[44F] With multiple chronic symptoms including aciduria, POTS, and recent glaucoma surgery

Patient Description

A 44-year-old female presents with multiple chronic symptoms. She has been experiencing aciduria for several months, noticeable every day with each sitting, and finds some relief by consuming half a squeezed lemon with a half glass of water each morning. She has had blood in her stool for the past 2 years, with the blood being neither bright red nor black, streaking the stool almost every time. Her muscles easily fatigue with the slightest repetitive movements. She was diagnosed with POTS 6 years ago. Her calves itch 2 or 3 times per day for the past few months, and she has petechiae on the right side of her abdomen. She has difficulty holding her urine for over a year, with urgency occurring once or twice a day, and her urine appears turbid. She experiences lightheadedness and has had shortness of breath when exercising for over 3 years, with a brisk walk causing chest pain, tightness, and a burning sensation. She experiences joint pain every night, especially in her elbows, shoulders, and legs, but without swelling. She had a stroke 7 years ago. Her family history includes cancer (sister with ovarian cancer at 17, grandfather with stomach cancer, and uncle with lung cancer at 52) and her aunt recently had heart surgery for congestive heart disease. She smokes light cigarettes, about half a pack daily, but is trying to quit and has reduced her smoking. She has been diagnosed with hypotension, POTS, glaucoma (diagnosed 2 months ago but had attacks for 7 years), and had a stroke. She is not currently taking any medications and has no known allergies or adverse reactions to medications.

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.

Causes of your aciduria (acid in urine):

Metabolic Disorders: Conditions like renal tubular acidosis can cause acid to build up in your urine. This condition affects the kidneys' ability to maintain a proper acid-base balance.
Dietary Factors: Certain foods and beverages can alter the pH of your urine, making it more acidic.

Causes of blood in your stool (hematochezia):

Gastrointestinal Issues: Conditions like hemorrhoids, anal fissures, or more serious conditions like colorectal cancer or inflammatory bowel disease (IBD) can cause blood in the stool.
Dietary Factors: Certain foods and medications can irritate the gastrointestinal tract, leading to bleeding.

Causes of muscle fatigue and POTS:

Postural Orthostatic Tachycardia Syndrome (POTS): This condition can cause symptoms like muscle fatigue, lightheadedness, and shortness of breath upon standing or exercising.
Chronic Fatigue Syndrome: This condition can cause severe, long-lasting fatigue that doesn't improve with rest.

Causes of pruritus (itching) and petechiae:

Dermatological Conditions: Skin conditions like eczema or dermatitis can cause itching. Petechiae can be caused by minor trauma, infections, or more serious conditions like blood clotting disorders.
Systemic Conditions: Conditions like liver disease or vasculitis can cause both itching and petechiae.

Causes of urinary symptoms (turbid urine, urinary retention, and aciduria):

Urinary Tract Infections (UTIs): These can cause symptoms like cloudy urine, urgency, and difficulty holding urine.
Bladder or Kidney Issues: Conditions like interstitial cystitis or kidney stones can cause similar symptoms.

Causes of joint pain:

Arthritis: Conditions like rheumatoid arthritis or osteoarthritis can cause joint pain, especially in the elbows, shoulders, and legs.
Autoimmune Disorders: Conditions like lupus can cause widespread joint pain.

Causes of shortness of breath:

Cardiovascular Issues: Given your family history of heart disease, conditions like congestive heart failure or coronary artery disease could be contributing to your symptoms.
Respiratory Conditions: Conditions like asthma or chronic obstructive pulmonary disease (COPD) can cause shortness of breath.

What you can do

Aciduria:

Consult a Doctor: It's important to see a healthcare provider to determine the underlying cause. They may recommend urine tests or blood tests.
Dietary Adjustments: Continue consuming lemon water if it helps, but also consider consulting a dietitian for personalized advice.

Blood in Stool:

See a Gastroenterologist: Given the duration and frequency of your symptoms, it's important to get a thorough evaluation, which may include a colonoscopy.
Dietary Changes: Increase fiber intake to help with bowel movements and reduce irritation.

Muscle Fatigue and POTS:

Consult a Specialist: A cardiologist or neurologist can provide specific recommendations for managing POTS.
Lifestyle Adjustments: Increase salt and fluid intake, wear compression stockings, and avoid prolonged standing.

Itching and Petechiae:

See a Dermatologist: A skin specialist can help diagnose and treat the cause of your itching and petechiae.
Topical Treatments: Use over-the-counter anti-itch creams or antihistamines to relieve itching.

Urinary Symptoms:

Consult a Urologist: A specialist can help diagnose and treat the underlying cause of your urinary symptoms.
Hydration: Drink plenty of water to help flush out your urinary system.

Joint Pain:

See a Rheumatologist: A specialist can help diagnose and treat conditions like arthritis or autoimmune disorders.
Pain Management: Use over-the-counter pain relievers and consider physical therapy.

Shortness of Breath:

Consult a Cardiologist: Given your family history and symptoms, it's important to rule out cardiovascular issues.
Exercise Modifications: Avoid strenuous activities and consider low-impact exercises like swimming or yoga.

What you should look out for

Given the complexity and severity of your symptoms, you should seek medical care as soon as possible. Reasons to seek care even more urgently include:

Severe or worsening symptoms: If any of your symptoms suddenly become more severe, seek immediate medical attention.
New symptoms: If you develop new symptoms like chest pain, severe abdominal pain, or significant changes in your vision, seek care immediately.
Signs of infection: Fever, chills, or other signs of infection should prompt you to seek medical care.

Remember, while I can provide information and suggestions, it's crucial to consult with real health professionals for a formal diagnosis and treatment. You can also use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.