Vivelle

Editor:

I am writing to you to see if anyone can offer suggestions for a patient I am treating. This is a mid-50's white female with a 4-to-5-year history of nonspecific neuromuscular disorder which seemed to follow a fairly-severe upper respiratory viral infection. She has been seen by multiple neurologists, rheumatologists, and has had an extensive workup at the Mayo Clinic where the diagnosis was made of a nonspecific neuromuscular disorder, and on some of the notes it was described as a tic.

She has a history of recurrent sinus infections, bilateral mastectomies with silicone implants 7-8 years ago for preventive measures, congenital heart valve defect, recurrent yeast infections, and had a hysterectomy and oophorectomy approximately 1-1/2 years ago for fibroids and increased bleeding. She also has been noted to have intermittently-elevated ANA, intermittently-abnormal thyroid function testing, and a slightly-elevated rheumatoid factor. She has also tested negative for Mycoplasma through PCR testing. Her present medications include Olonazepam 0.25 mg t.i.d., Vivelle patch 2x weekly; and calcium, iron, and multivitamin supplements.

Most recently I have seen her with a flare-up of her ongoing symptoms which she states starts with a sleep disturbance, then stiffness of muscles all over, sinus congestion, trouble swallowing, tingling in her arms greater than her legs, and severe fatigue. She also presented with what appeared to be myoclonic-type jerks which would happen occasionally every 5-10 minutes. She states that the flare-up seems to be worse when she has decreased sleep or salt, sugar, or nutri-sweet intake and will last 4-6 weeks if she just rests.

Presently I am at a loss of where to proceed with this lady and would appreciate any comments from readers.

Mark L. Martin, DO

Medical Office Building, Suite 200

825 Mankato Ave.

Winona, Minnesota 55987 USA

507-452-3233

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