MD STAT: Talk to a doctor.

How would you like to be able to simply ask a physician a question? To actually speak with a doctor regarding your medical and surgical questions? We bet you can't do that anymore. We physicians simply do not have time these days to pick up the phone and talk to you. So why not ask us? All contributors here are board-certified in the United States and we have some fantastic retired docs too. You may read their profiles on our left sidebar. We intend for this to be informative and fun. Welcome.

Monday, May 21, 2012

Near Syncope?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree.

Hello Docs

I am a female, 16 years old, 5"3, and 112lbs. I exercise often, and I am in good health.

I believe I have episodes of orthostatic hypotension. When I stand up, I sometimes get very lightheaded-more of a headrush, really. My vision fades to black, and I lose my sense of balance/control of my body, and often have to grip onto things or sit down to prevent falling. In more severe "episodes," I can feel my heartbeat in my head, chest and neck, I have slight chest pressure (but not pain), and I have slight difficulty breathing for a short amount of time. Ocassionaly I have a slight numb-feeling in my head and fingertips. Metaphorically, it feels like somoeone has turned off my "power button," waited a few seconds, then turned it back on. I feel fine after the episodes, but during the episodes it can feel like I'm going to pass out, and it's not pleasant.

I have had numerous near-syncope episodes, but those only happen maybe 2-4 times a week. Regular episodes occur around 2-3 times a day, and usually after long periods of time sitting or lying down and then standing up. I have fainted, but only 2 or 3 times. Once, more than a year ago in the morning, and again a few months ago. The second time I fainted, I hit the back of my head on my mom's metal exercise bike. There were no problems due to the injury, other than a bump on the back of my head that was painful to touch. And I might have fainted a third time about a month ago, but I'm not positive if I actually lost conciousness or not.

My question is this: Do you think it's necessary to see doctor? I personally would like to, but my problem is my mom. My mom doesn't want me to "label" myself with a problem and make things like getting a driver's liscence more difficult if the doctors can't even do anything about it (which based on internet research, they can't). So, should I urge my mom to take me to the doctor's? Do you personally think my symptoms are serious?

With Thankful Regards,
Emily

Gender: Female
How tall are you (feet and inches)?: 5ft3
What is your weight in pounds?: 112lbs
How old are you?: 16
How long has this been going on?: More than a year
Check all symptoms you are currently experiencing: None of these

Describe associated symptoms not listed above: I am not CURRENTLY experiencing any of these symptoms, but lightheadedness, vision that fades to black, chest pressure (but not pain), slight difficulty breathing for a few moments (like a catch in my breath), and loss of balance occur in my "episodes," when I sometimes stand up from sitting or lying down after a period of time, and lasts from 15-30 seconds. The episodes have gotten more frequent and slightly more severe in the last few weeks.

What have you done so far to remedy this condition? Please include tests and relevant studies here.

I haven't been to a doctor about this specific problem. But when I went to an urgent care for a sinus problem (which is now gone), I experienced a very severe "episode," and possibly fainted. The nurse was pricking my finger for blood for a mono test (as I felt like I had no energy), and he asked me stand up and walk over to the near-by table. By when I stood up, I got extemely light-headed and mumbled that to the nurse before trying to catch myself on the table (because I had lost my vision and balance). The nurse caught me and had me lie down on those bed/chair-things in the room that patients sit on. The main doctor didn't think anything of it, other than getting more blood for a more detailed bloodtest (which come back normal), and telling me that some people just faint more than others. (By the way- I am not squeemish at blood).

So, long story short, I have done nothing other than drink more water and consume more salt, but my symptoms have gotten worse in the last few weeks.

Please list any chronic medical problems and also list any prior surgery (lacerations don't count!): none
Check all conditions present in your immediate family... : Cancer, History of Back Pain
Please list any medication allergies that you have : : None
Please list any medications you are currently taking (and dosage if known) :: None
When was your last menstrual cycle?: 2 weeks ago
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Never

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

1. Do you personally think my symptoms are serious? Should I be worried?
2. Is it necessary to go to a doctor for my symptoms?
3. Is this just orthostatic hypotension, or could it be neurocardiogenic syncope (which one of my cousins has)?

