[40F] With multiple chronic symptoms including headaches, vertigo, and chronic bacterial vaginosis
Patient Description
A 40-year-old female presents with a complex medical history. She reports bilateral occipital headaches that began after a thunderclap headache during childbirth, which was preceded by a sinus infection. The headaches are aching in nature, rated 7/10 in intensity, and are alleviated by Nurtec. She also experiences constant left eye swelling and nausea since the thunderclap headache. Vertigo occurs when facial swelling is severe, triggered by lack of sleep, heat, and allergies. Additionally, she has left breast pain associated with lactation for the past 2 years, rated 4/10. She notes off-and-on swelling in the left side of her vagina for the past year, which changes over time. Chronic bacterial vaginosis is a primary concern. She has sinonasal disease and a pelvic fluid collection in the pouch of Douglas. She reports extreme sensitivity to smells, bloody gums, numbness and tingling in extremities, whole body fatigue, and balance issues. A slight delay in speech, now resolved, was noted. Her lowest recorded oxygen level is 71%. She denies seizures or loss of consciousness and does not use tobacco, alcohol, or recreational drugs. Her diet includes iced coffee once a day. There has been no recent travel. Family history includes her mother having a stroke and heart attack, and her father having a heart attack. Menstrual history reveals irregular periods with clotting and chronic bacterial vaginosis since the thunderclap headache. Past medical history includes HSV 2 diagnosed 6 years ago and a tonsillectomy. She is allergic to Macrobid. Current medications include Prozac 40 mg once daily, Lyrica 50 mg once daily, Nurtec twice a week, occipital nerve blocks every six weeks, Cetirizine once daily, Flonase once daily, and Hydroxyzine 50 mg daily, all started after sinus surgery post-thunderclap headache.
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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.
Chronic Bacterial Vaginosis (BV)
- Diagnosis: Chronic BV is a common vaginal infection caused by an imbalance of bacteria in the vagina. Symptoms often include discharge, odor, and discomfort.
- Treatment: Typically involves antibiotics such as metronidazole or clindamycin. Chronic cases may require longer courses or repeated treatments.
Pineal Gland Cyst
- Diagnosis: An 8mm pineal gland cyst without suspicious features is generally considered benign and often asymptomatic. However, it can sometimes cause headaches or other neurological symptoms.
- Treatment: Regular monitoring with MRI scans. Symptomatic treatment for headaches may include medications like Nurtec.
Sinonasal Disease
- Diagnosis: Chronic sinonasal disease can cause symptoms like headaches, facial swelling, and vertigo.
- Treatment: May include nasal corticosteroids (like Flonase), antihistamines (like cetirizine), and sometimes antibiotics if an infection is present.
Pelvic Fluid Collection
- Diagnosis: Fluid in the pouch of Douglas can be due to various causes, including infections, endometriosis, or ovarian cysts.
- Treatment: Depends on the underlying cause. Further evaluation by a gynecologist may be necessary.
Fatty Liver
- Diagnosis: Fatty liver disease is often related to diet, obesity, or metabolic syndrome.
- Treatment: Lifestyle changes such as weight loss, a healthy diet, and regular exercise.
Sleep Apnea
- Diagnosis: Sleep apnea can cause low oxygen levels, fatigue, and other symptoms.
- Treatment: Often involves the use of a CPAP machine, weight loss, and avoiding alcohol and sedatives.
Kidney Damage
- Diagnosis: Chronic kidney disease can cause symptoms like fatigue and changes in urination.
- Treatment: Depends on the stage of kidney disease. Management may include medications, dietary changes, and monitoring kidney function.
Headaches and Vertigo
- Diagnosis: Your headaches and vertigo could be related to your pineal gland cyst, sinonasal disease, or other neurological issues.
- Treatment: Medications like Nurtec for headaches, and addressing the underlying causes of sinonasal disease.
Breast Pain and Lactation
- Diagnosis: Pain in the left breast with lactation could be due to mastitis or other breast conditions.
- Treatment: Warm compresses, proper breastfeeding techniques, and consulting a healthcare provider for further evaluation.
What you can do
Chronic Bacterial Vaginosis (BV)
- See a doctor: It's important to get a proper diagnosis and treatment plan. Chronic BV may require a longer course of antibiotics.
- Maintain hygiene: Avoid douching and use mild, unscented soaps.
Headaches and Vertigo
- Consult a neurologist: Given your history of a thunderclap headache and ongoing symptoms, a neurologist can provide a thorough evaluation.
- Manage triggers: Avoid known triggers like lack of sleep, heat, and allergens.
Sinonasal Disease
- Use nasal sprays: Continue using Flonase and cetirizine as prescribed.
- Stay hydrated: Drink plenty of fluids to help thin mucus.
Pelvic Fluid Collection
- See a gynecologist: Further evaluation is needed to determine the cause and appropriate treatment.
Fatty Liver
- Lifestyle changes: Adopt a healthy diet, exercise regularly, and avoid alcohol.
- Monitor liver function: Regular check-ups with your healthcare provider.
Sleep Apnea
- Use CPAP: If prescribed, use your CPAP machine regularly.
- Maintain a healthy weight: Weight loss can significantly improve symptoms.
Kidney Damage
- Follow medical advice: Adhere to any dietary restrictions and medications prescribed by your healthcare provider.
- Monitor kidney function: Regular blood tests to check kidney function.
Breast Pain and Lactation
- Warm compresses: Apply warm compresses to the affected breast.
- Proper breastfeeding techniques: Ensure proper latch and breastfeeding techniques to reduce pain.
What you should look out for
Given the complexity of your symptoms, it's important to seek medical care for a comprehensive evaluation. Reasons to seek care more urgently include:
- Severe or worsening headaches: Especially if accompanied by vision changes, nausea, or vomiting.
- Severe vertigo or balance issues: If you experience falls or significant difficulty walking.
- Severe pelvic pain or swelling: If you notice increased pain, fever, or changes in vaginal discharge.
- Breast pain with fever: This could
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5 mo ago