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November 3, 2010 2:26 PM   Subscribe

Can you help narrow down what sort(s) of doctor(s) to see and what to investigate, given these symptoms? All symptoms have cropped up within the last two years. Before that, I felt healthy most of the time. Primary care doc has been little help, and most of the specialists seem to focus only on the symptoms within their own areas of expertise.

Hi, I'm a 30 year old woman, and I need medical help. YANMD, but I need to figure out who should be and what I should ask her/him about. I've tried to give a comprehensive (and therefore, long) picture of my health so that any of you who have been through this sort of thing or know more about getting good medical care than I do can make good suggestions.

The problem is that I have a number of different symptoms, all new in the last two years or so, and no idea what's connected and what isn't. My primary care doctor doesn't have any ideas what's going on with me and seems to think all of this must just be a coincidence. He keeps referring me to specialists for my symptoms, but they focus on the symptoms that are within their respective specialties, and no one has been able to tell me whether there might be something systemic going on that explains multiple symptoms. I'm hoping that some of you might be able to suggest a type of doctor or specialist who would be willing to explore causes of multiple symptoms (or help me rule out any connection) rather than just offering treatments for the symptoms.

- Psoriatic dermatitis (red, scaly, flaking, itching skin on my scalp, face, and neck). OTC treatments and prescription shampoo help some, but it hasn't gone away.

- Weight gain (about 50 pounds in the last 18 months). This may just be aging metabolism, but cutting calories and exercise haven't helped at all. If it's just age, I'm willing to accept that. I am not interested in diet or weight loss suggestions. I am not willing to entertain weight loss recommendations. I only want to know whether this is a symptom of a medical condition I should be concerned about.

- Excessive sweating. Basically, every time I do anything remotely aerobic (including walking a few blocks), I get pretty sweaty on my face, chest, armpits, and groin. I'm in relatively good shape and exercise regularly, and I'm not out of breath, so it's not just exertion. I get as sweaty walking the 15 minutes to work in the morning as a do during my hour-long evening workout. Something else seems to be going on.

- Fatigue. I've always had a bit of insomnia, so I'm used to being tired sometimes, but this seems to crop up frequently regardless of how much sleep I get.

- Muscle injuries in my extremities. I've been diagnosed with tendinitis in my wrists and plantar fasciitis in my feet. Standard exercises and braces help, but haven't cured the problem yet. It seems strange to me that my connective tissues would all get injured at the same time.

- Frequent sinus infections. I had these as a kid, then they went away, and now they're back at a rate of 4-6 per year. I had a sinus CT, which showed no blockages that would explain the issue. I'm already doing handwashing to prevent illness, daily sinus rinsing/neti pot, and all the standard stuff.

- Lower back soreness and pain: yoga helps some, but doesn't cure it. I only spend about half the day sitting and the rest standing or moving around. Just got a new mattress, which has also helped a bit. Still, some days, it hurts to move.

- Difficulty concentrating. I have trouble sitting through an hour-long TV show without getting distracted. I end up missing big chunks of story when I'm reading because my mind wanders. I took prescription stimulants for ADD in my early 20s, but didn't like the side effects and found that I worked better without it. This doesn't feel like ADD symptoms. It's less frantic and exciting than that, more like when you're too tired to focus properly, except it happens even when I'm not tired.

- (not sure whether this is relevant, but I'm anonymous, so I might as well say everything) My poo is really soft. I've always had regular, firm, clean poo. Now I get soft, messy poo, I have to go more often, and I sometimes have diarrhea.

Doctors I've already tried:
- Primary care: as I said, very nice man, very willing to refer me to specialists, but not able to offer many big ideas. Do I just need a new primary care specialist? My options are limited because I'm in a restrictive health plan, but I'm willing to look for someone good if anyone can tell me what to look for.

