[50F] With multiple systemic symptoms including fatigue, weight gain, and hair loss

Patient Description

A 50-year-old female presents with a range of symptoms including extreme fatigue, muscle aches and pains, slow-healing wounds (taking two to three weeks to heal and very painful, but blood clots quickly and minimal bleeding), stomach weight gain, daily stuffy nose, vision changes, constipation (last bowel movement was yesterday with normal color but hard to pass), frequent uncontrollable gas (occurring for about 6 months, roughly every hour, not triggered by specific foods, and not helped by treatments or dietary changes), hair loss, joint pain, dry and tight skin, increased appetite for sweets, pins and needles sensation down the right arm (for about 2 to 3 weeks), and frequent swelling of hands and feet (for more than 6 months, tightening during the day when warm). The most bothersome symptoms are weight gain, pain, fatigue, and hair loss. The patient has a family history of thyroid problems and diabetes (mother, maternal grandfather, and paternal grandfather with diabetes; mother, father, and two sisters with thyroid issues). The patient's thyroid was recently checked and is normal. Current medications include Wellbutrin (300 mg once a day) for depression, Phentermine (37.5 mg once a day) for weight loss, Hydrochlorothiazide (25 mg once a day) for water retention/swelling, Propranolol ER (60 mg once a day) for migraines, Clonazepam (1 mg as needed) for anxiety, Diclofenac (75 mg once a day) for joint pain, Doxycycline (50 mg once a day) for dry eye, and Pramipexole (1 mg once a day) for restless legs. The patient does not take any over-the-counter medications, supplements, or herbal remedies and has allergies to sulfa, Compazine, Phenergan, and Ativan. The patient does not use tobacco, alcohol, or recreational drugs and has not been exposed to any new environments, chemicals, or substances in the past year. There has been no recent travel to areas with different climates or potential exposure to new pathogens.

Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential diagnoses that could explain your condition. It's important to remember that these are just possibilities, and you should consult a healthcare professional for a formal diagnosis and treatment plan.

1. Hypothyroidism

Rationale: Despite your recent normal thyroid test, hypothyroidism can sometimes be missed or develop over time. Symptoms like fatigue, weight gain, hair loss, dry skin, and constipation are common in hypothyroidism.
Typical Treatments/Testing: Blood tests to check thyroid hormone levels (TSH, T3, T4). Treatment usually involves thyroid hormone replacement therapy.

2. Diabetes or Insulin Resistance

Rationale: Given your family history of diabetes and symptoms like weight gain, fatigue, and slow-healing wounds, diabetes or insulin resistance could be a concern.
Typical Treatments/Testing: Blood tests to check blood sugar levels (fasting glucose, HbA1c). Treatment may include lifestyle changes, medications, and monitoring blood sugar levels.

3. Chronic Inflammatory Conditions

Rationale: Conditions like rheumatoid arthritis or lupus can cause joint pain, muscle aches, fatigue, and other systemic symptoms.
Typical Treatments/Testing: Blood tests for inflammatory markers (CRP, ESR) and specific antibodies. Treatment may include anti-inflammatory medications and disease-modifying antirheumatic drugs (DMARDs).

4. Gastrointestinal Issues

Rationale: Frequent uncontrollable gas, constipation, and bloating could indicate gastrointestinal issues like irritable bowel syndrome (IBS) or small intestinal bacterial overgrowth (SIBO).
Typical Treatments/Testing: Gastrointestinal evaluation, including breath tests for SIBO, stool tests, and possibly a colonoscopy. Treatment may include dietary changes, probiotics, and medications.

5. Nutritional Deficiencies

Rationale: Symptoms like hair loss, fatigue, and slow-healing wounds could be related to deficiencies in vitamins or minerals (e.g., iron, vitamin D, B vitamins).
Typical Treatments/Testing: Blood tests to check for deficiencies. Treatment may include dietary changes and supplements.

What you can do

Weight Gain, Pain, Fatigue, and Hair Loss

Consult a healthcare professional: It's important to get a comprehensive evaluation to determine the underlying cause of these symptoms. Your doctor may recommend blood tests, imaging studies, or referrals to specialists.
Maintain a balanced diet: Focus on a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Avoid excessive sugar and processed foods.
Stay active: Engage in regular physical activity, such as walking, swimming, or yoga, to help manage weight and improve energy levels.
Manage stress: Practice stress-reducing techniques like meditation, deep breathing exercises, or mindfulness.
Track your symptoms: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

Frequent Uncontrollable Gas and Constipation

Dietary changes: Consider a low-FODMAP diet, which can help reduce gas and bloating. Increase fiber intake gradually to help with constipation.
Hydration: Drink plenty of water throughout the day to help with digestion and prevent constipation.
Over-the-counter remedies: Consider using over-the-counter medications like simethicone for gas relief and stool softeners or fiber supplements for constipation.

Slow-Healing Wounds

Wound care: Keep wounds clean and covered with appropriate dressings. Avoid picking at scabs or wounds.
Consult a healthcare professional: If wounds are not healing properly, seek medical advice to rule out underlying conditions like diabetes or infections.

Pins and Needles Sensation in Right Arm

Ergonomic adjustments: Ensure your workspace is ergonomically friendly to reduce strain on your arm and neck.
Stretching and exercises: Perform gentle stretching and strengthening exercises for your neck and arm.
Consult a healthcare professional: If the sensation persists, seek medical advice to rule out conditions like nerve compression or neuropathy.

What you should look out for

Given the range of symptoms you're experiencing, it's important to seek medical care to determine the underlying cause. Reasons to seek care more urgently include:

Unexplained weight loss or gain
Persistent or worsening fatigue
Severe or persistent pain
New or worsening symptoms
Signs of infection in slow-healing wounds (redness, swelling, pus)
Numbness or weakness in your limbs

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and appropriate treatment. If you have