[36F] With chronic gastrointestinal and sinus symptoms, and recent weight loss

Patient Description

A 36-year-old female presents with a year-long history of sharp and cramping stomach pain localized to the lower abdomen and around the belly button. The pain, rated 8/10, occurs right before bowel movements and stops instantly after. Bowel movements are inconsistent, ranging from several days apart to several times a day. Stool consistency varies, often containing mucus, bloody mucus, and dark brown or black chunks, and is usually clay-colored. The patient also reports bloating and gas. There is a significant weight loss and lack of appetite for around a year and a half, accompanied by fatigue, dizziness, and changes in mood. Sinus pressure and congestion, primarily on the right side, along with headaches and a sensation of something stuck in the throat, have been ongoing. A CT scan revealed a small mass in the right sinus area behind the eye. Additionally, the patient experiences fullness and dull throbbing aches in both ears, which started after a spider was removed from the right ear last August. The patient is profoundly deaf in both ears since birth. Skin issues include acne on the back of the neck, chest, chin, and forehead, sores on the back of the neck, and several hard lumps clumped together at the base of the neck, along with significant hair loss. Menstrual periods have been heavy and painful with a lot of blood clots for about two years, requiring super-size tampon changes every 2 hours on the heaviest days. Other symptoms include occasional nausea, lethargy, brain fog, headaches, and muscle aches, especially after consuming alcoholic beverages. The patient smokes about 10 cigarettes a day and drinks coffee. Medical history includes hypertension (diagnosed in 2019), possibly polycystic ovary syndrome, and Hashimoto's thyroiditis. The patient's mother has psoriasis. Stool tests in December 2023 were negative, and a colonoscopy in February 2024 was normal. A laser procedure was performed to close a hole in the right eye, unrelated to the sinus mass.

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 stomach pain, bowel movement changes, and weight loss:

Irritable Bowel Syndrome (IBS): Given the inconsistency in your bowel movements, presence of mucus, and pain that is relieved by defecation, IBS is a possibility. IBS can cause a mix of diarrhea and constipation, bloating, and abdominal pain.
Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could explain your symptoms, including the presence of blood and mucus in your stool, weight loss, and abdominal pain. These conditions often require a colonoscopy for diagnosis, which you have had, but sometimes additional imaging or biopsies are needed.
Parasitic Infection: Despite a negative stool test, some parasitic infections can be missed. The presence of worm-like threads in your stool could suggest a parasitic infection that might need further investigation.

Causes of your sinus pressure, headaches, and ear issues:

Chronic Sinusitis: The mass seen in your sinus CT scan could be contributing to your sinus pressure and headaches. Chronic sinusitis can cause congestion, pressure, and pain in the sinus areas.
Eustachian Tube Dysfunction: This could explain the fullness and dull throbbing aches in your ears, especially after the ear infection and removal of the spider.

Causes of your skin issues and hair loss:

Hormonal Imbalances: Conditions like polycystic ovary syndrome (PCOS) can cause acne, hair loss, and other skin issues. Your history of Hashimoto's thyroiditis could also contribute to these symptoms.
Infections or Autoimmune Conditions: The sores on the back of your neck and hard lumps could be related to an underlying infection or autoimmune condition.

Causes of your heavy and painful periods:

Hormonal Imbalances: Conditions like PCOS or thyroid disorders can cause heavy and painful periods with blood clots.
Uterine Fibroids or Endometriosis: These conditions can cause heavy menstrual bleeding and significant pain.

What you can do

Stomach pain, bowel movement changes, and weight loss:

See a Gastroenterologist: Given the severity and duration of your symptoms, it's important to consult a specialist. They may recommend further testing, such as imaging studies or repeat stool tests.
Dietary Changes: Keep a food diary to identify any potential triggers. Consider a low-FODMAP diet, which can help manage symptoms of IBS.
Hydration and Fiber: Ensure you are drinking plenty of water and consuming a balanced amount of fiber to help regulate bowel movements.

Sinus pressure, headaches, and ear issues:

Follow Up with ENT: Given the mass seen in your sinus CT scan, it's important to follow up with an ENT specialist for further evaluation and possible biopsy.
Nasal Irrigation: Using a saline nasal spray or neti pot can help relieve sinus congestion and pressure.
Avoid Allergens: Identify and avoid potential allergens that could be contributing to your sinus issues.

Skin issues and hair loss:

Dermatologist Consultation: A dermatologist can help diagnose and treat your acne and hair loss. They may recommend topical treatments, medications, or lifestyle changes.
Hormonal Evaluation: Consider seeing an endocrinologist to evaluate your hormone levels, especially given your history of Hashimoto's thyroiditis and possible PCOS.

Heavy and painful periods:

Gynecologist Consultation: A gynecologist can help evaluate the cause of your heavy and painful periods. They may recommend hormonal treatments, such as birth control pills, or other interventions.
Pain Management: Over-the-counter pain relievers like ibuprofen can help manage menstrual pain. Applying heat to the lower abdomen can also provide relief.

What you should look out for

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

Severe abdominal pain or persistent vomiting
Significant weight loss or inability to eat
Blood in your stool that is increasing in frequency or amount
Severe headaches or changes in vision
New or worsening lumps or sores on your skin

Remember, while I can provide information and suggestions, it's crucial to consult with real health professionals to receive a formal diagnosis and appropriate treatment. 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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