- Dermatologist: gave shampoos/creams/ointments for dermatitis. (I'm assuming that's what it is based on her diagnosis, and my symptoms seem to fit the descriptions and photos I've seen, but I'm willing to entertain other possible explanations.) No help on the sweating (she just said "some people are naturally sweatier than others.")

- Allergist. I have environmental and pet allergies, but I manage them by staying away from animals and taking prescription medication. Food allergy tests were negative.

- ENT. Great for treating the sinus infections, but can't find a good way to prevent them. I am not, my ENT tells me, a candidate for sinus surgery or other drastic measures.

- Endocrinologist: Tests for vitamin deficiency, Cushing syndrome, thyroid disorders were all negative. He had no further suggestions.

- Sleep specialist: I had a sleep study, and while I wake up slightly more than normal, I don't have apnea or any other treatable sleep disorder. She said I should sleep and wake at the same time every day, which I try to do, but I still oversleep a lot and feel fatigued.

Current health stats:
30 years old. BMI: 33 (2 years ago, I was at 28, which looked and felt like a good weight for my body).

Pills taken: allergy pills (prescription), multivitamin, iron supplement, fish oil, vitamin D. I have tried taking B vitamins, with no effect. I am not on hormonal birth control.

Lifestyle: Vegetarian diet, perhaps a bit more sugar than ideal, but plenty of plants and other healthy stuff. I eat fish often enough that I'm not worried about protein deficiency. Yoga 2x/week, exercise classes (boot camp style or boxing) 2x/wk. Walk about 4 miles a day. Spend a lot of time online, though I've been cutting back since the tendinitis in my wrists. I wear sensible shoes. I drink a lot of water. I don't have one of those sedentary jobs where I sit 8 hours a day; I'm up and moving about half the time.

If it turns out that I'm just unlucky and have a lot of unrelated medical symptoms, I can learn to live with that. It could be a lot worse. But given that all of this has started in the last two years or, so, it feels like too much to be just a coincidence. So, any thoughts?

I'm not looking for a diagnosis over the internet (I'm not stupid). I'm also not looking for anything other than scientific, evidence-based medicine. No homeopathy or hypnosis or magic spells. But I would like to brainstorm some ideas about how to get to the bottom of these symptoms. But if anyone can think of anything that I and my doctors haven't tried, I'm all ears. So, what sort of doctor should I see, and what should we try?
posted by anonymous to Health & Fitness (28 answers total) 4 users marked this as a favorite
IANAD, but these (Psoriatic dermatitis, weight gain, fatigue, lower back soreness and pain, difficulty concentrating, diarrhea) could be indicators of Celiac Disease. It doesn't always start as a stomach/bowel pain type of thing.

I was recently diagnosed with it and I had some of what you're going through...mental fog, bowel changes, itchy patches of skin, lower back pain, fatigue, weight gain. I didn't present with stomach pain.

CT scan will check for lower bowl malabsorption, blood test, endoscopy are the tests.
posted by dzaz at 2:33 PM on November 3, 2010 [3 favorites]

This sounds a lot like Celiac Disease to me. Not sure exactly what kind of doctor you'd need, though.
posted by MexicanYenta at 2:35 PM on November 3, 2010

Meant to add, maybe a gastroenterologist?
posted by MexicanYenta at 2:37 PM on November 3, 2010

Except for the weight gain, my amateur offered-over-the-internet diagnosis is Addison's Disease. Are you inexplicably tan?
posted by MrMoonPie at 2:39 PM on November 3, 2010

You should get a second opinion from a new primary care physician. I would look for someone who specializes in a holistic approach (not necessarily of the hippie variety, but someone like an internist or osteopath who looks at the whole body) rather than a family physician you would see for colds and immunizations. In my experience internists are better at putting the pieces of the puzzle together.
posted by joan_holloway at 2:43 PM on November 3, 2010

