[46F] Experiencing fatigue, loss of appetite, concentration difficulties, and left-sided pain

Patient Description

A 46-year-old female presents with a 4-week history of constant fatigue, described as feeling tired, weak, and lacking energy, which has significantly impacted her ability to work and perform daily activities. She also reports a 2-3 week history of loss of appetite, feeling full quickly after eating small amounts. Difficulty concentrating has been an issue for the past 2 weeks, affecting her work performance. The patient experiences a dull pain under the left ribs, rated as a 5 out of 10 in severity, without any known injury. She occasionally feels lightheaded and has had night sweats. There is no family history of chronic illnesses, and she has no known allergies or adverse reactions to medications. She has been vaping, which could be relevant to her symptoms. The patient is currently on Lamotrigine (200mg) for 2 years and Adzenys (18mg) for 3 months, both taken in the morning due to Lamotrigine's side effect of insomnia. No other medications or substances are reported.

Arora's Assessment

What might be happening

Based on the information you have provided, possible diagnoses include:

Chronic Fatigue Syndrome (CFS): This condition is characterized by extreme fatigue that can't be explained by any underlying medical condition. The fatigue worsens with physical or mental activity, but doesn't improve with rest. This could explain your constant fatigue, difficulty concentrating, and the fact that rest and sleep don't seem to alleviate your symptoms.
- There's no single test to confirm a diagnosis of chronic fatigue syndrome. You may need a variety of medical tests to rule out other health problems that have similar symptoms.
Gastrointestinal issues: Your loss of appetite and feeling full quickly, along with the discomfort under your ribs, could indicate a gastrointestinal issue such as gastritis or peptic ulcers.
- Diagnosis usually involves an upper endoscopy and biopsy. Treatment typically involves medication to decrease stomach acid.
Anxiety or Depression: Both of these conditions can cause physical symptoms like fatigue, difficulty concentrating, and loss of appetite. They can also cause feelings of restlessness or being "on edge," which might explain your difficulty taking deep breaths.
- Diagnosis is usually made through a psychological evaluation. Treatment typically involves psychotherapy (talk therapy), medication, or both.
Side effects of medication: Both Lamotrigine and Adzenys can cause side effects that include fatigue, loss of appetite, and difficulty concentrating. It's possible that your symptoms are related to these medications.
- If this is the case, your doctor may adjust your dosage or switch you to a different medication.

What you can do

Make an appointment with your doctor to discuss your symptoms. They can help determine the cause of your symptoms and recommend appropriate treatment.
Keep a symptom diary. Note when your symptoms occur, what you're doing at the time, and what you've eaten. This can help identify patterns and potential triggers.
Try to maintain a balanced diet and regular sleep schedule, even if you don't feel hungry or tired. This can help manage your symptoms.
If you're feeling stressed or overwhelmed, consider techniques like deep breathing, meditation, or yoga to help manage your stress levels.

What you should look out for

Please seek immediate medical attention if:

Your symptoms significantly worsen
You experience severe pain
You have difficulty breathing
You experience sudden weight loss
You feel faint or actually faint

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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