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Malaise, bloating, swelling, water retention, poor quality of skin, hair and eyes, done ultrasound, have IUD. Want direction

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General & Family Physician
Practicing since : 1980
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*Note all details subject to eye rolls *
Symptoms:
Physical:
Period: Every 2 weeks. Last “cycle” began 4/5/12 - 4/12/12, second wave began 4/25/12 – 5/2/12. I noted in fall of 2011 that they seemed to be coming more often and quick. My OB said I was not ovulating. The cycles are full periods, very heavy for the first 2-3 days with going through super tampon along with pad every 40-60 min. The first 2-3 days also have severe cramping, bloating and my moods are that I am a wretched human being.
Water Retention: My weight will flux 5-8 lbs on a regular basis (daily in a cyclic pattern, Im ok in the morning and waddling by evening). Also, I will swell with moderate prolonged exercise. I cant do a 35 min run or Zumba class without water retention both in the muscles and just under the skin from my lower abdomen down. Diuretics don’t touch it. Dandelion root, or prescription Hydrochlorothiazide. The only thing that helps is the ace inhibitor lisinopril HTCZ 20/25 mg with the diuretic. Now it is to the point where normal walking and even the foot pedal at work (im a dental hygienist) causes edema. The edema under the skin at times can be bad enough to become pitting edema. The only reason it isn’t on most occasions is due to the fact I am lean.
Urinary Incontinence: I will drink 30-60 oz of water and then not urinate randomly. I drink 120 oz water on average a day. Some days I’m fine and the balance is going well. Others randomly ill drink and hardly anything and my urine is very dark like I’m dehydrated. I also have a very good liquid electrolyte supplement with trace minerals to make sure its nota salt/electrolyte issue,nothing.
Skin: My skin is very translucent. Iron supplementation helps very slightly, but I still have a very clear and sometimes waxy appearance especially on the chest and breast area. The skin around my eyes is extremely dark and steadily gotten more sunken, recessed and BLUE. I keep very well hydrated, eat the bulk of my diet is fresh produce and vit C helps marginally. It looks similar to when people suffer from consistent allergies/stress/lack of sleep. ( 8-10 hr of sleep does not lift the darkness) Sometimes they will get very red as well and have red patches. There is also consistent acne in the very small none white head variety despite regular immaculate skin care with fragrance free sensitive skin products. (only mineral powder makeup daily on the general face) My skin in general is also very dry, during my period it is flaking off. I do multiple applications of moisturizer on my face each wash and I do not wash my general body aside from the essential underarms ect with wash because my skin will start to flake and itch. I also seem more sensitive to sun exposure more color/redness despite wearing high SPF 80 and UV tinted car windows with no sun bathing or extended exposure outdoors except occasionally at a BBQ ect.
Hair: Hair shedding randomly in handfuls, though that may be stress because it seems to be not terribly often. There has been however in the last year a great deal of new centric hair growth on the abdomen ( my “four XXXXXXX highway” ) my cleavage and bikini area as well as my lip and chin. My legs have remained the same and very fine hair. The centric hair is very thick, dark and course like pubic hair minus the hair on my lip/chin. Scalp is very oily.
Vaginal: I have had a general loss of interest in sex in general barring a few days a month. I am very dry and also have a consistent white/cream discharge that I have gotten checked and was said to be nothing. I have it very consistently and sometimes it gets heavy enough for me to mistake it for getting my menses until I check. My mensus twice a month is HEAVY, changing every 40 min to keep up with it and usually about quarter sized clots and a brown tone to it.
Headaches: I get what seem to be fatigue headaches almost every day. They started only slightly on very long work days and have progressed to daily. Sometimes by lunch hour, but most the time starting from 3pm and steadily get worse until 5-6pm when I get off work. Days off it will happen randomly either in the afternoon or evening. The headache is my temple area and back of the head at the base of the skull. Headaches come with severe mood swings. I know one is coming when I start to get a case of “I hate everything/everyone/the world” and my fuse is non existent. I will burst into frustration tears from pain in my head and mood over fumbling with my hands on something. The only thing that gets rid of the headaches (aside from OTC medication) is not moving/relaxing as well as getting something to eat. (very temporary though)Usually juice gets rid of it or a large chicken breast but if the chicken it takes longer. These have gotten SO regular that I have to warn my boyfriend and he knows my “tells” of my body rebelling. I also have had times when during these “flips” that I get very dizzy and swim headed. Particularly if I bend down/crouch and stand back up. ( I almost lose it and fall over)These episodes are not only daily but start earlier on my period ( lunch hour) and last through the night. Between this and the water retention, I am literally not functional the majority of the time. (to be XXXXXXX it is ruining my life) I tested my glucose after work to see if that was the cause of the headaches and it was 87, low but not enough or terrible.
