[19O] With joint pain, shortness of breath, and dizziness
Patient Description
A 19-year-old individual assigned 'other' at birth presents with joint pain, shortness of breath, and dizziness. The joint pain is constant throughout the day, making the joints feel weak, stiff, or like they need to be popped, rated as a 6 out of 10 in terms of severity. Occasionally, the knees and ankles get slightly swollen. The patient experiences shortness of breath, especially when going up or down stairs, with a severity of 3 when going down and 6 when going up. The patient has asthma, but the shortness of breath feels different from usual asthma symptoms. Dizziness occurs particularly when standing up quickly, described as the room spinning and feeling like they might fall over. This sensation lasts about a minute and occurs at least once a day, rated as 5-6 out of 10. Sitting back down or holding onto a wall helps alleviate the dizziness. The patient has not been diagnosed with conditions related to blood pressure or inner ear issues and has not had blood pressure checked when moving from sitting to standing. Sharp chest pain occurs occasionally, lasting from a few minutes to up to an hour, with deep breathing being painful during these episodes. There are no palpitations, irregular heartbeats, or episodes of fainting. The patient has ARFID, an autism-related eating disorder, and typically has 1-2 meals a day but stays hydrated. Medications include a daily allergy pill and a rarely used rescue inhaler for asthma. There is no use of tobacco, alcohol, or recreational drugs. The family history includes heart disease, stroke, cancer, and mental illness/neurodivergency. The patient was diagnosed with autism and possible ADHD this past year.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, here are some possible explanations:
Joint Pain
- Osteoarthritis: This is a common cause of joint pain, especially if it has been ongoing for years. It involves the wear and tear of cartilage in the joints.
- Rheumatoid Arthritis: This is an autoimmune condition that can cause chronic joint pain, stiffness, and swelling.
Shortness of Breath
- Asthma: Even though you mentioned that this feels different from your usual asthma symptoms, asthma can still present with varying degrees of shortness of breath.
- Deconditioning: Given that you haven't been as active recently, your cardiovascular fitness might have decreased, making you more prone to shortness of breath with exertion.
Dizziness
- Orthostatic Hypotension: This condition involves a sudden drop in blood pressure when standing up, leading to dizziness and a spinning sensation.
- Vestibular Issues: Problems with the inner ear can cause dizziness and a sensation of the room spinning.
Chest Pain
- Musculoskeletal Pain: Given that the pain worsens with deep breathing, it could be related to the muscles and bones in your chest.
- Asthma: Sometimes, asthma can cause chest tightness and pain, especially during flare-ups.
What you can do
Joint Pain
- Consult a Doctor: It's important to get a proper diagnosis. Your doctor may recommend imaging tests like X-rays or MRIs.
- Over-the-Counter Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.
- Physical Therapy: Exercises to strengthen the muscles around your joints can help alleviate pain and improve function.
Shortness of Breath
- Asthma Management: Make sure your asthma is well-controlled. Use your rescue inhaler as needed and consult your doctor for a possible adjustment in your asthma management plan.
- Gradual Exercise: Slowly reintroduce physical activity to improve your cardiovascular fitness. Start with light activities and gradually increase the intensity.
Dizziness
- Hydration: Ensure you are well-hydrated, as dehydration can worsen dizziness.
- Slow Movements: Stand up slowly from sitting or lying positions to give your body time to adjust.
- Consult a Doctor: A healthcare provider can check your blood pressure and possibly recommend further tests to determine the cause.
Chest Pain
- Consult a Doctor: Given the severity and nature of your chest pain, it's important to rule out any serious conditions. Your doctor may recommend tests like an ECG or chest X-ray.
- Avoid Triggers: Try to identify and avoid activities that trigger your chest pain.
What you should look out for
Given the complexity of your symptoms, it's important to seek medical care to get a comprehensive evaluation. Here are some red flags that warrant immediate medical attention:
- Severe Shortness of Breath: If you experience severe shortness of breath, especially if it comes on suddenly.
- Chest Pain: If your chest pain becomes severe, persistent, or is accompanied by other symptoms like sweating, nausea, or radiating pain.
- Fainting: If you experience episodes of fainting or near-fainting.
- Severe Joint Swelling: If you notice significant swelling, redness, or warmth in your joints.
Remember, while I can provide some guidance, it's crucial to consult with a healthcare professional for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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4 mo ago