[27F] Experiencing debilitating fatigue, chronic joint pain, and bloody stools

Patient Description

A 27-year-old female is reporting severe and debilitating fatigue that has been worsening over a few years, making it difficult to perform daily activities and affecting her school work. She experiences chronic joint pain rated 10/10 in severity, affecting multiple joints with associated popping and cracking noises. The pain is persistent throughout the day without any relief. She has a history of a car accident at age 17, with plates and screws placed in her left arm/hand. Additionally, she has been diagnosed with Major Depressive Disorder (MDD), severe anxiety, and PTSD about 5 years ago and is currently medicated for these conditions. She reports bloody stools every time she has a bowel movement, which has been a persistent issue despite dietary changes. She also experiences episodes of sweating and hot flashes approximately every hour, particularly noted over the past year. Sleep disturbances have been present for about 8 months, with difficulty falling or staying asleep despite medication. She reports constant thirst and has been diagnosed with epilepsy in 2012 and ADHD in 2002. Current medications include Zonegran, Trazedone, Paxil, and various vitamins (Calcium & Vit D3, Magnesium, L-lysine). No known drug allergies. The patient's symptoms suggest a complex, multisystem condition that severely impacts her quality of life.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

  • Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It's often considered when there's a history of widespread pain, and other potential causes have been ruled out.

    • Treatment typically involves a combination of medications, exercise, stress-reduction measures, and cognitive-behavioral therapy.
  • Chronic Fatigue Syndrome (CFS): This condition is characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue worsens with physical or mental activity but doesn't improve with rest.

    • Treatment is focused on symptom relief.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause bloody stools and abdominal pain. They can also cause systemic symptoms like fatigue and joint pain.

    • Treatment typically involves medications to reduce inflammation and other symptoms.
  • Diabetes: Frequent urination and excessive thirst are common symptoms of diabetes. However, it's less likely given the range of other symptoms you're experiencing.

    • Treatment typically involves lifestyle changes and medication to control blood sugar levels.

Please note that these are possibilities based on the information provided and are not a definitive diagnosis. It's important to consult with a healthcare provider for a thorough evaluation.

What you can do

  1. Schedule an appointment with your primary care provider to discuss these symptoms. They may refer you to a specialist such as a rheumatologist or gastroenterologist for further evaluation.
  2. Keep a symptom diary. Note when your symptoms occur, their severity, and any potential triggers. This can be helpful information for your healthcare provider.
  3. Try gentle exercises such as walking or swimming, which can help manage symptoms of fibromyalgia and chronic fatigue syndrome. However, it's important to start slow and gradually increase your activity level to avoid worsening your symptoms.
  4. Practice good sleep hygiene. This includes maintaining a regular sleep schedule, making your sleeping environment comfortable, and avoiding caffeine and electronic devices before bed.
  5. Consider seeking support from a mental health professional. Living with chronic symptoms can be challenging and can impact your mental health. A mental health professional can provide strategies to cope with these challenges.

What you should look out for

Seek immediate medical attention if:

  • Your joint pain is accompanied by redness, swelling, or warmth
  • You notice a significant increase in the amount of blood in your stool
  • You experience severe abdominal pain
  • You develop a fever or unexplained weight loss
  • Your symptoms significantly worsen or you develop new symptoms

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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1 yr ago

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People Also Ask


What are the common symptoms of fibromyalgia and how is it diagnosed?

Common symptoms of fibromyalgia include widespread musculoskeletal pain, fatigue, sleep disturbances, and cognitive difficulties. Diagnosis is typically based on a history of widespread pain lasting more than three months and ruling out other conditions.


How can chronic fatigue syndrome be managed effectively?

Chronic fatigue syndrome can be managed through a combination of lifestyle changes, such as pacing activities, cognitive behavioral therapy, and medications to alleviate specific symptoms like pain or sleep disturbances.


What are the signs and symptoms of inflammatory bowel disease (IBD)?

Inflammatory bowel disease (IBD) symptoms include persistent diarrhea, abdominal pain, rectal bleeding, weight loss, and fatigue. Diagnosis often involves endoscopic procedures and imaging studies.


What lifestyle changes can help manage diabetes symptoms?

Managing diabetes symptoms can involve maintaining a healthy diet, regular physical activity, monitoring blood sugar levels, and taking prescribed medications. It's also important to manage stress and get regular medical check-ups.


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