Friday, May 18, 2012

Is it Lymphoma?

I AGREE TO USE MD STAT FOR EDUCATIONAL PURPOSES ONLY, THAT NO DOCTOR PATIENT RELATIONSHIP IS FORMED BY MY PARTICIPATION IN THIS EXCHANGE, AND I UNDERSTAND THAT MY QUESTION AND ANSWER(S) WILL BE POSTED ON THE WEBSITE AND WILL BE VIEWABLE BY VISITORS TO THE SITE.: Yes, I agree. Hi doctors, I have asked a question before (hypokalemia mystery). I have no problems with my potassium now, no potassium supplements! I have a new problem that I am worried about. I am concerned about cancer, lymphoma. The past 1.5 years I have had siginificant weight loss in Oct 2010 I weighed 210 pounds, in September 2011 I weighed 150 I now weigh 130. At first I enjoyed the weight loss, but people have started to make comments about how I've lost too much too fast since I am doing nothing at all to make me lose the weight. I looked up causes of unintentional weight loss and a majority of them I have been tested for recently. One that stood out was lymphoma, now I'm a bit scared because some symptoms I've had match lymphoma, I itch all over, allergy meds don't work and my skin isn't dry but I scratch so much at night I make myself bleed. I have always been fatigued and have generalized weakness. 2 months ago I got the flu and did prednisone for a week and a sinus infection so amoxcillin for 10 days, since then I have been running fevers on and off every 3-4 days & the fever usually ranges from 101-103. 2 months ago I found a firm painless lumundemanding my left jaw. I saw my doctor 2 days ago and she wasn't concerned. She felt the lymph node under my jaw and found one enlarged in my neck, armpit & groin. She said it was a cold virus and that we should just recheck my weight in 1-2 months. The same day I saw my neuro-opthamologist (see her b/c of different pupil sizes). When I told her about my symptoms she was concerned and kept asking if my doctor was ordering imaging studies. She thought my pupil problem may be horner's syndrome and that a mass in my chect was causing my pupil differences but the test she did was negative. I just have this gut feeling that this may be cancer. I'm concerned because it seems like at least for lymphoma it doesn't show up in the blood unless it's greatly progressed because it orignates in the lymph system. Gender: Female How tall are you (feet and inches)?: 5'3'' What is your weight in pounds?: 130 How old are you?: 23 How long has this been going on?: More than a year Check all symptoms you are currently experiencing: Fever Weight Loss Describe associated symptoms not listed above: all over itching, fatigue, weakness, swollen painless lymph nodes fever is always between 101-103 I only take tylenol for if it I get really uncomfortable. When I get them I usually notice it because I've been really uncomfortable all day and hot, even though everyone else is around me is not hot at all or someone touches me and the comment on how hot my skin feels. I haven't had any night sweats, but I have had some changes in my night time sleeping habits, I used to always need to have at least four blankets on my bed because I would get so cold at night and I can't sleep unless I'm warm but now even one blanket on my at night can been to warm and I find myself kicking it off too hot with it. Also with the weight loss I've really never been below 150 at least ever since high school I've always been a bit overweight with my lowest weight being around 150 pounds, so even though I'm still at a normal weight for my height it's concerening to be because this has never been a normal weight for me. The weight loss is concerning, but I can't say that I am not pleased with it as well, really I think anyone would be. What have you done so far to remedy this condition? Please include tests and relevant studies here. : CBC with differential (normal) My docotr said if it was cancer it would show up here, but I'm not completly conviced because lymphoma at least originates in the lymph system. Comprehensive metabolic panel (normal) Thyroid normal not diabetic The only 'abmornal' results were barely out of range, BUN was 6 mg/dL, Anion Gap was 6mEq/L but those are always just a bit low like that for me, have been for years. I eat normally, nothing has changed in my diet, I really don't exercise. Please list any chronic medical problems and also list any prior surgery: Hemicrania Continua: treated with occipital nerve stimulator implant Neurocardiogenic Syncope: Loop recorder implant and explant surgeries. Inappropriate Sinus Tachycardia 3 EP studies Check all conditions present in your immediate family... : Asthma / Lung Problems Cardiac Disease Diabetes Hypertension Stroke Please list any medication allergies that you have : : nkda Please list any medications you are currently taking (and dosage if known) : Bisoprolol 10mg 1x a day (for inappropriate sinus tachycardia) Zoloft 100mg 1z a day (for neurocardiogenic syncope) Multi-vitamin 1x a day Nasacort AQ 55mcg Clatrin 10mg 1x daily Ambien CR 12.5mg 1x day When was your last menstrual cycle?: 3 weeks ago Are you currently using or do you have a history of tobacco use?: No Are you currently using or do you have a history of illegal drug use?: No Please describe your alcohol consumption :: Occasionally HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible What are the chances of this being lymphoma or another form of cancer? Am crazy for fearing that I may have cancer? Should I seek a second opinion, if so how is the best way to go about doing this? My health history is abit extensive and can make starting over difficult. Can I just wait it out with my current doctor or ask for more testing now? If more testing, what kind?

