[23F] With chronic gastrointestinal and musculoskeletal symptoms

Patient Description

A 23-year-old female has been experiencing a variety of symptoms including nausea, diarrhea, constipation, indigestion, fatigue, low back pain, and headaches. The nausea has been ongoing for 8 months, occurring multiple times a day, each episode lasting about 30 minutes to an hour, with some relief from Tums. Constipation has been an issue for a year and a half, managed with iron and vitamin B12 supplements due to low levels found in bloodwork almost 3 years ago, and 100 mg of docusate sodium taken twice a day. Joint pain is present in the wrists (1.5 years), knees (4 years), and ankles (8 years), with stiffness in almost every joint. The pain is usually a dull ache, sometimes sharp, and rarely throbbing, with a severity of 5 on average and 8 when sharp. Muscle pain is present in the upper back (7 months), neck, and shoulders (4 years), particularly around the shoulder blades and trapezius muscle, with a severity of 7 out of 10. Chronic low back pain has been present for over 5 years. Throbbing headaches in the temples and front/face occur multiple days a week for about 4 months, with severity ranging from 3 to 8 out of 10. Lightheadedness and dizziness, especially when standing up too fast or moving the head suddenly, often accompanied by blurred or black vision, nausea, or hot flashes, have been severe and returned about 3 months ago after being managed with supplements for low iron and B12. Diarrhea has been ongoing for 8 months, with bowel habits varying significantly. Bloating occurs in the lower belly and upper stomach most days for the past few years, possibly worsened by dairy and gluten. Other symptoms include burping, excessive gas, heartburn, and indigestion (severity of 7 out of 10 on average). The patient also experiences fatigue, sweating, sensitivity to light and temperature, abdominal pain or cramping associated with nausea, hunger, and feeling full, weight fluctuations, hemorrhoids and anal fissures, occasional fever or chills, and no diagnosis of gastrointestinal conditions like IBS, GERD, or Celiac Disease. The patient has ADHD, anxiety, and depression diagnosed in April 2020, February 2021, and December 2021, respectively. There are no known allergies or adverse reactions to medications. Current medications include Adderall XR 20mg once daily, Lamotrigine 50mg once daily, Sertraline Hydrochloride 100mg once daily, Iron 65mg once daily, B12 1000mcg once daily, Docusate Sodium 100mg twice daily, Loratadine 10mg once daily, and a Women's Multivitamin 75mg once daily. The patient has also been prescribed Junel Fe birth control but has not taken it for almost 3 months. Family history includes seasonal and animal dander allergies, asthma, high blood pressure, high cholesterol, hypothyroidism, heart disease, Alzheimer's disease, multiple sclerosis, sleep apnea, chronic lymphocytic leukemia, dementia, diabetes, breast cancer, bladder cancer, heart disease, and strokes.

Arora's Assessment

What might be happening

It is likely that your symptoms are related to multiple issues, including existing diagnoses. If you have more questions, we can continue chatting.

Causes of your nausea, diarrhea, constipation, and indigestion:

Irritable Bowel Syndrome (IBS): This condition can cause a combination of diarrhea, constipation, bloating, and abdominal pain. It is often triggered by stress, certain foods, or hormonal changes.
Gastroesophageal Reflux Disease (GERD): This can cause indigestion, nausea, and bloating. It occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach.
Food Intolerances: Sensitivity to dairy and gluten can cause bloating, diarrhea, and indigestion.

Causes of your fatigue and sweating:

Anemia: Given your history of low iron and B12 levels, anemia could be contributing to your fatigue and sweating.
Thyroid Issues: Hypothyroidism or hyperthyroidism can cause fatigue, sweating, and sensitivity to temperature.

Causes of your lower back pain, joint pain, and muscle pain:

Fibromyalgia: This condition can cause widespread muscle pain, joint pain, and fatigue. It is often accompanied by other symptoms like headaches and lightheadedness.
Chronic Pain Conditions: Conditions like arthritis or other musculoskeletal disorders can cause chronic joint and muscle pain.

Causes of your lightheadedness and headaches:

Postural Orthostatic Tachycardia Syndrome (POTS): This condition can cause lightheadedness, dizziness, and blurred vision when standing up quickly. It is often associated with fatigue and headaches.
Migraines: These can cause throbbing headaches, sensitivity to light, and sometimes nausea and dizziness.

What you can do

Nausea, diarrhea, constipation, and indigestion:

Dietary Changes: Consider eliminating dairy and gluten from your diet to see if your symptoms improve. Keep a food diary to track what you eat and how it affects your symptoms.
Hydration: Drink plenty of water to stay hydrated, especially if you are experiencing diarrhea.
Over-the-Counter Medications: Continue using Tums for indigestion. You might also consider over-the-counter anti-diarrheal medications like loperamide (Imodium) for diarrhea.
Consult a Doctor: See a healthcare provider to discuss your gastrointestinal symptoms. They may recommend tests like a colonoscopy, endoscopy, or food allergy testing.

Fatigue and sweating:

Iron and B12 Supplements: Continue taking your iron and B12 supplements as prescribed.
Balanced Diet: Eat a balanced diet rich in fruits, vegetables, lean proteins, and whole grains to support overall health.
Consult a Doctor: Discuss your fatigue and sweating with your healthcare provider. They may want to check your thyroid function and other potential causes.

Lower back pain, joint pain, and muscle pain:

Physical Therapy: Consider seeing a physical therapist for exercises and treatments to manage your pain.
Pain Management: Use over-the-counter pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol) as needed, but do not exceed the recommended dosage.
Heat and Cold Therapy: Apply heat or cold packs to the affected areas to help reduce pain and inflammation.
Consult a Doctor: Discuss your chronic pain with your healthcare provider. They may recommend imaging studies or refer you to a specialist for further evaluation.

Lightheadedness and headaches:

Hydration: Ensure you are drinking enough water throughout the day.
Slow Movements: Stand up slowly and avoid sudden head movements to reduce lightheadedness.
Consult a Doctor: Discuss your symptoms with your healthcare provider. They may want to check your blood pressure, heart rate, and other potential causes.

What you should look out for

Given the complexity and severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Severe abdominal pain or cramping
Blood in your stool or vomit
Unexplained weight loss
Fainting or severe dizziness
Severe headaches or changes in vision

Remember, I am not a doctor, and it is important to consult with a healthcare professional to receive a formal diagnosis and appropriate treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.