[52F] With multiple symptoms including headache, swelling, and fatigue
Patient Description
A 52-year-old female presents with symptoms that began yesterday, including sweating, a bad headache on the top of her head, swelling in her right hand, a sensation in her ears like a microphone, mood swings, fatigue when standing up, and frequent urination. She feels like her blood pressure is high, especially when bending over. The patient has a history of throbbing and dull aching headaches, which are alleviated by resting. She has been experiencing emotional abuse, leading to mood changes, forgetfulness, frequent crying, anxiety, fatigue, and moodiness over the past two years. She also reports shortness of breath and lightheadedness but denies chest pain or palpitations. The patient uses fentanyl and meth daily, along with tobacco. She has not been diagnosed with high blood pressure or other cardiovascular conditions. Recently, she has gained 4 pounds and has not been eating as much. Additionally, she has been experiencing dull pain in her upper left abdomen for the past two days, which occurs only when she moves. Family history includes heart disease. She was diagnosed with rheumatoid arthritis (R.A.) and spondylosis about a year and a half ago. She is allergic to steroid injections and is currently taking Prednisone as needed for emergency flare-ups, Naproxen (1 tablet every 12 hours), Folic Acid (once daily), and Wellbutrin (1 tablet every morning).
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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 what you might be experiencing:
High Blood Pressure (Hypertension)
- Symptoms: Headache, shortness of breath, lightheadedness, and feeling like your blood pressure is high.
- Rationale: These symptoms can be indicative of high blood pressure, especially if they worsen with stress or physical activity.
- Typical Treatments/Testing: Blood pressure monitoring, lifestyle changes, and possibly medication to manage blood pressure.
Anxiety and Stress
- Symptoms: Mood swings, frequent crying, anxiety, fatigue, and forgetfulness.
- Rationale: Emotional abuse and relationship stress can lead to anxiety and mood disorders, which can manifest physically and emotionally.
- Typical Treatments/Testing: Counseling, therapy, stress management techniques, and possibly medication for anxiety or depression.
Substance Use Effects
- Symptoms: Sweating, headache, mood swings, fatigue, and frequent urination.
- Rationale: Daily use of fentanyl and meth can cause a range of physical and psychological symptoms, including those you've described.
- Typical Treatments/Testing: Substance use counseling, detox programs, and support groups.
Rheumatoid Arthritis (R.A.) and Spondylolisthesis
- Symptoms: Pain in the upper left abdomen, swelling in the right hand, and fatigue.
- Rationale: These conditions can cause chronic pain and inflammation, which may contribute to your overall discomfort and fatigue.
- Typical Treatments/Testing: Pain management, physical therapy, and medications to control inflammation and pain.
What you can do
High Blood Pressure
- Monitor Your Blood Pressure: Try to measure your blood pressure regularly. Home blood pressure monitors are widely available.
- Lifestyle Changes: Reduce salt intake, eat a balanced diet, exercise regularly, and avoid tobacco and recreational drugs.
- Seek Medical Attention: Consult a healthcare provider to discuss your symptoms and possibly start medication to manage your blood pressure.
Anxiety and Stress
- Counseling and Therapy: Consider speaking with a mental health professional to address the emotional abuse and relationship stress.
- Stress Management: Practice relaxation techniques such as deep breathing, meditation, or yoga.
- Support System: Reach out to friends, family, or support groups for emotional support.
Substance Use
- Seek Help: Consider reaching out to a healthcare provider or support group for help with substance use.
- Detox Programs: Look into detox programs that can help you safely reduce or eliminate your use of fentanyl and meth.
Rheumatoid Arthritis and Spondylolisthesis
- Pain Management: Continue taking your prescribed medications and consider physical therapy to manage pain and improve mobility.
- Rest and Gentle Exercise: Rest when needed, but also engage in gentle exercises to maintain joint function and reduce stiffness.
What you should look out for
Given the complexity and severity of your symptoms, it's important to seek medical care as soon as possible. Here are some specific reasons to seek urgent medical attention:
- Severe Headache: If your headache becomes severe or is accompanied by vision changes, confusion, or difficulty speaking.
- Chest Pain or Shortness of Breath: If you experience chest pain or worsening shortness of breath.
- Severe Swelling: If the swelling in your hand or other parts of your body becomes severe or painful.
- Substance Withdrawal: If you experience symptoms of withdrawal from fentanyl or meth, such as severe anxiety, agitation, or physical discomfort.
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