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Arthritis (Expert Forum)
What to do next?
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.
What to do next?
by Trippsmom, May 29, 2003 12:00AM
I suppose you could just call me an idiopathic mess at the moment! Since January, with new developments weekly:
diarrhea, night sweats, Alopecia, Rash on ears,
twitching/tremors(legs, hands, neck), “Charlie horses” much worse in left leg,Stabbing/electrical shock-like pains (mostly in feet but also elsewhere),Redness on palms & feet, Petechiae – chest& breasts,Livedo Reticularis–legs, arms and breasts,Spider veining (face [malar pattern],chest,breasts), varicose veining (legs), Eyes:Retinal uveitis/Diagnosed by retinologist also itchy,dry, crusty,photophobia under fluorescent lighting,Joint pain/stiffness (no swelling or redness: hands, back/hips, ankles/feet),Myalgia and fatigue, Rib pain near sternum, Acalculous Cholecystopathy (via Hipa scan – Gallbladder out next week), neuro symptoms after sun exposure (spaciness, overemotional, confusion), newest symptom; rapid appearance of unevenly bordered freckles with no sun exposure plus growth of already present freckles.
Tests done: CBC,SED,TB,Hep-panel,CPK,anti-thyroid,protein,RPR, ANCA,ANA profile,Metabolic panel,hepatitis panel,hla-b27,stool cultures. All negative but for elevated serum potassium, and bun/Creatinine ratio (but individually not elevated.)
My primary concern would be what pathology should be ordered on the GB post-operatively that may help in a "diagnosis" for my Rheumatologist and GP? Secondly, should I call my GP about the freckling or just let it go until post-op exam (I know this type of freckling can be bad news!)? Lastly, do I go back to my Rheumatologist after surgery or elsewhere? THANKS!!!
diarrhea, night sweats, Alopecia, Rash on ears,
twitching/tremors(legs, hands, neck), “Charlie horses” much worse in left leg,Stabbing/electrical shock-like pains (mostly in feet but also elsewhere),Redness on palms & feet, Petechiae – chest& breasts,Livedo Reticularis–legs, arms and breasts,Spider veining (face [malar pattern],chest,breasts), varicose veining (legs), Eyes:Retinal uveitis/Diagnosed by retinologist also itchy,dry, crusty,photophobia under fluorescent lighting,Joint pain/stiffness (no swelling or redness: hands, back/hips, ankles/feet),Myalgia and fatigue, Rib pain near sternum, Acalculous Cholecystopathy (via Hipa scan – Gallbladder out next week), neuro symptoms after sun exposure (spaciness, overemotional, confusion), newest symptom; rapid appearance of unevenly bordered freckles with no sun exposure plus growth of already present freckles.
Tests done: CBC,SED,TB,Hep-panel,CPK,anti-thyroid,protein,RPR, ANCA,ANA profile,Metabolic panel,hepatitis panel,hla-b27,stool cultures. All negative but for elevated serum potassium, and bun/Creatinine ratio (but individually not elevated.)
My primary concern would be what pathology should be ordered on the GB post-operatively that may help in a "diagnosis" for my Rheumatologist and GP? Secondly, should I call my GP about the freckling or just let it go until post-op exam (I know this type of freckling can be bad news!)? Lastly, do I go back to my Rheumatologist after surgery or elsewhere? THANKS!!!
Doctor's Answer
by Kevin Pho, MD, May 29, 2003 12:00AM
, May 29, 2003 12:00AM
Hello - thanks for asking your question.
You have clearly had a comprehensive workup. CBC, ESR, TB, Hep-panel, CPK, anti-thyroid, protein, RPR, ANCA, ANA profile, metabolic panel, hepatitis panel, hla-b27, stool cultures was non-revealing. Scheduled for a cholecystectomy due to acalculous biliary pain.
Without examining you, it is impossible to say what is going on. There is no specific pathology that is ordered - if there is anything to be found, it will be done routinely.
Some other thoughts. I would consider some imaging tests to evaluate your symptoms. Diarrhea since January should be evaluated for chronic causes such as inflammatory bowel disease or colitis. Endoscopy such as colonoscopy or flexible sigmoidoscopy should be considered.
For your neuropathic pain (i.e. the shock-like pains), make sure that the potassium is not so elevated as to cause this - elevated electrolytes can certainly cause neuropathic pain.
I would have the freckling be evaluated by a dermatologist. Any rapid appearing skin lesions is concerning. A biopsy would give a definitive answer.
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.
Thanks,
Kevin, M.D.
You have clearly had a comprehensive workup. CBC, ESR, TB, Hep-panel, CPK, anti-thyroid, protein, RPR, ANCA, ANA profile, metabolic panel, hepatitis panel, hla-b27, stool cultures was non-revealing. Scheduled for a cholecystectomy due to acalculous biliary pain.
Without examining you, it is impossible to say what is going on. There is no specific pathology that is ordered - if there is anything to be found, it will be done routinely.
Some other thoughts. I would consider some imaging tests to evaluate your symptoms. Diarrhea since January should be evaluated for chronic causes such as inflammatory bowel disease or colitis. Endoscopy such as colonoscopy or flexible sigmoidoscopy should be considered.
For your neuropathic pain (i.e. the shock-like pains), make sure that the potassium is not so elevated as to cause this - elevated electrolytes can certainly cause neuropathic pain.
I would have the freckling be evaluated by a dermatologist. Any rapid appearing skin lesions is concerning. A biopsy would give a definitive answer.
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.
Thanks,
Kevin, M.D.
