[27F] With chronic fatigue, abdominal pain, and migraines
Patient Description
A 27-year-old female presents with extreme fatigue persisting for a week, with episodes occurring on and off for 14 years. The fatigue is severe enough to interfere with daily activities, causing prolonged sleep without feeling rested. The patient reports chronic lower right abdominal pain, described as a sensation of a balloon about to pop, with a pain intensity ranging from 4 to 9 out of 10. This pain has been present for 15 years, despite the absence of an appendix. Additionally, the patient experiences inconsistent stool patterns and frequent infections, contributing to a general feeling of weakness. Previously a boxer, she now struggles with walking and experiences joint and muscle aches. Migraines are described as throbbing and sharp, reaching a severity of 10 out of 10, and have been a recurring issue. The patient also reports heavy menstrual bleeding for the past 3-5 years. Blood tests indicate low platelets, monocytosis, elliptocytes, ovalocytes, and high vacuolated neutrophils.
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Arora's Assessment
What might be happening
Your symptoms suggest a complex situation that may involve multiple issues. Here are some possibilities:
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Hematological Concerns:
- Low Platelets and Blood Cell Changes: These could indicate a blood disorder or bone marrow issue. Conditions like anemia or other hematological disorders might be considered. Testing often includes blood work and possibly a bone marrow biopsy.
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Chronic Fatigue:
- Chronic Fatigue Syndrome or Anemia: Given your long history of fatigue, these could be possibilities. Anemia, especially, can cause fatigue, paleness, and weakness. Treatment may involve addressing the underlying cause, such as iron supplementation for anemia.
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Abdominal Pain:
- Gastrointestinal Issues: Chronic pain in the lower right abdomen could be related to gastrointestinal conditions, even without an appendix. Imaging studies or endoscopy might be needed for further evaluation.
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Migraines:
- Chronic Migraine: Your description fits with severe migraines, which can be debilitating. Treatment often includes medications to prevent and relieve migraines.
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Menorrhagia (Heavy Periods):
- Hormonal Imbalances or Uterine Conditions: These could be contributing to your heavy periods. An evaluation by a gynecologist might include hormonal tests or an ultrasound.
What you can do
Fatigue and Weakness:
- See a healthcare provider: It's important to get a thorough evaluation to identify any underlying conditions.
- Track your symptoms: Use MDandMe to journal your fatigue levels, activities, and any triggers.
Abdominal Pain:
- Consult a doctor: They may recommend imaging or other tests to determine the cause.
- Dietary adjustments: Sometimes, dietary changes can help manage symptoms.
Migraines:
- Identify triggers: Keep a migraine diary to track potential triggers.
- Pain management: Over-the-counter pain relief or prescribed medications can help.
Heavy Periods:
- Gynecological evaluation: A healthcare provider can assess for hormonal or structural causes.
- Monitor your cycle: Note any changes in your menstrual cycle using MDandMe.
What you should look out for
- Seek immediate care if you experience:
- Severe abdominal pain or changes in consciousness.
- Signs of severe anemia, such as fainting or chest pain.
- Worsening of any symptoms or new symptoms.
Remember, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan.
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3 mo ago
