[19F] Experiencing prolonged fatigue, nausea, and other systemic symptoms

Patient Description

A 19-year-old female has been experiencing fatigue, nausea, weight loss, loss of appetite, and hair loss for the past six months. The fatigue is the most bothersome symptom, occurring every day and lasting all day long, especially worsening with any physical activity. This fatigue is making it difficult for her to keep up with house chores and work. There have been no changes in sleep patterns or quality, nor significant stress or emotional changes in the past six months. Recent blood tests showed high neutrophil absolutes. Nausea has also been present for six months, initially relieved by marijuana but now unresponsive to any treatment. She has experienced fever, nightly night sweats, and swollen lymph nodes in her neck. She has a family history of fibromyalgia and was diagnosed with endometriosis. She has not traveled to any areas with known infectious diseases in the past year. To manage her symptoms, she has used muscle relaxers and Bentyl. She is currently taking Fluoxetine 20mg every night and Jolessa birth control, both for two years. She has allergies to any antipsychotics.

Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Chronic Fatigue Syndrome (CFS)

Rationale: Your profound fatigue that worsens with physical activity and does not improve with rest is a hallmark of CFS. This condition can also cause other symptoms like muscle pain, headaches, and difficulty concentrating.
Typical Treatments/Testing: Diagnosis is often made by ruling out other conditions. Treatment focuses on symptom management, including graded exercise therapy and cognitive behavioral therapy.

2. Hematologic Disorders (e.g., Leukemia)

Rationale: High neutrophil counts, night sweats, fever, and swollen lymph nodes can be indicative of blood disorders like leukemia. These conditions can also cause fatigue, weight loss, and loss of appetite.
Typical Treatments/Testing: Blood tests, bone marrow biopsy, and imaging studies are commonly used for diagnosis. Treatment may include chemotherapy, radiation therapy, or stem cell transplant.

3. Endometriosis-Related Complications

Rationale: Endometriosis can cause systemic symptoms like fatigue and nausea. The chronic pain and inflammation associated with endometriosis can also contribute to these symptoms.
Typical Treatments/Testing: Hormonal therapies, pain management, and sometimes surgical interventions are used to manage endometriosis.

4. Autoimmune Disorders

Rationale: Conditions like lupus or rheumatoid arthritis can cause fatigue, weight loss, and hair loss. These disorders often present with systemic symptoms and can be associated with high neutrophil counts.
Typical Treatments/Testing: Blood tests for specific antibodies, imaging studies, and sometimes biopsies are used for diagnosis. Treatment often involves immunosuppressive medications.

What you can do

Fatigue, Nausea, and Weight Loss

See a doctor as soon as possible: Given the severity and duration of your symptoms, it's crucial to consult a healthcare provider for a thorough evaluation. They may recommend blood tests, imaging studies, or referrals to specialists.
Symptom Management:
- Rest: Ensure you get adequate rest and avoid overexertion.
- Nutrition: Eat small, frequent meals that are rich in nutrients to help manage nausea and maintain weight.
- Hydration: Stay well-hydrated to help manage nausea and overall well-being.

Night Sweats and Fever

Monitor Symptoms: Keep a record of your night sweats and fever episodes, including their frequency and severity.
Comfort Measures: Use lightweight bedding and wear moisture-wicking sleepwear to help manage night sweats.

Swollen Lymph Nodes

Medical Evaluation: Swollen lymph nodes, especially when accompanied by other systemic symptoms, should be evaluated by a healthcare provider to rule out serious conditions like infections or hematologic disorders.

Hair Loss

Gentle Hair Care: Use gentle hair care products and avoid excessive styling or heat treatments.
Nutritional Support: Ensure your diet includes essential nutrients like iron, zinc, and biotin, which are important for hair health.

General Health

Symptom Journal: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider. This can help in identifying patterns and triggers for your symptoms.

What you should look out for

Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Rapid Weight Loss: Significant and unexplained weight loss should be evaluated promptly.
Severe or Worsening Symptoms: If your symptoms worsen or new symptoms develop, seek medical attention immediately.
Signs of Infection: Persistent fever, chills, or signs of infection should be addressed by a healthcare provider.

Remember, while I can provide information and suggestions, it's essential to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.