Help me compose a questionnaire for my doctor
June 9, 2010 1:02 AM   Subscribe

[medical advice filter] Yes, I know, you are not my doctor, but please give me some ideas about what I need to ask the person who IS my doctor, based on my symptoms. Apologies in advance for the length and special snowflake details.

Me: computer-bound job (sitting at a desk for at least 10 hours a day), female, 30, 66kg (145 lbs).

Two years ago, at 28, I was super fit, running 10K for breakfast, weighed around 57 kg (125 lbs), went to dance and swimming classes, lifted weights and felt pretty much on top of the world.

Since then, I started feeling pain in my left knee and hip. I attributed this to running, so I stopped running and turned to aerobics classes and similar types of exercise. I also gained almost 10kg (~20 lbs) in these 2 years, which I attributed to romantic late-night dinners with new boyfriend and learning to cook better. ;) But the romantic dinners have turned into functional, everyday after-work meals and can not be the main culprit.

My FitDay logs show that I consumed 1,715 calories daily on average since the beginning of the year. Considering my basic metabolic rate should be around 1800 kcal, I should be losing weight steadily, right? But my weight log shows a steady creep upwards. I exercise on average 3 times a week for 15 to 45 minutes (aerobics, pilates, yoga...)

Since the knee and hip problems, I have also had pain in my right shoulder (started ~3 months ago) and, since last week, in my right wrist. At first I thought shoulder pain is due to un-ergonomic desk and chair at work, but I changed them for a more ergonomic workstation 6 months ago, before the pain started. I have the same job as when I was super-healthy and fit so my amount of sitting hasn't changed.

During the last year or so, I feel pangs of intense pain in my belly for a few minutes, every two or three months. The pain is so strong I wake up in the middle of the night. It does not happen during ovulation (I chart).

Thanks to charting, I discovered my basal body temperature is on the low side (normal average: 35.8C = 96.44F; post-ovulation average: 36.7C = 98.06F).

I have occasional bouts of fatigue and depression, but who doesn't, in this modern world... I get an average of 7.7 hours of sleep, take multivitamins, have a good job and lovely friends and family.

So, if I sum this up, I see three major things:
- joint pain,
- weight gain,
- abdominal pain.

I plan to ask my doctor to check for:
- hypothyroidism,
- lyme disease,
- ovarian cysts,
- arthritis.

Please tell me, is there anything else I should be checking out?

And is this maybe just that "getting old" thing that I keep hearing about and my doctor will just brush me off?
posted by gakiko to Health & Fitness (18 answers total) 1 user marked this as a favorite
It would be worth asking the doctor for a blood test to check FSH levels. This would be to check if you were premenopausal. It is a fairly simple test. Joint pain and weight gain can be symptoms of this.

Given your abdominal pain I would also be asking the doc for a scan for signs of endometriosis.

I am not a doctor. Or a woman.
posted by MuffinMan at 1:55 AM on June 9, 2010

My FitDay logs show that I consumed 1,715 calories daily on average since the beginning of the year. Considering my basic metabolic rate should be around 1800 kcal, I should be losing weight steadily, right?

Figures for calorie consumption and use have error margins. The difference between your two figures is only 85 calories. A 5% error in both of your figures could tip you into overall weight gain. A 10% error in both figures could lead to gaining a lot of weight.

All of which is not to say that I think this is the case; I just don't think you can necessarily bank on the precision of your numbers.
posted by le morte de bea arthur at 2:32 AM on June 9, 2010

Response by poster: A 10% error in both figures could lead to gaining a lot of weight.

I agree, except that I calculated my metabolic rate based on 8h sleep + 8h sedentary + 8h office work, which should be conservative enough even for total couch potatoes, I think. I don't substract calories burned by exercise from my daily consumption, so I would think I have a large enough "safe" margin. But thanks for bringing it to my attention.
posted by gakiko at 3:53 AM on June 9, 2010

Everyone's BMR is different, so you can't really say that yours "should" be 1800 cals a day. 30-45 minutes of exercise three times weekly sounds good, but how often are you doing the 15 minutes? That's not going to burn any significant number of calories, if weight loss is your goal.

Honestly, everything you describe sounds within the range of normal. Bad ergonomics, gas pains, etc can account for all your symptoms. If you have a gut feeling that something is truly wrong, then pursue it with your doctor, but I don't anticipate that he/she will be too concerned or will run a lot of tests based on what you describe here.

I hope you feel better, but please don't get too worried at this point. It all really does sound normal.
posted by tetralix at 4:29 AM on June 9, 2010

"the romantic dinners have turned into functional, everyday after-work meals and can not be the main culprit. "

Even eating everyday meals, women tend to gain weight once they're partnered, often unconsciously eating larger portions that are closer to the (usually male) partner's, sharing off a partner's plate, skipping fewer meals, eating more rounded meals, etc.
posted by Eyebrows McGee at 5:39 AM on June 9, 2010

Response by poster: Tetralix, I feel that not being able to sleep on my side because of the pain (left - hip, right - shoulder) should not happen to an otherwise (seemingly) healthy person in early 30s. :( I don't know, is this normal? Because it is, then I'm screwed and can forget about having kids and a house and a dog and just hobble off to my death. :(

Sorry, my knee started really hurting again during a bit of gentle exercise last night and I'm a bit depressed about it all.
posted by gakiko at 5:42 AM on June 9, 2010

Response by poster: Ok, I'll get out of the thread after this last comment, I promise: I'm not all that worried about weight gain. I know what to do to lose weight - eat less and exercise more - but I'd like to be able to do it. Eg. right now, I can't do pushups or pullups because of shoulder pain, I can't lift barbells because of my wrist, I can't run or jump. I feel like a cripple and I'm not ready to admit defeat so early.
posted by gakiko at 5:47 AM on June 9, 2010