I think you're going to get answers that are all over the place. Do you LOVE your primary? I ask because he is who should be helping to guide you. Barring finding an awesome comprehensive doc I say you should get a second endocrinologist opinion and then hit a good gastroenterologist. Not to be a total pessimist, but I once went to FIVE different doctors of THE SAME SPECIALTY before I was finally diagnosed with an EXTREMELY COMMON malady. Unfortunately in these days of managed care and cost controls you really have to be your own detective and your own advocate. Good luck! I hope you find some relief soon.
posted by PorcineWithMe at 2:43 PM on November 3, 2010


Full thyroid panel PLUS test for Hashimotos (antibody test).
posted by availablelight at 2:44 PM on November 3, 2010 [2 favorites]

Something doesn't fit here. Your BMI says you're definitely overweight, yet your exercise routine is quite demanding, and should be keeping you in trim. Being vegetarian doesn't guarantee a good diet, particularly if you're eating too much sugar (how does that happen on your veg diet?). Have you been checked for diabetes?
posted by alonsoquijano at 2:54 PM on November 3, 2010 [1 favorite]

Does your health plan give you access to a university hospital or major medical center? You have a better chance of getting interdisciplinary care through one of their clinics than you do with a private practitioner.
posted by Wordwoman at 2:59 PM on November 3, 2010

Also: your symptoms resemble those of fibromyalgia. Have you seen a rheumatologist? (IANAD.)
posted by Wordwoman at 3:19 PM on November 3, 2010

IANAD (student). To review, your symptoms list is: scaly rash, weight gain, diaphoresis, fatigue, tendonitis, sinusitis, LBP, difficulty concentrating, and occasionally loose stools, and you are concerned particulaarly because they all started at around the same time two years ago. I would organize the symptoms list as follows:

(1) weight gain, fatigue, difficulty concentrating, and diaphoresis all generally relate to a hormonal issue such as adrenals (Cushing's/Addison's), thyroid disease, or estrogen-related disease (PCOS). It seems like most of these have been ruled out already. Another consideration is that depression or anxiety can cause these symptoms.

(2) tendonitis, lower back pain: lower back pain usually is a problem that comes with age. tendonitis is usually from overuse injury. Rarely there are auto-immune syndromes that explain musculoskeletal pain, and may also explain your rash: dermatomyositis, seronegative spondylopathies and polymyalgia rheumatica but they typically are associated with other symptoms such as significant muscle weakness which you do not mention having.

(3) loose stools: I'm not sure how often you are having diarrhea. If it is very often, it deserves further history and examination from a doctor, and perhaps more focused history regarding whether you have symptoms of celiac disease.

(4) scaly rash: not clear on this. would defer to your dermatologist's expertise.

(5) sinusitis: Most likely unrelated to your other issues. I think your PMD was right to refer you to an allergist and ENT.
posted by alex3005 at 3:29 PM on November 3, 2010 [2 favorites]

If your rash is in fact psoriasis, that plus plantar fasciitis, tendinitis, and low back pain could suggest psoriatic arthritis, which can also cause extreme fatigue. Rheumatologists are frequently the medical mystery diagnosis experts, so even if this doesn't end up being even close to your problems it might be worth seeing one.
posted by hydropsyche at 3:30 PM on November 3, 2010 [2 favorites]

I have an autoimmune disease and your symptoms are ringing bells for me; mine also presented as an array of seemingly unrelated problems that turned out to be related by systemic inflammation. Seconding a rheumatologist, and at the very least antibody tests ordered by your primary, though those can often turn up negative even when you do have an autoimmune disease.

It could conceivably be that you're just developing a lot of unrelated things at the same time, but you're young for that to happen without an underlying reason (but right in the age range when autoimmune diseases often present in women).
posted by camyram at 3:31 PM on November 3, 2010

IANAD. Putting in a vote for a new primary care doctor. Your current one has sent you around to five specialists but hasn't done the legwork for figuring out why you need to go to five different specialists. A fair number of tests have been done which point to *something* but your primary hasn't put the pieces together.
posted by Mister Fabulous at 3:57 PM on November 3, 2010

New primary care doctor. Rheumatologist.

