[54F] With progressive neuromuscular and bowel symptoms

Patient Description

A 54-year-old female presents with a two-year history of progressively worsening muscle spasms, primarily in the legs and feet, and stiffness affecting the legs, hands, feet, and back. The patient also reports clumsiness and coordination issues, which have led to multiple falls and a fear of falling. Bowel issues have been noted, including severe constipation alternating with diarrhea, and urinary frequency with a sense of urgency but minimal output. The patient has experienced a recent weight loss of approximately 10 pounds over two months. Visual disturbances such as increased blurriness and occasional word-finding difficulties have also been reported. The patient's medical history includes a recent diagnosis of fibromyalgia, chronic migraines, vertigo, and a severe case of mononucleosis as a teenager. The patient was also a micro preemie with an extended NICU stay. Current medications include Duloxetine 30 mg twice daily, Metoclopramide 5 mg as needed, and Vitamin B12 supplementation at 100 mcg daily. There is no known family history of neurological disorders and no known drug allergies.

Arora's Assessment

What might be happening

Based on the information you've provided, possible diagnoses include:

Fibromyalgia: This is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. It amplifies painful sensations by affecting the way your brain and spinal cord process painful and nonpainful signals. Your current diagnosis of fibromyalgia could explain many of your symptoms such as muscle spasms, stiffness, clumsiness, and bowel issues.
- Treatment often involves a combination of medications, exercise, stress-management measures, and healthy lifestyle habits.
Multiple Sclerosis (MS): This is a potentially disabling disease of the brain and spinal cord (central nervous system). In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Your symptoms of muscle spasms, stiffness, clumsiness, bowel and bladder issues, and vision changes could be indicative of MS.
- Treatment typically involves managing symptoms, speeding recovery from attacks, and slowing the progression of the disease.
Other neurological conditions: There are many other conditions that can cause similar symptoms, such as Parkinson's disease, stroke, or a brain tumor. These are less likely given your symptom pattern and history, but cannot be ruled out without further testing.

What you can do

Given the complexity of your symptoms, it's important to seek medical attention. Here are some steps you can take:

Schedule an appointment with your doctor to discuss your symptoms. They may refer you to a specialist such as a neurologist for further evaluation.
Keep a symptom diary. Note down when each symptom occurs, its severity, and any potential triggers. This can help your healthcare provider in diagnosing your condition.
Continue taking your prescribed medications as directed by your doctor.
Maintain a healthy lifestyle. Regular exercise, a balanced diet, and adequate sleep can help manage your symptoms.

What you should look out for

Please seek immediate medical attention if you experience:

Sudden worsening of symptoms
New symptoms such as severe headache, sudden vision changes, difficulty speaking or understanding speech, or severe weakness in one side of your body
Symptoms that interfere with your ability to perform daily activities

Remember, while I strive to provide accurate information, I'm not a doctor. Please consult with a healthcare provider for a formal diagnosis and treatment.

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10 mo ago

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[54F] With progressive neuromuscular and bowel symptoms

What might be happening

What you can do

What you should look out for

Experiencing symptoms?