[59F] Experiencing abdominal pain, nausea, and muscle weakness

Patient Description

A 59-year-old female presents with persistent aching abdominal pain on the left side extending to the back, food intolerance, nausea triggered by the smell of food or strong scents, fatigue, acute headaches with blurred vision, muscle weakness, and sporadic acute nerve pain. The abdominal pain, rated 6/10 in severity, has been persistent since November 2023 and is partially relieved by oxycodone with Tylenol. The patient has a history of UTI from November 2023 to January 2024, ischemic colitis diagnosed in January 2024, cervical fusion in 2023, COVID-19 in 2021 and 2023 with long COVID symptoms following both instances, and a spinal fusion in May 2023. The patient reports constant lower back pain across the sacroiliac region, which began after a fall in August 2022, with a severity of 8/10, reduced by heat and worsened by movement. Headaches began in January 2024 after strong antibiotics were prescribed, and the patient has a history of headaches prior to 2016. Muscle weakness affects the left arm and leg, with the leg giving out after standing for 6-8 minutes, rated 3/10 in severity. There is sharp shooting nerve pain in the right leg and foot, alleviated by deep pressure, and it occurs randomly. The patient has had an adverse reaction to vancomycin, Rocephin, and other strong antibiotics. Family history includes high blood pressure, cancer, heart disease, diabetes, and sarcoidosis. The patient's diet is currently limited to clear liquids and foods with little to no smell due to food intolerance, and she can only consume small portions. There is no known history of kidney or liver disease in the family, but the patient has a history of high blood pressure, cancer, heart disease, diabetes, and sarcoidosis. The patient's recent lab results show normal RBC, WBC, RDW, hemoglobin, and platelet counts, with elevated creatinine, low eGFR, low BUN/creatinine ratio, and high ALT (SGPT). Given the complexity of symptoms and lab results, a consultation with a nephrologist for kidney function assessment and a gastroenterologist for abdominal and digestive concerns is recommended. Differential diagnoses to discuss with the specialist may include kidney impairment or failure, liver disorders, and potential complications from previous infections or surgeries.

Arora's Assessment

What might be happening

Based on your symptoms and medical history, the following conditions could be considered:

Chronic Pancreatitis: This condition is characterized by inflammation of the pancreas that does not heal or improve, but gets worse over time, leading to permanent damage. Chronic pancreatitis eventually impairs a patient’s ability to digest food and make pancreatic hormones. Symptoms can include upper abdominal pain that radiates to the back, nausea, vomiting, weight loss, and diarrhea.
- Treatment often involves managing pain and complications, and includes lifestyle changes, such as quitting drinking and smoking, and following a healthy diet that is low in fat and includes small, frequent meals. In severe cases, surgery or other procedures might be necessary.
Kidney Disease: Your elevated creatinine, low eGFR, and low BUN/creatinine ratio could suggest kidney disease. Symptoms can include nausea, vomiting, loss of appetite, fatigue and weakness, and muscle twitches and cramps.
- Treatment usually focuses on controlling the cause of the kidney disease. This might involve medication to control high blood pressure, cholesterol, anemia, and swelling. In severe cases, dialysis or a kidney transplant might be necessary.
Nerve Pain: The sharp shooting pain you described could be due to a nerve condition such as neuropathy. This can be caused by a variety of conditions, including diabetes, infections, autoimmune diseases, and certain medications.
- Treatment often involves managing the underlying condition and can include medications to control the nerve pain.
Migraines: The acute headaches you described could be migraines, especially since they are accompanied by blurred vision. Migraines are recurrent headaches that cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head.
- Treatment often involves medications to relieve symptoms and prevent further attacks. Lifestyle changes, such as stress management and avoiding triggers, can also be beneficial.

What you can do

You should seek immediate medical attention for your symptoms. In the meantime, here are some things you can do:

Try to rest and stay hydrated.
Avoid foods that seem to trigger your symptoms.
Over-the-counter pain relievers may help with your headaches and abdominal pain, but they should be used sparingly and only under the advice of a healthcare professional.

What you should look out for

If your symptoms worsen or you experience any of the following, seek immediate medical attention:

Severe abdominal pain
Blood in your stool or urine
A high fever (over 101°F)
Severe vomiting or diarrhea
Sudden, severe headache
Sudden weakness or numbness on one side of your body
Difficulty speaking or understanding speech
Sudden vision changes

Please remember that while I strive to provide accurate information, I am not a doctor and this advice should not replace a consultation with a healthcare professional.

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11 mo ago

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