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Family Medicine (Expert Forum)
Multiple Symptoms
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Multiple Symptoms
by korbmom, Nov 30, 2001 12:00AM
I'm a 36 year old female who has had various symptoms all year.
I've been to several doctors and all say everything, including thyroid is "normal", but I don't feel normal. What might I want to get tested for given the following:
(1) I bled after my annual pap smear for the first time ever (bright red that afternoon, then spotting the next day)
(2) I've had an on-going pain in my lowest left rib area all year
(3) I occasionally have stools that are a light brown color (like coffee w/creamer in it)
(4) I have a rapid heart rate in general (80-100 bpm at rest but normal EKG and echocardiogram)
(5) My left leg will sometimes jerk involuntarily as I'm falling asleep at night
(6) I passed a kidney stone earlier this year
I've been to several doctors and all say everything, including thyroid is "normal", but I don't feel normal. What might I want to get tested for given the following:
(1) I bled after my annual pap smear for the first time ever (bright red that afternoon, then spotting the next day)
(2) I've had an on-going pain in my lowest left rib area all year
(3) I occasionally have stools that are a light brown color (like coffee w/creamer in it)
(4) I have a rapid heart rate in general (80-100 bpm at rest but normal EKG and echocardiogram)
(5) My left leg will sometimes jerk involuntarily as I'm falling asleep at night
(6) I passed a kidney stone earlier this year
Doctor's Answer
by Forum-M.D.-DT, Dec 01, 2001 12:00AM
Thank you for visiting the Family Practice Forum
I would like to begin by reviewing your symptoms individually and then discussing how these may all fit, somehow into one clinical "problem".
1. Bleeding after your pap. This is by no means abnormal. However, if you have also noted increased bruising or other bleeding tendencies such as a bloody nose, you need to have a blood test to check to make sure your "clotting factors" are normal. This is done with a blood test for something called a Prothrombin Time/Partial Thromboplastin Time. (PT/PTT).
2. Pain in your left rib area. The spleen lies beneath the area you are describing. An enlarged spleen, while commonly without symptoms, is present with many disorders including monoculceosis, hepatitis and many red and white blood cell disorders. Checking a blood test for liver function (LFTs) as well as for the white and red blood cell counts (also called a complete blood count or "CBC") may be in order. If it is the rib itself that is hurting, you would want to have an Xray or possibly a bone scan to help determine if there is and underlying abnormality of the bone. Also, if you have other joints/bones that are hurting a blood test to check for arthritis may be indicated.
3. Light brown stools in and of themselves are not "abnormal". However, if there are problems with the secretion of bile into the intestinal tract, the stools may become lighter. Black stools may indicate bleeding in the intestinal tract.
4. Normal heart rate is 60-100 beats/min. Therefore, 80-100 bpm is not necessarily abnormal. However, if you have had a resting heart rate of, say 60-70 in the past, there are many possible causes for the increase in your heart rate. Anemia and dehydration are some common causes.
5. The leg spasms you describe at night remind me of a condition called "restless legs syndrome" Muscle spasms may also be present in patients who have a low potassium level. It is an unpleasant sensation in the legs (and occasionally the arms) which occurs at rest and is relieved by movement. The discomfort associated with this syndrome will cause significant insomnia in most patients. Symptoms may occur at any time during the day but are much more common at night.
Some causes for Restless Legs Syndrome include:
1. Iron Deficiency
2. Vitamin B12 Deficiency
3. Diabetes
4. Uremia / Kidney disorders
5. Polyneuropathy
6. Peripheral Vascular Disease (blood vessel disease)
6. Kidney Stones. These stones are composed of uric acid or calcium most commonly.
Essentially, all 6 of these symptoms do not fit neatly into "one" disease state that I am aware of. However, there are some "patterns" here I would like to mention. Several of the symptoms you describe may indicate a problem with your blood counts (i.e. Anemia) your liver (i.e. hepatitis) or your spleen. If you came to my office with these symptoms it would be important for me to do the following:
1. Check a CBC (to make sure your white and red blood cell counts are normal)
2. Check a PT/PTT (i.e to check for "bleeding disorders"
3. Check your liver function and kidney function (blood test)
4. Possibly check for an underlying inflammatory or arthritic condition (blood test).
5. Check your electrolytes.
Keep me posted on the finding of your tests and hopefully we can identify the underlying medical problem(s) and get you feeling well.
Dean M. Tomasello, M.D.
I would like to begin by reviewing your symptoms individually and then discussing how these may all fit, somehow into one clinical "problem".
1. Bleeding after your pap. This is by no means abnormal. However, if you have also noted increased bruising or other bleeding tendencies such as a bloody nose, you need to have a blood test to check to make sure your "clotting factors" are normal. This is done with a blood test for something called a Prothrombin Time/Partial Thromboplastin Time. (PT/PTT).
2. Pain in your left rib area. The spleen lies beneath the area you are describing. An enlarged spleen, while commonly without symptoms, is present with many disorders including monoculceosis, hepatitis and many red and white blood cell disorders. Checking a blood test for liver function (LFTs) as well as for the white and red blood cell counts (also called a complete blood count or "CBC") may be in order. If it is the rib itself that is hurting, you would want to have an Xray or possibly a bone scan to help determine if there is and underlying abnormality of the bone. Also, if you have other joints/bones that are hurting a blood test to check for arthritis may be indicated.
3. Light brown stools in and of themselves are not "abnormal". However, if there are problems with the secretion of bile into the intestinal tract, the stools may become lighter. Black stools may indicate bleeding in the intestinal tract.
4. Normal heart rate is 60-100 beats/min. Therefore, 80-100 bpm is not necessarily abnormal. However, if you have had a resting heart rate of, say 60-70 in the past, there are many possible causes for the increase in your heart rate. Anemia and dehydration are some common causes.
5. The leg spasms you describe at night remind me of a condition called "restless legs syndrome" Muscle spasms may also be present in patients who have a low potassium level. It is an unpleasant sensation in the legs (and occasionally the arms) which occurs at rest and is relieved by movement. The discomfort associated with this syndrome will cause significant insomnia in most patients. Symptoms may occur at any time during the day but are much more common at night.
Some causes for Restless Legs Syndrome include:
1. Iron Deficiency
2. Vitamin B12 Deficiency
3. Diabetes
4. Uremia / Kidney disorders
5. Polyneuropathy
6. Peripheral Vascular Disease (blood vessel disease)
6. Kidney Stones. These stones are composed of uric acid or calcium most commonly.
Essentially, all 6 of these symptoms do not fit neatly into "one" disease state that I am aware of. However, there are some "patterns" here I would like to mention. Several of the symptoms you describe may indicate a problem with your blood counts (i.e. Anemia) your liver (i.e. hepatitis) or your spleen. If you came to my office with these symptoms it would be important for me to do the following:
1. Check a CBC (to make sure your white and red blood cell counts are normal)
2. Check a PT/PTT (i.e to check for "bleeding disorders"
3. Check your liver function and kidney function (blood test)
4. Possibly check for an underlying inflammatory or arthritic condition (blood test).
5. Check your electrolytes.
Keep me posted on the finding of your tests and hopefully we can identify the underlying medical problem(s) and get you feeling well.
Dean M. Tomasello, M.D.
Thank You