instruction: hello doctor I have been dealing with severe lower back pain hip pain butt and leg pain fatigue insomnia hot and sweaty pain in wrist and fingers foot pain left foot my toes are curved down and one is curved to the left I do not know if this has anything to do with arthritis but there are occasional lesions in my nose and occasional neck pain I am currently taking cymbalta I have had arnold chiri malformation and underwent decompression surgery
output: hello I am sorry you are having these symptoms have you had any laboratory workups done before how about imaging studies there are many causes of your current symptoms and this makes it more complicated since you have arnold chiari malformation this includes autoimmune condition degenerative condition and metabolic conditions I would recommend that you do further testing to understand your condition I would recommend that you check your abc complete blood count of rheumatoid factor sept serum glutamic pyearuvic transaminase and got serum glutamic oxaloacetic transaminase bun blood urea nitrogen creatinine ear erythrocyte sedimentation rate cop reactive protein thyearoid function test and fbi fasting blood sugar as initial tests in the meantime I recommend that you undergo a physical therapy program to include ultrasound tens transcutaneous electric nerve stimulation william flexion exercise myofascial release joint conservation techniques range of motion exercises within pain free range endurance exercise as tolerated I would also recommend you take naproxen three times a day for pain and ibuprofen twice a day for breakthrough pain once you have the results of the tests please do follow up I hope this helps follow up with lab results