Sorry, from your initial description I didn't get that the pain was that severe or limiting. That type of pain definitely does warrant investigation---have you tried things like hot packs, gentle stretching, ibuprofen, etc? Maybe your doc will refer you to physical therapy or start you on some mild anti-inflammatories, depending on what he/she finds. Good luck.
posted by tetralix at 6:03 AM on June 9, 2010

When I had the kind of intense abdominal pain you describe (every couple of months, lasting a few minutes), it turned out to be my gallbladder. Just another thing to put on the list for the doc...
posted by Daily Alice at 6:12 AM on June 9, 2010

Yeah, don't count on those calorie requirements being accurate. I track what I eat and what I do obsessively and consume about 1/3 more calories than I "need" without gaining weight. The best way to calculate what you burn per day is to log your calories and weight every day and work backwards from there.
posted by pjaust at 6:22 AM on June 9, 2010

From your radiating pain you could have spine issues. Degenerative discs, herniation, joint issues, even bone spurs can cause the pains you're describing.

For example. I have a burning shoulder pain issue? Why? Bone spur pinching on nerve.

I have inner elbow pain? Why? Degernative disc or again the bone spur.

Go see a physiatrist. They are a non-surgical orthepaedic/spine specialist. They'll take some xrays, maybe an MRI and then do some physical therapy.
posted by stormpooper at 6:26 AM on June 9, 2010

This could be anything from thyroid to metastasized ovarian cancer. Get a really great GP willing to spend some time with you and run tests. DON'T head straight to a specialist.
posted by availablelight at 6:43 AM on June 9, 2010

Mononucleosis can cause joint pain, and can also lead to an enlarged/inflamed spleen and liver. May be worth checking out if it's not one of those you listed. I felt miserable when I had it some years ago. Get well soon!
posted by The Toad at 7:42 AM on June 9, 2010

Re: abdominal pain - a blood test can determine if you have stomach enzymes in your blood which would indicate something like a stomach ulcer forming. You also don't mention anything about what exactly you eat - as you get older you can develop lactose intolerance or colitis, acid reflux or any other type of food intolerance on the planet so you may want to track your diet and the occurance of pain to see if anything stands out. Of course your doctor will probably want to look for other culprits as well such as gall bladder, al, but it would help your doctor rule out food- related issues if you had a diary of what you ate and when the pain was. As a woman I would also see your gyno, because I've known too many people with horror stories about fibroids on thier ovaries and burst falopian tubes and other woman part related maladies that started with minor infrequent discomfort and went undetected for years, usually only found when they were trying with difficulty to get pregnant.

Re: joint pain - with the gained weight, could this be caused by muscle strain? Maybe when you ran you cartilidge was getting "shredded" and is a bit worn? I would also ask about pinched nerves, espcially since your problems are in the hip and shoulder.

As for the weight gain I think that's just due to your metabolism slowing and not excercising as much as when you ran. Obviously it's still crucial info for your doctor as they may want to check for hormone levels and thyroid function.
posted by WeekendJen at 8:52 AM on June 9, 2010

Quick note: make sure you tell your doctor how much the pain is affecting your life. Without that reference, as you've seen here, it's easy to misunderstand your current issues as normal aches and pains.
I am not a doctor, but I have seen many for joint pain issues.
posted by mismatched at 8:53 AM on June 9, 2010

If your GP runs the blood tests and rules out endocrine stuff, I would try a rheumatologist next. Joint pain is their thing, and they also tend to be great at medical mysteries, since so many of those are auto-immune or involve joint pain. If you have the option of picking your own doctor, look on the forums for your country's national arthritis organization to find a rhematologist in your area who is known for treating undiagnosed patients well (definitely not true for all of them). For a rheumatologist or orthopedist or physiatrist, or probably even a GP, keeping a pain journal of when and what hurts each day, if anything seems to make the pain better or worse, if there are certain times of day when things hurt, if you experience stiffness, swelling, or feel heat coming off of your joints, etc.
posted by hydropsyche at 9:02 AM on June 9, 2010

An ergonomic workstation won't magically fix everything, especially if you've had poor ergonomic habits for a long time. Plus, many workplace ergonomic "specialists" I've seen kind of suck. I wouldn't discount ergonomics as the cause of your arm pain, hell, your new more ergonomic workstation could be causing the pain! It's happened to me.

I'm not a doctor, but nothing seems particularly strange about your health except maybe the stomach pains. I also turned thirty in recent memory and have injured myself from working out too much, become more sedentary, and gained some weight. I can't sleep on the side that I have injured (although I did go to an orthopedist to get it fully diagnosed, which would be my advised next step if the GP doesn't find anything obviously wrong). Bad movement patterns in young adulthood can have some nasty effects on the aging body. You'd probably be well-served getting a bit of physical therapy if this turns out to just be injury or overuse related. If light work is causing you severe pain it is worth it to know why, and what to do about it. And you have my sympathy about feeling like you can't exercise at all... it really, really sucks.
posted by ch1x0r at 4:45 PM on June 9, 2010

Do not rule out an imbalance stemming from your feet. Suponation or pronation of the left foot can travel up through your body (including stomach fascia) by overcompensation. This is not often the area of a GP, more of a physical therapist. To figure this out: take a tennisball and roll slowly under your feet for at least 5 minutes. If this has effect: go see a PT. Yes your stomach pains can be an unrelated endocrine symptom, but simplest is for now to assume you have only thing wrong with you, manifesting in different spots.
posted by Eltulipan at 2:32 PM on July 19, 2010

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