How do I find out if some bigger health problem is causing thus depression?
December 28, 2011 8:27 AM   Subscribe

Depression! But maybe it's hypothyroidism? Dr google tells me it might be cancer (ovarian or bowel) when I add in the other health changes I've had over the last year. Hope me? What do I ask? Who do I see? No insurance. Location and gmail inside.

Hypothyroidism runs in both sides of my family. Complications - it fails to alter the weight of the skinny side, and also on that side the blood numbers look normal until medication is added and symptoms improve. Further complication - I only speak to 3 of my biological relatives with anything approaching regularity.

This is a punny set up for my next worry. My poop has been...different. For a while (months? A year?)it was mucousy, now (6 months or so) it's not firm and is kind of grey. I've always liked pooping, well. I mean, it's never bothered me. Now I get a bit constipated. My farts. (ok, I'm a lady, we don't fart, but the closest thing I do to farting...) They used to be infrequent and never smelled like anything before. Now. Oh they're awful. Drove by a sewage treatment facility on a road trip recently and that sick cloying sweet smell. I fart like that half a dozen times a day now. No changes in my diet. No antibiotic use. No travel to foreign country.

My menstrual cycle used to be very very regular. 23 day cycle (yes, miserable, a week of bleeding and 2 weeks off) so when they started getting closer to 28-20 days last winter, I rejoiced. I'm 30. It didn't seem strange a year ago, but they're just not regular. Sometimes 24 days, sometimes 30. Not crazy, never longer than 36, but...that seems like a big window. Not on birth control.

Gained 10 pounds about this time last year, after years and years of working at it, but I hadn't changed anything.

Twice in the past week some stranger has asked about 'the baby' but I'm not pregnant, so that was awful.

And the depression. This bout has been my worst ever. Onset was a few months after an abusive relationship ended and coincided with the beginning of winter. I live in Florida (and am asking anon to protect potential future health insurance coverage/spare my family from worry/spare myself from being accused of being a drama queen by the 1/3 of my 'family' who might read mf). I sought out my psychiatrist and have changed mess twice since October. Improvement, yes. But! It's Xmas and I'm visiting family, hiding in my room, crying when I talk with the 2 family members here. They want to make this better.

I'm dizzy, achey, cranky, and not in a PMS way.

At home I run 3 times a week even though the depression tells me bed is all I deserve. I walk a lot for commuting.

What should I ask whoever I see? What else should I be reporting on? Urination is frequent, but I've always had a tiny bladder, so that seems unrelated to me. Migraines, I started getting then about 3 years ago. Very very painful. Auras. Difficulty controlling my arms/fingers sometimes when migraine is happening.

My once perfect and lustrous fingernails peel after just two or three days w nail polish now, so I've stopped using it. My skin is still very soft, only a tiny bit dry on elbows.

Breast cancer in my aunts on both mothers and fathers sides. The only sibling health issue I know of is the hypothyroid in my younger sister.

Gmail: maybe.cancer at well, gmail of course that would be a dot com thingy. I return to south Florida Wednesday. I can access miami, ft lauderdale and boca via piblic transportation. Where do I go to be seen for, um, free? I work 20 hours in the busiest week and have applications out everywhere for 'real jobs.' Rent and psychiatry have taken all my money to date.
posted by anonymous to Health & Fitness (13 answers total) 2 users marked this as a favorite
First things first - have you applied for Medicare?
posted by desjardins at 8:45 AM on December 28, 2011 [1 favorite]

Dr google tells me it might be cancer (ovarian or bowel) when I add in the other health changes I've had over the last year. Hope me? What do I ask? Who do I see?

First thing, stop consulting Dr. Google. This will only lead to anxiety, I promise. Dr. Google thinks everything might be cancer or some other life-threatening problem, and does not have the years and years of medical training and experience to suss out the most likely diagnosis. Especially if you are already suffering from depression, please don't give your mind more cause to freak out by checking your symptoms on the internet.

Second thing, you need to see a general practitioner or internist. You have such a variety of symptoms going on, there's no way anyone here could effectively say "You need to see THIS kind of specialist." But a general practitioner, if they feel that they cannot figure it out on their own, will have better insight into what kind of specialist you should see. They would also be able to order tests that might help clarify the situation, which could further clarify what kind of specialist you should be referred to if necessary.

Third thing, make a bulleted list of your symptoms and health changes. Make it as concise as possible, while still including everything. You could use the question you wrote above and just pare it down to the bare minimum:
* Family history of hypothyroidism, doesn't show up on bloodwork
* Several months mucousy stools, now gray and loose
* Irregular menstrual cycles
* etc.
You don't have to include all the things you've tried to fix the issue or things you've ruled out (diet changes, no antibiotics, etc.) -- the doctor will ask you about these things if s/he thinks they're relevant. Having a very clear, concise list to hand over will help ensure that you don't forget to mention anything, and will help you get the most out of the very limited time that a doctor has a for an individual clinic visit. If you show up with 2 pages of solid paragraphs, the MD is going to miss something trying to scan through it quickly.