Eyes: I have the dark (blue/red) sunken in look to them most days. Usually progresses and gets worse from morning into evening and resolves slightly after I sleep. Also I have noted on/off cases of blurry vision that will last from a few minutes to an hour (once when I was driving back from Philadelphia and even with my glasses I couldn’t read the big highway signs and that was terrifying to drive).
Mental/Emotional: Severe mood swings. I will go from happy and normal/carefree to curled up in a fetal position in my living room sobbing/shuddering and wanting to cry out. I get severely hostile when I have the headaches. I have anxiety and panic attacks with rapid heart beat, flushing ect It usually starts when I feel physically my body starting its downward spiral feeling and my body tenses. I know its hormonal so usually I just let myself cry it out, get tired then let my body bounce back with the endorphins. This happens pretty consistently through the month, though, on my menses it is extremely hard to control. ( which is now 2 weeks a month and is unmanageable) I am someone very involved in meditation and self healing practices. I am able to recognize that this is not me but my body. To further that conclusion, the herbal: Milk thistle helps me a touch. The milk thistle takes away all the tenseness and bodily reaction and when I’m on it. Milk thistle is a well known holistic for detox the liver and flushing things out for general health. I also suffer from depression (no reason), easily overwhelmed, easily confused and I have a feeling of brain fog 24/7. My memory, forget it, I will forget parts of a conversation I am having and walk into a room and forget why (several times in a row)
Exercise intolerance: No matter what time of day. I cannot be active. The headaches start, the body “shifts” I feel terrible malaise and I burst into tears that I cant manage to run, jump, do normal things. If I push myself to just do it, I leave the gym feeling awful. Overall bodily “bad” feeling, headache, ANGY, depressed, muscle and joint aches. I should feel good after leaving. I feel like im dammed if I do, dammed if I don’t. I feel awful if I don’t, and I do if I attempt it (just if I attempt it then I get body aches). I don’t do extreme exercise. My boyfriend is a personal trainer and has made sure Im not overdoing it or doing things in bad form. I also will get bouts where if I run, I find it hard to breath. Normally if I run my body just has a surge of “awful feeling” the headaches start and I feel my face getting drawn in and I get frustrated and burst into tears on the treadmill after 5 minutes.
Cravings: I crave sugar. I control the amount. I eat VERY well, bulk of my diet is fresh vegetables (8-11 per day) lean meat and I make my own salad dressing with greek yogurt. The only carbs I have though are cake, sugar free cookies and dove chocolate promises. I keep how much down to a minimum as I can tolerate. When I eat long digesting carbs like oatmeal, ezekial bread ect I get the WORST gas and bloating. I was tested for a gluten intolerance and I came up negative. So I literally have to stay away. Rice doesn’t bother me as much but makes me feel not so good. I randomly will crave protein as well.
Stomach and GI: As I mentioned, I cannot eat any carb that it “toothy” in texture. I get the worst bloating and gas starting 5 hours after almost to the minute. I am uncontrollable. Coal, Gas x, probiotics ect don’t touch it. I also have gas and bloating REGARDLESS during my period. The gas is manageable since I altered my diet but I am so bloated all the time now that a girlfriend made a comment to me if I was ok and I looked uncomfortable/bloated/5 mo pregnant (I have a flat stomach) My stomach is also incredibly loud. Making allot of gurgles and rumbles during this time.
Malaise: I have it 24/7, particularly starting from my lower back up and working through my entire body (especially legs) It is the general “awful” feeling that I have described and gets out of control with ANY stimulus. Mental, emotional, physical.
Background: I am a 5’9 female, Caucasian, 140 lbs (without water retention, then , I am 153lbs). I don’t drink or smoke nor have a history of drug use. I eat very well and I am active (try to be now that my body refuses) I participate in allot of the meditation and healing arts community so I have no mental, emotional reason to have melt downs like I am. There is no thought behind them beyond basics and just a horrible surge of raw emotion. I had a streak of no period from 2005-2008 that would not come despite progesterone shots ect, during this time my breast went down in size from a full 34B to not even a AA as well as my face became thin (cheeks and temples), dry skin, and eyes deeper and my lips lost fullness. This was the time I started to notice the water retention issues and occasional mood swings. I had problems with the mood swings since I started my period. My father put me on birth control when I was 15 due to the severity. I was on birth control until 2005 and then was on/off it until 2009 when I had the Paraguard IUD placed to take me away from the hormones.