Friday, May 11, 2012

Lyme Relapse?

My daughter was diagnosed with Lymes a year ago and was treated. Now she is having symptoms again. Low temp, bad headaches, dizziness, fatigue. She is just seeing her regular doctor who has her on doxycycline for 2 weeks, and the symptoms are not getting better. In fact she feels worse like she is in a fog?, and now she has a swollen lymp node under her chin. I think she should go to a specialist, as from what I am reading she needs someone with more knowledge about lymes. Her doctor says to wait a few more days and if she's not feeling better they are going to do an mri?

The remaining info completed is about my daughter as best as I know
Gender: Female
How tall are you (feet and inches)?: 5 feet
What is your weight in pounds?: 140
How old are you?: 31
How long has this been going on?: More than a month
Check all symptoms you are currently experiencing: Nausea
Check all conditions present in your immediate family... : Diabetes
Please list any medication allergies that you have : : allergic to penicllin
When was your last menstrual cycle?: Now
Are you currently using or do you have a history of tobacco use?: No
Are you currently using or do you have a history of illegal drug use?: No
Please describe your alcohol consumption :: Rarely

HOW QUICKLY DO YOU NEED THIS TO BE ANSWERED?: As soon as possible

whether or not my daughter should see a specialist, or continue with her doctor

______________________________________________

This may surprise you to hear but I do not think your daughter needs a specialist in Lyme disease. The reason is that it is not at all clear to me that this is Lyme at all. Much has been made of 'chronic Lyme disease', but the best evidence we have is that there really is not such thing and that, if the organism that causes Lyme disease is not demonstrated by positive lab testing, that further treatment with antibiotics is unlikely to do anything but cloud the picture. And this is not just me talking, I am merely quoting the New England Journal of Medicine.

Here is a good quote from the linked article above....

Conclusions

Chronic Lyme disease is the latest in a series of syndromes that have been postulated in an attempt to attribute medically unexplained symptoms to particular infections. Other examples that have now lost credibility are “chronic candida syndrome” and “chronic Epstein–Barr virus infection.” The assumption that chronic, subjective symptoms are caused by persistent infection with B. burgdorferi is not supported by carefully conducted laboratory studies or by controlled treatment trials. Chronic Lyme disease, which is equated with chronic B. burgdorferi infection, is a misnomer, and the use of prolonged, dangerous, and expensive antibiotic treatments for it is not warranted.
"

Stick with her current doctor. Look for other explanations. Print the New England Journal article out and take it with you. One thing is sure, the PUBLIC believes in chronic Lyme or recurrent Lyme. It is certainly possible to be infected with Borrelia burgodorferi more than one time, but if the tests for acute infection are negative and there is no telltale rash then I might kindly suggest that the diagnosis of Lyme is likely to be incorrect and that other possible causes need to be sought. I will stand by for my colleagues to weigh in. Thanks for your question.