As for the no insurance issue, I wish I could help but I don't know how to answer that question. Perhaps Florida has a medical assistance program for people who are uninsured? Hopefully others will chime in on that issue.
posted by vytae at 8:45 AM on December 28, 2011 [3 favorites]

It could be celiacs, anything. You need bloodwork. A doctor will know what to order. Are there ANY low-income, sliding scale clinics? Some Planned Parenthood branches (which are sliding scale) do limited primary care.
posted by availablelight at 8:59 AM on December 28, 2011

Seconding what others have said about being careful of Dr. Google. You know your own medical (and family medical) history best, and there is reasonably good advice to be had from the NIH, CDC, etc., but you need to see a doctor to help sort all of this stuff out. The internet can give you medical information until the cows come home, and I've found online medical information (from sources like, e.g., MedlinePlus) that's been useful with discrete problems, but you've got a lot of symptoms here that may or may not be related, and you need a professional to help figure out the problem/s, a course of treatment and/or change in environment, etc.

Practically speaking:

* Look for free or low-cost clinics nearby.
* Find out if you're eligible for Medicare or Medicaid.
* If nothing is free and you can't get any sort of low-cost coverage, ask family or friends for financial help.
* Bring that written medical summary/list that vytae mentioned to your first appointment.
* Chin up! The uncertainty and understandable concern you must be feeling are not helping things, and getting some solid, professional medical advice will take much of that away.

On a related note, if you haven't tried already, you might see if you're eligible for food assistance, or similar programs. While these aren't directly about medical care, it might help free up funds.
posted by cupcakeninja at 9:22 AM on December 28, 2011

I had lots of these symptoms and it turned out my iron levels were slightly low. Started taking iron, and immediately felt much better. My point here - it could be something totally minor, and you're working yourself into a frenzy by imagining the worst. Go see a general practitioner and get a basic round of blood tests.
posted by judith at 9:53 AM on December 28, 2011

It could be any number of things. I agree with the above advice that you need to see a general practitioner and they will need to do a variety of tests. IANAD, this is not medical advice, etc.

I don't know about cheap/free care in south Florida, but whenever you get in to see a doctor, probably getting tests for your thyroid, iron (ferritin too), a celiac test done and probably a test for vitamin levels that are key to feeling energetic (such as B12 and D) would be prudent. Getting what you want out of a doctor is a funny dance--I think listing your symptoms and family history, seeing what they recommend and then pressing for any other tests you want is part of it. If they don't want to do a test, ask why not and it's okay to tell them you can't afford to come back, etc., so please run the test now.

(Your symptoms sound like classic celiac to me, but IANAD, and you really need to see one. FWIW, LOTS of things sound like celiac, or iron deficiency or any number of ailments.)

Another idea for cheaper healthcare--are there any flat rate clinics in Miami or nearby that you could go to? I found one like I was thinking of in Southwest Florida:

I'm sorry you're suffering, that all sounds pretty awful.
posted by purple_bird at 10:16 AM on December 28, 2011

Get your thyroid levels checked. There is no way you can be hypothyroid without it showing up in a blood test.. Make sure they check BOTH hormones. I had my thyroid removed 7 years ago and have to deal with thyroid level checks 1 every 2 years.
posted by majortom1981 at 11:07 AM on December 28, 2011

Complications - it fails to alter the weight of the skinny side, and also on that side the blood numbers look normal until medication is added and symptoms improve.

Okay, so what symptoms DO they have? You say on the skinny side there is "no" weight gain, but I think you should talk with your relatives because it's possible they did gain weight but, being already skinny, it didn't show as much (I was skinny, and gained 5, then 10 lbs when I was subclinical and the endocrinologist wouldn't even treat it until I had gained almost 40 lbs!).

But if they don't gain weight, your weight gain is probably not from hypothyroidism, right? It could be, I'm sorry to say, turning 30. Aging can do a number on your metabolism--in general, everything slows down. That may be what is going on with your menstrual cycle, too. Hypothyroidism generally involves HEAVIER menstrual periods, not lighter.

With hypothyroidism, I would also expect to see lots of fatigue: falling asleep in the middle of the day, sleeping too much, falling asleep when you are trying to read or concentrate. Not insomnia. You'd probably have very dry skin (cracking heels and elbows, white patches, looking like an alligator when you shave your legs if you don't moisturize), hair loss or at least brittle hair and fingernails, not soft fingernails.

One thing, though, that is worrisome is your depression. Hypothyroidism and depression can play tug-of-war with each other, with each one making the other harder to treat. BUT having your depression worsen when you are already feeling sick and bad about yourself as you seem to be is not unheard of, either.

And the other issues do make it sound more like a dietary problem than hypothyroidism. In my understanding, black hard stools (sorry to be graphic) are more likely a sign of cancer than the clay kind.

My son, when he was a baby, had to take iron supplements and, well, yeah, with the clay color and the other digestive symptoms, I'm seconding the iron-poor diet being a possible culprit. If those soft fingernails of yours are white, or your nail beds are pale, that's another good indicator for anemia.

