###Input :Confused from Rheumatology appointment. Doc seemed concerned but also not?25M, 6'4, 195lbs.Been dealing with some health issues that have been affecting me pretty heavily and it was suggested I see a rheumatologist just to be safe.He ran some panels where there seemed to be some out of range factors that he wasn't concerned about. The three he did bring up, though, was aANA Screen IFA - Positive | Pattern was Nuclear, Speckled.ANA Titer - 1:40WBC - 2.4 x10(3)/mcLHe wasn't worried about these results, either. My WBC is usually right below reference range, but not typically this low. He did say that that WBC count should have an eye kept on it.. but not to worry about a positive ANA screen or a titer of 1:40.Is this anything I should check up on? The bouts of what I deal with are really messing with daily life and aside from an endoscopy (which I struggle to believe would be causing any of my issues) that showed gastritis and duodenitis, as well as some labs that came back "out of range" here and there.. these results seem to atleast possibly point towards something?Any feedback is appreciated, thank you.If any other labs are needed, please let me know. I can pull them from online. ###Output :Low WBC and positive ANA are two criteria for lupus. You did not specify what your health issues were though.The presence of a nuclear speckled pattern is often indicative of an autoimmune disorder, as it suggests the presence of antinuclear antibodies.


###Input :27F immunocompromised and sick for two weeks. Getting worse. Rheumatologist is out of town and ER doctor sent me home pending blood test results that are still processing. Insight?Demographics: 27 female. Height 5ft 6in, weight 190lbs. Married.Conditions: rheumatoid arthritis and lupus; SVT.Meds: 2000mg sulfasalazine, 400mg plaquenil, 200mg Cimzia injection every two weeks.Non-smoker, no alcohol, no caffeine.Duration of complaint: 2weeksI have four doses of pfizer covid vaccine.Currently negative for covid.Two weeks ago before my scheduled Cimzia injection I spiked a low-grade fever. It was about 37.8c. Since then, my temperatures have been 37.5c to 38.5c. Acetaminophen will not bring my temperature down. It initially started with fatigue and headache and fever.Last week I began to get a sore throat, sweating, clamminess, chills, mild sinus pressure, confusion, shortness of breath, and a slight cough.I went in for monthly rheumatology bloodwork on 7/28. Ill attach the results. Mildly decreased WBC and Neutrophils.On 7/29 I went to the emergency room as my primary doctor instructed me to because I was not improving. Many cultures were taken. WBC further decreased and neutrophils were more than half of the previous day. There is a WBC Morphology pending pathologist review.Sepsis cultures have not shown any growth over the day.X-ray of chest showed no abnormality.Im confused as to what could be causing this. The ER doctor also said he was confused and it could be a medication or a nasty virus (was not tested for these) and that I have neutropenia and I am quite immune compromised but left it at that.Today, 7/30, I have had more difficulty breathing, particularly with movement or talking. Im coughing green/yellow thick mucus. More fatigue. My lungs feel heavy.Im thinking of heading back to the ER tomorrow if symptoms get worse, but Im not sure it will do any good for me or provide me with more.Is there any insights?Ive reached out to my rheumatologists receptionist as well as my primary doctor. However, Monday here is a holiday so the offices are closed. The earliest I could see my primary is on Tuesday, and Im not sure how much further it will progress by then.here is the link to my imgur albumI understand that some of the blood work with the hematology panel is still pending.Also, what does it mean with the WBC morphology Reviewed by technologist Sent to Pathologist for review?Thank you in advanced ###Output :I wouldn't wait a day more. Go to the ER. In my opinion you should be started on broad spectrum antibiotics asap, while waiting for results.


###Input :How do you feel about patients bringing their own files?How do you feel about patients who bring their own files?Im a 28F and was recently diagnosed with a chronic illness and have at least one more serious medical issue suspected. Im asking for advice navigating the diagnostic and treatment process for multiple complex medical issues.Is there anything a CI patient like me can do to make diagnosing and treating easier? Ive heard other chronically ill patients advise to bring a folder full of all medications, symptoms and symptom changes, lab results, etc. to hand to the doctor each visit. Is that something helpful or would you just think they were extra/a hypochondriac?Are there any other things ci patients can do/not do to help? Pet peeves? Im having to go to my pcp or a specialist ALL the time recently and want to make the process as smooth as possible.(For the auto mod: 28F, 5 ft. 10 in., 140 lbs approx., white, dealing with autonomic dysfunction and suspected autoimmune issues as diagnosed by my pcp, neurology, cardiology, and rheumatology teams, have had symptoms for 10 years, medical history previously listed, not taking any relevant medications, no drinking, smoking, or recreational drugs) ###Output :You can bring it but I'd prefer it being sent over before our visit OR letting us review it after the visit. A summary is preferable unless it's truly relevant to what I'm seeing you for. There's just not enough time in a clinic visit to go through a huge stack of medical records


###Input :So giving you a copy you could keep would be helpful? Ill keep that in mind! ###Output :Only if it's relevant


###Input :Unexplained Wounds need help to find answersMy husband served over in Iraq in 2011 and came home due to a machine gun falling on his groin and he had to have nerve blocks. 4 years later he started developing these ulcers that in a matter of hours would turn necrotic. When he was over in Irag he was stationed near burn pits. We've been to countless specialists such as dermatology, infectious disease, rheumatology, wound care. We've been to 10 different hospitals and not one doctor can find the cause of this. For about 2 years we thought it was Pyroderma Gangernosum, but with PG if you cut into it, it will make it worse. With my husband it helps. We have become so hopeless and this is so debilitating. Hes lost countless jobs we are praying to find answers and find someone who has this awful disease that may know what it is. My Husband is 27 years of age 5 ft 5 he weighs 200lbs doesnt smoke or drink. unexplained Wounds ###Output :Buruli UlcersBrucelosisI only suggest those two as Ive had a patient with the first one who served in the Middle East, and initially a differential was the second. We also get the Buruli ulcers here, but we call them Bairnsdale ulcersId suggest an infectious diseases specialist.What is a burn pit?Oddly enough I couldnt link the WHO page for the first one.


###Input :Please do this! I have met someone who has had similar complaints and they were not able to get a definitive diagnosis.Also, Schnooks, are you a physician in Australia? I understand Buruli ulcers had some what became an issue in 2018 there. While it isn't an issue here in the States, I wonder if this contributes to misdiagnosis? Thanks for your input! ###Output :I am, anaesthetic registrar.Its not my area, but I think theyre still a problem and actually getting worse (spreading, increasing frequency). They certainly make the news more frequently. Despite the fact theres a syndrome Bairnsdale ulcer down here, apparently theyre a frequently forgotten diagnosis. So it wouldnt surprise me if the same illness would be far from front of mind elsewhere in the world.


###Input :Buruli (mycobacterium ulcerans) is typically gotten in tropical areas by exposure to contaminated water or bites from infected aquatic type insects iirc. As nasty as these burn pits seem if it were buruli the pits aren't likely the culprit. Burning introduces things into our lungs, which is awful but would not give him this type of infection. If he were stacking the animals etc onto the pit or otherwise handling similar items, well then... bingo. ###Output :Middle East isnt tropical (right?), neither is Bairnsdale (Victoria, Australia), both of these places have Buruli ulcers...I have no idea what is going on in OP, but I know neither of my suggestions are commonly thought of in initial work up stages and Ive seen similar presentations here in Oz. And the historical regions of prevalence of a lot of things is changing.QquestionI said typically, which is accurate. I'm certainly familiar with the Australian outbreak. I recall saying bingo, which feels like agreeing to me, and I do agree. It's a definite possibility the specialists they saw didn't consider it. I suppose I muddied the water for no particularly good reason... That's fair.Can also be contracted by unpasteurized dairyIs there a special test for this?Not really, but Id imagine the requesting physician should mention it in their diagnosis list. (It makes the microbiologists go ah, well look for that by setting up these tests)Basically swabs then culture (mycobacterium grow bloody slowly, so it is an extended culture) and PCR (looks for DNA from the bacteria, quicker, but not always as useful).Thanks for the info re burns pits. I would definitely recommend infectious disease specialist/s, being in close contact with burning, dead, decaying animals  human waste is a recipe for really weird parasites/bacteria.


###Input :Did they inform him of the Burn Pit Registry through the VA? ###Output :These look like theyre due to an exotic infectious agent. He needs biopsies, cultures, and I would think about trying doxycycline for like 6 weeks. Ask your ID doctor about empiric antibiotic treatment and see what they think.


###Input :We have done all that and he has bottles and bottles of that medicine but there is never an infection WBC is always normal everything is normal. He does have a vitamin c deficiency ###Output :WBC doesnt really mean much. It can be helpful but it doesnt mean this isnt infectious. Has he ever done antimycobacterial therapy? Rifampin, isoniazid, etc?


###Input :No but we will look into that with his dr ###Output :Would you mind updating us if this gets diagnosed or if a future treatment works well? I gave you my best impression but this is not like anything Ive ever seen outside of textbooks, and I want to learn from this in case I ever have the chance to help a patient like your husband.QOut of curiosity, I am NAD, but could this be caused from an insect or spider? The reason I ask is I have friend who was bit by a spider while in Afghanistan and he still suffers complications from the wound site. While not near as extreme as what OPs husband is going through, but is it possible that OP is suffering from some sort of parasite or long term degeneration from venom? Would that turn up on any clinical tests? And do you think it would be prudent for OP to contact medical professionals in the country where OP was originally exposed?Has he had biposies of the lesions?QYes he has had biopsies several in fact alot of them come back as a burn but that's not the proble. This is not a burn.The fact that biopsy reports give the wrong answer and he's seen multiple specialists possibly suggests that you're dealing with a new, hitherto undocumented entity. What treatments has he had for this if any? Response to certain drugs could tell us what sort of disease process this is.


