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Forum Name: Psychiatric Topics
Question: Symptoms - organic? psychiatric?
|1mklady - Fri May 06, 2005 12:10 pm||
Hello. I am a 42 year old female with a variety of symptoms. Symptoms have been coming on for about 8 years. Here's the list:
fainting spells, near fainting spells
muscle fatigue and weakness
fatigue, extreme, always feel tired no matter how many hours I sleep
chronic diarrhea and bowel incontinence
weight loss of 15# since January, no change in eating habits
joint pain in hands, wrists, hips, feet
difficulty concentrating, short term memory difficulty
asymptomatic UTI's (no pain, no frequency change, no urgency change)
Over the past 4 months, the fatigue, near fainting spells, tremors and muscle weakness and migraines have become worse. I have been under tremendous stress with work, working 60+ hours a week, worked 80 hours one week (I am a hospice RN) along with personal stress of having my 15 yr old daughter move in with my husband and me (her moving in wasn't the stress, it was having to deal with my ex-husband).
3 weeks ago things seemed to spiral downward and out of control. I was on call that weekend, worked about 10 hours on saturday, woke up saturday morning with jaw pain on the left and stiffness in jaw. On sunday, I woke up and was exremely exhausted, tremors in hands and legs severe, my jaw was even trembling. I worked about 5 hours and came home and literally collasped into bed, slept for 4 hours and when I woke up, felt absolutely no better.
Monday morning I tried to go to work but after driving my daughter to school, I was shaking all over. I saw my MD that afternoon. He was a new MD for me, I began seeing him in March because the near fainting spells were getting worse. He began doing blood tests all of which were normal: CMP, CBC, sed rate, RA factor. Only test that came back positive was ANA at 1:80. I have previously had 2 other positive ANA's, one that was 1:80 and the other I don't remember exactly but was somewhere around 1:240. I had seen a rheumatologist who diagnosed undifferentiated connective tissue disease.
When I saw my MD that monday, he put me on prednisone 40mg a day for 3 days then tapering down. He said he suspected polymyalgia. On the 40mg, I didn't really feel any better, not quite as fatigued, but all other symptoms were still severe.
He then suspected addison's disease and ordered cortisol and ACTH levels but I was still on the prednisone., had 3 days of 40mg and the day of the tests decreased to 30mg. He said they were normal; I don't know exact levels. That afternoon, I began feeling very ill: palpitations severe, sob, severe muscle fatigue and tremors, fuzzy thinking, severe pain in my abdomen and legs. I never lost consciousness but was totally unable to move any part of my body. I was admitted to the hospital and treated for an apparent adrenal crisis. My sodium which had been 141 that AM was 135. My potassium was 3.7 that morning and 3.9 that afternoon. Glucose that am was 84, 183 that afternoon. My carbon dioxide was 16.5 that afternoon. My ALT was 27 and my AST was 9. CBC that afternoon showed WBC 9.2, LYMP .9, MID .4, GRAN 7.9, LYM%9.8, MID% 4.6, GRA%85.6. HGB was 16.3, RDW 11.3, MPV 7.3. Other labs done while hospitalized: T4: 8.6; TSH .48; PTH: 44.
After 3 days in the hospital, I was discharged on florinef .1mg and prednisone 10mg. My symptoms did not go away. I gained 15# overnight. My MD dc'd the florinef but continued the prednisone.
4 days later I was no better. So my MD ordered an ACTH stim test. I was to decrease the prednisone to 5mg on Friday, and take none Saturday or Sunday. The stim test was monday morning. My results are:
baseline cortisol: 20.3
baseline aldosterone was drawn but level not back yet
30 min cortisol level: 30.7
60 min cortisol level: 30.1
I also had a 21-hydroxylase autoantibodies test but results are not back yet.
My MD is saying my ACTH stim test was normal and is ruling out addisons. I am questioning the accuracy of the test due to the prednisone. I was only off it for 48 hours before the test.
Any advice or thoughts would be appreciated!
|Shannon Morgan, CMA - Tue May 10, 2005 5:05 pm||
Since most every obvious organic disease have been ruled out, are you sure you can't rule out depression? Almost every symptom you list is a symptom of depression, even things you wouldn't think of can be related. Being in the medical field, we have more access to information about illnesses. Depression can do all sorts of things to your mind. No, I am not suggesting you are a hypochondriac, but maybe you should see a good psychiatrist. Depression is very common, moreso in women. Most every woman experiences it at one time in her life. It doesn't always mean you are sad, or have any reason to be.
If you have a history of depression or other mental disorder in your immediate or extended family, you really need to get it checked.
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