[25F] Experiencing unilateral weakness, shortness of breath, and stress incontinence

Patient Description

A 25-year-old female reports a constellation of symptoms including weakness of the hand, forearm, and thigh, as well as upper calf muscle weakness on the left side. She also experiences swelling in the left thigh, dizziness, mild disorientation, profound fatigue, and stress incontinence. The patient notes that the more severe weakness is accompanied by dizziness. She has been dealing with these symptoms for approximately a month, with shortness of breath that is not constant but can be severe at times. The shortness of breath is exacerbated by prolonged talking and mild exercise but can sometimes be alleviated by deep breathing or yawning. The patient has a history of fibromyalgia diagnosed in 2020 and autonomic dysfunction diagnosed in 2018. She also reports a family history of autoimmune conditions, including lupus and Sjogren's syndrome in her mother. Currently, the patient is taking Vyvanse for ADHD, which she started 2 months ago, and is on a 30 mg dose for the past month. She uses NuvaRing for birth control. She has allergies to Zithromax, Tamiflu, and Reglan. No recent evaluations for autoimmune conditions have been conducted.

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Arora's Assessment

What might be happening

Based on the information you've provided, several conditions could be causing your symptoms:

  • Fibromyalgia: This is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas. Your symptoms of profound fatigue, muscle weakness, and nerve pain could be related to fibromyalgia. However, fibromyalgia typically doesn't cause localized swelling like you're experiencing in your left thigh.

    • Treatment usually involves a combination of medication, exercise, stress management, and healthy lifestyle habits.

  • Autonomic Dysfunction: Also known as dysautonomia, this condition occurs when your autonomic nervous system (which controls functions like heart rate, blood pressure, and bowel and bladder emptying) doesn't work properly. This could explain your symptoms of shortness of breath, stress incontinence, and possibly your episodes of disorientation and profound fatigue.

    • Treatment typically involves managing symptoms and any underlying conditions.

  • Side Effects of Medication: Some of your symptoms, such as mood swings and increased heart rate, could be side effects of your ADHD medication, Vyvanse. However, this wouldn't explain all of your symptoms.

  • Autoimmune Disease: Given your family history of lupus and Sjogren's syndrome, it's possible that an autoimmune disease could be causing some of your symptoms. Many autoimmune diseases can cause a wide range of symptoms, including fatigue, muscle weakness, and swelling.

    • Treatment typically involves managing symptoms and reducing immune system activity.

What you can do

As an AI, I can't diagnose you, but I recommend that you seek medical attention. Your symptoms are complex and require a thorough evaluation. Here are some steps you can take:

  1. Schedule an appointment with your primary care doctor. They can perform a physical exam and order tests to help determine what's causing your symptoms.
  2. Keep a symptom diary. Note when each symptom occurs, how long it lasts, and any potential triggers. This can help your doctor identify patterns and potential causes.
  3. If you're concerned about side effects from your medication, don't stop taking it without talking to your doctor first. They can help you weigh the benefits and risks, and they may be able to adjust your dosage or switch you to a different medication.

What you should look out for

Seek immediate medical attention if you experience:

  • Sudden, severe shortness of breath
  • Chest pain
  • Sudden, severe weakness, especially on one side of your body
  • Sudden, severe headache
  • Difficulty speaking or understanding speech
  • Loss of balance or coordination
  • Sudden vision changes

These could be signs of a serious condition, such as a heart attack or stroke.

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9 mo ago

People Also Ask

Can fibromyalgia cause muscle weakness and swelling in specific areas?

Fibromyalgia is known for causing widespread musculoskeletal pain and fatigue, but it typically does not cause localized swelling. Muscle weakness can occur, but swelling in specific areas might suggest another underlying issue.

What are common symptoms of autonomic dysfunction?

Common symptoms of autonomic dysfunction include dizziness, fainting, problems with heart rate and blood pressure, digestive issues, and bladder control problems. It can also cause fatigue and disorientation.

Could Vyvanse be causing some of my symptoms?

Vyvanse, a medication for ADHD, can cause side effects such as increased heart rate, mood swings, and anxiety. However, it may not explain all of your symptoms, especially those related to muscle weakness and swelling.

How can a family history of autoimmune diseases affect my health?

A family history of autoimmune diseases like lupus and Sjogren's syndrome can increase your risk of developing similar conditions. Autoimmune diseases can cause a variety of symptoms, including fatigue, muscle weakness, and swelling, and may require specific tests for diagnosis.

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