[23F] With chronic pain, fatigue, and neurological symptoms

Patient Description

A 23-year-old female presents with a range of symptoms affecting her daily life. She reports experiencing lower abdominal pain for months, described as cramping and bloating, with a severity of 6 out of 10. This pain worsens when she is on her feet for long periods or around her menstrual period, and ibuprofen provides temporary relief. She also has daily lower back pain, mostly dull but sometimes radiating down her legs and into her buttocks. For the past two years, she has been feeling lightheaded, sometimes accompanied by her vision going black, and rates this as severe. She experiences brain fog, fatigue, and low energy every day. Additionally, she suffers from headaches a couple of times a week, with sharp shooting pains rated 7 out of 10 and dull headaches rated 5 out of 10. She has constant muscle and joint pain, sleeps excessively, and has gained weight due to lack of activity caused by her symptoms. Her menstrual periods have always been very painful, with severe cramps, heavy bleeding, acne, and mood swings. She has not been given a true diagnosis for these symptoms but has been told they might be related to long COVID or POTS. She is currently taking Zoloft 75mg daily and has tried various over-the-counter medications, supplements, and herbal remedies inconsistently. She has no known allergies or adverse reactions to medications.

Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses that could explain your condition. Here are some possibilities:

1. Postural Orthostatic Tachycardia Syndrome (POTS)

Rationale: POTS can cause symptoms like lightheadedness, fatigue, brain fog, and headaches. It often worsens with prolonged standing and can be associated with other symptoms like abdominal pain and muscle/joint pain.
Typical Treatments/Testing: Diagnosis often involves a tilt table test, blood tests, and heart rate monitoring. Treatment may include lifestyle changes, increased fluid and salt intake, medications to manage heart rate and blood pressure, and physical therapy.

2. Long COVID

Rationale: Long COVID can present with a wide range of symptoms, including fatigue, brain fog, headaches, muscle/joint pain, and gastrointestinal issues like abdominal pain and bloating.
Typical Treatments/Testing: There is no specific test for Long COVID, but a thorough evaluation by a healthcare provider can help. Treatment focuses on symptom management, which may include medications, physical therapy, and lifestyle modifications.

3. Chronic Fatigue Syndrome (CFS)

Rationale: CFS can cause severe fatigue, brain fog, muscle/joint pain, headaches, and sleep disturbances. It often overlaps with other conditions like POTS.
Typical Treatments/Testing: Diagnosis is based on clinical criteria, as there is no specific test. Treatment focuses on managing symptoms through medications, cognitive behavioral therapy, and graded exercise therapy.

4. Endometriosis

Rationale: Endometriosis can cause severe menstrual cramps, lower abdominal pain, and lower back pain. It can also contribute to fatigue and other systemic symptoms.
Typical Treatments/Testing: Diagnosis may involve pelvic exams, ultrasounds, or laparoscopy. Treatment options include pain medications, hormonal therapies, and sometimes surgery.

What you can do

Lightheadedness and Fatigue

See a doctor: It's important to consult a healthcare provider to evaluate for conditions like POTS or Long COVID. They may recommend tests like a tilt table test or blood work.
Stay hydrated: Drink plenty of fluids and consider increasing your salt intake, but consult your doctor first.
Compression stockings: These can help improve blood flow and reduce lightheadedness.

Brain Fog

Cognitive exercises: Engage in activities that stimulate your brain, such as puzzles or reading.
Healthy diet: Eat a balanced diet rich in fruits, vegetables, and whole grains to support brain health.
Sleep hygiene: Maintain a regular sleep schedule and create a restful sleep environment.

Lower Abdominal and Back Pain

Pain management: Continue using ibuprofen as needed, but consult your doctor for long-term pain management strategies.
Physical therapy: A physical therapist can help with exercises to strengthen your back and improve posture.
Heat therapy: Applying a heating pad to your lower back and abdomen can help relieve pain.

Headaches

Track triggers: Keep a headache diary to identify potential triggers and discuss them with your doctor.
Pain relief: Over-the-counter pain relievers like ibuprofen can help, but consult your doctor for persistent headaches.

Menstrual Issues

Consult a gynecologist: A specialist can evaluate for conditions like endometriosis and recommend appropriate treatments.
Pain relief: Over-the-counter pain relievers and heat therapy can help manage menstrual cramps.

General Tips

Regular exercise: Engage in low-impact activities like walking or swimming to improve overall health and reduce symptoms.
Symptom journal: Use MDandMe to journal your symptoms, track progress, and share insights with your healthcare provider.

What you should look out for

Given the complexity and severity of your symptoms, it's important to seek medical care. Reasons to seek care more urgently include:

Severe or worsening symptoms: If your symptoms become more severe or new symptoms develop.
Fainting or severe dizziness: Especially if accompanied by vision changes or blackouts.
Unexplained weight loss: Significant weight changes without trying.
Severe pain: Any pain that becomes unbearable or significantly impacts your daily life.

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