[44F] Experiencing a wide range of neurological and gastrointestinal symptoms

Patient Description

A 44-year-old female reports experiencing a complex array of symptoms including a red, dry, and bumpy rash on her cheeks persisting for 5 days, heightened skin sensitivity, mild fevers, a heavy feeling in the skull with a hot forehead despite the absence of fever, and a sensation of rushes through the body. These symptoms have been occurring over the past few days to months. Additionally, she describes abdominal pain with slight cramping and nausea starting today, alongside a weird, metallic taste in her mouth. The patient also reports episodes of dizziness, particularly in the evenings and nights, described as feeling disconnected from her brain, and a sudden sensation of dehydration in her face and hands. She has a history of fibromyalgia, Sjogren's syndrome, and inflammatory bowel disease (IBD), diagnosed approximately 10 years ago. Currently, she is on Gabapentin (300mg 3x/day) and Suboxone (4mg/day). The patient mentions significant weight and muscle loss, difficulty retaining nutrients, and episodes resembling seizures, which have rendered her mostly bedridden. These health issues began escalating after a car accident last year. She denies any allergies or adverse reactions to medications.

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Arora's Assessment

What might be happening

Based on the information you've provided, possible explanations for your symptoms include:

  • Fibromyalgia: This is a chronic disorder characterized by widespread pain, tenderness, and muscle stiffness throughout the body. It can also cause fatigue, sleep disturbances, and cognitive difficulties, which may explain your feeling of being disconnected and the weird sensations you've been experiencing.

    • Treatment typically involves a combination of medication, exercise, stress management techniques, and healthy lifestyle habits.
  • Sjogren's Syndrome: This is an autoimmune disease that often accompanies other immune system disorders like rheumatoid arthritis and lupus. The main symptoms are dry eyes and dry mouth, but it can also cause skin rashes, joint pain and stiffness, persistent dry cough, and fatigue.

    • Treatment focuses on relieving symptoms, which may include medication to increase production of saliva and tears, and nonprescription remedies for dryness.
  • Inflammatory Bowel Disease (IBD): This term includes conditions characterized by chronic inflammation of the digestive tract, such as Crohn's disease and ulcerative colitis. Symptoms often include diarrhea, abdominal pain, fatigue, and weight loss. This could explain your abdominal discomfort and the weird taste in your mouth.

    • Treatment typically involves a combination of medication and lifestyle changes, such as diet and stress management.
  • Side effects of medications: Gabapentin and Suboxone, the medications you're currently taking, can cause a variety of side effects. Gabapentin can cause dizziness, fatigue, and changes in mood or behavior, while Suboxone can cause nausea, headache, and skin rash.

    • If you suspect your symptoms are related to your medication, it's important to discuss this with your doctor. Do not stop taking your medication without medical advice.

What you can do

Given the complexity and range of your symptoms, it's important to seek medical attention. Here are some steps you can take:

  1. Schedule an appointment with your primary care doctor to discuss your symptoms. They can help determine if your symptoms are related to your existing conditions, side effects of your medication, or something else.
  2. Keep a symptom diary. Note when each symptom occurs, its severity, and any potential triggers. This can help your doctor understand your condition better.
  3. Stay hydrated and maintain a balanced diet. This can help manage symptoms of dryness and malnutrition.

What you should look out for

Seek immediate medical attention if you experience:

  • Severe abdominal pain
  • Blood in your stool
  • Sudden, severe headache
  • Difficulty breathing
  • Seizures

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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10 mo ago

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People Also Ask


What are the common symptoms of Sjogren's Syndrome?

Sjogren's Syndrome commonly causes dry eyes and dry mouth, but it can also lead to skin rashes, joint pain and stiffness, persistent dry cough, and fatigue.


Can fibromyalgia cause feelings of disconnection or cognitive difficulties?

Yes, fibromyalgia can cause cognitive difficulties often referred to as 'fibro fog,' which includes feelings of disconnection, memory issues, and trouble concentrating.


What are the potential side effects of Gabapentin and Suboxone?

Gabapentin can cause dizziness, fatigue, and mood changes, while Suboxone may lead to nausea, headache, and skin rash. It's important to discuss any side effects with a doctor.


How can inflammatory bowel disease (IBD) affect nutrient absorption and weight?

Inflammatory bowel disease (IBD) can lead to malabsorption of nutrients due to chronic inflammation of the digestive tract, which can result in weight loss and nutritional deficiencies.


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