###Input :My husband is fighting for his disability because this is so debilitating he cant work. But without a diagnosis the disability people keep denying himHire a VA disability appeals attorney. It cost me 2 grand twice, the first time got me from 30% to 90% and the second time got me from 90% to 100% total and permanent. I personally have far less severe injuries than what your husband has and was suffering the same issue.There are also attorneys for SSI/SSDI benefits, though I havent personally used them as applying for SSDI as a 51 year old is relatively easy. As a 27 year old though it is damn hard and you likely will need a lawyer or a few years of trying, and a lawyer works out cheaper in the long term. ###Output :Need more history, things like past medical problems, medications, drug use, etc. Differential as I see it includes infectious, autoimmune, vasculitis, drug use, medication, environmental (especially considering the burn pit). It's very odd that it would take years after that exposure that these ulcers would start, but not impossible. Why has he lost countless jobs? What did previous skin biopsies show? What have his labs shown?


###Input :He has no other medical problems, he isnt one any medications, no drug use in fact he quit smoking 5 months ago. He started having small ulcers as soon as he came home but now they are way worse. Hes lost jobs because he has to be off so long and they let him go ###Output :And the skin biopsies? And the labs?Qsome have came back as a burn which they are not and others show nothingAnsNeed the actual reports, which are always available through either a patient portal website or though a medical records department. Also need the lab reports.


###Input :Does This Really Sound Like Dermatomyositis?BackgroundAge, sex: 31Mheight: 5 11race: whiteprimary complaint: purplish skin along with tachycardia and extreme fatigue/tirednessduration: I have experienced skin discoloration since I was a kid, but this progressively got worse once I was an adult. The tachycardia started when I was about 24 and has progressively gotten worse.Medications: My rheumatologist has me on hydroxychloroquine (200 mg), prednisone (started at 50 mg, but now taking only 5 mg), and pantoprozole (40 mg). An ER doctor started me on meclizine (25 mg) as needed for dizziness that started about a month ago. I have also been on Adderall XR since 2019. I currently take 25 mg, up to two in the morning. I do not drink, smoke, or use any recreational drugs.Other medical conditions: ADHD. Morphea (I developed this when I was 8, and it has never gotten any bigger). Splenomegaly. In July 2021, I had encephalitis due to reactivation of varicella-zoster virus.I apologize in advance for the length of this post. I just want to be sure I include anything that might be relevant.Starting in 2014, my heart rate would randomly jump up to 120-140 bpm, and I would experience tingling in my extremities. The purplish skin started when I was a child, but it has gotten worse over the last few years. Between 2014 and 2021, I had multiple echocardiograms done to check for any abnormalities of the heart, but doctors never found any. I also wore a holster for a month, and that came back mostly normal.A couple of months after I had encephalitis, a rheumatologist diagnosed me with dermatomyositis based on the redness and scaliness on my knuckles and redness around my fingernails. Lab tests showed that my muscle enzymes (CK, aldolase), liver enzymes, and IgM all were elevated, but additional diagnostic testing has not shown anything to confirm dermatomyositis. Ive had an MRI of my legs, hands, abdomen, lungs, and heart. The abdominal ultrasound showed that I have a slightly enlarged spleen. Everything else looked normal. I have never experienced muscle weakness or the characteristic rash that DM patients usually have. I did see a dermatologist after I started treatment. She said it looked like it could be DM, but there wasnt anything on my skin for her to biopsy.Since my rheumatologist started treating me for DM, my heart rate tends to stay around 80-90 bpm, and the palpitations are much less severe when I do experience them. My most recent blood tests came back normal except for my IgM. However, my skin still turns purplish, and it sometimes feels like there is a rubber band around my arms.I dont know if there is any connection between the encephalitis, tachycardia, and DM, but it makes me wonder if there is something more serious than DM going on. My doctor does not think its necessary to explore other possible causes. She says that the treatment she has me on will treat any rheumatological disease. I really like and respect her. Shes the first one Ive seen who acts like she cares about my health. I just want some kind of confirmation that shes right.I appreciate any feedback, insight, suggestions, etc. Also, I can submit my full CBC report if that would help at all. ###Output :Please include one of preferably more of the pictures in your post as an imgur.com link. It makes it easier to help with something when it can be examined visually. Additionally, share the values of your ANA, ENA, CK, aldolase


###Input :Thank you for your response. My apologies for not getting back to you sooner.I am not sure about the ENA. I did a Google search and think I found what test results to include. Let me know if these results are not what you need.Below are the results of lab tests from September 22. These tests were done before I started treatment for DM.CK - 1,063 units/literAldolase - 26.3 units/literANA - Negative (<1:80)RNP/Sm - < 12 unit(s)Anti-Smith - < 12 unit(s)C3c - 107.0 mg/dLC4c - 20.0 mg/dLKappa FLC - 12.7 mg/LLambda FLC - 17.5 mg/LFLC - 0.73 ratioIgG Card - < 9 GPL-Units/mLIgM Card - 16 MPL-units/millileterI'm not sure if ALT and AST help with diagnosing DM, but they came back abnormal. This isn't unusual for me (they've been as high as 240 on tests I've had done over the last 10 years), but I thought I'd include them, just in case:ALT - 56 units/literAST - 44 units/literBelow are the changes in some of these values when I had the lab tests performed again on November 4. These tests were done after I had already started prednisone and hydroxychloroquine.CK - 83 units/literAldolase - 9.2 units/literIgM Card - 23 MPL-units/millileterALT - 15 units/literAST - 14 units/literHere are the best images I have of the skin discoloration. Because the discoloration on my knees is usually worse while I'm in the shower and right after I get out, I took the photos and video of my knees in the shower. There is nothing graphic in these images, but I wanted to explain why I took them in the shower.Right hand - https://imgur.com/icyYOPQKnuckle, right hand - https://imgur.com/fD48uK0Left arm - https://imgur.com/JVPth2XBoth knees - https://imgur.com/bszpHWgRight knee - https://imgur.com/cjdn4zVBlanching (Video) - https://imgur.com/3KszJT7 ###Output :No mention of the most important test - skin biopsy results. Everything you present is less important.


###Input :She said that there was nothing for her to biopsy. This is the note that she included in her report:Physical exam: dilated nailfold capillary loops of fingernails, L>R. Mild erythema of proximal nail folds of fingernails. Ragged cuticles. No evident Gottron's papules, heliotrope sign, shawl sign, holster sign, or other stigmata of DM. Scalp clear with no erythema or scale-prior labs including myositis panel, CK (elevated), and aldolase (elevated) reviewed. Negative myositis panel noted.-findings on exam today support prior diagnosis of DM (esp in context of markedly elevated CPK and aldolase), although unfortunately there is not a high-yield spot to biopsy to provide additional support of this diagnosis. Suspect that pt's cutaneous findings have improved with plaquenil + prednisone therapy ###Output :Spots change over time. Right hand knuckle that you show could be a Gottron's papule. Lupus can look like this as well, as can many other conditions.


