[40F] With persistent hip, shoulder, abdominal pain, and nausea
Patient Description
A 40-year-old female has been experiencing a range of symptoms for over a month, including dull and pressure-like pain in the top right hip bone, exacerbated by standing and walking. She also reports shoulder pain, persistent nausea, and almost daily vomiting, primarily in the mornings. Additionally, she has been dealing with abdominal pain that is sometimes sharp but mostly dull and crampy, along with back pain in the left lower area. The patient has experienced fever, chills, loss of appetite, urgency and frequent urination, and heartburn or acid reflux. She has not noticed any blood in her stool or vomit and has not had difficulty swallowing. Her menstrual periods are regular but have been short with initial clots. She has a family history of gastrointestinal issues, heart disease, stroke, autoimmune diseases, diabetes, cancer, and psychiatric illnesses. The patient had her gallbladder removed 19 years ago and is allergic to codeine. Her current medications include Gabapentin 300 mg three times a day, Hydroxyzine 50 mg (unsure of dosage), Wellbutrin 250 mg (unsure of dosage), Depakote 150 mg (unsure of dosage), and Adderall 30 mg twice a day. She also smokes cigarettes.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, there are a few potential diagnoses and conditions that could be contributing to your discomfort:
Hip Pain
- Osteoarthritis: This is a common cause of hip pain, especially if it worsens with standing and walking. It involves the wear and tear of the cartilage in the hip joint.
- Bursitis: Inflammation of the bursae (fluid-filled sacs) that cushion the hip joint can cause pain, especially with movement.
Shoulder Pain
- Rotator Cuff Tendinitis: This condition involves inflammation of the tendons in the shoulder, often causing pain with movement.
- Shoulder Impingement Syndrome: This occurs when the shoulder blade puts pressure on the underlying soft tissues when the arm is lifted.
Nausea and Vomiting
- Gastroesophageal Reflux Disease (GERD): This condition can cause nausea and vomiting, especially in the morning.
- Gastritis or Peptic Ulcer Disease: Inflammation or ulcers in the stomach lining can cause nausea and vomiting.
Abdominal Pain
- Irritable Bowel Syndrome (IBS): This condition can cause crampy abdominal pain, diarrhea, and other gastrointestinal symptoms.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain and diarrhea.
Back Pain
- Muscle Strain: This is a common cause of lower back pain, often due to overuse or improper lifting.
- Herniated Disc: A herniated disc in the lower spine can cause pain that radiates to the lower back.
Unifying Diagnoses
- Autoimmune Conditions: Given your family history, conditions like lupus or rheumatoid arthritis could potentially explain multiple symptoms.
- Chronic Inflammation: Conditions that cause chronic inflammation, such as certain autoimmune diseases, could be contributing to your symptoms.
What you can do
Hip and Shoulder Pain
- Consult a Doctor: It's important to see a healthcare provider for a thorough evaluation. They may recommend imaging tests like X-rays or MRIs.
- Physical Therapy: A physical therapist can provide exercises to strengthen the muscles around your hip and shoulder.
- Pain Management: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. Applying ice or heat to the affected areas may also provide relief.
Nausea and Vomiting
- Dietary Changes: Eating smaller, more frequent meals and avoiding spicy or fatty foods can help reduce nausea.
- Hydration: Drink plenty of fluids to stay hydrated, especially if you're vomiting.
- Consult a Doctor: A healthcare provider can evaluate for conditions like GERD or gastritis and may prescribe medications to help manage symptoms.
Abdominal Pain
- Dietary Adjustments: A diet high in fiber can help manage symptoms of IBS. Avoiding trigger foods can also be beneficial.
- Hydration: Drinking plenty of water can help with digestion and reduce cramping.
- Consult a Doctor: A healthcare provider can evaluate for conditions like IBD and may recommend further testing or treatment.
Back Pain
- Exercise: Gentle stretching and strengthening exercises can help alleviate back pain.
- Pain Management: Over-the-counter pain relievers and applying heat or ice to the affected area can provide relief.
- Consult a Doctor: A healthcare provider can evaluate for conditions like a herniated disc and may recommend further testing or treatment.
General Tips
- Track Symptoms: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
- Lifestyle Changes: Quitting smoking and reducing marijuana use can improve overall health and potentially alleviate some symptoms.
What you should look out for
Given the severity and duration of your symptoms, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe or worsening pain
- Unexplained weight loss
- Blood in stool or vomit
- Fainting or severe dizziness
- Shortness of breath or chest pain
Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment.
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3 mo ago