You need the new primary care doctor because your current primary care doctor should have referred to you a rheumatologist long ago.

That said, chronic sinusitis is often a sequela of both autoimmune diseases and chronic viral infections. My doc explains this to me with the rainbarrel metaphor--if your rainbarrel (i.e., immune system) is full, any new stress (i.e., inhalant allergies or cold viruses) can cause it to overflow (i.e., develop sinusitis).
posted by Sidhedevil at 4:12 PM on November 3, 2010

Yeah, those sound like my celiac symptoms, too. You should go to a gastroenterologist for a blood panel. If you get a doctor who says overweight people can't have celiac, get another one. Keep in mind that the celiac tests can be wrong 20% of the time, so even if you get a negative test you might think about giving a gluten free diet a try for two or three months. I literally started feeling better within 36 hours after I last ate gluten.
posted by sugarfish at 4:29 PM on November 3, 2010

How long ago did you go to the endocrinologist for a thyroid panel? I ask because when I had symptoms like this for a year, I went to one and my tests were within the normal range that the lab used but were borderline hypothyroid; two years later after my symptoms had gotten worse and I finally went a non-sucky primary doctor, all of my lab results were firmly in hypothyroid territory. Your endocrine system is not static, so finding another primary doc and/or endocrinologist for retesting would be a good start.

I'd also recommend getting tested for celiac disease, but going on a gluten-free diet for a couple of months to see if symptoms improve is a cheap way to test that theory out. I have not been diagnosed with celiac disease, but I have family members who have been and symptoms that are similar to theirs, and like sugarfish, I felt better within a couple of days after I went gluten-free.
posted by bedhead at 4:40 PM on November 3, 2010

I think ALEX3005 has done an excellent job of summarizing some possibilities--it seems to me the ringer in all this is the 50 lb. weight gain--that is a lot of weight in two years given your exercise patterns and diet. And,that type of weight gain is not impossible, but unlikely, with Celiac or other major GI problems. It would seem that major endocrine or autoimmune disease have been also been ruled out. I would probably see a gastroenterologist and then rheumatologist . However--while figuring this out I would begin working on the weight gain--somehow calories are coming in and not being expended. I would strongly encourage you to keep meticulous track of calories, exercise and weight for 8-12 weeks. Weight gain/loss/maintenance during that time will provide helpful information to you and to any physician you consult. As a layman I am guessing that most of this is related to weight gain, coincidences, anxiety/depression and problems that are often secondary to excessive weight. Good luck
posted by rmhsinc at 5:10 PM on November 3, 2010

I'm sorry, but no. Bodies are not Bunsen burners. It is quite possible to gain a great deal of weight due to underlying medical conditions. I lost a dress size within three weeks of removing gluten from my diet, not because I was eating better -- I wasn't -- but because I was no longer suffering from malnutrition due to lack of absorption. My body figured out it wasn't in famine mode and adjusted accordingly.

People don't eat their way into 50lb weight gains in 24 months unless there is something like untreated binge eating. When there isn't, there's usually a serious underlying medical condition.

The OP said she didn't want weight loss advice. I just removed like a dozen lines of snark, but all I'm going to say is that suggesting a fat person count calories is incredibly condescending.
posted by sugarfish at 5:30 PM on November 3, 2010 [3 favorites]

rmhsinc, that kind of thinking killed my mother. She kept gaining weight, and her doctor's response was to put her on more and more restrictive diets. After a year of her eating 500 calories a day and her still gaining weight, he finally sent her to an endocrinologist, who diagnosed Cushing's Disease.

She died of a massive heart attack before her prescriptions were filled. I am sure that a year without treatment of a serious endocrinological disease AND a starvation diet played a big role in that.

