Dr. House, what is causing my mysterious fatigue and joint pain?

January 3, 2010 11:55 PM

[medical diagnosis filter] Long list of symptoms headlined by fatigue and joint pain - can anybody offer any suggestions of what I might have? (my family doctor can't figure it out).

As stated, I have a long list of symptoms that I've been experiencing for around 5 months. I have seen multiple doctors several times (CT scan, blood work, etc.) but nobody can figure out what is causing this. I'm hoping that somebody out there has experienced something similar and may be able to shed some light on this.


Symptoms:
-fatigue
-skin sensitivity
-joint pain
-miniature hardened blisters on my hand (they hurt)
-loss of hair
-weight loss
-kidney activity is above normal (my doctors discovered this right away)


My doctors are fairly certain that it is NOT:
-cancer
-hepatitis A/B/C
-mono


Relevant info:
Male
25 years old
Vancouver, BC

Generally healthy, exercises regularly and eats a balanced dairy-free diet that is healthier than most, no recent travel outside of Canada and the United States.


Thanks for your time. Any input or follow-up questions are appreciated.

posted by cheemee to health & fitness (29 answers total)

Have any of your doctors discussed the possibility of an autoimmune disorder? And/or have you seen a rheumatologist?
posted by scody at 12:01 AM on January 4, 2010 [2 favorites]

Has your doctor done a test for Vitamin D deficiency?

Many of your symptoms are very similar to what I was dealing with about 18 months ago. I'm in Seattle, and my doc said that many, many people who live in this area - and I'll lump Vancouver in "this area" - suffer from undiagnosed D deficiency, which can cause many of the symptoms you describe. My symptoms had my doctor saying that it could be anything from fibromyalgia to bone cancer, but he's pretty conservative, so we started with a simple blood test.

A "normal" level of Vitamin D is somewhere between 35-55 ng/mL (the different things I've read on this vary on the actual optimal level, but it's somewhere in that range). When I was tested, my blood level was 11 ng/mL.

Some doctors will treat with a megadose of Vitamin D3 - around 25,000 - 50,000 IUs - but again, my doc is conservative, so I did 4,000 IUs daily, and brought my levels up gradually. After about six weeks, the difference was remarkable. After a year, I was up to 27 ng/mL, and I'm probably closer to normal now, though I'm a horrible patient and haven't had my levels checked recently.

If you haven't had this checked, do it. Your dairy-free diet, plus your location, make me really think that this might be something worthwhile for you to look into. Good luck!
posted by Lulu's Pink Converse at 12:09 AM on January 4, 2010 [2 favorites]

-kidney activity is above normal (my doctors discovered this right away)

What is kidney activity?
posted by naplesyellow at 12:10 AM on January 4, 2010

Is your hair loss in specific patches? Where on your hands are the blisters?

Do you happen to have any blisters around your ankles/feet?
posted by Menthol at 12:12 AM on January 4, 2010

Like others, I am wondering how your thyroid, vitamin D, vitamin B12, etc. levels are? I'm assuming the doctors have done all that blood work, as well as checked you for Lyme or other tick diseases, or even shingles?
posted by gudrun at 12:28 AM on January 4, 2010

Do the blisters go away after a while?
posted by IndigoRain at 1:18 AM on January 4, 2010

My standard answer, check for Lyme disease.
posted by ellenaim at 1:59 AM on January 4, 2010

Are you on any kind of medication? When my father had tons of weird symptoms doctors couldn't decipher, it turned out the plant that manufactured one of his medications was accidentally making it twice as large a dose as it should have been.
posted by Nattie at 2:56 AM on January 4, 2010

Like scody, I'm thinking you should see a rheumatologist. Autoimmune diseases are notoriously hard to diagnose and most primary care docs simply don't have the expertise. Things they will want to know: Is there a pattern to your joint pain? Is it more small joints (hands) or large joints (hips)? Is the pain worse at certain times of day?
posted by hydropsyche at 4:23 AM on January 4, 2010

Has your doctor done a test for Vitamin D deficiency?

Chiming in to say the same thing happened to me, after several years of feeling like crap and convincing myself I had lupus (It's never lupus!). It's easy to test for and really easy to treat, so I think you should definitely ask to get tested if you haven't already.
posted by cottonswab at 5:12 AM on January 4, 2010

Nthing the visit to a rheumatologist.
posted by Drasher at 5:39 AM on January 4, 2010

I read a long article yesterday about celiac disease and sensitivity to gluten, and why so many people these days are exhibiting symptoms. Maybe cut out flour and sugar for two weeks and see if there's an improvement?
posted by raisingsand at 6:19 AM on January 4, 2010

Nthing a test for vitamin D and B-vitamin deficiencies.

Your symptoms sound very much like what I dealt with two years ago. I went to a rheumatologist and was tested for numerous autoimmune diseases. Nada. I also went to a gastroenterologist and was screened and tested for celiac disease (complete with an EGD and biopsies). Zip.