###Input :3.5f with mystery illness 4 childrens hospitals and 14 specialists cant diagnoseThis is going to be so, so, so long and Im so sorry. But we dont know what else to do. Ive tried to compress it the best I could. 3f with medical mystery.First year of life: -couldnt latch until 2 months old -refused all food, in all forms. -up every 20 minutes every single night, wouldnt nap longer than 30. -had newborn shakes that stuck around a year old. -consistently has BM 60-70% mucus, and majority of time was green.February 2017(1 year old): -staring spells began -CT at hospital was clean, sent us to neuro. -EEG performed, no episodes happened, clean. -lost all of the words she had and remained non verbal, despite starting speech therapy at 18 months, until over 2.Eventually they went away after a few months. Doc said absence seizures are harmless and not to be concerned. Released us from his care.June 2017: 16 months old. -woke up and couldnt walk. Screamed when weight put on leg. Took to urgent care. Urgent care ran labs and found a sed rate of 44. Referred us to an orthopedic surgeon. Orthopedic surgeon did treatment for transient synovitis. When it became clear that wasnt the cause, sent us to rheumatology.August 2017: -diagnosed with Oligoarticular JIA (right knee only at this point). -started on naproxen.November 2017: -first steroid injection. Kenalog into right knee. -two days later, woke up screaming and manically itching legs. Hives sprouted. Face swelled, eyes became black, hives all over neck and face. Started wheezing and gagging, rushed her to the ER. ER said it was an anxiety attack from the itching, not anaphylaxis. -steroid injection worked for about two months.Spring 2018 (2 years old): -staring spells started creeping back. -swelling in both knees was coming and going. She was in extreme pain and couldnt walk more than a few feet. Rheumatologist said it wasnt arthritis, it was growing pains. Referred to PT. -we werent super worried about the staring spells, and wanted to wait until the arthritis was sorted out to see neuro. The staring spells were coming more frequently. Her speech therapist asked us if wed ever had her evaluated for epilepsy, as she sees several kids with it, and our daughters episodes were scaring her. -We decided to get her in with neuro. It would be a two month wait.May 2018: -second opinion rheumatologist said there was obvious arthritis and sent her for a second round of steroid injections. Allergy had deemed the first reaction as a coincidence, not from the injections. -had an allergic reaction to the injections again. -she begins collapsing and falling pretty much non stop. To the point where PT and Speech therapists were suggesting a helmet because she wasnt catching herself when she fell.June 2018: -steroid injections failed -our first appointment with PT. PT noticed several left side deficits, severe balance issues (that were worsening), and wrote a letter to neuro suggesting an MRI be done. -woke up soaking wet, dripping in urine, and her urine was brown. Took her to the ER, ER noted it was brown but testing was normal, and she was well hydrated. -had an episode where myself and her speech therapist were present. Eyes glazed over and she started walking around like she was drunk. She became delirious. Then that turned into manic aggression (totally out of character). It lasted 20 minutes start to finish, ended with several staring spells. Speech therapist wanted to call an ambulance. 4-5 minutes later, she was completely back to normal. Took her to the ER where they said it was behavioral. I insisted they call neuro, who said it sounded like worsening seizure activity and scheduled an EEG for the next month. -pediatrician urged us to go to a different childrens hospital and demand an MRI. CT showed a small arachnoid cyst, MRI was clean. Her left side reflexes were slow, and she had a positive babinski reflex on left foot. -lost gross motor skills like squatting or standing up without using hands. Could no longer identify letters, though she had been able to since before 2. -discharged after a negative EEG, but nothing happened while she was hooked up. Told us to get video. -balance continued to deteriorate, along with left side deficits. -got videos of staring spells, neurologist said that it could be seizures or it could be sensory. She passed sensory tests with flying colors, OT said it was highly unlikely to be sensory. Neuro told us to go to a different hospital. -things calmed down for about 3 weeks.July 2018: -PT started noticing balance issues worsening again, she wouldnt catch herself when she fell or even try to. Began falling 2-3 dozen times a day. -she began dropping. Like a robot running and then its power source dying. My husband and I would have to sprint and throw pillows or our hands under her head to keep it from hitting the floor. We couldnt be more than a few feet from her. She would collapse, lay there for 10-20 seconds in a haze, and then sit up. -July 19th she told us her head hurt. A few minutes later, she looked out of it. I pulled out my phone because it mimicked the look when she had the episode of delirium. She began stumbling, so I pulled her onto my lap. She began aggressively rubbing her face and making weird faces. Her body then began to jerk/shake. Lasted 20 seconds. When it stopped, she continued to lay down, still, with her eyes glossed over. Her urine was brown again. -pediatrician sent us to ER. Admitting doctor said it was a tonic clonic seizure based on the video. Was attached to a vEEG for 9 hours, nothing happened. EEG was clear. Doctors said it was behavioral and released her from further neurological care. said there was nothing wrong with her. They called her speech therapist who was livid, as she had been watching her deteriorate right along with us. I needed backup since the doctors were blowing me off. Doctors told speech therapist it was behavioral and from sleep deprivation. But she slept 14 hours a night. -as month goes on, shes dropping and having staring spells non stop. -PT says nothing about daughters exam makes sense. Her balance is awful and deteriorating when walking, standing, crawling, kneeling, but she can jump. Shes developmentally advanced so it doesnt seem lime it could be a developmental issue. Shes also watching my daughter turn into a shell of herself and is begging doctors to do something. -MRI of knees and hips was ordered by new rheumy after worsening gait issues. MRI showed a healing stress fracture in the knee, along with bone marrow edema (with no trauma to explain it) -went limp on a ride at six flags and her eyes rolled to the back of her head for a full 2 minutes. -went to playground and she was climbing one of those coils. Body went limp and she fell 5 feet. I caught her and set her down while her arms twitched and she was unresponsive. Slept for several hours after, and took several minutes of shaking to wake up.August 2018: -basically everything continued with no answers from anyone.October 2018: -a 3 day inpatient EEG was scheduled and nothing happened. I mentioned to the doctors that it looked like a mass was growing on her legs and they didnt look. Sent us home. -pediatrician saw the masses and sent us to orthopedic surgeon. -the muscles in her left knee began to atrophy, despite her being crazy 24/7. She never sits still and is always jumping/climbing/running. Orthopedic surgeon said it was definitely neurological, sent us to a new neuro. The atrophy was so bad we were approaching loss of mobility. She still cant walk for more than 1-2 minutes at this point. -atrophy worsens until November. Other symptoms start to go away.November 2018: -started methotrexate injections for the JIA.January 2019: 3 years old. -urine began to darken again. -symptoms started popping up mildly. -had episodes where shed scream and rub her legs manically saying bees were attacking her. She did it both while we were there, and when we werent. I watched her do it on the baby monitor in the middle of the night. -neuro ordered MRI of spine. Normal. -on jan 16th, I heard noises in her room. I looked on monitor and she was sitting and swaying in her bed. I got to her bed to put her back down and by then, she was jerking. I tried to get her attention but she was unresponsive and eyes were glazed over. -I pulled her onto my lap, where she remained out of it. Her body was jerking, and her right leg started convulsing like it was on a washing machine. Once the jerking slowed, I asked her to point out her nose and mouth. She failed but thought she did it. I put her back to sleep, where she remained restless. Her urine was normal again 2 days later. -urine brown again on Jan 25th. Had a staring spell at a birthday party and was unresponsive for 30 seconds. Fell asleep in the car 10 minutes later, slept for 45 minutes, and then woke up screaming. Continued to scream for almost an hour. Urine was clear again a few days later. -Neuro tested for porphyria. Corproporphyria level was 2.5x adults high normal but said it wasnt high enough to be porphyria. No pediatric reference ranges exist.February 2019: -fingers started severely pruning and turning white in just a few minutes, while her sisters hands (who was 1.5) were completely normal. -throughout all of this, little bite/pimple like bumps showed up on face/neck/joints. They come and go. In February, they got bad. No fleas, no bugs, always accompanied other symptoms.March 2019: -GI said that while shes tall, shes short based on how tall she should be since Im 510 and husband is 64. Wanted to run tests. Thinks theres a larger autoimmune disease at play. -genetics said that something is definitely wrong, doctors needs to coordinate. Said porphyria test could have been deteriorated because it sample taken at home and exposed to light in the car. Said hes concerned by the progression and created a team of doctors to evaluate her case. Was afraid it was possibly life threatening. -testing was planned for summer when she began showing symptoms again. She remained asymptomatic.September 2019: -things remained calm, arthritis was under control. -began flaring in both knees and both ankles. -staring spells, balance issues, and not catching herself came back.October 2019: -things are worsening again. -left ankle is atrophying. Neuro wont call me back. -PT is concerned she wont be able to walk soon because the stuff that atrophied last year has never come back. She still cant walk more than a few minutes without collapsing. Sleeping 13 hours a night. Is complaining of pain and isnt eating. -preschool teachers reporting odd behavior and lots of collapsing. -most recently broke her wrist because she fell down the stairs and didnt try to catch herself. She landed on face and chest, with her arm against her chest. -ETA: her urine was brown again this morning for the first time since spring.Any ideas? Weve been to four childrens hospitals and will be pursuing new ones when we move in February. Im so scared for my daughter and still cant understand the lack of concern by the doctors weve seen. I dont want my daughter to suffer anymore and I dont know what else I can do.Thank you so much. ###Output :If a second opinion is needed on this comment, I 100% agree with this. OP is free to try and ask the reddit community out of pure desperation, but be careful of lay comments, even from physicians who aren't experts in OP's child's care.


###Input :In my opinion Rasmussen would've shown up on an EEG or Scan, as the episodes are lasting a while and the activity of the inflammation would probably have been detected, though it's not impossible. I don't see how this goes in line with the arthritis, the stress fracture indicates that the loss of function and pain should not be purely neurological, maybe there are 2 problems going on simultaneously.I feel that you're a bit lost with doctors who don't do anything. So I'll suggest things to do by yourself:start a detailed diary, try to recall everything, every doctor's visit, result, try and collect the imaging done, lab results. But also start recording symptoms like ataxia, seizures, pain, atrophy. Every day. Also note any environmental changes that might occur shortly before episodes. This should include nutrition, but also stress, long exposure to sun, noise, physical activity. Get videos if you can.buy urine test strips, check her urine when it's normal 2-3 times, then when it gets dark. Check for blood, proteins, sugar. If you can, contact urine when it's brown in a clean jar and have your doctor send it to lab.if you have access to it and feel comfortable, also check blood sugar in normal and episode conditions. Again, note it done carefullyconsider to get psychological evaluation and counselling. Not only are you going through a very difficult situation, you will also avoid people saying that's only behaviour, and you're not willing to accept it. I'm not saying it is, but by acknowledging it a possibility, you rule out one more thing.consider changes in nutrition. Observe if anything changes. Might work, might not. Changes may include protein level, fat level, sugar level, etc.Then, what to do while relying on doctors:I agree with getting a second MRI. One usually isn't enough. It needs 2 to notice changes.did you get a check of the peripheral nerve system? I'd ask the neuro to check that. If they don't call back, they're probably out of ideas. Hey a new one.Get a general ultrasound of the organs.get blood test of porphyrines in normal and episode conditions.get liver and kidney blood test in normal and episode conditionsreach out to get metabolic diseases checked, like fatty acid issues, glycogen issues. Try also getting genetical analysis. I don't know about your financial situation, if you're located in usa and they don't do those, consider a visit in a different country. We have a whole ward here for diagnosis. Try reaching out to mayo or Cleveland.consider reaching out to help groups for genetic or rare diseases. They often have valuable contacts and ideas. https://www.globalrarediseasecommission.com/Report/tracks/track-1.htmlI wish you all the best! ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification.


###Input :I would strongly recommend rainbow over ccf for pediatrics. ###Output :So to make sure that I have the situation in a nutshell: 3.5 y/o female with progressive weakness, intermittent episodes of loss of tone that are not accompanied by EEG changes, intermittent episodes of darker urine in the morning, and a diagnosis of oligoarticular JIA. Please correct anything that I got incorrect and I have some clarifying questions.-what is the state of her motor function now? Can she run, climb a ladder on the playground, fatigue quickly like walking around a store?-do the weakness episodes seem intermittent, like lasting for a few hours to days, or are they every single day.-does she have unsteadiness when reaching for objects? Having her hand seem to stumble past a cup or fork for example?-does she have any drooping of her eyelids? It would be to the point where the black of the pupil is obscured by the lid or she has to lean her head back to look at you.-following steroid injections did any of her other symptoms seem to get better? the weakness and seizure like episodes.-any family history of children passing away or having major medical issues. Do you, your spouse, or the child's siblings have any medical issues?-any issues during the pregnancy or delivery? Did she have to go to the NICU for any reason?


