Help me describe my ailments!
February 24, 2017 8:32 PM   Subscribe

YNMD, I know-- just want some help with how I describe things to a doctor. I've been feeling a number of small discomforts continuously for the last two months. In combination, they are debilitating at times. Doctor said there is nothing wrong, and I wonder if I need to refine my descriptions.

I am 32, female, hitherto very healthy. I eat healthfully (little to no processed food, sufficient protein, lots of veggies), and I used to run/cycle but these two months I've mostly just be able to walk-- 5-10km a day.

The main problem is that my muscle ache, very badly, all the time. Stretching, massage, baths help, but the ache starts again as soon I stop these activities. Walking helps, too, but not enough. My entire back, shoulder, neck, lower back, hips, and down my legs are sore and achy. The muscle ache feels like burning-- similar to post-exercise ache. It is especially bad in the morning and at night, and in the last two weeks I start getting shooting pains in my extremitis. It's been very uncomfortable to sit in chairs-- or lie down, or stand, really.

Perhaps related, but I am not sure-- I've also been struggling with insomnia. I often can't fall asleep despite exhaustion until about 4 or 5 in the morning. I have a hard time staying asleep, too.
I can sleep very soundly in the evenings for about two hours, but often have to work during that time. During the day I am awake, but my concentration is shot and my mind is foggy. This is probably due to poor sleep. I am exhausted all the time.

Before you say dehydration-- I've been drinking at least 3-5 liters of water everyday, and still feel uncomfortably thirsty. My throat feels sore and burning, and it's especially bad at night (while writing this post I drank 64oz of water and peed twice. the thirst feels unbearable). My skin has also been dry and itchy all the time.

Basically, in a very non-scientific way, I feel very "inflammation-y" and just uncomfortable. My hormones are a little weird-- I get PMS-like symptoms when I really shouldn't be getting them, but this might be because I'm not sleeping. My life is of course stressful (because whose isn't), but even when I can manage to put everything on the backburner I am just spending all day managing these ailments.

Mostly I want the backpain and the insomnia to stop. I have access to a number of walk-in clinics and a slightly better appointments-based clinic, but the doctors are always very rushed and said they could only address one issue at a time. So now I have prescriptions for physiotherapy and some painkillers, and got a lot of lectures about leading a healthy lifestyle, but no real help.

So-- dear hivemind. How do I go in and effectively capture all these things, or convince the doctors that I want something more effective than "rest and manage your stress." These little things together are driving me nuts (and yes, I noted the irony).
posted by atetrachordofthree to Health & Fitness (14 answers total) 2 users marked this as a favorite
Your doctor said there is "nothing wrong" - but what tests did she or he run? What indicators are being looked at, and were they explained to you?

There are so many possibilities.

Tested for Lyme?
Rheumatoid arthritis, other autoimmune disorders?
Sleep disorders?
posted by Miko at 8:42 PM on February 24, 2017 [1 favorite]

It might actually be worth seeing a sleep specialist - that amount of insomnia can definitely cause physical issues.
posted by showbiz_liz at 8:43 PM on February 24, 2017 [1 favorite]

The doctor at the walk-in clinic took my blood pressure and temperature and looked at my throat. No blood test. Said "everything seems fine, maybe you are stressed out."
posted by atetrachordofthree at 8:52 PM on February 24, 2017

After months of complaining, I finally talked my husband into going to the doctor last fall for a very random set of physical complaints. He got an exam and kind of a blow-off.

I made him go back six weeks later, with a list on paper of the symptoms and some tracking of them over the previous 6 weeks and specifically saying "this is an issue, it's been going on for months, I've already been in once for it, I need it taken seriously." She ordered bloodwork, and lo and behold some shit came back, and he got a referral and stuff has proceeded from there.

Something you should do is specifically schedule a physical and yearly exam, which should include bloodwork (say that word, if they don't). Ideally you would do this through a gynecologist, women's clinic, or Planned Parenthood so there's more likelihood you won't be blown off because you're a complaining woman. Make an organized list or spreadsheet of your symptoms and track them between now and that appointment so you have some metrics you can back yourself up with.

