<s>[INST] Hello doctor, I am experiencing muscle pain and joint pain for ten years which consistently got worse. The recent diagnosis shows leukocytosis. My WBC is consistently high at around 13000 - 15000. I also suffer fibromyalgia, migraines, TIA, unknown source of seizures, peripheral neuropathy, left hemiparesis, muscle disorder, muscle spasm-paraesthesia, diabetic type 2, AVN of hips, DDJ and DDD disease. I am currently taking Bacoflen 20 mg four times a day, Cymbalta 30 mg once daily, Valium 5 mg, Gabapentine 300 mg four times a day, Humalog, Metformin 1000 two times a day, Bydureon Pen once a week, and Medical Cannabis. I consulted a rheumatologist and a neurologist. Rheumatologist swore it was Lupus. The neurologist swore it was SPS. My recent lab report: Complement component C3C - 188H Range 90-180 (twice tested). Glucose 168 mg/dL. Alpha 1 globulin 4H - Range 0.2 - 0.3. Gamma globulin 7L - Range 0.8 - 1.7. Vitamin D - 18L - Range 30 - 100. C-reactive protein 0.83H. [/INST] Hello. Your main presentation is chronic muscle pain and joint pain. For that specific cause rule out first like connective tissue disorder, muscle dystrophy, neuropathic pain, spinal problem, HIV, thyroid issue, etc. For connective tissue panel testing, CT scan, serum TSH (thyroid-stimulating hormone) estimation, serum T4 estimation like investigations are useful. Here neurologist may perform investigation like NCV (nerve conduction velocity), EMG (electromyography), for finding the specific cause. According to the cause further specific treatment will be given. If SLE (systemic lupus erythematosus) suspected by rheumatologist then it will be confirmed by connective tissue panel testing that includes testing of anti-dsDNA, anti-Sm, etc. You are prescribed Gabapentine, muscle relaxant and Duloxetine drugs and these drugs can cause fibromyalgia or chronic fatigue syndrome. Control your diabetes as it can lead to neuropathic pain and other complications. As per report vitamin D looks out of range that is low, so for that Cholecalciferol sachet can be taken with milk once a week. </s>