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Family Medicine (Expert Forum)
Further Follow-up Indicated?
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.
Further Follow-up Indicated?
by arianna, Dec 13, 2002 12:00AM
I am wondering whether I can wait another month to see if values change with iron therapy as given by alt. practioner before testing further for any other cause other than iron deficiency. Would appreciate any insights or thoughts. Thank you. GP is ill, and am unble to see him presently.
I have had nausea for six months, which was initially began after eating gluten and subsequently (practioner thinks now, incorrectly) attributed to food intolerances/possible hypoglycemic episodes and addressed that way (I was initially diagnosed with allergies and chemical sensitivities at Yale). I eliminated gluten and dairy, with great relief in severe migraines (which had been increasing and uncontrolled by meds) and sinus. However, despite these significant improvements in allergies, sensitivities, migraines (have almost stopped entirely), and sinus- intermittant bouts of nausea continue.
My calories have dropped from a regular intake to 700 in last four months to 300 a day in the last month or two. My portions are smaller due to evading the nausea. Some feeling of bloating, burping- mild to insignificant. Have lost 35lbs. in 9 weeks due to lack of appetite (needed to lose, but not that fast), and avoiding what seemed to be causing nausea. I am now forcing myself to eat. Anorexia has been ruled out; Electrolytes normal; Normal Glucose. I have no appetite, and very little tastes good- lack of taste. My physicians and I realized this week (as I felt very, very sick) to what extent I was going to avoid nausea (occurs after eating also, but worst in AM- though throughout day, whether have eaten or not). Nausea is not constant. Dry mouth, difficulty swallowing due to dryness. Nausea does seem to improve (overall) with eating, although still occurs within 15 min. of eating. It seems very intermittant, which is a bit of a puzzle. I also have episodes of extreme fatigue, muscle pain, nausea after exercise (which doesn't surprise me due to my sudden change in diet). Early thirties, female. Extreme fatigue and palor (palor improved since eating yesterday and today).
Yesterday blood tests revealed (some of the results): Anemia 21 (35-175), Transferrin Saturation 0.0 (15-50), ESR Westgren 30 (0-20), Ferritin 43 (10-154), TSH 3.21, MCV, MCH two points low, RDW two points high, Glucose 97, blood counts within normal range (Neutrophils, 3251)(Lymphocytes 2464) Monocytes (467) Eosinophils (186) Basophils (32), Electrolytes normal. History includes major surgery/laparotomy two years ago and international travel in Middle East.
All of my health complaints began to worsen or develop after surgery, which I take to mean that my health was not up to par to begin with.
Thank you for any insights or recommendations as to what specialty I might follow up with.
I have had nausea for six months, which was initially began after eating gluten and subsequently (practioner thinks now, incorrectly) attributed to food intolerances/possible hypoglycemic episodes and addressed that way (I was initially diagnosed with allergies and chemical sensitivities at Yale). I eliminated gluten and dairy, with great relief in severe migraines (which had been increasing and uncontrolled by meds) and sinus. However, despite these significant improvements in allergies, sensitivities, migraines (have almost stopped entirely), and sinus- intermittant bouts of nausea continue.
My calories have dropped from a regular intake to 700 in last four months to 300 a day in the last month or two. My portions are smaller due to evading the nausea. Some feeling of bloating, burping- mild to insignificant. Have lost 35lbs. in 9 weeks due to lack of appetite (needed to lose, but not that fast), and avoiding what seemed to be causing nausea. I am now forcing myself to eat. Anorexia has been ruled out; Electrolytes normal; Normal Glucose. I have no appetite, and very little tastes good- lack of taste. My physicians and I realized this week (as I felt very, very sick) to what extent I was going to avoid nausea (occurs after eating also, but worst in AM- though throughout day, whether have eaten or not). Nausea is not constant. Dry mouth, difficulty swallowing due to dryness. Nausea does seem to improve (overall) with eating, although still occurs within 15 min. of eating. It seems very intermittant, which is a bit of a puzzle. I also have episodes of extreme fatigue, muscle pain, nausea after exercise (which doesn't surprise me due to my sudden change in diet). Early thirties, female. Extreme fatigue and palor (palor improved since eating yesterday and today).
Yesterday blood tests revealed (some of the results): Anemia 21 (35-175), Transferrin Saturation 0.0 (15-50), ESR Westgren 30 (0-20), Ferritin 43 (10-154), TSH 3.21, MCV, MCH two points low, RDW two points high, Glucose 97, blood counts within normal range (Neutrophils, 3251)(Lymphocytes 2464) Monocytes (467) Eosinophils (186) Basophils (32), Electrolytes normal. History includes major surgery/laparotomy two years ago and international travel in Middle East.
All of my health complaints began to worsen or develop after surgery, which I take to mean that my health was not up to par to begin with.
Thank you for any insights or recommendations as to what specialty I might follow up with.
Doctor's Answer
by Forum-M.D.-DT, Dec 13, 2002 12:00AM
Thank you for visiting the Family Practice Forum.
Based on your symptoms I suspect you either have a bleeding ulcer of the stomach or duodenum (first part of the small intestine), severe iron deficiency anemia or a combination of the two. Low MCV and MCH are associated with anemia due to blood loss or iron deficiency. Thalassemias are another cause. Your pallor, extreme fatigue, anemia and low transferrin saturation also point to the above possibilities. You need to see a "Gastroenterologist" to have your stomach / intestines examined more thoroughly. I would not wait another month based on what you have described here. I am also very VERY concerned about your calorie intake of only 300 cal / day and your weight loss of 36# in 9 weeks. (That is nearly 4# / week !!) You need to see a doctor ... Today.
I hope this helps.
Based on your symptoms I suspect you either have a bleeding ulcer of the stomach or duodenum (first part of the small intestine), severe iron deficiency anemia or a combination of the two. Low MCV and MCH are associated with anemia due to blood loss or iron deficiency. Thalassemias are another cause. Your pallor, extreme fatigue, anemia and low transferrin saturation also point to the above possibilities. You need to see a "Gastroenterologist" to have your stomach / intestines examined more thoroughly. I would not wait another month based on what you have described here. I am also very VERY concerned about your calorie intake of only 300 cal / day and your weight loss of 36# in 9 weeks. (That is nearly 4# / week !!) You need to see a doctor ... Today.
I hope this helps.