###Input :According to what I found online, Mount Sinai has the only genetic test for porphyria. Trust me, I had a couple hundred dollars ready to spend on the genetic testing but everyone I spoke to who was versed in this stuff said it wouldnt make a difference ###Output :TF is going on in here? What is wrong with all of you people? None of you are physicians, I doubt even medical professionals, and even the "best" "written" comments in here are absolute drivel. You are NOT being helpful. You are torturing someone while stoking a House, MD type fantasy.Dear OP, I sympathize with you. Dealing with a sick kid is trying and tough and this awful thread is NOT useful to your mind state NOR your health.A problem I have noticed in my short career has been clear communications to patients. I highly doubt after 4 hospitals, 14 specialists, and however many other physicians and staff that no one has come up with a diagnosis. What does this mean? I bet at minimum you had multiple different teams with multiple different personnel working on your daughter's case. It's possible the primary team wasn't doing their damn job of synthesizing all of the specialists information into easy to understand information and presenting that information to you. Even when we don't "know" what's going on, I can still call something idiopathic (as in I don't know) or I can throw out a variety of possible causes in what we call a differential diagnosis.To everyone saying "gEt GEnEtIC tEsTiNG". That's not even how any of this works. Even if we were to use "genetic testing" this would only confirm the diagnosis, NOT LEAD US TO THE DIAGNOSIS. Even then it is absolutely unnecessary for treatment in this case. Genetic testing is useful when we are performing family planning or working on research on illnesses. To my knowledge, and I'm open to any updates, bread and butter medicine does not YET have the tools to use genetic testing in the fashion many of you seem to think exists.


###Input :Thats been our understanding. Genetic testing is like the final puzzle piece once all of the other testing is done, and narrows down the list of possible causes. The geneticist said there was a list about 30 things long that he thinks it could be, but wanted further testing before divulging them, which I get.We have seen 4 childrens hospitals but the specialists span. Weve seen 1 endocrinologist, 1 allergist, 4 neurologists, 3 rheumatologists (our new rheumy actually suggested another opinion since she was out of ideas too), 1 GI, 2 geneticists, 1 orthopedic surgeon, and 1 ophthalmologist. They were supposed to be coordinating on a team that diagnosis rare diseases, but when she remained asymptomatic, we held off. We didnt want to put her through anything more if the tests would be inconclusive, under the direction of the team. But red flags have been popping up over the past few months, and theres been a lack of response or a shrug. The atrophy was so bad in the knee last year that she could barely walk. The muscle/tissues/whatever it was never grew back, and she cant walk more than a few minutes. PT is concerned that with the loss of knee support, the ankle atrophy is going to be detrimental. Which is how I ended up here. Her pediatrician finally got neuro to call us and shell now be getting ultrasounds of both legs.I wanted to take a list to her doctor and say could it be any of these?Shes spent most of her life in constant pain, in doctors offices, and its just killing us. I want her to have a normal life, and if she cant, I just want to make it as pain free as possible. ###Output :The most important thing I can recommend is finding a good PCP to make sure you have a medical home. That doctor should keep track of everything and keep the puzzle pieces together for you. I'm hoping that's already your pediatrician. From what you write, it seems like each specialist is stumped and is each trying to treat symptoms as they see it. Let's say we can't find what is going on, this is what we would be doing anyway. I say if things have been continuing to worsen, you may try another hospital system. I'm partial to Mayo, CHOP, and Children's National. On the other hand, you may have to consider that there isn't much to do but keep her comfortable. Palliative doctor's role are just that, keep people with chronic disease comfortable. That may include working with PTs, pain specialists, and whatever other tricks they have up there sleeves.


###Input :'m not a doctor. Along with a suggestion, I just want to say how sorry I am to hear about your family going through this. I know how terrible I feel when our daughter just has a cold.Because I'm not a doctor, I don't have a diagnosis to suggest, but instead I want to suggest that you start collecting data, lots of data, then find your most analytical friend(s) and get them looking at it. They don't have to be a doctor; they're more likely to work in science, technology, engineering, business or law.What I'm suggesting you collect is literally everything your daughter eats, drinks, does and where she goes, including basic nutritional information what she's eating and drinking - carbohydrates, fats, etc. The same stuff that they put in big letters on most food packages.Along with that, put in what symptoms she had and how bad they were; devise a rating for her day if nothing else, where "5" is "it was a terrible day" to "1" is "she barely had any symptoms at all."This is going to be a complete pain in the ass.If it's a metabolic problem, there's a chance you'll see something like "when she has a high-carb, low-fat diet, she has a bad day" or "when she has a lot of fat, she does great" or some other permutation.If it's somehow an environmental problem, then maybe you'll see that "when she stays at grandma's house she's better than when she sleeps at home" or "if she doesn't go to school, she's better" or "she played in the basement today and she's a wreck."The doctors are clearly missing something, and maybe with some analysis you can find some clues to point them in the right direction. You may have the problem that they've already made up their mind about her and there's no changing it; in that case, you also need new doctors.Best wishes. ###Output :Posts by unflaired users that claim legitimacy by virtue of professional medical experience are not allowed.If you are a medical professional who wishes to become a verified contributor to this subreddit, please message the moderators with a link to a picture of your medical ID, student ID, diploma, or other form of verification. Imgur.com is convenient, but you can host anywhere. Please block out personal information, such as your name and picture. You must include your reddit username in the photo!We do not accept digital forms of identification.


###Input :Rash EVERYWHERE? Please helpHello, so a little background. I am a 23yo F. I suffer from an ED and weigh approximately 80lbs and am 51. I was diagnosed with MCTD, scleroderma, dermatomyositis, and a grocery list of other things, but I feel those are most prevalent to the issues I am having. I also use marijuana regularly as well as vape. So. I moved to MI from MO last summer. Ever since about.. November 2021 I have been having skin issues. The skin is incredibly dry, most spots opened and scabbed and now they hurt and itch. No lotion I have tried (10+) seem to help. I have it on my legs, arms, chest, hip, back, face, behind/in my ears. Ive never had my skin look like this while living in MO. I have seen my PC and I have a rheumatology appointment end of April. I dont even want to imagine how much more this will progress. Does anyone know what this is? Or how I can manage it to minimize symptoms? Im at a loss. Please help! Skin rash ###Output :Images do not allow us to see the extent and appearance of the eruption. A diagnosis is not possible. You are medically complex and you need dermatology care. I work closely with many rheumatologists and we have mutual respect. I would not count on a rheumatologist to manage your skin.


###Input :What does high glucose in a CSF mean?28, Female, T1D 14 years, 59 165 lbs. I have upper extremity weakness in my legs and arms, worsening over the last year. Cant walk up stairs, all my tests come back inconclusive including genetic testing and nerve (I mean literally I have had an ENTIRE work up- MRIs, X-rays, blood work, neurology, spine clinic, rheumatology) so Im left with getting a triple muscle biopsy and had a spinal tap today. The only result that came from that was high glucose CSF and I cant find anything about what that signifies versus the low glucose.ETA: additional test results just came back showing high wbc and rbc in the fluid. ###Output :Generally we're looking for low glucose in the CSF, as that's a sign that bacteria may be in there. There's usually a ratio between CSF and serum glucose (CSF is about 60% of serum), so I'd wonder if your serum glucose was just on the higher end when you got the LP done due to your T1DM.


###Input :Good to know. Im sure Ill hear back Monday, but additionally seeing the high WBC + RBC in the fluid made me nervous. ###Output :How high for each?Reply Wbc 13, rbc 16


###Input :My Arms Are Turning Blue, Please HelpTL;DR: I removed lab values, as they are no longer the most recent. I have normal skin underneath, to my knowledge, my skin just sheds blue - unaware as to why. I have neurologic and gastric issues, like already stated in edit one, so no need to retouch on that, just briefed about a new procedure I didnt know was going to be requested. I will update about the (dead) blue skin, the literal reason for the post in the first place, if ever discovered.No confirmed, or believed hematologic issues. I only shed blue skin? My skin recently came off, and its pink underneath like it used to be, for some reason it just comes off in blue heaps (random dead skin, I assume, but unsure as to why the color is blue). The veins are extremely bright, but thats about it underneath, I believe. I already have eczema/atopic dermatitis, I know that, but this still confuses me because it doesnt appear to be that. I plan on seeing my derm soon just in case.I thought Id add this information, only to discuss how thorough Ive tried to be, but none of which is the cause for it either. I have a whole host of neurological issues, migraines and OC as listed below, among other newly diagnosed issues, like tremors and possible nocturnal seizures (Im epileptic). Im going to be getting a VEEG done, as ordered by the newly epileptologist I just began seeing. My medications are being readjusted, and a hospital is the only safe way to do so.I also have gastric issues, like I said below.Bottom line, thank you all. If I ever figure out why Im shedding blue skin, Ill make sure to share.TL;DR: I took all suggestions as best I could. I was denied by hematology, rheumatology found no issue despite only slightly abnormal values (mainly NOT severe muscular degeneration that Ive now been made aware of, it didnt alarm him like I said), EKG and EEG requested are both normal. There have been newly diagnosed neurologic issues, but easily fixed with botox.Edit: Thank you to everyone who suggested various things that it could possibly be, and please know that I took your advice, both from this post, and the follow-up one I made awhile back, that Ive since deleted. Here is the in-depth follow-up that some had asked me to provide.Hematology: I was denied by two different hospitals, even though I had a thorough PCP referral, as both places said my issues werent possibly blood related. There were no other hematologic options in my area, so I decided I needed to move on from hematology completely, because I wasnt getting anywhere. Ive not been tested for any hemoglobinopathy as suggested on this post, or any other blood-related issue due to this.Rheumatology: This was the major one recommended on my other post, and I actually just went there a couple days ago after a successful (and surprisingly quick) referral. Despite my leg pain, color-changes and other various issues discussed below, the doctor doesnt believe its anything rheumatology related, either. A physician on the other post I had made, suggested getting a work-up and asking about APS (antiphospholipid syndrome), but I was only tested for possible muscle diseases to my knowledge. I havent received those results yet, but Im sure theyll be normal. Well see.Ive also recently had a redo of my heart echocardiogram done (which came out normal) because the last one was poorly imaged. My most recent (required) EEG was completely normal, but Ive been put on yet another epilepsy medication, unfortunately.The only thing Ive been diagnosed with, since when this was originally posted, has been migraines and occipital neuralgia, which I now receive injections for.Original Post:25F, 185lbs, white, non-smoker, non-drinker.TL;DR: major breathing difficulty, chest discomfort/pressure, (mainly) left leg heaviness/throbbing, odd blood consistency and possibly abnormal values.Hello, Im in quite a predicament. Ive now been labeled a zebra by a vein specialist, because no one can figure out the reasoning behind my current issues.For context, this is now seems to be a somewhat progressive issue, as different symptoms have arisen as time has gone on. I began not being able to breathe well sometime last year, but every time medical professionals take my O2 stats, it never goes below 98. However, its becoming increasingly harder within these last few months, especially taking deep breaths. After having some bad reflux episodes, I was told I had GERD, and then given some medication. However, Ive now been hospitalized twice for my severe breathing issues, both occasions in September, after my GERD diagnosis (and its well controlled/no reflux episodes), so I have a feeling its definitely a separate issue. My chest also feels as if theres a crushing force on it very frequently.I started getting severe leg pain, that made my (especially my left) calves feel heavy one minute, almost like carrying around tree trunks, and then pulsing/throbbing the next. I was scanned for blood clots in my left leg while at the ER, and everything came back normal. The same day I was scanned, a nurse noticed my left arm being a vibrant blue. The ER doctor then pointed out the fact hed noticed that it was also on my right arm at that point, as well. Ultrasounds have recently been done on both my arms, but those results also came back normal.My blood is now starting to be impacted as well I believe, as its appearing to have trouble stopping or clotting quickly. Im not sure if this issue is related to the color-changing or not. My blood will borderline gush out after blood draws/IV site wounds. My RBC has also been consistently high for awhile now, and my MCH and MCV are now dropping again. The values being abnormal arent by much or extremely significant, but Im not sure the reason for the abnormality either (again, reiterating the fact that Im not sure if its connected to the color-changing or not). ###Output :Except for the bleeding, you're pretty much describing a sickle cell disease crisis. Did you ever have a hemoglobin electrophoresis test?EDIT: I saw the conversation further below. Some common traits for hemoglobinopathies are indeed low hemoglobin, high RBC and low MCV. I'd say you could catch about 80% based on these values (but then, electrophoresis is still required for final diagnosis, or DNA testing for alpha thalassemias). Anemias can be compensated for with high RBC counts. MCV, as in sickle cell anemia, may be normal since the sickeling occurs in the microcirculation at low PO2s.EDIT2:I'll give a short summary of things written below (including personal interpretation of what was written) for any physicians currently tuning in;Summary28F, non smoker, non drinker, not on birth controlFatigueSevere leg pain (excruciating), pulsing, throbbingSevere pain 'everywhere', especially shoulder bladesBlue discoloration in armsOxygenation is fineBoth arms and legs were scanned but no clots were foundNo history for excessive bleeding during surgery or tooth extractionsPeriods were heavy in the past, but no longerPictures could be interpreted as deep-tissue bleeding/bruising, but no discoloration has been described (cave too recent)No weight loss, fevers, infectionsLiver and spleen are normalLabNo full lab results on hemostasis (e.g. PT, APTT, Fibrinogen)Initially high RGB, normal MCV, hemoglobin. Now all three are decliningNormal d-dimer, normal plateletsNo hemoglobin electrophoresis was donePossibilities (in no particular order)(Acquired) Bleeding disorderThrombosisSickle-Hb C diseaseAnxiety...?