I had 2 ultrasounds on my ovaries and uterus, one general and one by a specialist: normal.
I had hormones worked up in 9/2011 and they are the following:
LH: 3.5
FSH: 5.3
Estradiol: 19
DHEA Sulfate: 106
Progesterone: 0.2
Sex hormone binding Glob: 60
Free Testosterone: 2.7
Testosterone: LC-MS/MS (A#0000) 24
I had a new MD do general lab work and my liver showed inflammation and the ultrasound came up fine.
My own attempts: I have tried EVERYTHING on my own to rectify this. I cleaned up my diet, drink plenty of water, take vitamins and have tried so many holistic tings its embarrassing. On the note of holistics: 1. I am VERY careful and only buy from reputable brands. 2. I do ALLOT of HW on each before trying. 3. Any supplement that I have tried that balances hormones sends me THROUGH THE ROOF. Either I go nuts. Or for example: DIM is supposed to metabolize bad estrogen and free up free testosterone to balance you out. My body shredded all fat off my legs and started to store on my abdomen like a man. (also I went nuts) I react VERY fast, usually by day 5 I know if a supplement is evil or not. The only things that seem to help or be ok are the ones that detox and flush out like milk thistle, calcium d glucarate, vitamin C. The only hormone supplement that seemed to be ok and help was progesterone cream but after a while I started to get more hair and just felt off kilter so I stopped. (though no insanity) I even reacted to natures way hair skin and nails when I tried to at least ease some symptoms. Probiotics didn’t help a thing with my GI ( I tried 4 different types over the past 1 ½ years) and my body laughs at ANYTHING OTC and even some prescriptions like the hydrochlorothiazide. Only things that help are lisinpopril HCTZ and detox herbs like milk thistle ect.


Finishing comments: I deal with ALL these symptoms, every, day. Between the malaise, bloating, swelling, water retention, take, crying fits, headaches, skin, eyes, hair and generally looking like death stuck in a microwave with no ability to do activities I love, function or be productive. I am done. I am officially burnt out to a crisp. This thing is ruining my life. My only want is to get rid of this so I can be who *I* am and move forward. It has ruined so much already, trips, friends stepping away, work, my quality of life is completely gone. I refuse to tolerate this any longer and watch it ruin more things like my boyfriend. ( he has been an XXXXXXX but I don’t wish to test him) I just want to feel good. My new MD is doing exactly what he should, I have no issues with him. However, I am so burnt out. Ive lost all patience. ESPECIALLY when I no longer have ANY good days anymore. Bearing that in mind. I cant live like this for 3 months while he refers me to an endocrinologist and another 3months of tests while my life gets ruined. I am here for collaboration. I am here to present my case so if anyone feels they know what this is, what I should test for to give me a good lead and direction for my Dr. to reach a diagnosis ASAP. Thank you so much for reading my report and giving feedback.
Posted Fri, 8 Jun 2012 in Thyroid Problem and Hormonal Problems
 
 
Answered by Dr. Rahul Tawde 20 hours later
Dear XXXXXXX,
Thanks for writing in. It is indeed very sad to see the suffering you are growing through. I have read all your complaints in detail.You have not provide the reference ranges for the hormonal tests you have done. Reference ranges will depend on the method used to estimate them and also on the specific kit. So I need the reference range of these tests for proper interpretation. Is paraguard IUD still inside?
In your case, first thing that we have to resolve is whether this is an Endocrine problem or a non endocrine problem or both. 2nd thing is whether all your complaints can be explained by a single disorder. From endocrine point of view I can say with confidence that no single endocrine problem can explain all your symptoms and neither do your symptoms suggest any specific endocrine disorder. Adrenal insufficency is one disorder which can explain some of your problems. But I strongly feel your problem requires multispeciality care involving an endocrinologist, physician, gastroenterologist neurologist and a psychiatrist. I doubt that a doctor from any single speciality will be able to address and treat all your problems. You require a concerted and integrated approach.
I would recommend following tests in your case:
Cortisol, ACTH (Both at 8 am fasting sample), Thyroid function test, Oral glucose tolerance test, hemogram, urine routine, 24 hour urinary protein and liver function tests. You may also need to undergo venous doppler of b/l lower limbs to see if there are any incompetent valves or varicose veins. Further testing will depend on the results of these tests.
I feel you are having severe emotional disturbance and I recommend you see a psychiatrist at the earliest.
I hope with diligent evaluation they will be able to get to the root of your problem and resolve most if not all of your complaints.
Get back to me with the clarifications I have sought from you and also if there are any other specific questions left.

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