[48F] With severe fatigue, joint pain, and shortness of breath

Question

My cousin passed away from leukemia at 17. I'm scared a lot of my symptoms are indicative of leukemia.

Patient Description

A 48-year-old female presents with severe fatigue, joint pain, and shortness of breath following exertion for the past two months. The fatigue is debilitating, described as feeling like having 'cement legs,' and is exacerbated by any physical activity. The patient also reports a distended abdomen, cold hands and feet, and a dull ache in the joints. Lab work indicates low red blood cells, low hemoglobin, low hematocrit, and high white blood cells. The patient experienced a fever in the evenings for four days last week and woke up in the middle of the night soaking wet with sweat. She suffers from chronic constipation and maintains a diet rich in asparagus, leafy green vegetables, and cauliflower. Medical history includes Graves' disease, Raynaud's, high cholesterol, prediabetes, scattered atherosclerotic plaque in the abdominal aorta, and non-alcoholic fatty liver disease (NAFLD). The patient is not currently medicated for Graves' disease or Raynaud's. Current medications include Levothyroxine 125mcg and Quviviq 100mg at bedtime. The patient has a sulfa allergy and is not taking any over-the-counter medications, supplements, or herbal remedies. She does not use any topical medications, creams, inhalers, or nasal sprays, and has not recently stopped taking any medications.

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Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

Severe Fatigue, Joint Pain, and Shortness of Breath

  1. Anemia: Your lab results indicate low red blood cells, hemoglobin, and hematocrit, which are consistent with anemia. Anemia can cause severe fatigue, shortness of breath, and cold extremities. The high white blood cell count suggests an underlying inflammatory or infectious process.

    • Typical Treatments: Iron supplements, dietary changes, or treatment of the underlying cause (e.g., chronic disease, infection).
  2. Chronic Inflammatory or Autoimmune Condition: Given your history of Graves' disease and Raynaud's, it's possible that an autoimmune condition could be contributing to your symptoms. Autoimmune diseases can cause joint pain, fatigue, and other systemic symptoms.

    • Typical Treatments: Anti-inflammatory medications, immunosuppressants, and lifestyle modifications.

Distended Abdomen and Minor Ankle Swelling

  1. Non-Alcoholic Fatty Liver Disease (NAFLD): Your history of NAFLD could be contributing to abdominal distension and swelling. Liver dysfunction can lead to fluid accumulation in the abdomen (ascites) and peripheral edema.

    • Typical Treatments: Lifestyle changes, weight loss, and medications to manage liver health.
  2. Heart Failure: The presence of atherosclerotic plaque in your abdominal aorta and vessels, along with minor ankle swelling, could suggest heart failure. Heart failure can cause fluid retention, leading to swelling and abdominal distension.

    • Typical Treatments: Medications to manage heart function, lifestyle changes, and monitoring fluid intake.

Fever and Night Sweats

  1. Infection or Inflammatory Process: The recent fever and night sweats could indicate an underlying infection or inflammatory condition. This could also explain the elevated white blood cell count.
    • Typical Treatments: Antibiotics or other medications to treat the infection, and further investigation to identify the source.

What you can do

Severe Fatigue, Joint Pain, and Shortness of Breath

  • See a Doctor: Given the severity and duration of your symptoms, it's important to consult a healthcare provider as soon as possible. They may perform additional tests to determine the cause of your anemia and other symptoms.
  • Rest and Hydration: Ensure you get adequate rest and stay hydrated. Avoid strenuous activities that exacerbate your symptoms.
  • Diet: Continue eating a balanced diet rich in iron and nutrients. Consider discussing with a nutritionist for personalized advice.

Distended Abdomen and Minor Ankle Swelling

  • Monitor Symptoms: Keep track of your abdominal distension and swelling. Note any changes or worsening of symptoms.
  • Elevate Legs: Elevate your legs when sitting or lying down to help reduce swelling.
  • Compression Stockings: Consider wearing compression stockings to help manage ankle swelling.

Fever and Night Sweats

  • Monitor Temperature: Keep a record of your temperature and any episodes of night sweats. This information can be helpful for your healthcare provider.
  • Stay Cool: Use lightweight bedding and keep your bedroom cool to help manage night sweats.

What you should look out for

Given the complexity and severity of your symptoms, it's important to seek medical care promptly. Reasons to seek care even more urgently include:

  • Severe Shortness of Breath: If you experience severe shortness of breath or difficulty breathing, seek immediate medical attention.
  • Chest Pain: Any new or worsening chest pain should be evaluated by a healthcare provider.
  • Severe Swelling: If you notice significant swelling in your legs, abdomen, or other areas, contact your doctor.
  • Unexplained Bruising or Bleeding: Any unusual bruising or bleeding should be reported to your healthcare provider.

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

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4 mo ago


People Also Ask


What are the common causes of anemia and how can it be treated?

Anemia can be caused by a variety of factors including iron deficiency, chronic diseases, vitamin deficiencies, or bone marrow disorders. Treatment typically involves addressing the underlying cause, such as taking iron supplements for iron deficiency anemia, or managing chronic conditions.


How does Graves' disease affect the body and what are its symptoms?

Graves' disease is an autoimmune disorder that leads to overactivity of the thyroid gland (hyperthyroidism). Symptoms can include weight loss, rapid heartbeat, sweating, nervousness, and irritability. Treatment may involve medications, radioactive iodine therapy, or surgery to reduce thyroid hormone production.


What lifestyle changes can help manage Non-Alcoholic Fatty Liver Disease (NAFLD)?

Managing NAFLD often involves lifestyle changes such as losing weight, eating a healthy diet low in saturated fats and sugars, increasing physical activity, and avoiding alcohol. These changes can help reduce liver fat and improve liver function.


What are the potential causes of night sweats and how can they be managed?

Night sweats can be caused by infections, hormonal changes, certain medications, or underlying medical conditions like hyperthyroidism or autoimmune disorders. Managing night sweats involves treating the underlying cause, keeping the sleeping environment cool, and wearing lightweight clothing to bed.

1 Comments


Arora (Bot)#24147

4 mo ago

I'm sorry to hear about your cousin. While some of your symptoms, such as fatigue, joint pain, and high white blood cell count, can be seen in leukemia, they can also be caused by other conditions like anemia or autoimmune diseases. It's important to discuss your concerns with a healthcare provider who can perform specific tests to rule out leukemia and determine the exact cause of your symptoms.

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