###Input :I have not, I dont even know what that is. ###Output :No problem. Would you mind posting your history of values? Mainly hemoglobin, RBC, MCV


###Input :Sure! Im going to hit the hay first since its 6 AM here and I havent slept yet, but when I get up, Ill get my bloodwork out.How do you want me to write it out on here? Like the reference ranges, and then my results? ###Output :Screenshots are fine too btw.Otherwise, maybe like so? Dates aren't crucial, just give an indication of how far apart (e.g. months between or hours). If there's a missing value in one of the labs, just put a '-' so the values stay aligned vertically.RBC [ref], x, x, x, x MCV [ref], x, x, -, xI'd update your original post, and we'll go from there.


###Input :I updated it! I just separated it by the blood test, and it looks kind of chaotic I know, but I tried my best.Ill have to grab ahold of more of my bloodwork at my primarys office soon, so that theres not just three ###Output :Hmm, these results neither confirm nor refute my first thought. But on seeing the photos they remind me more of deep-tissue bruises.Do they ever go away or change color at all? Was a tourniquet placed on your upper-right arm?Could you perhaps elaborate a bit on your bleeding history? Ever had any surgery or tooth extractions? Nose bleeds? How are your periods?Personally really looking forward to the comments of the hematologist.


###Input :Can alpha thalassemias present with normal hemoglobin, but chronically low ferritin? My hematologist suggested my hemoglobin was normal because I burn through ferritin so quickly. Like OP, my specialists have all but thrown in the towel after four years of treatments (for a diagnosis that has now been thrown out - Von Willebrands 2M).I have had high RBC and low MCV, normal HCT and HGB, low B12 and D (take weekly injection of the former, high dose oral supplement of the latter). Ive had two iron transfusions ~4 years ago. I can provide complete blood work for the last four years if that would help. ###Output :Hemoglobinopathies (like thalassemias) produce red-cells that have a shorter life-span than regular 'normal' red cells. So yes, there is a high turnover and therefore higher demand of nutrients. However, there are other explanations as well. If you like further exploration I would suggest you make a new thread? Results from the last 4 years would give a tremendous head start.


###Input :I updated D-dimer and platelet results now that Im home to see my bloodwork. I apologize I keep replying, but since you made the list, I thought Id let you know, in case you end up not seeing it. ###Output :Do you have a picture of your blue arms? Is it al over? Are the blue areas painful or itchy?


###Input :Theres a small sliver, same area on both sides, that is my pale skin. The rest of my arms are completely blue. Im currently trying to link photos, but I still am in the process of deleting photos, so that my already filled up iCloud storage will allow me to actually create a link lol. ###Output :Would be really useful to see a picture! (Once youve had some sleep)


###Input :Dont link through your iCloud to avoid being doxxed or anyone with nefarious intentions causing you more trouble.Edit: create an Imgur account (takes 2 seconds) and link ###Output :Are you on any medications, otc stuff, supplements? Lots of exogenous substances can cause blue pigmentation (colloidal silver, amiodarone, minocycline to name a few).


###Input :I put the data in that I was asked for, but I can totally do the whole thing, if you think itd be helpful! Quite a bit of my results are online, though, so Ill probably take some screenshots. Ill add it in the post too, once I do. ###Output :Screenshots would be fine (and probably easier) as long as its readable.


###Input :I put it in my post! Theres a lot of screenshots lol, so beware, but its every test result Ive received most recently (September 11th). ###Output :Is it just your arms that are blue? And the right started before the left?QYes, just my arms. The left one started turning blue before the right one, its the blood oddity that started in the right. My lips used to also occasionally turn blue months and months ago, but now its strictly my arms.Sorry it took so long to get back to you things have been crazy on my end with covid. Ive been thinking a lot about your case over the last few days. I think its really strange that its only your upper extremities that are changing color. Please keep an eye out for color changes on your legs or other body parts. Typically when there is some form of differential cyanosis (one part is blue and others arent) we think of cardiac defects and if its one specific limb poor perfusion. But given your age and normal echo a cardiac defect causing your symptoms is unlikely. My next best guess would be something like pernicious anemia/B12 deficiency. This could explain your developing anemia and some of your pain symptoms. The blue coloring could be due to easy bruising related to it. However given that you have microcytic anemia (small red blood cells) and we typically see a macrocytic anemia (big red blood cells) with pernicious anemia/B12 deficiency. But that doesnt necessarily rule out that as a cause for you symptoms. To evaluate this you would start by checking b12, folate levels. Like other have mentioned you could have a hemoglobinopathy causing the cyanosis and anemia which would be more consistent with your microcytosis. However I would have expected this to show up before now, have some known family history of anemia or bleeding disorders, and/or have cyanosis or bruising on more of your body than just your arms. My best guess would be some kind of vasculitis causing vasospasm in your arms giving them a cyanotic appearance. The vasculitis could also be causing the pain you experience in your legs. Your developing microcytic anemia could be early anemia of chronic disease with maybe a pinch of iron deficiency thrown in. Id recommend asking for a ferritin and iron level to evaluate the anemia more. In terms of vasculitis workup, its a bit out of my wheelhouse so Id recommend considering seeing a rheumatologist for further evaluation. Those docs typically (or at least the ones I have worked with) are more of the safari guides than other docs and specialize in zebras.Tl;dr: Possibly a vasculitis, consider rheumatology. Also could be B12 deficiency/pernicious anemia or hemoglobinopathy but less likely due to nerd stuff as above.*edit: Like to add that you should probably also consider seeing a hematologist as well if you havent.


###Input :Thank you! I appreciate all this information greatly, and I will definitely take the advice. Im sorry things are bad with COVID right now, honestly I couldnt imagine what its like to be a doctor during this pandemic. Ive already had it myself, and my mother almost died from it. Its nasty stuff. Im praying for all of you.I went to the doctor today (my primary), and Ive been given a referral to hematology and cardiology, as most of my previous heart echo was suboptimally imaged and apparently the cardiologist remarked several times that he couldnt see hardly anything. Were making 100% sure its not my heart first, and then were going to hematology because Im having extreme bleeding issues again. I had blood drawn today for a new PT and PTT also and the tubes were filled up within seconds. The phlebotomist even remarked on the situation, and my blood appears to be almost the consistency of water. I was born at the hospital Im going to for hematology, so maybe there can be some connection if possible. Also, apparently on my last echo, it was remarked as me having trivial to mild mitral valve regurgitation but Im not quite positive what that is anyways, or if it is even something to question.Ill definitely be hitting up rheumatology next, especially if these dont pan out. ###Output :Mitral valve is valve on the left side of your heart. The regurgitation means it leaks a little allowing some blood to flow backwards. I wouldnt think much about trivial to mild mitral regurgitation especially if it was a bad echo. I hope you find your answer. Please feel free to DM me at anytime if you have questions or concerns. Always happy to help


###Input :Rheumatology- [49][female] Methotrexate and ColdMy mom is a patient of La county hospitals but does/t have a PCP only a specialty clinic doctor that she sees every 3 months so Im hoping to get some advice. She recently got a cold this past weekend, she tested for covid and had a negative result. She has a cough and is taking Acetaminophen from OTC. She is due to take Methotrexate today due to her Lupus treatment for her flare. Her doctor recently increased her dose to 10 pills weekly which I understand to be an immunosuppressant. How does this affect her if she has a cold? Should she skip until she gets better? ###Output :That's a spectacular question,I wouldn't panic, I don't think it's radically dangerous but this does merit a phone call to the doctor's office. It's important and should be answered by someone who understands her particular history with lupus quite well.I say don't panic because it is not radically uncommon for people to take immunosuppressive drugs when they are in fact sick with an infection, that is the whole basis of taking steroids(the most iconic immunosuppressive drugs) when you have covid, it's looked at like a double-edged sword. So that's good with bad. In theory it could make her cold much more intense and last much longer than it would in a normal person .I don't know how bad her lupus flare is and if that's going to hurt her more withholding the drugs; or how bad her cold is, and if she's really going to fall apart, so I will refrain for making an explicit recommendation.I recommend you get this specialist to give the recommendation, but either way giving it or holding it, she will probably be okay for the meanwhile.