Lastly, you could have something going on with an ovarian cyst, explaining the change in cycle and your puffy abdomen (the pregnancy comments). The majority of ovarian cysts are benign and disappear on their own, though you should get that checked out.

So, in your situation, I'd start by taking vitamin supplements and eating more iron because that's healthy anyway (you don't have to eat meat if you don't want to--figs, for instance, are a good source of iron). And definitely check in to Planned Parenthood for an ob/gyn exam. If you see someone for your depression, mention how much worse it is.

You sound like a candiate for Medicaid in Florida. Look into it if you still want your thyroid levels tested.

And stay away from Google!
posted by misha at 11:39 AM on December 28, 2011

Evidently I meant Medicaid, not Medicare in my first comment.
posted by desjardins at 12:18 PM on December 28, 2011

There is no way you can be hypothyroid without it showing up in a blood test.

Except for those of us who have underachiever pituitaries. It is in fact very possible to be hypothyroid without having bad blood tests. Some of the OP's family members have experienced this, and I did, too. (I would never have been diagnosed if my thyroid eye disease hadn't made it perfectly obvious that I had an autoimmune thyroid problem.)
posted by artistic verisimilitude at 1:57 PM on December 28, 2011 [2 favorites]

There is no way you can be hypothyroid without it showing up in a blood test.. Make sure they check BOTH hormones.

av is correct, and there's more. Some of us have both pituitary issues and thyroid receptor cell issues; my labs definitely do not tell the whole story. In addition, if you are having thyroid testing done for the first time or before going on replacement meds, here is a list of recommended labwork.

If I were in your shoes, I'd try to see a well-respected ND or OS, given that there are gut issues (candida? celiac?)

Wishing you well on your health.
posted by vers at 3:45 PM on December 28, 2011 [1 favorite]

Sorry if I missed this, but are you on psych meds?

I'm asking because when I was on the medical merry-go-round, I was given a drug that caused me to have hypothyroidism. I also had a drug that mimicked the symptoms you'd get if you had a tumor on your pituitary gland. Finally, to round out the fun, I had some irregular Pap smears and thus, a second cancer scare.

First thing I'd do is stop Googling your symptoms. Seriously! Google isn't your friend or your doctor. Second thing I'd do is maybe go to Planned Parenthood. It may sound odd, but in my case, all of my symptoms were diagnosed and treated by my nurse practitioner there... I got lucky in the sense that she had some experience with psych drugs, but it's a cheap and good place to at least get started even if you aren't on meds.

You have my sympathy.
posted by sm1tten at 4:31 PM on December 28, 2011

Mod note: From the OP:
So. what follows is the longest possible way of saying, Thanks, Metafilter, for encouraging me to navigate my great nation's messed up medical care situation to advocate for myself. I feel like you all have been quietly rooting for me since December, even if you've forgotten that I even asked this question. It's getting scarier, but I feel like I'm on my way to having some answers, even if for the short terms it's just getting anxiety medication to make breathing and sleeping easier while we try to figure out what's actually wrong.

My thryoid results (antibodies, free t4, TPO, free Triiodothyronine, TSH) are all normal. Of course, there is no baseline, so maybe still not normal for me. My deep tendon reflexes were non-existent and I had some other symptoms and signs beyond my two page typed up list that are consistent with Hashimoto's.

Doctor then ordered CBC, CMP and some other stuff to look at anemias. Because of my financial situation, they said I could do it in two phases - making marks by the things they wanted immediately and what they might want later depending on those results. I went ahead and got it all done at once. Glad I did, because when those results came back (which required a lot of riding herd on my part, originally the doctor who called back to confirm that my results were in just saw the thyroid lab and said it was normal, but didn't read my chart to see that more had been ordered Grrrr, so that took a while to straighten out) I was told there were abnormalities inconsistent with anemia. They wanted another CBC, a blood smear and a reticulocye count.

They wouldn't tell me over the phone why they wanted all of that.

So I had the blood drawn last week, and over the weekend got itchy all over, shortness of breath, and found myself getting angry -absolutely furious! over inconsequential crap.

The shortness of breath is vying with joint pain for the title of "worst part." The on call doctor did not call me back last night, so I called the practice again this morning (Metafilter, you have given me the confidence that I have a right to keep after these people, just like everyone else does). They said come in today/tomorrow or go to the nearest emergency room. (I thought _nearest_ was a nice touch. That probably suggests that I shouldn't be sitting at work for the next half hour before I leave to go to the doctor. Whatever. I need the money, and sitting around the house worrying wasn't going to fix anything.) I'll either get some answers this afternoon or more tests.

I used up my question for this week, so I couldn't ask what the hell they wanted with the new tests. And that's as it should be. I've stopped asking Dr Google to diagnose me. And that is a huge victory, so thanks for that as well. Don't tell me what reticulocyte counts and blood smears are used to diagnose. I'm sure it's a hundred different things.

If there is more schmoopy, I promise to bring it to MetaTalk when I'm ready.
posted by mathowie (staff) at 9:51 AM on March 5, 2012

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