Hi, I have a question for the members of this community. It's regarding my wife and current symptoms. I know that none of you are doctors, but I figured that you would be a good group to ask. I'd appreciate any helpful response.
Over the past few months, my wife has been loosing weight. She's now less than she was in high school. Her metabolism seemed to be very fast because she was always hungry. I suspected possibly hyperthyroid. We took her in and it was indeed hyperthyroidism, but it corrected itself within two months without treatment. Her thyroid is now normal, but she still is unable to gain weight, she's very fatigued a lot, she may have some new minor depression symptoms, and she's been pretty pale in the face.
Three days ago she noticed a swollen lymph node on her neck. It's tender to the touch, which I was told is a good sign. She told me that day that she was very tired and ached everywhere. She had no fever, but has been complaining of back pain and neck pain for a couple weeks or so. The last few days she has complained a lot of pain almost everywhere, just deep aches she says. Yesterday she was the same, so I told her to get in to the doctor while I was at work, since it was friday. They drew blood and were able to get two results back instantly: CBC and Monospot. She was negative for mono. Her CBC was normal except that her white blood cell count was 2.7, so very low. The doctor was very concerned about the low WBC and ordered other tests, but we wont have those until Monday. (She can't remember what they ordered, so I don't know). The doctor was very concerned that her WBC was so low. She put her on a broad spectrum antibiotic (Cephalexin) to cover any possible bacterial infections that may try to make their way in- so basically the antibiotic is acting as her immune system while her WBC is so low.
So her symptoms include: fatigue, bone aches, muscle aches (especially thighs, back and neck), slight headaches, pale face, weight loss, swollen lymph node, very low WBC.
We have a follow up appointment with the doctor on monday to go over results, but she and I are a bit anxious after doing some research on our own. I wanted to ask you all, since most of the research we have done suggests Lymphoma or Leukemia. What is your opinion? Did any of you or your loved ones have these symptoms? I don't know what esle to ask even though there is a lot on my mind. I'd appreciate any helpful input. Thank you.
Speaking from personal (family members) and professional (nurse) experiences, it would be difficult to state it is definitely cancer. She has symptoms that could also indicate an autoimmune disease or even something viral. Yes, the low WBC is very concerning.
Secondly, labs, a bone marrow aspirate, biopsies(Lymphoma) would have to be completed to confirm a definite diagnosis of Lymphoma or Leukemia.
Hang in there until you get some definite answers. I feel for you and your wife.
I have a little update. She's still feeling sick, mostly entire body aches, weakness, and fatigue. Tylenol takes the aches away, however. We were able to get the rest of the lab results. TSH is normal. Her Complete Metabolic Panel was all normal. ESR Sed Rate was 5 on a range of 0-20, so also normal. Does a normal Sed Rate rule anything out? We have a follow up appointment Monday with the instructions of going to the ER over the weekend if she gets worse. Thanks everyone.
Update time: Well, yesterday (monday) morning we had her in with a doctor again. We repeated a CBC and her WBC was the same, but this time her platelet count was now low. It had dropped 95,000 over the weekend and was now abnormally low. He ordered a chest Xray which he sent to the Radiologist, who said it is normal. That's great news. He ordered a couple more tests and we received one result today. C reactive protein was elevated 8.1 on a scale of 0-3. We are still waiting for the results of the ANA and CMV. She had an ultrasound today at the request of a general surgeon who will be doing a lymph node biopsy on friday. If the ANA comes back abnormal, we will be referred to Rheumatology and cancel the biopsy for now. If the ANA is normal, we will proceed with a biopsy and be referred to Hemotalogy. The doctor seems to think it is either something autoimmune, like Lupus, or possibly something like Lymphoma. So we are still nervous, but at least she's being treated now. She was prescribed something to help with the pain and something to help her sleep, so she's feeling better today.
the good (or at least 'better') news is that it's looking like autoimmunity as Londres first suggested.
my guess would be that such a rapid drop in platelets points to action by the immune system. If it were due to lymphoma, the mechanism is that cancer cells in the marrow crowd out normal production - that'd likely be more gradual. But immune cells can wipe them out really fast.
So I'd suggest keeping an eye out for ITP symptoms: purpura, bruising, etc. Her platelet count might get lower every day. Check inside the mouth for bleeding. Ask for a CBC whenever you can - she'd get one before the possible biopsy so ask for a copy as soon as it's done. IIRC, <30K gets to the range of possible worry, <15K more so.
I'd not take fish oil, vit E etc for now (being blood thinners).
Her general body symptoms also seem to point to autoimmunity.
However, keep in mind that ITP or other autoimmunity can *still* be secondary to lymphoma - i.e. deranged B cell cascading mutations.
(Just be aware that autoimmunity can also be drug induced. - an aspect of a drug molecule can make the immune system think there's an invader. That'd probably be rarest possibility of all, though.)
(Also, it could still be virus. E.g. viruses attach to platelets and the immune system then kills the platelet while attacking the virus.)
any history of Hashimoto's thyroiditis? i.e. the immune system attacks the thyroid, can inflame it and cause an initial period of hyperT - but then gradually results in hypoT as the thyroid gets destroyed. (Her bout of weight loss with a BIG appetite is not consistent with cachexia from cancer, but is with the hyperT as you'd mentioned.)
How about Raynaud's history?
The odd thing is the normal ESR followed by the relatively high CRP. Maybe ESR would also have been high if taken on that same day. That would be consistent with the seemingly sudden onset thrombocytopenia. Are there a bunch of CBCs where you can track the decline over the past months?
One question I'd research: to what extent would a negative ANA preclude autoimmunity?
Your advantage is that docs have many patients but *you* have only one patient, so you can oversee things the whole while and maybe help guide dx and tx. Good luck to both of you.
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