###Input :Thank you! I feel much less panicked now. Ive tried getting a hold of her doctor but have not able to. Ill continue trying. On the lupus thread, Ive also seen that others have been told by their doctors to skip methotrexate when they had a cold. Ill let her know to skip and take it next week, when shes hopefully back to her normal self. ###Output :I think that's probably an OK decision. Not my decision. I don't know her.


###Input :Chest/Neck CT/PET in preparation for lymph node biopsy for neurological/rheumatologic(?) symptoms, also showed lung nodule?Hello everyone! I just had a chest CT and neck CT with contrast to evaluate lymphadenopathy of the neck as well as potential lymph node activity of the chest, and to move towards a lymph node biopsy.This is what was found so far (also had an ER ultrasound showing multiple mildly enlarged lymph nodes in parotid, submandibular, levels 1 and 2 no fatty hilum)-Multiple nonenlarged reactive appearing cervical chain lymph nodes bilaterally. Asymmetric 0.9 cm left level 5 and 4/5 nodes, with preservation of the fatty hilum, likely reactive. Subcentimeter right retropharyngeal node similar to the recent cervical spine MR, with an elongated reactive appearance.My ENT, advised by the rheumatologist I am seeing, was somewhat hesitant on doing the biopsy before having a PET scan done because she stated a biopsy would interfere with a PET/CT for 12 weeks afterwards. The PET scan was recommended by the rheumatologist, as we do not have solid leads for the issues I am having and per his words can collect more sensitive data. I have symptoms progressing by the day, and would like to go ahead with the biopsy and forgo the PET scan also because of the high radiation dose. My questions are, does a biopsy really impact PET results for so long, and would it make sense to perform? Can I request the biopsy first instead? Also, would an excisional biopsy really be needed over a core needle biopsy?The CT also found a 4 mm right lower lobe nodule adjacent to pleura image versus subpleural atelectasis. Should i be concerned about this nodule or its location, and could it represent a rheumatologic disease process?I appreciate any advice! I am a mystery case to all the doctors I have seen and feel completely utterly hopeless.28F, 57, 172 lbs, Asian, No drug use or smoking of any kind, Current Medications include Levothyroxine, estrogen, and progesteronePrimary Issue- Multi system wide involvement including neurological, dermatologic, possible rheumatologist, endocrinologic- Severe neurological presentation of symptoms beginning as constant left-sided facial pain, progressing to tingling and cold, then constant numbness and deadness of sensation in peri orbital area, decreased corneal reflex, whole cheek, down to jaw, and through lips, combined with massive headaches in occipital temple and behind the eye, feels like face is falling off face and sagging. Loss of muscle in face and body as well as muscle twitching/pulsing in top and bottom eyelids (right and left) constant muscle twitching/aches/pain in random muscles throughout body. Recently spread of pain in parotid, submandibular, occipital, ear canal, left neck, supraclavicular areas with associated mildly enlarged and reactive lymph nodes, mostly on left but also bilaterally. Very recently tightness, compression, and loss of sensation in left front of foot and back of left calf which is still present.Many other non-neurological symptoms, have seen 60+ doctors.Duration: 2 years of worsening symptoms. ###Output :Reactive lymph nodes are usually from some infection or inflammation and biopsy will likely not be helpful. Id say go for the PET first. The lung nodule does not seem worrisome. PET once again may be helpful to see if it is metabolically active


###Input :Positive ANA test 1:1280, whats next?Hello im F 24 i weigh 110lbs and am 51 Ive been on a four month journey of trying to figure out whats wrong with me, had an oncology appointment recently as my physicians were suspicious for a lymphoma or leukemia. Had an ANA test along with a myriad of others and it came back positive 1:1280 speckled pattern. im being sent to a rheumatologistIm wondering what are the different things that can come from this positive test? and are petechiae something that happens with autoimmune diseases?ive had widespread lymph node swelling, with some hard immovable ones in my neck and underarmsdaily feversnight sweatsweight loss 10lbs in four monthspetechiae and bruisingred bumps in areas of lymph swellingfacial flushingburning sensation on skin face, neck, shoulders, armswidespread intense itchinessextreme fatigue, weaknessdizzinessupper abdominal pain & hip/lowback painand migrating pain that feels like growing pains in my bones throughout my body ###Output :Could be lupus, maybe Sjogrens. Both can look like lymphoma and cause most of the symptoms youve listed. Rheum will test a battery of inflammatory markers, immunoglobulins and antibodies for a specific connective tissue disease (CTD). Many CTDs can cause petechiae and purpura due to vascular fragility and small vessel vasculitis. It can take some time to make these diagnoses.


###Input :Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it! ###Output :I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!


###Input :Should I see a Rheumatologist?Hi I am 26F, 150lbs, currently only taking hormonal birth control (sprintec). I have been dealing with recurring hand and arm pain for the past four months or so. I'd estimate since the end of January 2023. It started as a sort of tingly feeling in my fingers with some pain around the proximal interphalangeal joint in all 10 of them. I wouldn't describe the tingling as numbness exactly, as it's not the pins and needles that others use to describe it, but it is constant. The pain is in both hands, but my right hand is worse as that is my dominant hand. As there is no specific moment I can remember when this started, I thought this might have been carpal tunnel or some other overuse injury from spending time knitting & crocheting as well as being on the computer 8-10 hours a day for my job/fun. I stopped knitting as much and when it didn't get better around a month in I stopped knitting completely. The pain does get worse when I use the computer and my phone so I am trying to limit the use of both and I have already switched to using a vertical mouse which didn't seem to make a difference. Specifically when I click the mouse with my right pointer finger I feel a pinch between my ring and pinky fingersI went to an orthopedic hand surgeon who said that he didn't think it was carpal tunnel as those are unusual symptoms for it and even more unusual to be experiencing the pain in both hands. He took X-rays that he said looked normal, and he ordered a bunch of blood tests for me including one for Rheumatoid factor. He also prescribed me physical therapy after I complained about still being in pain. The physical therapist did a bunch of intake tests that showed my grip strength and other strengths were on the low end, but normal and he seemed stumped on how to help me. After 3 sessions of in office physical therapy I did not seem to get better and if anything it's worse. As I now feel regular pain up my arms around my forearm and triceps (feels kind of like a tight stretching) in addition to the pain I described earlier. Also in the last couple of weeks I've experienced actual numbness in both of my pinkys, on seperate occasions. For the record I wasn't as diligent with the PT as I could have been, ie sometimes I would do exercises only once or twice a day instead of the recommended 2-3 times. I was diligent about the heat he recommended though.My blood tests came back all negative so the doctor said that he's at a loss, suggested I maybe make an appointment with a rheumatologist and prescribed me a 4mg medrol dose pack as a last ditch effort. During and after the prednisone I didn't really notice a change in pain levels. That coupled with the negative Rheumatoid Factor suggests to me that maybe there is no inflammation causing this? But I know that seronegative rheumatoid factor exists, hence why I'm now asking on reddit. Does it seem like this could be RA? Would it be worth it to go to the Rheumatologist for this? Was my doctor just wrong and it is some kind of overuse injury and I should just try a new orthopedic doctor? Maybe someone less specialized in the hands because the physical therapist suggested it might be a spinal issue since the pain is traveling up my arms. Should I just give up on doctors and try to be more diligent about the physical therapy on my own?For the record here are all the blood tests I got:CBC W/PLAT AUTOMATED DIFF - Only showed I have a slightly low red blood cell countANA PANELSEDIMENTATION RATEC-REACTIVE PROTEINRHEUMATOID FACTORURIC ACIDHLA-B27 ANTIGENCYCLIC CITRUL PEPTIDE ABSANACHOICE(R) SPECIFIC ANTIBODIES W/RFLX TO DSDNA ###Output :Picture does not sound rheumatologic to me. In addition to the negative labs and imaging, most patients have relief with steroids on initial diagnosis of a rheumatologic condition. This tells me what is going on is unlikely autoimmune or inflammatory.Some ideas and thoughts on things that can cause pain/tingling/weakness in the arms and hands that I do have are have you ever had any neck trauma or whiplash? Has your B12 and thyroid been checked? Do you have any history of migraines?


###Input :No neck trauma or whiplash and I'm not sure my B12 has ever been checked. I went to an endocrinologist last year because I found out I had a high level of thyroid peroxidase antibodies (166 iu/ml) after testing for a seperate concern, but my T3, T4, TSH were all normal so she said to come back in a year. I hadn't thought about it because the endo seemed very unconcerned, but do you think that could cause this?Also no real history of migraines, I remember I had 2 around when I started puberty and haven't had one since. My (older) siblings do occasionally have them though, not sure if that would matter. ###Output :Hypothyroid can certainly cause some real muscle pain, joint pains and parasthesias (tingling in hands/feet). As a matter of fact, carpal tunnel syndrome is a common neuro symptom of hypothyroidism and is often reversible with thyroid hormone therapy.Get your thyroid checked. Id still also check B12.


