Open Question: Your patient comes in with fatigue, dizziness, joint pain, etc. - what do you suspect?
I just want some fresh heads to think about this. Something is missing.
You have a patient, early 20s, female, who comes in complaining of dizziness, fatigue, joint pain (especially in the knees). She’s a healthy weight, vegetarian, no use of drugs/alcohol.
You look at the patient history and see complaints of:
dizziness
fatigue
joint pain
Take her BP and it’s normal, but borderline low.
You investigate closer - anything you look into, the patient ends up being diagnosed with.
1. You see that she has irregular periods, so put her back on the birth control she has been on since she was 13 (because of the same problem - she’s not sexually active).
2. Look at her heart and find palpitations/murmur, so you put her on medicine for that, hoping that’s the cause of the fatigue. It helps the palpitations, but doesn’t help the fatigue.
3. Her family has a history of sleep apnea, so you send her to a sleep doctor for testing, and it turns out she has Narcolepsy.
4. The medication for narcolepsy doesn’t do anything, so you decide to check her thyroid — you figure out that she has Hashimoto’s disease and put her on medication for that.
All of this, and she still doesn’t feel better. She’s still dizzy - not as bad as before - still fatigued.
You want more answers, so you ask her if she can think of ANYTHING that could have led to all these symptoms, you find that she:
Swam in the Amazon River a few years ago
Lived next to a sewer and played in it as a child
Lived on a farm, riding horses, and had multiple ticks daily (including dozens of seaticks at a time when she’d step in a nest of them)
Also had many mosquito bites - her legs are scarred from them.
Went to Mexico when she was 14 and lived with locals for a summer
What are you going to do next? What tests do you want to run?
Note: Patient is not sickly, not frail. She doesn’t catch sicknesses more than any other person, and appears to be strong and healthy.
Hi Stephen, thanks for answering!
Joint pain= not everyday, but the days it occurs her knees hurt about a 7. Sometimes when she’s walking her knee will randomly slightly give out (she won’t fall - she’ll catch herself and just slightly stumble)
No exposure to sickly people.
Fatigued pretty much upon WAKING.
Definitely not sexually active
Echo shows everything’s fine - EKG shows sinus arrhythmia, premature ventricular complexes
She was diagnosed with Hashimoto’s disease and it’s under control with medication. Was borderline hypothyroid. Don’t have the #s in front of me.
She has blacked out twice. Once the day after giving blood, once the day before she was bedridden with an undiagnosed illness (lasted a week)
Medications:
Ocella
Toprol
Levothyroxine
I should also mention that I am NOT a doctor. Just a person looking for answers. The doctors working on this case just really aren’t getting to the root of the problem. They’re happy just to throw some medication at her.

Mon, 26 Apr 2010 06:01:52 GMT

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