[35F] Experiencing severe pain, cognitive decline, and other symptoms

Patient Description

A 35-year-old female presents with a range of symptoms that have been affecting her daily life. She reports experiencing pain that radiates down the left side of her body, starting from her lower back and extending down her left leg. The pain is described as dull and constant in the back, sharp in the leg, stiff and throbbing in the collar bone, and stabbing in the chest. This pain started suddenly about 4 to 5 months ago and is constant throughout the day, rated around 5 or 6 on the pain scale. The only relief she finds is by lying on her side with her knees to her chest. She also reports shortness of breath that started about 2 months after the pain began, rated around 5 on a scale of 1 to 10. This shortness of breath worsens with any activity, even walking, and is alleviated by sitting and avoiding activities that increase her pulse. Additionally, she experiences daily migraines without light and sound sensitivity, rated around 7 on a scale of 1 to 10. These headaches started around the same time as the shortness of breath. She has hard, unmovable lumps under the skin on her skull, specifically in her neck and the back of her head. These lumps were first noticed about 6 months ago, initially small and soft but now larger and hard. The patient also reports severe memory problems, including forgetting how to spell words and developing a stutter. These memory issues started about 5 months ago, before other symptoms, and have significantly affected her daily life, including job changes and getting lost while driving. She experiences balance problems, weakness in her legs, frequent dropping of objects, and occasional shaking of her left hand. Other symptoms include weird feelings in her head behind her ears, including ringing and a sensation of something moving inside her ear, constipation with some blood in her stool, and a decrease in bowel movements to about 3 times a week. She has also experienced unexplained weight loss of about 35 lbs in 2 months. Her medical history includes herpes, which is being managed with treatment. She has no known allergies or adverse reactions to medications and is currently taking an iron supplement every other day. Her family history includes Alzheimer's, cervical cancer, and lung cancer.

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 pain, shortness of breath, and headaches:

Spinal Issues: Conditions like a herniated disc or spinal stenosis could explain the radiating pain down your leg and lower back. These conditions can also cause weakness and balance issues.
Fibromyalgia: This condition can cause widespread pain, fatigue, and cognitive difficulties, often referred to as "fibro fog."
Neurological Disorders: Conditions like multiple sclerosis (MS) or other neurological disorders could explain the combination of pain, cognitive issues, and balance problems.
Lymphoma or Other Cancers: The hard, immovable lumps on your skull, combined with weight loss and night sweats, could be indicative of a more serious condition like lymphoma or another type of cancer.

Causes of your memory problems and cognitive decline:

Neurological Disorders: Conditions like early-onset Alzheimer's or other forms of dementia could explain your severe memory problems and cognitive decline.
Chronic Fatigue Syndrome: This condition can cause severe fatigue, memory problems, and other cognitive issues.
Nutritional Deficiencies: Severe iron deficiency or other nutritional deficiencies can also lead to cognitive issues and fatigue.

Causes of your shortness of breath and chest pain:

Cardiovascular Issues: Conditions like heart disease or pulmonary embolism could explain your shortness of breath and chest pain.
Respiratory Conditions: Chronic obstructive pulmonary disease (COPD) or other respiratory conditions could also be a factor.

Causes of your lumps and ear issues:

Lymphadenopathy: Swollen lymph nodes can be a sign of infection or more serious conditions like lymphoma.
Ear Infections or Eustachian Tube Dysfunction: These could explain the weird feelings and ringing in your ears.

What you can do

Pain, shortness of breath, and headaches:

See a doctor as soon as possible: Given the severity and duration of your symptoms, it's crucial to consult a healthcare provider for a thorough evaluation. They may recommend imaging tests like X-rays, MRIs, or CT scans to investigate the cause of your pain.
Pain management: Over-the-counter pain relievers like ibuprofen or acetaminophen may provide temporary relief. However, consult your doctor before taking any medication.
Rest and gentle exercise: While rest is important, gentle exercises like stretching or walking can help alleviate some of the pain.

Memory problems and cognitive decline:

Consult a neurologist: A specialist can perform cognitive tests and possibly recommend imaging studies to understand the cause of your memory issues.
Mental exercises: Engage in activities that stimulate your brain, such as puzzles, reading, or memory games.
Healthy diet: Ensure you're eating a balanced diet rich in fruits, vegetables, and whole grains to support brain health.

Shortness of breath and chest pain:

Seek immediate medical attention: Shortness of breath and chest pain can be signs of serious conditions like heart disease or pulmonary embolism. It's crucial to get these symptoms evaluated as soon as possible.
Avoid strenuous activities: Until you see a doctor, avoid activities that exacerbate your shortness of breath.

Lumps and ear issues:

Consult an ENT specialist: An ear, nose, and throat specialist can evaluate the lumps and ear issues to determine the cause.
Monitor the lumps: Keep track of any changes in size, shape, or pain associated with the lumps.

What you should look out for

Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Sudden worsening of symptoms: If any of your symptoms suddenly worsen, seek immediate medical attention.
New symptoms: If you develop new symptoms like fever, severe headache, or vision changes, consult a healthcare provider immediately.
Severe shortness of breath or chest pain: These could be signs of a heart attack or other serious conditions and require immediate medical attention.

Remember, while I can provide information and suggestions, it's essential to consult a healthcare professional for a formal diagnosis and treatment plan. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

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