###Input :69M - prostate cancer? - what to expect?Hello, this is concerning my father (69M). He's 6'3" and about 15st. Anatomically this concerns this prostate, and geographically we're in the United Kingdom.He is a moderate regular drinker (2-3 small glasses wine most nights) but has never taken recreational drugs. He used to smoke but quit about 35 years ago.He has mild asthma and chronic sinus issues caused by nasal polyps that cause total nasal obstruction. He is awaiting followups for a cauterising surgery, but this seems unrelated.As part of routine bloods, my dad got a psa test about a month ago, which came back at 13.3, which is obviously elevated.His GP hasn't seen him in person and hasn't carried out a rectal exam, but instead referred him to urology. His urology referral was a telephone consult to tell him that he was being booked in for an MRI.He had the MRI (with contrast) last week and today was told that there was something suspicious on the left side of his prostate, and that he would need a biopsy. He hasn't had the biopsy yet.I understand that this is all geared towards a prostate cancer diagnosis, and I understand that at this stage, prostatitis is unlikely. All the clinicians with whom my dad has spoken have been very reticent when he has asked about cancer, but simultaneously tell him he might need a bone scan based on the outcome of the biopsy.I'm under no illusions that prostate cancer is high on the differential, but could benign prostatic hyperplasia still be on the cards? I understand that both conditions are diagnoses histologically, but it would be helpful to know whether PC and BPH look distinct on images?For background info - he has no urinary symptoms but has been losing weight steadily for about 3 years (maybe 4st in 3 years?). Assumption has been that he hasn't been eating much because his nasal polyps have robbed him of his sense of last largely. He also lost his wife (my mum) to breast cancer six months ago. He can't cook and eats rubbish, and also likely has depression.Any insight here would be useful in terms of differentials, outlook (based on the vagaries I've provided) and generally what to expect. I definitely feel that no clinical has been forthright with my father thus far. That's no criticism of the docs, but it hasn't helped him and has compounded his stress as he's gone straight to Google and catastrophised. ###Output :Urologist. Impossible to provide much advice since he hasn't actually been diagnosed with prostate cancer and there are many nuances depending on what type / grade / stage of prostate cancer we are talking about. Certainly a chance you can have an elevated PSA and no prostate cancer even with an MRI. Only way to find out is biopsy. Results of that would determine what needs to be done.If he does have prostate cancer it is almost certainly localized to the prostate. Options would then be surgical prostate removal, radiation, or surveillance and waiting. Obviously I don't want to go into these with out a proper diagnosis. Biopsy happens in the office, takes about 15 min. Results take a week or two to come back.


###Input :[Urology] 27M, Pee drops "leaks" after peeing. Embarrassed to visit a doctor.As the post says, I am 27M. After peeing few drops of pee leak out after peeing.As a "solution", i "rub" my penis to move any pee in the canal outside. I do it even from behind the testicles. However recently, it seems even that doesn't work out. As i still get few drops of pee afterward, especially when i sit down.I wanted to go to a doctor, however i am extremely embarrassed. And I am not even sure if there is anything that can be done at this point.The thing is: the reason i believe this is happening, is because when i was a kid, i inserted a thermometer in my urethra, it was deep enough that i felt it penetrating something and pee came out.However if i recall correctly nothing really changed after that incident and this leaking issue started happening about 5 to 8 years ago. ###Output :To put your mind at ease, there is a VERY low likelihood that these issues are secondary to your "self-exploration" event that you journeyed on when you were younger. Additionally, there's absolutely no reason to be embarrassed about this. This is what us physicians do on a daily basis, and we do what we do because we love to help people (most of us, that is). And I promise, for every "embarrassing" event you think you might be bringing to the table, I guarantee all of us have seen much, much worse. But again, there's absolutely zero shame in what you're going through whatsoever. Get a referral to a urologist from your PCP; all they focus on is genitourinary tract issues, and they should hopefully be able to help you find an answer to what's going on.


###Input :Piggybacking... had this start happing to an extent sometime in my 30s or 40s, and figured this was just attributable to aging... Would a urologist visit typically be warranted if there's no other symptoms or related trauma that could have caused it? ###Output :It's true that many men will develop these types of symptoms later in life due to something called BPH (benign prostatic hyperplasia), which is essentially when the prostate grows too large and starts "pinching" the urethra closed, which subsequently may lead to symptoms such as difficulty starting a stream or completely emptying when they go. However, your 30's is way too early for this to begin occurring. I would start with going to your PCP first so they can do a physical exam and ask more questions, and then they can help decide whether or not a urology consult is appropriate for you.


###Input :Cystocele76 old woman. Her nurse practitioner diagnosed her with cystocele. What kind of doctor would be the right doctor for cystocele? Would gynecologist be better option than an urologist since the patient is a woman? ###Output :Luckily you don't have to choose: there are urogynaecologists out there, which are gynaecologists who specialize on urological and proctological issues in women. I'd go to one of those.


###Input :Does OB/gynecologist fit that category? Medicare physician finder doesn't even have the doctors category of urogynecologist on their web portal. ###Output :Ah, I see. Sorry, I'm not in the united states. It's the right type of doctor, yes, but it doesn't tell you their sub-specialisation. Maybe look the ones you find via the portal up on the internet or call their office?


###Input :27m - Urology/Andrology Question - successful Penile vein ligation and shockwave treatment contra indication? What happens to ligated veins ?Hello to all,I have been diagnosed with severe organic erectile dysfunction and am using PDE5I, injectable PGE1 (Alprostadil) and sometimes alpha-1-antagonists (doxazosin).I am suffering from organic erectile dysfunction and had a successful dorsal vein ligation (3 years ago - superfical and deep dorsal vein as well as two ectopic veins (which helped me to get erections with medication).Even though shock wave treatment might not be very promising I still want to try it and as I happen to live in a country where it is comparatively cheap I am about to do 10 sessions in 5 weeks.But I fear that it might "unblock" the vein ligation ?Hypothethically speaking - if the ligated veins where freed from their suture would they pop open again ? Or is there scar tissue built up which will continue to block the vein ?I fear the shockwaves might damage the "suture". Since I cannot happen to find information about that online maybe someone can help me out.Thank you and best, ###Output :The suture themselves dissolve after a while. So 3 years later the veins are closed by scar tissue. Also, when a blood vessel is surgically closed, a longer segment of the vein eventually becomes "clogged". Sounds very unlikely that anything could break them open again, even if they should deliberately try.So I don't think you should worry about this specific complication. There's probably a lot of other possible complications though, I don't know much about this specific shock wave procedure. Sounds very experimental though. Do you know how it's supposed to help for ED?


###Input :Constant 9/10 flank pain Female 31Hello fellow people of reddit. I hope you are all doing better than I am currently.Overview: I had my first set of kidney stones in may of 2022. I had another set in July of 2022. In December of 2022 I started having constant pain in my flanks. Ive been to the emergency room several times since then. Ive seen urology, Ive seen my pcp, Ive seen the pain clinic, Ive seen a nephrologist. I have bloods done frequently as well as UAs. Ive been ignored and sent home every time when I seek help. Otc meds dont work and the narcotics just make me sick. I feel like Im going insane. Im Im so much pain on a constant basis. My mental health is starting to tank because of this. Any advice would be appreciated.I do have hypercalcemia, and hyperparathyroidism, and my nephrologist believes I could also have necrosis in my kidneys.I am 31, obese, 5 foot 3 inches tall. I have never smoked, dont drink, dont do drugs other than weed in gummy form every now and then.Current Meds are:Concerta, Propranolol, Losartian, Amlodipine, Nebulizer, Quvar, Alb inhalerHere are my most recent labs.UA:https://gyazo.com/d5f6f1fc96058f29dd17ea6d2e3126f9https://gyazo.com/fca06118e1b739c171942f1b3050492fCBC with Auto Differential:https://gyazo.com/940243c0ec3bb61963388832f51c2bd0CMP:https://gyazo.com/2586ac67b7574917dcb76db00ddf78ae ###Output :The fact there is calcium oxalate in your urine, plus blood +++ indicates there may be a stone in the process of breaking up, and this is what is causing the pain for you (especially if you have a history of kidney stones). Looks like a slight UTI too, which isn't going to help.


###Input :Thats what I said, but the only stone they can see is, according to them, no bigger than a grain of sand. The doctor I saw last night also said that I didn't have a UTI. I've had the crystals and blood in my urine every single UA since December. ###Output :You don't have a raging UTI and your culture is negative from what I can see. But there are white blood cells in your urine, and bacteria (though no leucocytes/nitrates, which tend to be the classic uti markers). Plus, a high number of epithelial (skin) cells, which indicates sample contamination. So, not anything that warrants treating.And yes, kidney stones can literally be a grain of sand size and cause utter havoc.


###Input :Man, I wish the doctors here would understand that. Because every time Ive gone to the ER (which is a lot unfortunately because I cant deal with the pain and otc meds don't work on it) they just tell me Im being dramatic and to go home. ###Output :I'm sorry to hear that. When I come across patients with pyelonephritis/renal colic etc, they tend to benefit somewhat from hot water bottles.


###Input :My heating pad does help to a degree. Sometimes, it helps enough that I can sleep or do whatever it is I need to. And sometimes it does nothing. ###Output :Do you have any imaging? Does the pain come and go? Where is it located? Is it the same as when you had kidney stones? What therapies have you tried, what did urologist say about the pain?


###Input :Nephrology says it's probable stones and/or renal papillary necrosis.s.ne. There's a constant dull ache and then like a colicky pain that gets really bad really fast. It feels very similar to past kidney stones. The pain is on both flanks and spreads to my side right above my hip.I've had a couple of CTs. The last one showed at least one itty bitty stone. There's a constant dull ache and then a colicky pain that gets really bad really fast. It feels very similar to past kidney stones.I've done heat, cold, narcotics, NSAIDS (which the nephrologist said to stop) Ive done physical therapy, exercise, and stretching.The urologist says he didn't see anything and that I'm being dramatic.My PCP says there is something wrong and to see urology.Nephrology says its probable stones and/or renal papillary necrosis.The pain clinic says Im being dramatic ###Output :I agree that NSAIDS and opiates are not the way to manage this, and I believe your pain you are not "dramatic".How high is your calcium? Your hyperparathyroidism is possibly the most crucial thing to get under control. Chronic hypercalcemia obviously predisposes to stones, but also to a disease called nephrocalcinosis which can be painless but sometimes causes marked pain as small rocks of calcium get lodged in the draining portion of the kidney.The other not mutually exclusive possibility is you are having ureteral spasms, which are associated with hyperparathyroidism and hypercalcemia but no stones.So it is crucial to get your hyperparathyroidism under control. Even with "normal" calcium this can cause kidney problems and with hypercalcemia can cause kidney failure. If this is already under control then possibly it will get better once the ongoing calcium deposition improves. Dietary changes can also decrease calcium deposition, your nephrologist can advise on these.There are several medications available that are somewhat helpful for ureteral spasms including oxybutynin and tamsulosin but would focus on the underlying cause.


