[37F] With multiple symptoms including back pain, swelling, and anemia

Patient Description

A 37-year-old female presents with mid to upper back pain, swelling in the stomach and legs, sores under the armpit and breast on the right side, a lump on the left side of the neck, rough skin, intolerance to sodium, and anemia. The swelling began a few months after giving birth in 2019 and worsens with high sodium intake and prolonged standing. The swelling is soft and sometimes red or purple, improving slightly with rest, elevation, and water pills. The lump on the neck is firm, sometimes painful, and changes in size, particularly with high sodium intake. The patient also reports fatigue, shortness of breath, weight gain, chest pain, dizziness, and heavy, prolonged menstrual periods. Medical history includes primary lymphedema, Factor V Leiden, preeclampsia in 2019, and being RH negative. The patient is allergic to sulfa drugs. Current medications include an adult dose of aspirin daily, 800mg of Motrin every 4 hours during periods or twice a day for pain, 2,000mg of Vitamin C daily, and occasional water pills. Hemoglobin level is 7.0.

Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Heart Failure

Rationale: The swelling in your legs and stomach, shortness of breath, fatigue, and weight gain could be indicative of heart failure. Heart failure can cause fluid retention, leading to swelling (edema) and other symptoms.
Typical Treatments/Testing: Your doctor may recommend blood tests, an echocardiogram, and possibly a chest X-ray. Treatment often includes medications like diuretics (water pills), ACE inhibitors, or beta-blockers.

2. Lymphedema

Rationale: Given your history of primary lymphedema, the swelling in your legs could be related to this condition. Lymphedema can cause chronic swelling due to a buildup of lymph fluid.
Typical Treatments/Testing: Management often includes compression garments, manual lymphatic drainage, and physical therapy.

3. Anemia

Rationale: Your hemoglobin level of 7.0 is quite low, indicating anemia. This could explain your fatigue, dizziness, and possibly your shortness of breath.
Typical Treatments/Testing: Treatment depends on the cause but may include iron supplements, dietary changes, or other medications. Your doctor may also investigate the cause of your anemia with additional blood tests.

4. Infection or Inflammatory Condition

Rationale: The sores under your armpit and breast, along with the lump on your neck, could indicate an infection or an inflammatory condition. The lump could also be a swollen lymph node.
Typical Treatments/Testing: Your doctor may recommend a biopsy, imaging studies, or blood tests to determine the cause. Treatment may include antibiotics or anti-inflammatory medications.

5. Dental Issues

Rationale: Your decaying and broken teeth and constant tooth infections could be contributing to your overall health issues, including anemia and possibly systemic inflammation.
Typical Treatments/Testing: Dental evaluation and treatment, including possible antibiotics for infections and dental procedures to address decay and damage.

What you can do

Back Pain

See a healthcare provider: It's important to get a proper diagnosis for your back pain. They may recommend imaging studies like an X-ray or MRI.
At home: Apply heat or cold packs, take over-the-counter pain relievers like ibuprofen (Motrin) or acetaminophen (Tylenol), and avoid activities that worsen the pain.

Swelling in Stomach and Legs

See a healthcare provider: Given the chronic nature and severity of your swelling, it's crucial to get a thorough evaluation. Your doctor may adjust your medications or recommend additional treatments.
At home: Elevate your legs when possible, wear compression stockings, and reduce your sodium intake. Keep track of your symptoms and weight using the MDandMe journal.

Sores and Lump

See a healthcare provider: These symptoms need to be evaluated to rule out infections or other serious conditions. Your doctor may recommend a biopsy or imaging studies.
At home: Keep the affected areas clean and dry, and avoid irritating them. Over-the-counter pain relievers may help with discomfort.

Anemia

See a healthcare provider: Your low hemoglobin level needs to be addressed. Your doctor may recommend iron supplements or other treatments based on the underlying cause.
At home: Eat a diet rich in iron, including foods like lean meats, beans, and leafy green vegetables. Avoid tea and coffee with meals as they can inhibit iron absorption.

Dental Issues

See a dentist: It's important to address your dental issues to prevent further complications. Regular dental check-ups and treatments are essential.
At home: Maintain good oral hygiene by brushing and flossing regularly. Use an antiseptic mouthwash to help control infections.

What you should look out for

Given the complexity and severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Severe shortness of breath or chest pain: These could be signs of a heart condition or other serious issues.
Fainting or severe dizziness: This could indicate a significant drop in blood pressure or other serious conditions.
Rapidly worsening swelling or pain: This could indicate an infection or other urgent medical condition.
Unexplained bruising or bleeding: This could be related to your anemia or another underlying condition.

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. You can use MDandMe to journal your symptoms, track your