- the cramps come in areas that you were not exercising? ie cramp in hand when exercising legs.

JACUSTOMER-pg9n9bim- :

When I did the hula hooping, I experienced some localised discomfort. Then, 24 hours or so later, I felt cramps all over, many of them at the level where I was working, or nearby, but also some in locations like my jaw, and calves. I have had cramps on and off for the last 2 days since then.

Dr.Customer:

I'd like to do some more research. Can I try to get back to you later on?

JACUSTOMER-pg9n9bim- :

Absolutely. Many thanks for your help so far. Should I at this point rate you, or is it better to wait?

Dr.Customer:

You can rate me now and I will still get back to you later. If you are not satisfied so far then please wait until you are ready to rate me as excellent.

Dr. Charogat, Doctor
Category: Medical
Satisfied Customers: 1803
Experience: Licensed in both NYS and NJ with experience in surgery and medicine.
Dr. Charogat and other Medical Specialists are ready to help you
Expert:  Dr. Charogat replied 2 years ago.
Hi,

Thank you so much for the rating and the tip. I have a few more questions right now.

Can you tel me please, when you had the blood test did they test for levels of muscle protein in your blood or urine?

I just want to verify with you, you don't take any medications that are over the counter. This would include pain relief medications, oral contraceptives, medications that help decrease anxiety or depression, medications that help you stop smoking?

Have you tried drinking something like Gatorade WHILE exercising? (ie stop every few minutes, or in between sets of exercises to drink)?

Also, I shoud have asked earlier about smoking and drinking.

(Please realize that all these questions are important and there is no judgement here - so please don't be embarrased to answer a of them.)

I'l just end for right now with one thing - it seems (from the papers I've been reading now) that some researchers have found that exercising vigorously can increase the chance of having cramps in the musces being used, or other musclels. This is because it seems that as you use your musces the level of electrical impulse from your muscles that are needed to create a cramp are reduced.

I'll be looking forward to your answers. Still planning on answering later today.

G-d Bless
Customer: replied 2 years ago.

Blood test: they tested for serum creatinine and serum creatinine kinase level. Is that what you mean?

Medications: very occasionally, Panadol for pain relief. Also vitamin and mineral supplements. A herbal remedy "Quiet Life" that I started taking only after the cramping started. Nothing else.

Gatorade while exercising: I did try that once, and it didn't seem to make any difference. Again, my symptoms can come at any time, and don't seem to be specifically related to the time since I exercised.

Smoking and drinking: no.

So, could it be that I've picked up some virus that reduces the threshold needed for my muscles to cramp, so that now I'm less tolerant of exercise, especially one like hula hooping that I haven't done for a while?

[Added later] I think I'm seeing some patterns to the aggravating activities. There were several instances earlier on in this sequence when I went on the stationary bike in the gym, and later I was suffering with cramps, with a peak in symptoms about 48 hours later. It seems to be aggravating to work my stomach muscles: hula hooping is an extreme example. During this time, my long-standing IBS has flared up (increased cramping and gas), although (as ever) it comes and goes. The whole syndrome has been accompanied by autonomic symptoms, such as dizziness when standing up and occasional feeling of breathlessness, often just before or just after a bowel movement -- especially if the intestines are playing up.

I should say that this all started after I pulled a muscle in the thoracic back when doing a back rotarion. To address this, every day for a week in the gym I spent a short time lying on a foam roller to stretch out my back, until I eventually suspected that this was worsening my pre-existing neck sensitivity. Again, I am wondering if this in fact points towards an underlying problem at the abdomen/thoracic level. However, more or less simultaneously to the time I was healing the injury, I started feeling extremely tired for about a week and suffered several episodes of fast and weak pulse. (This seems gone now.) Could a virus (or something else) have infected a nerve in the thoracic area? Or should I be looking for some other reason for my cramping?

Expert:  Dr. Charogat replied 2 years ago.
Hi,

I'm reading our entire conversation again from the beginning. Something is bothering me about this but I haven't quite put my finger on it yet.

I noticed that your doctor did not test your calcium levels. That would be a very important test as abnormal calcium levels can cause many things - including cramping. Another thing is that during exercise your body displaces the calcium so that if a blood test is done then it will show a low calcium level. During the time it takes for the calcium to return to the blood (or any other time your blood calcium levels are low) your muscles are in an hyperexcitable state. I think this would be a really important test for you. Autonomic symtpoms will certainly occur in the presense of abnormal amounts of electrolytes (including calcium). I would also want to know if LD/LDH (lactate dehydrogenase) levels are normal.

The calcium levels are also of concern to me because of the episodes you mentioned of the fast weak pulse (even though it is gone now).

I am very wary of natural remedies as (at least in the USA) they are not well regulated. I also do not have much knowledge about them so I tend to stay away from them.

I don't think this is coming from a virus that you had - ie post viral syndrome. I don't think it would be an inflamed or infected nerve. When speaking about nerves there is almost always a cutoff. What I mean is that if you have a problem with your hands then the issue can be anywhere from your brain - down to where the last of the nerves for your hands are. If you have a problem with your legs then the same is true. BUT symptoms in your hands/arms would be very unlikely to come from something lower down in the body - so a lesion in your mid-lower back would not cause hand cramps.

Do you know when you can find out about getting a blood test that would be more comprehensive than the one you've had so far? I also think that with all of the different things together I would check for both Lyme (like we've already discussed), and also make sure there is no autoimmune issue going on.
Customer: replied 2 years ago.

Thanks for the ideas. There are plenty of things there I'll need to follow up on.

Just one more thing. Why do you think Lyme disease is more likely than post viral syndrome? Wouldn't they both operate by infecting the nervous system?

Expert:  Dr. Charogat replied 2 years ago.
Okay.

Please feel free to come back with any follow-up questions.

G-d Bless

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