###Input :My calcium bounces between 11.5 and 13.5. I have surgery to remove the overactive parathyroid glands at the end of next month. It was supposed to be this month but the hospital broke a needed machine the day before it.I will have to looked into the nephrocalcinosis, I haven't heard of it before. ###Output :Holy smoking gun batman.Yes I suspect this surgery will help tremendously with your pain. If it was delayed long you should have been on a calcium lowering agent, though likely a little late to start now.


###Input :Fun fact my endocrinologist told me to take calcium and vit d.Im really hoping the surgery helps because I might just loose my mind if it doesnt. My calcium has been like this for about three years but I was always told it was fine until recently. ###Output :I don't know the details so I can't really assess what is going on here, but in general we wouldn't let someone be that high for that long. Surgery is usually done fairly early and if not medical therapy offered, targeted at lowering not raising the calcium.


###Input :Unfortunately, I had a pcp that seemed to believe that everything was either due to menstruation, things I was doing, or that it was due to my low mental health or that I was lying. But he was the only one my insurance would cover. As soon as I switched doctors I got referrals and scans and procedures but that only happened in November of last year.The Ed always said it wasnt that high and it wasnt something to worry about. ###Output :The ED is never going to treat hypercalcemia or really any chronic problems. It isn't acutely life threatening unless very high so not on their radar.They aren't mini-PCPS.Unfortunately people have poor access and get stuck in the ED visit spin cycle with care never moving forward. I think you are on a goodish path now though.


###Input :The case of the constant invisible urine flood: neuro? Psych? Other?This is a bizarre one, so Im hoping for any ideas here.Pt (family member) is an 80 year old female residing in an assisted living facility with hx of benign essential tremor and recent dx of possible Parkinsonism (tremor, left side more than right. A&Ox4; No signs of dementia; MOCA 7.1 score 28/30. More hx and meds below) About three months ago, pt c/o urine constantly running down my legs. She reports that her clothing, shoes and socks get soaked with urine, to the extent that she leaves wet footprints when walking, and smells urine strongly in her room and on her clothing. She has been wearing adult incontinence briefs, but reports that the urine bypasses these briefs.Heres the problem. Family, caregivers, physicians, nurses, and therapists cannot see, smell, nor feel the urine. When pt says her pants are soaked, they appear and feel dry to the touch. Incontinence briefs also feel dry, and there is no sign of urine on pts bedclothes or clothing. She recently spent two weeks in an acute care hospital and another two weeks in a rehab hospital, and in that time, only one instance of urinary incontinence was noted and that was on admittance when it had been some time before she could be seen.She has seen a neurologist who prescribed Sinemet (carbidopa/levodopa) for her tremors. The neurologist mentioned that Sinemet can exacerbate incontinence, but didnt really address pts insistence that she is constantly having urine flow that soaks her legs and shoes but somehow bypasses the incontinence briefs leaving them dry.She has seen a urologist, who prescribed a bladder training regimen and voiding journal, but a bladder scan showed she is emptying her bladder just fine. Labs show no sign of UTI or other infectious or inflammatory process. Urology suggested this was more likely a sensory issue than a urology issue and referred back to the neurologist.Pt insists that her fellow assisted-living residents can also see and smell the urine, and has reported that she believes the caregivers are lying about not seeing it in order to be polite.Complicating this is that pt has a history of anxiety disorder, depression, sometimes exaggerating physical symptoms and deciding she has a grave condition of some sort until tests are done to rule it out. A psychologist has suggested she may have a personality disorder with emotional dysregulation and attention-seeking features as well.The fact is, though, this pt is miserable and 100% insistent that she is experiencing a constant flow of urine and sitting in wet clothes all the time. We cant get her in to the psychiatrist until late April.Are there ANY ideas of what we may be missing to explain this from a neurological/sensory standpoint or another place to look? I have been really trying to advocate for this pt but its very difficult when the problem seems to be invisible for everyone but her. On the chance this is not psychosomatic, Id really like to make sure weve considered all options and are not just blowing her off because of her mental health issues.No alcohol, no drugs other than prescribed, no marijuana, no tobacco/nicotine use.Meds: Sinemet 25/100 2 tabs tid (Parkinsonism) Bupropion 75mg qam (depression) Liothyronine 5mcg tid (hypothyroid) Levothyroxine 50mcg qam (hypothyroid) Trazodone 50mg qpm (sleep) Buspirone 5mg bid (anxiety) Alprazolam 0.5mg qpm (anxiety/sleep) Ibandronate 150mg q30day (osteoporosis)Surgical/other hx: Hysterectomy/bilateral oophorectomy ~40 years ago Pregnancy: G2P2 ~50 years ago Melanoma removal, L knee, ~5 years agoLabs:CBC shows minor anemia beginning the day after starting Sinemet but seems to be resolving.BMP normal except for elevated AST (last values from Jan 2023 to Mar 2023 were 88, 71, 144, 156, 162, 91, 101 in chronological order.)Imaging:MRI Lumbar spine w and w/o contrast 2/1/2023: they didnt think it had anything that would explain constant urine flow but I can post the report if needed.CT head 1/30/2023: impression was: 1. No acute intracranial abnormality.2. Atherosclerosis. ###Output :I would guess these are vivid hallucinaties, resultibg in a delusion. These can be caused by her combination of meds ( levodopa, bupropion and trazodone can cause agitatie and confusion in eldery patients). Did it start after starting levodopa? Parkiinson itself can cause vivid hallucinations too,but often parkinsons is more advanced then. And it could also be caused by depression. Older people often have these kind of delusions when they have psychotic depression.I would go back to the neurologist or psychiatrist for an evaluation. Probably stopping some meds should be tried, or antipsychotics compatible with parkinsons like clozapine added. But ask her doctors first what and how.


###Input :Oh, I forgot to answer your question: No, this started quite awhile before she started levodopa and buspar.She had been taking bupropion, trazodone, and alprazolam for years, but spent a few weeks in an inpatient psychiatric facility specifically focusing on elderly patients (edit: for depression/SI) about 9 months ago, and the psychiatrist there doubled her bupropion from 75mg qd to 150mg qd.The urinary problem started about three or four months after that. Two months ago, she was hospitalized for increasing tremor and weakness, at which time a consulting psychiatrist said to titrate her off the bupropion as he felt it was contributing to her anxiety levels. At that time, her bupropion dosage was cut in half to the 75mg she is currently on.The increasing tremor and weakness were determined to have been simple deconditioning due to self-isolating, turning away physical therapists, and not moving around much at all. She went from acute care to an intensive inpatient rehab facility and very quickly (about 2 weeks) regained much of her strength and a decrease in tremors.Thank you so much! We are trying to wean her off bupropion for that exact reason (not hallucinations specifically, but because it can exacerbate anxiety), so thats good to know. We just saw the neurologist yesterday but he sort of waved it away and suggested we discuss med interactions with the pharmacist.Further complicating matters is that shes tried pretty much every SSRI and SSNRI for depression and has had bad reactions to all of them, so bupropion at the time was thought to be a sort of last-ditch effort and seemed to be working for her. Since it also works on dopamine, the neurologist was completely unconcerned about it, but admitted that comprehensive med review was not in his wheelhouse.We did specifically ask the neurologist if this could be related to the Parkinsonism and he said he didnt think so because of the rest of how her condition appears.So, it sounds like I should continue trying to get her into the psychiatrist sooner? So far her other doctors dont seem to think theres a problem that they can speak to. ###Output :For depression with psychotic symptoms, like these hallucinations/delusion, often tricyclic antidepressants are used, so probably meds she has not tried yet or maybe a few decades ago when they were more common.Personally i would try to get an appointment as soon as possible, because something is clearly not right and she is suffering probably.That could be a psychiatrist specialised in the eldery or (another?) neurologist. Consulting a pharmacist with an interest in psychopharmacology however also a good idea in the meantime.Armchair diagnosis is easy, but i could be very wrong and there is something else going on. This is just some thoughts that came to mind


###Input :Child urology: Double kidney, megaurether, uretheroceleFemale, 10 months old, 70 cm, 7.5 kgHi all,I am searching for second opinions and experiences for my 10 months old daughter.She was born with a double kidney whose upper part is polycystic and thus not working properly. The urether of this part became a megaureter, probably because it ends in an ureterocele in the bladder.Her first surgery was when she was 1 month old. They cut into the ureterocele so the urine can flow into the bladder. However, at this point they thought she had only one urether for both systems and thus there had been enough urine to guarantee sufficient flow. When she had a persistent infection with Klebsiella pneumonia, we were referred to specialists who saw the second urether and, 2 weeks later, her second surgery was done to make a urostoma, so the basically standing urine from the megaureter could flow directly outside. The ureter is smaller now and except that she receives prophylactic treatment with antibiotics, everything is normal. But the stoma has to be closed of course. Now there are 2 options:connect the ureter from the dysplastic part of the double system with the healthy ureter from the healthy partcut out the dysplastic part of the double system and part of its ureter, leaving the other part and the ureterocele where they are, as there is no refluxOur doctors recommend option 1), as the surgery is shorter (90 minutes vs 3 hrs) and less invasive (opening up the existing hole from the stoma a bit more vs making an additional cut close to the lungs) and the healthy kidney part is not damaged (vs certain loss of at least 7% function). The only risk is that the connection of the two ureters leaks, which is rare and easily fixed they say.These are all compelling arguments, but we were also told that option 2) is the more common one. Does anyone have experience with similar cases? What's her best option in your opinion?Thank you very much for any feedback! ###Output :!redditsilver