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Arthritis (Expert Forum)
CFS? Lupus Testing
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions and support regarding arthritis issues such as: Arthritis, Autoimmune Disease, Bursitis, Fibromyalgia, Gout, Juvenile Rheumatoid Arthritis, Lupus, Myositis, Neuralgia, Osteoarthritis, Polymyalgia Rheumatica, Rheumatoid Arthritis, Sciatica, Tendinitis, Vasculitis.
CFS? Lupus Testing
by angelJoy, Jun 15, 2006 12:00AM
I finally had a CBC done as I am constantly tired. I take frequent naps andd actually can fall asleep about anywhere. My friend called and talked to me in the middle of a nap and I had no idea I had spoken to her. I also have roscea, a fungal patch on my mid back and upper thigh(the DR. is treating with Jock itch and seems to be helping), a hoarse throat that feels as if something is stuck, and my hip bothers me at night(the Dr. felt bursitis) My bones and muscles ache at night but are better since starting Effexor 75. mg. that I have been on about 6 weeks. The CBC levels came out normal although I was a bit low in iron. I also have some swelling on and off in my lymph nodes under my arm and groin. I told my Dr. I wanted more testing as I am tired of being tired. I have an active life, am a PE teacher, have 2 children and the stress of having a friend with cancer. I went on the Effexor feeling I was depressed but truth is I have always been tired and taken lots of naps. So was my Dad, and he died of non-hodgekins lymphoba at 53. I am 44. I requested further blood work. My blood pressure was 88/60 something and the nurse felt this was low but my Dr. wasn't concerned. I am generally quiet about these symptoms, not overly concerned about my health but this has been going on for almost 2 years. My Dr. felt it was exhaustion but I certainly sleep whenever and wherever I can.
Questions:
1. Would my CBC have ruled out lymphoba?
2. Is there anything in particular I should be looking for in blood test results?
3. What about the blood pressure?
4. Am I sleeping too much?
5. Are there vitamens or other suggestions you may have?
6. Do these symptoms point to Lupus and how do they show up in lab results?
7. Could it be CFS?
Thank-you for any help you can give.
Questions:
1. Would my CBC have ruled out lymphoba?
2. Is there anything in particular I should be looking for in blood test results?
3. What about the blood pressure?
4. Am I sleeping too much?
5. Are there vitamens or other suggestions you may have?
6. Do these symptoms point to Lupus and how do they show up in lab results?
7. Could it be CFS?
Thank-you for any help you can give.
Doctor's Answer
by Kevin Pho, MD, Jun 16, 2006 12:00AM
, Jun 16, 2006 12:00AM
To answer your questions:
1) The CBC is not the definitve test to rule out lymphoma. A biopsy of a lymph node as well as imaging studies are further tests that may be needed.
2) Many conditions can lead to fatigue. I would include a metabolic panel, liver tests, tests for mono, TSH and vitamin B12 studies.
3) 88/60 can be considered low in some patients. However, in well-conditioned athletes, this is not uncommon.
4) Difficult to say without evaluation. I would consider the aforementioned tests to evaluate for any conditions that can lead to excessive sleep.
5) I wouldn't recommend treatment without a clear diagnosis.
6) An ANA level can be done to initially evaluate for lupus.
7) CFS is a diagnosis of exclusion - meaning it can be considered if the testing remains negative.
These considerations can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
1) The CBC is not the definitve test to rule out lymphoma. A biopsy of a lymph node as well as imaging studies are further tests that may be needed.
2) Many conditions can lead to fatigue. I would include a metabolic panel, liver tests, tests for mono, TSH and vitamin B12 studies.
3) 88/60 can be considered low in some patients. However, in well-conditioned athletes, this is not uncommon.
4) Difficult to say without evaluation. I would consider the aforementioned tests to evaluate for any conditions that can lead to excessive sleep.
5) I wouldn't recommend treatment without a clear diagnosis.
6) An ANA level can be done to initially evaluate for lupus.
7) CFS is a diagnosis of exclusion - meaning it can be considered if the testing remains negative.
These considerations can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Fatigue and aches are almost universal with Lyme, and if the rash looks like any of these, it's most definitely Lyme, according to the CDC. These rashes can hang around for a long time, and even come back for a short time after you first get treated with antibiotics.
http://www.lyme.org/gallery/rashes.html
When a Lyme doctor sees someone with Lyme and swollen lymph nodes and a sore throat, they immediately test for this other tick borne infection, Ehrlichia, which is a white blood cell parasite. People whom I've known with the Lyme Ehrlichia combo are often misdiagnosed with CFS, because they have devastating fatigue.
I would strongly urge you to see a Lyme experienced physician, which you can find by typing in your location to "Flash Discussions", then "Find a Physician" here:
http://lymenet.org/
Be aware that Lyme testing through the commercial labs is notoriously insensitive, with the FDA-approved test kits missing over 50% of positive cases.
In my opinion, IGenex, which specializes in tick-borne diseases, is the only reliable Lyme lab, because they test for multiple Lyme strains, not just the B31 Shelter Island strain, and they report on the most specific Lyme markers, the 31kDa and 34kDA bands. IGenex has recently passed Cal., NY, and CDC quality testing with flying colors. You can download the IGenex testing forms from my website; give these to your MD if you want to use this lab. MDL isn't bad a bad lab either.
Fewer than half the people with Lyme ever see a tick bite or a rash. Early treatment is essential with Lyme, so don't delay.
KrisKraft
http://www.lymediseasefilm.com/