[60F] With systemic symptoms including muscle pain, fatigue, and bone marrow edema

What might be happening

Rachel, based on the symptoms you've described—extreme fatigue, muscle pain and weakness (worse on the left side), bone marrow edema, increased vascularity to a lump on your right shoulder, bone pain, high mean corpuscle hemoglobin, protein and blood in your urine, frequent headaches, slight fevers, chills, increased bruising, skin thinning, thyroid and adrenal nodules, and severe TMJ—there are several possible explanations. These symptoms may be related to multiple underlying conditions:

1. Multiple Myeloma or Bone Marrow Disorders

   • Bone marrow edema, bone pain, fatigue, protein in the urine, and increased bruising are concerning for a condition affecting the bone marrow, such as multiple myeloma. This is a type of blood cancer that can cause these symptoms. The increased vascularity to the lump on your shoulder could also be related to abnormal bone or soft tissue changes.
   • Testing: Your doctor may recommend blood tests (e.g., serum protein electrophoresis, light chain assay), urine tests, and possibly a bone marrow biopsy to confirm or rule this out.

2. Polymyalgia Rheumatica (PMR)

   • Muscle pain and stiffness, particularly in the arms and legs, along with fatigue, are common in PMR, which is more prevalent in people over 50. However, PMR does not explain all your symptoms, such as the lump or blood in the urine.
   • Testing: Blood tests for inflammation markers (e.g., ESR, CRP) may help diagnose this condition.

3. Paraneoplastic Syndrome or Endocrine Disorders

   • The thyroid and adrenal nodules could be contributing to your fatigue, muscle weakness, and skin changes. These nodules may also be part of a broader paraneoplastic syndrome, where a tumor elsewhere in the body causes systemic symptoms.
   • Testing: Imaging (e.g., ultrasound, CT scan) and blood tests for thyroid and adrenal function will help evaluate these nodules.

4. Autoimmune or Inflammatory Conditions

   • Conditions like lupus, vasculitis, or other autoimmune diseases could explain the combination of muscle pain, fatigue, protein in the urine, and systemic symptoms like fevers and chills.
   • Testing: Your doctor may order autoimmune panels (e.g., ANA, rheumatoid factor) to investigate this possibility.

5. Other Possibilities

   • The lump on your shoulder could represent a benign or malignant tumor, or it could be related to a bone or soft tissue condition. The MRI you recently had will provide more clarity.
   • Blood in the urine could indicate kidney or bladder issues, such as an infection, stones, or even cancer.

What you can do

1. Follow up on your MRI results

• The MRI will provide critical information about the lump on your shoulder and the bone marrow edema. Make sure to discuss the findings with your doctor as soon as they are available.

2. Address fatigue, muscle pain, and weakness

• At home:
  • Gentle stretching and low-impact exercises like walking or yoga may help maintain mobility without overexerting yourself.
  • Use heat packs for muscle stiffness or ice packs for areas of swelling or pain.
  • Over-the-counter pain relievers like acetaminophen or ibuprofen may help, but consult your doctor before use.
• With your doctor:
  • Ask about blood tests to check for inflammation, vitamin deficiencies (e.g., vitamin D, B12), or thyroid and adrenal function.

3. Monitor and manage systemic symptoms (fevers, chills, bruising)

• At home:
  • Keep a symptom journal using MDandMe to track when fevers, chills, or bruising occur. This can help your doctor identify patterns.
  • Stay hydrated and rest as much as possible.
• With your doctor:
  • Discuss the possibility of blood disorders or autoimmune conditions. Blood tests like a complete blood count (CBC) and coagulation studies may be needed.

4. Address protein and blood in urine

• At home:
  • Drink plenty of water to stay hydrated and avoid dehydration, which can worsen kidney function.
• With your doctor:
  • Request a urinalysis and kidney function tests to evaluate the cause of protein and blood in your urine. Further imaging, like an ultrasound of your kidneys, may also be necessary.

5. Manage TMJ symptoms

• At home:
  • Apply warm compresses to the jaw area to relieve stiffness.
  • Avoid hard or chewy foods that strain the jaw.
  • Practice gentle jaw exercises to improve mobility.
• With your doctor:
  • Consider seeing a dentist or TMJ specialist for further evaluation and treatment options.

What you should look out for

While waiting for your MRI results and follow-up appointments, watch for the following red flag symptoms that require immediate medical attention:

1. Severe shortness of breath or chest pain

   • Could indicate a heart or lung issue, such as a blood clot or heart failure.

2. Sudden or severe weakness, especially on one side of the body

   • Could suggest a stroke or neurological issue.

3. High fever with confusion or severe chills

   • Could indicate a serious infection or sepsis.

4. Severe bone pain or fractures without injury

   • Could point to a bone-related condition like multiple myeloma.

5. Noticeable or persistent blood in urine

   • Could indicate kidney or bladder issues that need urgent evaluation.

6. Rapidly growing or painful lump on your shoulder

   • Could suggest a more serious underlying condition.

Rachel, your symptoms are complex and may involve multiple underlying conditions. It’s important to follow up with your healthcare provider as soon as possible to get a clear diagnosis and appropriate treatment. In the meantime, use MDandMe to track your symptoms, document any changes, and prepare questions for your doctor. Let me know if you need help with anything else!