Best case, they'll send you off for the bloodwork first and have you come in for the physical when the results are back, but it doesn't always work that way.
posted by Lyn Never at 9:09 PM on February 24, 2017 [7 favorites]

IAAN/ IANYNurse. IMHO, the most urgent thing you have going is that you should be tested for diabetes sooner rather than later. Extreme and frequent urination is a pretty classic symptom. Please go back to walk-in to discuss that.

However, do not expect a walk-in clinic to deal with the whole panoply of symptoms. They are designed for acute problems with on-the-spot, immediate answers and treatment. What you have is more subtle and chronic.
Instead, establish yourself with a primary care provider. (After you make sure you don't have diabetes.) They are more focused on long-term problems. Be prepared to go back to the same provider a few times. It sometimes takes them a few tries before they start thinking about non-specific symptoms in a more focused way. You may need a referral to a specialist, such as a rheumatologist or allergist or endocrinologist.

You are describing your symptoms very well. You may want to be sure to address them as a group. Emphasize that this group of symptoms has all started in the past two months. Also emphasize that this is a huge quality of life problem, even if the symptoms are non-specific or subtle.

Best wishes to you.
posted by SLC Mom at 9:18 PM on February 24, 2017 [14 favorites]

Go find a non-urgent-care primary care physician. Feel free to shop around if you don't click. This is not a walk-in clinic situation. Something is going on and you're right to be aggressive about finding answers. What you've written here is a great description. You could even print this question and bring it. You just need someone who will listen.
posted by quince at 10:00 PM on February 24, 2017 [3 favorites]

IANYD /IMA veterinarian- but the increased thirst/urination seems like it should definitely be on the list of symptoms to discuss and should trigger " blood panel and urinalysis" testing. In vet med PU/PD ( polyuria/polydipsia)- drinking and peeing a lot -have a long but specific list of diagnostic rule outs and is an important clue. Possibly the muscle pain could be from electrolyte changes that might be diagnosed with labs ?( or unrelated). Agreed that you want an internist and not a walk in clinic Dr that's generally used to acute illness/ injury issues.
posted by morchella at 11:07 PM on February 24, 2017 [3 favorites]

You need to see a proper doctor. One you can see repeatedly unless you have a diagnosis. Walk-in clinics are not for chronic or complex conditions, they're for people who need urgent but not emergency care. In the real world, you're unlikely to find Dr House in a walk-in clinic.

It seems to me that there's nothing wrong with the way you're describing your problems, the issue is that you're not seeing the right kind of doctor. You need a GP/PCP. I'm no doctor but I can think of several possibilities that fit the symptoms you describe and none of them are quick/simple to diagnose. That's why you need to be able to see the same doctor and build up a relationship.

Out of interest, prior to these muscle aches/insomnia were you ill? Cold/flu or other viral illness?
posted by missmagenta at 3:37 AM on February 25, 2017 [2 favorites]

Your symptoms sound similar to those experienced by a family member who was subsequently diagnosed with an autoimmune disease. I'm going to repeat what others have said above: get a primary care doctor, write down your symptoms and keep a diary of them to bring to your appointment.

Good luck and I hope that you'll find an answer and that leads to you feeling better soon.
posted by sciencegeek at 5:22 AM on February 25, 2017

See a real doctor. (edit, regular doctor, I understand clinic doctors are real doctors)
Write down your symptoms, severity, and how long you've experienced them.
Wear a boring outfit. (Yeah, they judge you by your outfit.)
If they brush you off, see a new doctor.
Key phrases are "affecting my quality of life" - "not normal" - "unbearable symptoms" - Symptoms that don't respond to standard treatment" - "symptoms that are worsening"
Ask what they think it might be. Ask for tests.
Also, if they don't take notes and/or ask you questions about your symptoms - they also likely don't care and are just working off a checklist. You need someone who cares.

