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Over a year, still no diagnosis

I'm posting this for my husband (40, 277, in good physical condition previously, with physically demanding job), who has been having medical issues for a year now. It began with waking up in the morning with pressure in his lower back that was remedied by going to the bathroom. Bending, twisting, picking up things, etc. never bothered him, which seemed to indicate it's not a back problem. Then it moved on to constipation, & when he could go his stool was flattened. Over time his symptoms are getting worse & more seem to pop up every time we go to the doctor. Fatigue to the point he takes 1-2 naps a day & still sleeps through the night. Coughing fit when exerted, shortness of breath when walking, decreased appetite. Swelling in his feet & legs off & on, which got worse this March to the point he had pitting when skin was pressed. Two weeks ago he woke up to find his work pants were more than 2 inches too small (same work pants he wore the day before). So far he's seen 3 different family doctors, GI specialist, & ortho, all who say there's nothing wrong. 3 recent blood tests all show levels in the normal range; some on the low end, some on the high end, but everything within normal. A recent x-ray showed a possible blockage, but CT & MRI ruled it out. One blood test came back with high thyroid levels, but thyroid ultrasound showed nothing. GI specialist said to walk more (which he can't because of swelling & shortness of breath), increase fiber & eat more fruits/veggies. When he went to the ER because of the abdominal swelling, they told him to cut back on fiber, fruits & veggies. The current family doc ordered an MRI, then referred him to the ortho for possible back injury; ortho said there's no indication of back injury. He did have a case of diverticulitis about 6-7 years ago, had no pain associated whatsoever even though everyone told him diverticulitis is extremely painful, & so far has has no pain to speak of. Minor discomfort at times, infrequent pain (4-6 on the hospital's 1-10 scale), but nothing lasting. After a year, all we seem to get is "let's wait another month and see if it clears up on its own", but he's out of leave for work & is at risk of losing his job, not to mention his quality of life is horrible. At this point I'm looking for ANY suggestion or idea.
3 Responses
8271277 tn?1397395007
First - there is a lot of information here and a lot that isn't here! The thyroid - what test was high? A normal ultrasound doesn't mean that an abnormal blood test is not a problem. The most common "thyroid" blood test is the TSH, which is actually a pituitary hormone called Thyroid Stimulating Hormone, and if it is high it indicates a low thyroid, which could cause a lot of your husband's problems such as edema, fatigue, constipation, etc. The problem with thyroid blood tests also is that there is a wide range of normal, and so a TSH in the high-normal range when someone perhaps had a low-normal TSH would indicate a reduced thyroid level, although it wouldn't be picked up by lab tests. Leg edema can be caused by other things such as varicose veins, and unless your husband is very tall, his obesity can contribute to his edema. It is unlikely that his edema is caused by kidney or heart failure, but certainly with his shortness of breath and edema, if an echocardiogram (cardiac ultrasound) has not been done to rule out heart failure (from cardiomyopathy or similar problems), that should be done. Recurrent abdominal pain and bloating may be a result of adhesions - this is where areas of intestine stick to other areas of intestines and cause temporary blockages. This causes pain and bloating, but is notoriously difficult to diagnose with x-rays, CT, etc.  Adhesions are seen after previous surgery or inflammation (such as diverticulitis).  Best wishes.
4851940 tn?1515694593
Oedema in the legs can be due to heart or kidney problems.  Ibuprofen can also cause oedema.

Even though he does get oedema, he still needs to drink plenty of water and not think that dehydrating himself will help to lessen the swelling - it won't and will also concentrate the urine leading to possible stones.

Coughing, having difficulty breathing can also be connected to heart problems, but also to lung problems like asthma.  So he should get his heart and lungs checked out.  Anxiety and stress can also lead to shortness of breath due to panic.

There is clearly a problem where the cause has not yet been found. Get your husband to find out from the doctor which blood tests he has had.  They don't always check for everything.

With regard to the swollen belly, this could be due to allergic reactions to food - or simply by gaining weight.  Men who have a problem with going to urinate can also get a swollen belly due to fluid retention because of prostate problems.  If he is having a problem going to urinate like has an urge, but can't pee, then it would be worth getting the prostate checked out.

He knows that he does have diverticular disease and occasionally he may get a blockage due to that which would cause pain - when the diverticular pocket is blocked and inflamed then that is called diverticulitis.  It is important to ensure not to get constipation.  Suddenly eating a lot of high fibre foods and especially cereals will bloat the belly, but this is usually a temporary thing.  If he is putting on weight, then that will explain the big belly.

It may also be that he may have an allergy to gluten, or lactose.

Get him to keep a diary of what he eats and drinks and see if you can find a pattern to him feeling unwell.  

If he is feeling tired after eating food and needs to sleep a lot, it would be worth getting him checked out for diabetes and to see if he may have anaemia.

Bear in mind too that worry, stress, anxiety can lead to depression and that too can make one feel tired.


4851940 tn?1515694593
Oedema in the legs can be due to heart or kidney problems.  Ibuprofen can also cause oedema.

Even though he does get oedema, he still needs to drink plenty of water and not think that dehydrating himself will help to lessen the swelling - it won't and will also concentrate the urine leading to possible stones.

Coughing, having difficulty breathing can also be connected to heart problems, but also to lung problems like asthma.  So he should get his heart and lungs checked out.  Anxiety and stress can also lead to shortness of breath due to panic.

There is clearly a problem where the cause has not yet been found. Get your husband to find out from the doctor which blood tests he has had.  They don't always check for everything.

With regard to the swollen belly, this could be due to allergic reactions to food - or simply by gaining weight.  Men who have a problem with going to urinate can also get a swollen belly due to fluid retention because of prostate problems.  If he is having a problem going to urinate like has an urge, but can't pee, then it would be worth getting the prostate checked out.

He knows that he does have diverticular disease and occasionally he may get a blockage due to that which would cause pain - when the diverticular pocket is blocked and inflamed then that is called diverticulitis.  It is important to ensure not to get constipation.  Suddenly eating a lot of high fibre foods and especially cereals will bloat the belly, but this is usually a temporary thing.  If he is putting on weight, then that will explain the big belly.

It may also be that he may have an allergy to gluten, or lactose.

Get him to keep a diary of what he eats and drinks and see if you can find a pattern to him feeling unwell.  

If he is feeling tired after eating food and needs to sleep a lot, it would be worth getting him checked out for diabetes and to see if he may have anaemia.

Bear in mind too that worry, stress, anxiety can lead to depression and that too can make one feel tired.


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