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Dr.Amita
Dr.Amita, Doctor
Category: Medical
Satisfied Customers: 2127
Experience:  MD.Extensive knowledge of medicine.Faculty at a leading tertiary care teaching hospital.
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Should I see a Neurologist or Rheumatologist or Orthopaedic

Customer Question

Should I see a Neurologist or Rheumatologist or Orthopaedic Surgeon?I developed severe and apparently permanent adverse reactions as a result of Hepatitis B vaccine.
About 4 years ago I was completely healthy and very athletic before this vaccination and have now
suffered severe, debilitating autoimmune side effects from this vaccine. Such as getting joint pain,
and a limited range of motion when I lift weights in the gym, only on one side of the body, not in
both shoulders at once, just the left, previously I had no shoulder problems, I used to lift 100KG but
now I get joint pain when I lift 50KG and these started after vaccination. There's a measurable loss in
stamina before the vaccine to how I am now, I experience breathlessness much earlier when I do
cardiovascular exercise then before I had the vaccine. I have chronic fatigue and it is not improved by
getting rest. I have a dry persistent cough when there's nothing to bring up.I have a severe constant pain whenever I'm sitting down, it's on the upper left side of my abdomen, it's
always in the same place. This place hurts when I'm using my laptop or when I'm watching TV or when I'm
sitting on the bus. Sometimes I get sharp stabbing pain on the left side of my stomach. The ache seems to
dissapear after I stand up. I suffered the residual effects of all these symptoms for more than 4 years.
Submitted: 10 months ago.
Category: Medical
Expert:  Dr.Amita replied 10 months ago.

Thanks for your question.

You should see a rheumatologist and if possible an immunologist who specialise in immune mediated reactions as you feel that this is a reaction to vaccination you have had.

Customer: replied 10 months ago.
In my case only one joint is painful. Wouldn't it be better to consult a Orthopaedic surgeon?
Customer: replied 10 months ago.
What's the difference between orthopaedician and a rheumatologist? Can you please say it I did some Google searching and didn't find that much.
Expert:  Dr.Amita replied 9 months ago.

I am sorry for the late reply.

I had been offline for few days and could not access the justanswer website.

You have symptoms in addition to the joint pain.That gives another dimension to the problem.Moreover you feel that the problem has started only after the vaccination.The clinician who assesses you, has to synthesize the the different parts of the information to make a diagnosis.

If only problem was with one joint orthopaedician may have been consulted.Because you have other symptoms which orthopaedician may not be the best person to assess , you should see a rheumatologist.

Rheumatologist is trained to assess the joint pains which are due to systemic causes like auto immune disorders, connective tissue disorders or other immune system related disorders.

Orthopaedic specialists are trained to assess and treat joint pains which are due to injuries, trauma, degenerative joint conditions.They are not trained to treat joint pains related to immune disorders.

Customer: replied 9 months ago.
Should I see a Neurologist or Gastroenterologists or Immunologist? I've had normal blood tests done and it all came out fine. I'm having an Ultrasound scan soon. I eat and excrete fine, there is no problem there. The problem is when I sit down, the upper left abdominal pain starts. It's only in the seating position, the pain isn't there when I stand up or lie down flat. I showed the location of the pain to my GP and he said it's the Spleen.
Customer: replied 9 months ago.
I did legal research on case reports where the claimant won their claim regarding the injury they suffered
from as a result of Hepatitis B vaccine. 5 out of 11 case reports I found were Nerve or muscle related. That's why I feel I should also see a Neurologist
Expert:  Dr.Amita replied 9 months ago.

Nothing in your description suggests a neurological issue.In view of stomach issues you may see a gastroenterolgist as well.

Customer: replied 9 months ago.
I'm having a Ultrasound scan and if it comes out normal, then isn't it likely to be neuro-muscular related?
Customer: replied 9 months ago.
But I know it's not my stomach because when I eat, I can feel the food go down my system normally but then I sometimes get the upper left abdominal pain, it is different I can feel the stomach processing food and the upper left abdominal pain both at the same time, and they are in two different locations.
Expert:  Dr.Amita replied 9 months ago.