Finally, the gastroenterologist did a simple blood test. Turns out I had severe deficiencies in vitamin D, the B-complex vitamins, and magnesium. A few supplements later, and I was feeling physically better than I ever had in my life.
posted by marteki at 6:47 AM on January 4, 2010

Definitely go see a rheumatologist. If you don't get anywhere there, I'd suggest seeing an allergist. They may seem overly simplistic, but some people have very unusual allergic reactions, and if it's something that you are repeatedly exposing yourself to, then that might account for the variety and severity of your symptoms. Rheumatologist is your best bet, though. Good luck!
posted by katemcd at 7:16 AM on January 4, 2010

I hate to be the one always chirping up with 'Celiac Disease', but get an upper GI to rule it out. What you have sounds just like me, except that the rash was on my back and I was 27 (and female). My blood tests were negative, the endoscopy was the way I was diagnosed. Don't just cut out the flour and sugar, a real gluten-free diet is more complicated than that and could cause false negatives on tests.
posted by TooFewShoes at 7:28 AM on January 4, 2010 [1 favorite]

Seconding Lyme disease. When I had it, the doctor had to be convinced to run the test despite classic symptoms.
posted by caminovereda at 9:20 AM on January 4, 2010

I had all of these symptoms and a couple other ones, but the primary ones were:

fatigue
joint pain
weird skin sensitivity (ITCHY!!!) + odd hard white blistery things (mostly located - but not exclusively - around joints)

I asked the internet, and the internet said that I might have a wheat allergy. I called my nutritionist sister, and she confirmed that this could be the problem. So I cut wheat out of my diet completely. (I didn't opt for going gluten free since I didn't really have any serious ongoing GI problems that couldn't be explained by other poor eating choices, although cutting wheat out of my diet significantly reduced the amount of gluten I was eating.)

Within three weeks, I slept all night and felt well-rested all day long. My joints didn't bother me. And my weird skin thing had subsided to a dull roar (and is gone completely now, six months later).

Now, it's pretty clear that wheat is the problem for me. Controlled tests have tended to confirm that eating wheat is a surefire way to make myself miserable. Eating a dinner roll to be polite is pretty much doom. (In related news, the holidays have been hell!) I don't know if that helps, but it's pretty easy to test on your own if that's the problem.
posted by greekphilosophy at 10:09 AM on January 4, 2010

IANAD (as usual).

I'm wondering if severe gout is factoring in? It's less likely than the other suggestions, and it's easy to rule out via test. Just including this for sake of completeness. Lyme or Celiac/vitamin deficiency are more likely.
posted by Citrus at 10:23 AM on January 4, 2010

Get your thyroid checked.
posted by chocolatetiara at 10:44 AM on January 4, 2010

You might hear fibromyalgia at some point--it's what occurred to me--but it's up to you whether or not you believe it's a real ailment.
posted by liketitanic at 10:57 AM on January 4, 2010

You might hear fibromyalgia cancer at some point--it's what occurred to me--but it's up to you whether or not you believe it's a real ailment. Put that into perspective for you.

It's real. I wish it wasn't, because it's mighty damn inconvenient as it can both trigger my epileptic seizures and be triggered by my seizures. I'm told by my doctor that a large number of people with a serious medical condition ALSO develop fibromyalgia syndrom (FMS) co-morbidly. Sometimes the FMS symptoms can confuse the diagnosis of the primary complaint, as it did for many years with my health.

See a Rheumatologist. Don't ignore the digestive or allergy possibilities, though.
posted by _paegan_ at 11:40 AM on January 4, 2010

On that same note, FMS does NOT usually include all of those symptoms.
posted by _paegan_ at 11:44 AM on January 4, 2010

You might have some form of porphyria. This is a group of diseases; their diagnosis is a very complicated topic.
posted by neuron at 11:59 AM on January 4, 2010

Unlikely, but my two cents: do you have a normal range of motion in your joints? Are you excessively flexible or inflexible? Some of these symptoms could be due to a connective tissue disorder.

Good luck.
posted by swerve at 12:39 PM on January 4, 2010

It's real. I wish it wasn't, because it's mighty damn inconvenient as it can both trigger my epileptic seizures and be triggered by my seizures. I'm told by my doctor that a large number of people with a serious medical condition ALSO develop fibromyalgia syndrom (FMS) co-morbidly. Sometimes the FMS symptoms can confuse the diagnosis of the primary complaint, as it did for many years with my health.


I do think it's real--my wife has it--but was trying to avoid a derail, as I'm sure you know that lots of people, including medical professionals, doubt that it is, in fact, a problem from which people suffer and it's often diagnosed for a cluster of symptoms like the OP's for which there is no other cause. So, uh, back off there, tiger.
posted by liketitanic at 3:28 PM on January 4, 2010

And the only thing I see there that can't be included in a fibromyalgia cluster is the kidney symptoms. MAYBE the blisters, but maybe not.
posted by liketitanic at 3:29 PM on January 4, 2010

Scleroderma. Seems to explain everything, including the hardened skin (blisters) on your fingers.

Don't stop eating wheat, if they need to test you for celiac they'll need you to have been eating wheat for the test to work right.

The various rheumatological disorders are often co-diagnosed with/mistaken for fibromyalgia/lyme disease. No offense to anyone here, but before you accept a diagnosis of fibromyalgia insist that they rule out everything else--at the very least, everything rheumatological. Fibro tends to be doctor code for "I give up", even though you might have it.
posted by kathrineg at 5:15 PM on January 4, 2010

^^Of course I am not a doctor and I have no way of knowing if you do have what I think you might possibly have.

Seriously, though, don't change your diet without a doctor's okay.
posted by kathrineg at 5:26 PM on January 4, 2010

So, uh, back off there, tiger.

Sorry, didn't mean to come off vicious. LOLme. I didn't believe in it, initially, either and scoffed at my ex-husband's frequent suggestions that I look into it.

And the only thing I see there that can't be included in a fibromyalgia cluster is the kidney symptoms.

I have the kidney symptoms; my rheumatologist is currently deciding it's part of my FMS. I am unfamiliar with the blister symptoms, though.
posted by _paegan_ at 5:35 PM on January 4, 2010