Neurological & musclular symptoms for over a year

[Adam67]

In April 2010 I had two weeks in which I felt wiped out and went to bed at about 8pm, I also started having issues with sexual dysfunction. Between April and August I slowly developed tingling in my hands and feet, left hand most involved, muscle pain in both calves and hamstrings and my right arm and I sometimes felt dizzy.
I went to the docs in August 2010 and they ran a load of tests, electrolytes, vitamin, diabetes, tests for weird diseases causing muscle breakdown etc. All were fine apart from having raised liver enzymes.
In November the doc gave me quinine which helped with the muscle pain a lot.
I went to the optician about my dizzyness in August, got glasses for near sightedness and the dizzyness went right away and has not returned. I have developed muscle twitching all over which seems intermittent.

In the last week I've noticed I have worse tingling in both hands and worse pain in both legs all over. All symptoms are symetrical. Apart from that my right shoulder clicks and pops like mad and seems to tire more easily.
I have no muscle weakness as I train with heavy weights daily so would know right away. I have take cialis over the last week and wonder if this can cause tingling? So, could this be MS as I have been worried about? My symptoms don't come and go to any great extent however, I have plenty of energy and heat doesn't bother me. However whenever I look up my symptoms, MS!

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

You have a constellation of symptoms that is difficult to classify into one diagnosis based on the information you provided. If the symptoms are worse in the hands and feet, this can be caused by a process called a neuropathy. There are 2 types of nerves that provide sensation to the feet, large nerves and small nerves. A problem with either of these could lead to burning and tingling. There are many many causes to this group of disorders called "neuropathies". They include but are not limited to most commonly diabetes, vitamin deficiencies, autoimmune disorders such as lupus or a disease called Sjogren's, certain types of neoplasm, and certain toxins (such as lead). As I mentioned, there are several other genetic, metabolic, and hereditary disorders that cause neuropathy, and what tests need to be ordered depend on the history and physical examination of the patient. With small fiber neuropathy, the EMG/NCS test which measures how nerves conduct electricity and how muscles respond to them may be normal. In large fiber neuropathy, it will be abnormal. Small fiber neuropathy can be diagnosed with a skin biopsy and with a test called a QSART.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve. Fibromyalagia is another medical condition that leads to whole body pains, and is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.

Regarding the MS aspect of the question, it is an inflammatory demyelinating disease that affects the central nervous system. To make the diagnosis there are specific criteria, in which objective neurologic findings are present affecting 2 or more locations in the nervous system in 2 or more episodes. In order to make this diagnosis, a detailed history and neurologic examination is required. MRI is very helpful and needed.

Lastly, post-infectious processes (such as a virus) can cause muscle aches.

These are just a few possibilities. I suggest you follow up with a neurologist at some point for a thorough workup.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Adam67]

Stress and emotional problems was something I've considered as over the last two years I've had a lot of problems in my family and financial life to deal with.

My Doctor felt my symptoms were less likely to be something horrendous due to their widespread and general nature.
I will see about a neurological work up to try and shed some light.

Thank you very much for your reply.