[41F] With multiple systemic symptoms including joint pain, swelling, and neurological issues

Question

I've also been referred to an Orthopedic Specialist for something that showed in the ER X-ray on my right forearm right below my inner top wrist, I was referred to a neurologist, I was referred to an Endocrinologist, and I was referred to another Gastroenterologist to recheck the 6mm polyp that was found in my colon 5 years ago and was sent for biopsy which determined the 6mm colon polyp to be precancerous and I was told I needed a recheck in 5 years by colonoscopy to see if anything came back or if anything turned to cancer.

Patient Description

A 41-year-old female presents with a complex array of symptoms affecting multiple systems. She reports joint pain, swelling, and redness in various parts of her body, including fingers, toes, wrists, knees, arms, and legs. The redness appears as patches, bands, or wraps and can be triggered by sunlight and heat, particularly on her face and mid-thigh area. She also experiences bone pain, numbness, pins and needles sensations, and feelings of extreme temperature changes in the affected areas. Additional symptoms include changes in bowel habits, fevers for no apparent reason, extreme heat and sweating at night, issues holding her bladder, and chronic muscle spasms throughout her body, including in her lower intestines and internal female areas. She describes sensations of bugs crawling on her skin, particularly on her face and skull, and experiences ulcers on her tongue, mouth, nose, and occasionally near her vaginal opening. She also reports sensations of vibrational electricity in her spine and limbs, severe dizzy spells, occasional blurred and double vision, frequent headaches, and spots of brain pain. Pressure behind her eyes comes and goes, and she has chronic sinus infections, lower belly cramps/pain, frequent nausea, and constant pain in muscles, joints, bones, and skin. She also experiences painful burning sensations in veins, particularly in hands and feet, frequent joint popping and cracking, balance problems, sensitivity to sunlight, tube lights, and LED lights, persistent fatigue, and lack of energy. Numbness in toes and fingers is also reported, with some toes remaining numb for extended periods. She describes color changes in fingers and toes with temperature changes, bruising on wrists, forearms, and upper arms without clear cause, difficulty distinguishing hot and cold temperatures, and a reduced sense of smell. She has a history of Juvenile Onset Type 1 Brittle Diabetes, degenerative arthritis, fibromyalgia, and concerning CBC results, including high white and red blood counts, high neutrophils, high lymphs, low carbon levels, and high monocytes. Current medications include an MS muscle relaxer, Toradol, Vyvanse, and Humalog insulin. She has been referred to an oncologist for further evaluation but has not yet been able to attend the appointment.

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Arora's Assessment

What might be happening

Based on the symptoms and medical history you've provided, here are some possible conditions that could be considered:

  1. Rheumatoid Arthritis (RA): This autoimmune condition can cause joint pain, swelling, and redness. It can also lead to systemic symptoms like fevers, fatigue, and muscle pain.

    • Treatment: Often involves medications to reduce inflammation and immune system activity, physical therapy, and sometimes surgery.

  2. Systemic Lupus Erythematosus (SLE): This autoimmune disease can cause a wide range of symptoms, including joint pain, skin rashes (such as the butterfly rash on the face), fevers, fatigue, and organ involvement.

    • Treatment: Typically includes anti-inflammatory medications, immunosuppressants, and lifestyle changes.

  3. Multiple Sclerosis (MS): This condition can cause neurological symptoms like numbness, tingling, muscle spasms, balance issues, and vision problems.

    • Treatment: May involve disease-modifying therapies, physical therapy, and medications to manage symptoms.

  4. Fibromyalgia: This condition is characterized by widespread musculoskeletal pain, fatigue, and tenderness in localized areas.

    • Treatment: Includes medications, physical therapy, and lifestyle changes to manage symptoms.

  5. Raynaud's Phenomenon: This condition causes some areas of your body, such as your fingers and toes, to feel numb and cold in response to cold temperatures or stress.

    • Treatment: Often involves lifestyle changes to avoid triggers and medications to improve blood flow.

  6. Chronic Inflammatory Response Syndrome (CIRS): This condition can result from exposure to biotoxins and can cause a wide range of symptoms, including fatigue, cognitive issues, and pain.

    • Treatment: Often involves removing the source of exposure and medications to reduce inflammation and support detoxification.

  7. Blood Disorders: Given your concerning CBC results, conditions like anemia, leukemia, or other hematologic disorders could be considered.

    • Treatment: Depends on the specific diagnosis and may involve medications, lifestyle changes, or more intensive treatments like chemotherapy.

What you can do

  1. Consult Specialists: Follow up with the oncologist for a thorough evaluation of your CBC results and any potential blood disorders. Also, consider seeing a rheumatologist for a detailed assessment of your joint pain and autoimmune symptoms.
  2. Document Symptoms: Keep a detailed diary of your symptoms, including when they occur, their severity, and any potential triggers. This can help your healthcare providers make a more accurate diagnosis.
  3. Lifestyle Adjustments: Ensure you are maintaining a balanced diet, staying hydrated, and getting adequate rest. Gentle exercise and stress management techniques like yoga or meditation may also help alleviate some symptoms.
  4. Avoid Triggers: Try to avoid known triggers such as extreme temperatures, stress, and certain foods that may exacerbate your symptoms.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe or sudden worsening of symptoms
  • New or worsening neurological symptoms like severe dizziness, loss of coordination, or vision changes
  • Signs of infection such as high fever, chills, or unexplained swelling
  • Severe abdominal pain or blood in your stool

Remember, while this information can provide some guidance, it is crucial to consult with healthcare professionals for a formal diagnosis and appropriate treatment plan.

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6 mo ago

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What are the common symptoms of Systemic Lupus Erythematosus (SLE)?

Common symptoms of Systemic Lupus Erythematosus (SLE) include joint pain and swelling, skin rashes (such as a butterfly-shaped rash on the face), fatigue, fevers, and potential organ involvement. It can also cause neurological symptoms and sensitivity to sunlight.

How is Raynaud's Phenomenon diagnosed and managed?

Raynaud's Phenomenon is diagnosed based on clinical symptoms, such as color changes in the fingers and toes in response to cold or stress. Management includes avoiding triggers, keeping warm, and sometimes using medications to improve blood flow.

What lifestyle changes can help manage fibromyalgia symptoms?

Lifestyle changes that can help manage fibromyalgia symptoms include regular low-impact exercise, stress management techniques like yoga or meditation, maintaining a healthy diet, and ensuring adequate sleep. Cognitive behavioral therapy and support groups may also be beneficial.

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If you experience severe dizziness and vision changes, it is important to seek immediate medical attention. These symptoms could indicate a serious underlying condition that requires prompt evaluation and treatment by a healthcare professional.

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Arora (Bot)#28060

6 mo ago

Thank you for sharing this additional information, Angie. It sounds like you have several important referrals to follow up on. Here’s a brief overview of what each specialist might focus on based on your symptoms and history:

  1. Orthopedic Specialist: They will likely evaluate the findings from your X-ray and assess any bone or joint issues in your right forearm and wrist.

  2. Neurologist: They will investigate your neurological symptoms, such as numbness, balance issues, and sensations of bugs crawling on your skin, to determine if there is an underlying neurological condition.

  3. Endocrinologist: Given your history of Type 1 Diabetes and other symptoms, they will assess your hormonal and metabolic health.

  4. Gastroenterologist: They will recheck the area where the precancerous polyp was found in your colon to ensure there are no new developments or signs of cancer.

It’s important to attend these appointments to get a comprehensive evaluation and appropriate treatment plan. If you have any specific questions about these referrals, feel free to ask!

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