Ultrasound test being normal does not mean that everything is good and fine.It is just an aid at visualizing the organs inside abdomen.Your doctor has to decide what may going wrong.

Feeling pain in different location to feeling food getting processed does not mean that there is a neurological disorder.

Customer: replied 9 months ago.
do you think it is organ related then and not neuro-muscular related? I did research and found that Hepatitis B vaccine has been linked to immunological and neurological disorders.
Customer: replied 9 months ago.
I meant that the location of the pain and food being processed means that the pain is not a stomach issue
Expert:  Dr.Amita replied 9 months ago.

Location of pain in abdomen is just a rough idea regarding the pathology.It is not absolute.We cannot diagnose the condition causing pain here.We can just guide you regarding what may help.

It is advisable to see a doctor who can diagnose the cause of your pain.

Customer: replied 9 months ago.
This is a better description. I have a constant pain while I'm seated, which is focused in one specific area, on the upper left side of my abdomen. The pain isn't there when I stand up or lie down flat.
Expert:  Dr.Amita replied 9 months ago.

Change in pain with change of position indicates that this may not be related to intra abdominal pathology.Still it does not mean that it is neurological in nature.

Customer: replied 9 months ago.
The pain is related to muscle movement and positional that's why I think it's neuro-muscular.
Expert:  Dr.Amita replied 9 months ago.

It may be muscular , that does not mean neuro muscular.

Customer: replied 9 months ago.
What is the difference?
Expert:  Dr.Amita replied 9 months ago.

There would be a neurological reason like compression on a nerve or some other nerve pathology like inflammation of the nerve etc...The nature of nerve pain is different, usually radiating type.

Muscular would be due to a muscle spasm etc...

Customer: replied 9 months ago.
what tests do you recommend I do? I was thinking I should do a EMG/Nerve Conduction Studies.
Expert:  Dr.Amita replied 9 months ago.

Let your doctor decide what tests would be needed.

Customer: replied 9 months ago.
You suggested I should see a Rheumatologist to assess the joint pains which are due to systemic causes like auto immune disorders, connective tissue disorders or other immune system related disorders.So if the joint pain is related to auto immune disorders, don't you also think the upper left abdominal pain is also related to auto immune disorders meaning neuro-muscular because this pain wasn't there before having the vaccination.
Expert:  Dr.Amita replied 9 months ago.

Not necessarily.The auto immune mechanism may or may not involve nerves.

Customer: replied 9 months ago.
You're a Orthopedic doctor and you suggested I get checked by a Rheumatologist right?Does a Rheumatologist deal with upper left abdominal pain?
Expert:  Dr.Amita replied 9 months ago.

I am not an orthopedic doctor.I am a physician and I did suggest that you get yourself checked by a rheumatologist but after having had the detailed conversation with you, I feel that you may be better served by seeing an orthopaedician.

Your shoulder as well as abdominal pain which is likely to be muscular can be assessed by your orthopedic specialist.

If orthopaedician feels necessary you may see a neurologist.

Customer: replied 9 months ago.
Okay and if Orthopedic doctor feels necessary, he will do EMG/Nerve Conduction Studies right?
Expert:  Dr.Amita replied 9 months ago.

Yes, he may advise the test if he feels it to be useful.

Dr.Amita and other Medical Specialists are ready to help you
Customer: replied 9 months ago.
Do you think upper left abdominal pain could be Neuropathic pain?
Expert:  Dr.Amita replied 9 months ago.

I don't feel so.

Customer: replied 9 months ago.
Do you feel the Ultrasound will reveal the issue on Upper left abdomen or will it need to be investigated further with a CT scan?
Expert:  Dr.Amita replied 9 months ago.

Cannot tell.Your doctor may be able to tell.

Customer: replied 9 months ago.
Could it be Neuropathic pain in my upper left abdomen.
Customer: replied 9 months ago.
I have joint pain in my little toes when I walk,
sometimes the right toes and sometimes the left toes
Customer: replied 9 months ago.
There is no external abnormality, it feels like a constant pain and it hurts when I walk but when I'm sitting down or sleeping the pain isn't there on my toes.Regarding my upper left abdominal pain could it be Neuropathic pain?