[18F] Experiencing pica, shortness of breath, insomnia, and chest pain

Patient Description

An 18-year-old female has been experiencing a strong craving for ice, known as pica, since July of 2023, particularly when at work around ice. Additionally, she has been dealing with shortness of breath for about two years, rating the severity as 5.5-6, which occurs randomly, often after eating ice or lying down after work. She has difficulty falling asleep, taking 30 minutes to 2 hours to do so and typically sleeps for 4-6 hours a night. This issue has persisted long enough that she is unsure if it affects her daytime concentration, though she recalls struggling during an SAT exam. She experiences headaches and has noted her skin is pale, with her lips having a blue tint and her veins being very noticeable. Recently, she mentioned experiencing chest pain for about two years, described as feeling like needles stabbing her chest with every inhale, making it difficult to breathe deeply. She has not noticed any heart palpitations and is not currently taking any medications.

Arora's Assessment

What might be happening

Based on the information you've provided, the following conditions might be considered:

Iron Deficiency Anemia: This condition occurs when your body doesn't have enough iron to produce hemoglobin, the part of red blood cells that gives them their red color and enables them to carry oxygen around your body. Symptoms can include fatigue, weakness, pale skin, shortness of breath, and pica (craving and chewing substances that have no nutritional value, such as ice).
- Diagnosis typically involves a blood test to check your hemoglobin and hematocrit levels, as well as your iron levels. Treatment usually involves iron supplements and changes to your diet to include more iron-rich foods.
Anxiety or Stress: Difficulty falling asleep and maintaining concentration can be symptoms of anxiety or stress. However, you've mentioned that you don't believe you're experiencing increased stress or anxiety at this time.
- Cognitive-behavioral therapy (CBT) and medication are common treatments for anxiety. Lifestyle changes, such as regular exercise, a healthy diet, and good sleep hygiene, can also help manage symptoms.
Hypoxia: This is a condition in which not enough oxygen makes it to your cells and tissues. Symptoms can include shortness of breath, headaches, and blue coloration of the lips or skin. Hypoxia can be a serious condition and should be evaluated by a healthcare professional.
- Treatment depends on the severity and cause of your hypoxia. It may include oxygen therapy or procedures to help your lungs work better.

What you can do

Seek medical attention: Given the severity and duration of your symptoms, it's important to see a healthcare professional who can provide a formal diagnosis and appropriate treatment.
Keep a symptom diary: This can help you and your healthcare provider identify any patterns or triggers related to your symptoms.
Maintain a balanced diet: Eating a diet rich in iron can help prevent iron deficiency anemia. Foods high in iron include red meat, poultry, seafood, and leafy green vegetables.