[17F] With chronic digestive issues, headaches, and multiple systemic symptoms
Patient Description
A 17-year-old female has been experiencing a range of symptoms for several months to years. She reports daily nausea and upset stomach, often worsening after eating, along with bloating and excessive gas. These symptoms started about 4 months ago, with stomach pain and cramping for the past 2 months. Pain is rated between 4-5 on average, sometimes reaching 7-8. Stools are soft, sometimes diarrhea (2-3 times on days it occurs), with a brownish-orange, sometimes greasy appearance. She has experienced unintentional weight loss of about 10 lbs over 5 months and has a reduced appetite.
She also reports daily headaches located around the eyebrows and the base of the head and neck, present for 4-5 years. The headache is described as aching, sometimes progressing to throbbing, with a severity of 4-5, occasionally higher. No specific triggers identified, but sometimes relieved by ibuprofen or magnesium.
Additional symptoms include poor circulation in hands and feet, tingling legs, shakiness upon standing for long periods, dizziness and lightheadedness, especially when rising quickly, sometimes leading to vertigo and motion sickness. She experiences periodic lower back pain, mostly when playing video games or under stress, and sometimes radiating to the shoulders. Anxiety is particularly noted during the week before her period and ovulation, and due to stomach issues. She has purple nail beds, large nail ridges, fatigue, muscle weakness, and dry skin (flaky on the face and hands, rough on the ankles). She also has keratosis pilaris (KP) on the upper arms, pale skin that does not tan easily, and sensitivity to light.
Her menstrual history includes regular periods with some cramping, but not severe. Family history includes Hashimoto's thyroiditis and hormonal imbalances. She lives in a house built in 1930 with a potential mold issue due to a roof leak. Bloodwork showed ferritin level of 30 and total iron of 215. She tested negative for celiac disease and food allergies, and her thyroid function test showed TSH level of 4, with no antibodies present.
She occasionally takes ibuprofen, Tylenol, Tums, or Pepto. Currently, she is taking supplements including ACV, vitamin D3/K2, L-glutamine, magnesium glycinate, B complex patches, adrenal support with ashwagandha, artichoke with milk thistle, periodic vitamin C, and sometimes a multivitamin.
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Arora's Assessment
What might be happening
It is likely that your daughter's symptoms are related to multiple issues, including potential deficiencies and other underlying conditions. Here are some possible explanations:
Digestive and Stomach Issues
- Irritable Bowel Syndrome (IBS): Given the chronic nature of her symptoms, including bloating, gas, and changes in stool consistency, IBS could be a possibility. IBS often worsens with stress and certain foods.
- Gastroesophageal Reflux Disease (GERD): The burning sensation and stomach pain could be related to GERD, which can cause similar symptoms.
- Food Intolerances: Even though celiac disease and food allergies were ruled out, food intolerances (e.g., lactose or fructose intolerance) could still be contributing to her symptoms.
Headaches
- Tension Headaches: The location and nature of her headaches suggest tension headaches, which can be triggered by stress, poor posture, or muscle strain.
- Migraine: Given the chronic nature and severity, migraines could also be a possibility, especially if they are accompanied by other symptoms like light sensitivity.
Circulatory and Neurological Symptoms
- Orthostatic Hypotension: The dizziness and shakiness upon standing could be due to a drop in blood pressure when standing up, known as orthostatic hypotension.
- Peripheral Neuropathy: Poor circulation and tingling in the hands and feet could be related to peripheral neuropathy, which can be caused by various factors, including vitamin deficiencies.
Other Symptoms
- Iron Deficiency: Despite the high total iron, the low ferritin level suggests that iron stores are low, which can cause fatigue, muscle weakness, and pale skin.
- Hypothyroidism: The TSH level of 4 is on the higher end of normal, which could indicate subclinical hypothyroidism, especially given the family history of Hashimoto's thyroiditis.
- Hormonal Imbalances: The worsening of symptoms during PMS and ovulation suggests that hormonal fluctuations could be contributing to her symptoms.
What you can do
Digestive and Stomach Issues
- Dietary Adjustments: Continue to monitor her diet and consider keeping a food diary to identify any potential triggers. Avoid high-fat foods that seem to worsen her symptoms.
- Hydration: Ensure she stays well-hydrated, especially if she experiences diarrhea.
- Probiotics and Digestive Enzymes: Reintroduce probiotics and digestive enzymes to support gut health.
Headaches
- Stress Management: Practice stress-reducing techniques such as deep breathing, meditation, or yoga.
- Posture: Encourage good posture and consider ergonomic adjustments to her study or gaming setup.
- Pain Relief: Continue using ibuprofen or magnesium as needed, but consult a healthcare provider for long-term management.
Circulatory and Neurological Symptoms
- Gradual Movements: Encourage her to stand up slowly to prevent dizziness and shakiness.
- Compression Stockings: Consider using compression stockings to improve circulation in her legs.
- Hydration and Salt Intake: Ensure she stays hydrated and consider increasing salt intake if advised by a healthcare provider.
Other Symptoms
- Iron Supplementation: Given the low ferritin level, consider discussing iron supplementation with a healthcare provider.
- Thyroid Function: Monitor her thyroid function regularly, especially given the family history of thyroid issues.
- Skin Care: Use moisturizers to manage dry skin and consider seeing a dermatologist for persistent issues.
General Health
- Exercise: Encourage gentle, regular exercise to improve overall health and reduce fatigue.
- Mental Health: Address anxiety through counseling or therapy if needed, especially if it is impacting her daily life.
What you should look out for
Given the complexity of her symptoms, it is important to seek medical care for a comprehensive evaluation. Reasons to seek care more urgently include:
- Severe or worsening symptoms: If any of her symptoms become significantly worse or unmanageable.
- New or unexplained symptoms: If she develops new symptoms that are concerning.
- Signs of serious conditions: Such as fainting, severe abdominal pain, or significant weight loss.
Remember, while this advice can help guide you, it is essential to consult with a healthcare provider for a formal diagnosis and treatment plan. You can also use MDandMe to journal her symptoms, track progress, get insights, and share longitudinal medical notes with her provider.
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4 mo ago