I have a chronic illness and multiple health problems that took years to diagnose and I've seen at least 15 doctors over the past 4 years (and many more over my life.) I have a great GP but only after going to some duds that didn't care or didn't take me seriously because I managed to dress myself in the morning.
posted by Crystalinne at 5:33 AM on February 25, 2017 [2 favorites]

Hi there,

Sorry you're having health problems. My suggestion is to see a specialist if you can. My experience has been that urgent care doctors are fine if you have a really obvious problem, but may not have the time or inclination to get into a trickier diagnosis. For the one or two unusual issues I've had, I saw several primary care/urgent care doctors who just acted puzzled and made some wrong diagnoses before seeing a specialist who nailed it down instantly.

Maybe ask your primary care physician for a referral?
posted by Comrade_robot at 6:12 AM on February 25, 2017

Seconding, thirding?, asking for bloodwork to be done. Glucose, A1C possibly a glucose tolerance test for diabetes, TSH, T3,T4 for thyroid, RF and other autoimmune panels and a general chemistry panel. These are fairly inexpensive and non-invasive tests.
posted by mismatchedsock at 9:28 AM on February 25, 2017

Ok, this is based on something our cat had, but the excessive thirst / water consumption / urination makes me think you might have a kidney infection. Apparently they can often go "slow-burn" and not cause a fever. In any case, the thirst / water consumption sounded to me like the biggest specific red flag that should trigger a doctor to run a set of blood tests.
posted by heatherlogan at 5:41 PM on February 25, 2017

Yes, a story like this would be very overwhelming for someone in an urgent care/walk-in clinic (or even an ER, though you probably would have been more likely to get labs done there). Primary care/internal medicine are the people to address this as noted above. But I do think there are some ways in which you can help yourself by how you explain your situation.

My main tips on how to tell the story:
- discuss things that are objective and quantifiable, like drinking 3 to 5L of water daily and how often you urinate (try keeping a log).
- don't talk about this pain as "back pain". It's not back pain (although it is pain in your back) and someone who's hearing a litany of things might be confused by this, as I'm guessing happened at the walk in because PT is a typical remedy for chronic back pain. All your muscles hurt. The medical term is "myalgias."
- for insomnia, just say insomnia and excessive daytime sleepiness. It will help if you have tried over the counter sleep aids and sleep hygiene already, so you can explain that that hasn't worked - this is the most easily solved of the problems because there are a variety of effective and readily available prescription sleep aids and it probably doesn't require any specific workup.
- it will generally help if you can give time courses for each of the symptoms, that can help to determine if they may be related or if they are potentially separate problems. You don't mention how long you've been having the myalgias, or how long you've been drinking so much water and urinating so much (polydipsia and polyuria). Organize your story. Example: "For the past 6 months, I've been having muscle aches all over my body, without any trauma or exertion to explain them. The muscle aches have been constant, daily, and slowly getting worse over the period of 6 months, and now there are also shooting pains in my arms and legs. For two weeks now, I've also been suffering severe thirst all the time, no matter how much I drink. Normally I don't get up at all to urinate during the night, but the past two weeks, I'm up 3 or 4 times per night to urinate because I'm drinking 5 liters of water per day. During this two week period, I've also had a very sore throat and dry and itchy skin."

I'd recommend leaving out words like "hormones" or "inflammation-y" that sound like you're interpreting symptoms, and sound 'woo' - if there's something wonky with your hormones or inflammation levels, that will be determined objectively through the workup. You could mention symptoms like "irritable" or "depressed" (if that's what you mean by 'hormones are weird') or whatever symptoms you feel as "inflammation" (does that mean you feel hot? flushed? sweaty?).

I'm not sure what they were saying they thought you could improve lifestyle-wise, but I would recommend a statement like "OK, I understand what you're saying and I can work to improve that further, but these symptoms are severely impairing my quality of life, and I already live a healthier lifestyle than most people. I can't leave here without some kind of solution I can use if lifestyle changes aren't working, and I need to understand why you're assuming this is a lifestyle related problem without doing any workup to identify an underlying problem first."
posted by treehorn+bunny at 7:46 PM on February 25, 2017 [4 favorites]

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