Food logs are great, but addressing a complex of problems like this with weight-loss dieting is counterproductive at best.
posted by Sidhedevil at 5:38 PM on November 3, 2010 [1 favorite]

Seconding rheumatologist - I have rheumatoid arthritis complicated by gluten intolerance, and quite a few of your symptoms ring bells for me.
posted by restless_nomad at 5:41 PM on November 3, 2010

Let me correct something--when I said "working on the weight gain" what I meant was understanding the weight gain--it is up to the poster to decide whether or not she wishes to do something about it. From a medical point of view it is important to understand why weight is being gained/lost. An honest and complete tracking of caloric intake and expenditure can be very useful n determining whether weight gain/loss is metabolic or a result of significant imbalance in caloric intake/expenditure. I must admit I am surprised at the reactions to my suggestion. Knowing baselines is important in assessment and treatment. I did not suggest a weight loss program. I also suggested she see a gastroenterologist or rheumatologist.
posted by rmhsinc at 5:53 PM on November 3, 2010

when I said "working on the weight gain" what I meant was understanding the weight gain--it is up to the poster to decide whether or not she wishes to do something about it.

I think what she wants to do about it is to identify and address the underlying medical problem.

That said, I completely didn't grok that what you were saying was "track your calorie budget just to make sure the weight gain isn't caused by some change in your diet or exercise patterns, and so that you have the data to share with the appropriate doctors" and I agree that that is an important step, so my apologies for misunderstanding the intent of your post.

And my hope for the OP is that she will not have a doctor like my mother's who insisted she must be lying in her logs or "cheating" on her diet.
posted by Sidhedevil at 6:20 PM on November 3, 2010

I have celiac, and had nearly ALL your symptoms, including significant weight gain. My doctor thinks the weight gain has to do with the fact that my body was starving/malnourished all the time, and would hold on to any nutrition that could still be absorbed by my totally destroyed small intestine (i.e. sugar).

I would recommend getting a celiac blood test. I spent most of my life having one sinus infection after another. I haven't had one since my diagnosis. My dandruff, muscle cramping, terrible pooping and fatigue all went away. I wish my doctors had been aware of celiac and I had gotten tested years earlier, but I didn't do so until a cousin of mine was diagnosed. I know you don't want to be diagnosed over the webs, but you should be tested for autoimmune diseases.
posted by Maude_the_destroyer at 7:35 PM on November 3, 2010

The weight gain could also be a symptom of metabolic syndrome. You can have this for years with no symptoms whatsoever. Has your weight gain been around your midsection? It causes extra insulin in your system, which can have all sorts of negative effects. It affects all the cells in your body, and is a precursor to diabetes. Your blood sugar levels can be completely normal, and you could still be insulin resistant.
posted by annsunny at 7:57 PM on November 3, 2010

It can't hurt to try eliminating gluten from your diet. The tests for celiac are not particularly reliable, but cutting out gluten for a month will show results if that is the problem. If it is, I would strongly recommend you find an acupuncturist who is familiar with celiac. He or she can make a huge difference in helping to return your body to health.

Of course, it could be something else entirely, but eliminating gluten and observing the results is something that's within your power to do.

Good luck. It took years to diagnose my post-polio syndrome, which included fatigue and mental confusion, and the stress of having multiple doctors look at individual symptoms was extreme.
posted by kestralwing at 12:50 AM on November 4, 2010 [1 favorite]

I'm not going to try to diagnose you because I am in no way qualified to do so. i will just say that a fifty-pound weight gain is a very large weight gain and while it may not be the cause of some of your other symptoms it could certainly be aggravating some of them, specifically: lower back and joint pain, increased perspiration, fatigue and muscular injuries.
posted by Decani at 2:48 AM on November 4, 2010

not a doctor, but since it hasn't been mentioned...talk to your gynecologist about polycystic ovary syndrome. it could explain the weight gain and the sweating, and sometimes there are dermatological symptoms. joint and back pain could be due to the weight gain and resulting changes in your body mechanics to compensate.
posted by thinkingwoman at 3:13 PM on November 4, 2010

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