Patient: I would like to know what tests I should have done as I am concerned about my symptoms – my health has deteriorated quite drastically over the last year. I will list my symptoms and highlight what has been found in the results of my latest tests. I am 38 yrs old. Symptoms: 1. Fatigue 2. Joint and muscle pain – on a bad day my whole body aches. My back is really sore and on a bad day I can hardly walk, but even on a good day I cannot walk for more than 15 minutes before I am in agony. Over the past two weeks my right upper leg and knee has been considerably more swollen than my left leg. 3. My ring size has gone up by at least 3 sizes (on a good day – on a bad day it is 4 sizes) over the last year despite the fact that I have lost weight over the last year – I have come down from a size 18-20 to a size 14-16 (US) or 46-48 down to a size 42-44 (Euro). 4. Occasional chest pain (when I get really stressed) and palpitations. 5. Quite severe night sweats and if I do housework in the winter even – after about 20mins I am red in the face and sweating and get very hot. 6. Yellowish lumps under my eyes and my skin has become patchy (photo attached of six months ago and now). 7. Numb patches especially on my legs (so if I run my fingers down my leg there are patches of numbness). 8. Numbness or pins and needles quite frequently down side of my arms and in my pinkie and ring fingers. 9. Shortness of breath sometimes, especially when the pain has been severe and I have taken Ibuprofen, but the pain makes me nauseous at times. 10. For four months I had a kidney infection and had 5 courses of antibiotics which did not seem to help. I then developed a pelvic infection which was not sexually related and after results came back, the antibiotic prescribed finally cleared up the infection. 11. For no apparent reason and without warning, if I have been on my feet too long, my legs just give in and I fall – this happened previously for about a year after I had a herniated disc. When I have been on my feet like this and am in a lot of pain, I am unable to lift my legs, so if I want to get in the car for instance, I physically have to lift my leg in with my hands. 12. I also have been getting repeated boils. Tests: 1. I requested a menopause test as I thought that possible due to the night sweats etc. However, that came back normal, except for the cholesterol, which was 8.0 – glucose etc was normal. Due to my age and my mother’s failure to tell me about the history (she has the genetic cholesterol and is on statins) I would not normally have received a cholesterol test as I am considered too young – it was only done at my request. There is a history of genetic cholesterol in my family on my mother’s side and some have died quite young from heart attack. However, the doctor wants to run further tests 3 months later which will be in a month’s time and wait before putting me on statins dependent on the results of the next blood tests. 2. Next I requested testing for rheumatoid arthritis as this is also in my family and due to the increasing pain and stiffness in my joints especially my fingers which my right index finger has a small lump growing on the joint nearest my finger nail and it hurts and is stiff. The tests for the rheumatoid arthritis came back negative, but my overall white cell count was high and this is what the result said: Eosinophilia. Normal RBC and platelet populations. ESR fell within normal at 19mm per hr. The C Reactive protein was also flagged at 7.6mg per L. 3. I normally have a blood pressure of around 110 over 70, sometimes a little lower. But over the last year, my blood pressure has increased to at least 140 over 85, sometimes higher. My normal pulse rate is between resting at around 80-85 and 97 when I am very scared or nervous, but this has also increased to over 100 at resting – if I walk on the treadmill at a reasonably slow pace, within less than two minutes my pulse is over 170 and I battle to catch my breath. If I want to be able to keep breathing, I have to walk very slowly.
Doctor: Thank you for the detailed story. When I hear stories like this of multiple symptoms a system disease should be consider ed over multiple diseases. Systemic diseases that should be tested for include endocrine conditions, blood cell disorders and inflammatory disorders. It appears that has already been tested for in yourself and the results have come back negative. Other conditions that should not be overlooked include cancers and if multiple imaging is required, then you may have to go through several tests. As a starting point, chest x ray, an ultrasound of the abdomen and consideration of CT’s of the chest and abdomen should be discussed with your doctor.If a diagnosis is found – great – treatment can begin. If a diagnosis is not found, the possibility of stress and poor lifestyle or life balance should not be overlooked. I have seen many patients in your situation where all the symptoms resolved with a change of job in addition to improved exercise and diet.If stress and poor lifestyle are not a possibility or you are unable or unwilling to adjust, then I always recommend a consultation with a naturopathic doctor to see if non medical alternatives may work for your symptoms – This requires some trial and error bu it may be beneficial.I wish you good luck