[39F] With multiple symptoms including severe leg cramps, persistent dry cough, and urinary urgency
Patient Description
A 39-year-old female presents with multiple symptoms, including severe leg cramps that are worse at night, described as a severe ripping, burning, and spasm all in one. She also reports severe random pain in the back of her knee radiating down her leg, a persistent dry cough ongoing for a few months with episodes that come out of nowhere and are not relieved by any measures, urinary urgency, frequent vaginal yeast infections, and extreme agitation described as irritability that doesn't affect daily activities but makes even little things irritating. Additionally, she experiences a random intermittent rash and itching on her abdomen (not associated with agitation) and intermittent flank pain for about two weeks. The patient has swelling in her right leg related to CRPS (Complex Regional Pain Syndrome) but no redness, warmth, changes in skin color, or muscle weakness. She has not had any recent injuries or trauma to the leg. Her diet consists of GJ tube feedings of Vital 1.2 at 40ml/hr, with attempts to flush every hour but managing about 20ml every few hours. She has a significant family history of sick sinus syndrome, strokes, autoimmune diseases, diabetes, cancer, and psychiatric illnesses. Her menstrual periods have been irregular since the delivery of her daughter four years ago. Her past medical history includes asthma (diagnosed as an infant), COPD (diagnosed in 2004), CRPS (diagnosed in 2022), bronchitis, pneumonia, sick sinus syndrome, hypokalemia, anemia, eosinophilic esophagitis, kidney stones, and pyelonephritis. The patient is currently taking Albuterol inhaler/neb PRN, Duoneb PRN, Qvar inhaler, Zofran PRN, Scopolamine patch, Promethazine PRN, Temazepam QHS, Tizanidine TID, Dilaudid PRN, and Pepcid.
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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.
Severe Leg Cramps and Pain Radiating Down Your Leg
- Complex Regional Pain Syndrome (CRPS): Given your history of CRPS, the severe leg cramps and pain radiating down your leg could be related to this condition. CRPS often causes severe pain, swelling, and changes in the skin.
- Peripheral Neuropathy: This condition can cause severe pain, burning, and spasms in the legs, often worsening at night. It can be related to diabetes, vitamin deficiencies, or other underlying conditions.
Persistent Dry Cough
- Asthma or COPD: Your history of asthma and COPD could be contributing to your persistent dry cough. These conditions can cause chronic cough and respiratory symptoms.
- Gastroesophageal Reflux Disease (GERD): GERD can cause a chronic dry cough, especially if you have a history of esophageal issues.
Urinary Urgency and Frequent Vaginal Yeast Infections
- Urinary Tract Infection (UTI): UTIs can cause urinary urgency and frequent infections. Given your history of pyelonephritis, this could be a recurring issue.
- Diabetes: Frequent yeast infections can be a sign of uncontrolled diabetes, which is prevalent in your family history.
Extreme Agitation and Intermittent Rash
- Medication Side Effects: Some of your medications, such as Tizanidine or Dilaudid, could potentially cause agitation or skin reactions.
- Allergic Reactions: The intermittent rash and itching could be due to an allergic reaction to something in your environment or a new product.
Intermittent Flank Pain
- Kidney Stones or Pyelonephritis: Given your history of kidney stones and pyelonephritis, the flank pain could be related to these conditions.
What you can do
Severe Leg Cramps and Pain Radiating Down Your Leg
- Consult your doctor: It's important to discuss these symptoms with your healthcare provider to determine if your CRPS treatment needs adjustment or if there is another underlying cause.
- Pain management: Continue taking your prescribed medications and consider physical therapy to manage CRPS symptoms.
- Hydration and electrolytes: Ensure you are well-hydrated and consider electrolyte supplements if recommended by your doctor.
Persistent Dry Cough
- Asthma/COPD management: Ensure you are using your inhalers as prescribed and discuss any changes in symptoms with your doctor.
- GERD management: If GERD is suspected, consider dietary changes, avoiding late meals, and discussing medications with your doctor.
Urinary Urgency and Frequent Vaginal Yeast Infections
- Hydration: Drink plenty of water to help flush out your urinary system.
- Hygiene: Maintain good hygiene and consider using unscented products to avoid irritation.
- Consult your doctor: Discuss these symptoms with your healthcare provider to rule out infections or other underlying conditions.
Extreme Agitation and Intermittent Rash
- Medication review: Discuss your symptoms with your doctor to see if any medications could be contributing to your agitation or rash.
- Allergy management: Consider using antihistamines for the rash and avoiding potential allergens.
Intermittent Flank Pain
- Hydration: Drink plenty of water to help prevent kidney stones and support kidney function.
- Consult your doctor: Discuss your symptoms with your healthcare provider to rule out kidney stones or infections.
What you should look out for
Given the complexity of your symptoms and the potential for serious underlying conditions, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe or worsening pain: If your pain becomes unbearable or significantly worsens.
- Signs of infection: Fever, chills, or signs of a urinary or respiratory infection.
- Breathing difficulties: Any new or worsening shortness of breath or difficulty breathing.
- Neurological symptoms: New or worsening weakness, numbness, or changes in sensation.
Remember, while I can provide information and suggestions, it's important to consult with your healthcare provider 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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6 mo ago
