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My Symptoms Are Chronic Exhaustion, Poor Sleep, Bloated Tummy, Intestinal
Question: My symptoms are chronic exhaustion, poor sleep, bloated tummy, intestinal gas, muscle weakness, and back pain. I have been to a lot of doctors. One doctor said it is EBV, but others say it isn't, that everybody is a carrier of EBV. I have been going to PT and the chiropractor. I feel like a hypochondriac, but the symptoms are real and disabling. I also have lumps in my bottom, which were tested. They are some kind of cysts in my sweat glands, and probably will never go away.
My symptoms are chronic exhaustion, poor sleep, bloated tummy, intestinal gas, muscle weakness, and back pain. I have been to a lot of doctors. One doctor said it is EBV, but others say it isn't, that everybody is a carrier of EBV. I have been going to PT and the chiropractor. I feel like a hypochondriac, but the symptoms are real and disabling. I also have lumps in my bottom, which were tested. They are some kind of cysts in my sweat glands, and probably will never go away.
My meds:
7.5 mg of Armour thyroid per day, Hashimoto's 20+ years.
GYN has had me on doxycycline for weeks for the lumps in my bottom, but it is not an infection, so don't know why I have to keep taking these.
Vitamins and minerals, incl probiotics.
My blood tests are normal except that for 30+ years I have had elevated MCV and another one like that. My cholesterol went to 225 as soon as I became menopausal. It stays there regardless of what I do.
My BP is normal. I am not diabetic.
7.5 mg of Armour thyroid per day, Hashimoto's 20+ years.
GYN has had me on doxycycline for weeks for the lumps in my bottom, but it is not an infection, so don't know why I have to keep taking these.
Vitamins and minerals, incl probiotics.
My blood tests are normal except that for 30+ years I have had elevated MCV and another one like that. My cholesterol went to 225 as soon as I became menopausal. It stays there regardless of what I do.
My BP is normal. I am not diabetic.
My meds:
7.5 mg of Armour thyroid per day, Hashimoto's 20+ years.
GYN has had me on doxycycline for weeks for the lumps in my bottom, but it is not an infection, so don't know why I have to keep taking these.
Vitamins and minerals, incl probiotics.
My blood tests are normal except that for 30+ years I have had elevated MCV and another one like that. My cholesterol went to 225 as soon as I became menopausal. It stays there regardless of what I do.
My BP is normal. I am not diabetic.
7.5 mg of Armour thyroid per day, Hashimoto's 20+ years.
GYN has had me on doxycycline for weeks for the lumps in my bottom, but it is not an infection, so don't know why I have to keep taking these.
Vitamins and minerals, incl probiotics.
My blood tests are normal except that for 30+ years I have had elevated MCV and another one like that. My cholesterol went to 225 as soon as I became menopausal. It stays there regardless of what I do.
My BP is normal. I am not diabetic.
I take compounded estradiol and progesterone transdermal creams. My cortisol is high at night and low in the morning. Nobody has been able to help me get it turned around.
I have a ton of allergies.
I have a ton of allergies.
I take compounded estradiol and progesterone transdermal creams. My cortisol is high at night and low in the morning. Nobody has been able to help me get it turned around.
I have a ton of allergies.
I have a ton of allergies.
My age is 71.
My age is 71.
Brief Answer:
A step by step approach explained on diagnosing and treating your condition
Detailed Answer:
Hello and welcome to "Ask a Doctor" service,
I carefully read your query and understand your concern with having symptoms and not being able to find a cause and treatment for it. This is often devastating for both the patient and the medical providers.
EBV may be a cause of exhaustion and some of the symptoms you are having may be caused by it but there are tests that prove if you are having this infection can be conducted to make sure if you have this infection or not.
On the other hand, EBV may cause chronic fatigue syndrome which is diagnosed if fatigue is for more than 6 months and the patient does not have other causes for it. So, it is an exclusion diagnosis.
It is important to make sure to exclude other conditions such as autoimmune conditions, uncontrolled hypothyroidism, multiple sclerosis, fibromyalgia, Lyme disease, depression, etc.
Your dose of Armour is so little, normally it is started at 30 mg and continued at 60-120 mg. If you have not had a TSH done in the last 3-6 months I would recommend you to repeat it and if TSH is over 5 then you will need to adjust the dose of Armour. Hypothyroidism is a potentially major cause of fatigue and the rest of the symptoms you mention and needs to be ruled out as the cause.
As for the Lyme disease and autoimmune conditions, blood tests for Lyme disease and also CBC, ERS and ANA can be done.
Multiple sclerosis has a very small chance of being the cause of your symptoms (mostly weakness). A visit with the doctor (neurological examination) may confirm the weakness and lead to further needed examinations (sometimes MRI of the brain and spine is indicated if findings suggest multiple sclerosis).
If all the tests and examinations come out normal and the thyroid's drug dose does not need to change then depression can be considered. The careful physical examination will also give clues on the presence or fibromyalgia (this is treated similarly to depression as well).
In this case, your doctor may give you a questionary to fill and try to score your depression which will guide further treatment.
Psychotherapy, medications (citalopram, sertraline, mirtazapine, etc) and a healthy lifestyle are generally the treatments recommended in this case.
It is important in cases when patients have complaints that are difficult to diagnose that they continue the follow up with the same doctor. This is because this way steps can be followed one by one towards diagnosis. Changing medical providers will bring confusion and delay the diagnosis.
To conclude:
- your symptoms are very wide and not specific to certain conditions, thus there are several conditions that may be considered as the cause.
- confirming that you are having the right dose of thyroid medications is necessary is thyroid can be a cause of your symptoms if it is not working properly
- some other tests are recommended to rule out infections (Lyme Disease, EBV) or autoimmune conditions to rule out these diseases. A good neurological exam is needed as well (to rule out multiple sclerosis of fibromyalgia).
- It is very likely you may have had these tests done but just to be sure, you need to have tests to check your general health such as lipids, creatinine and electrolytes, and liver function tests (ALT, AST, Bilirubin, etc).
- if all tests and examinations come out normal then stress and depression or chronic fatigue syndrome can be considered and treatment for this can be implemented (there are clear criteria to diagnose these and generally the treatment is similar).
- it is important to not change medical providers frequently so you can have a more full evaluation and timely diagnosis and proper treatment.
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Kind regards,
Dr. Antoneta Zotaj,
General and Family Physician
A step by step approach explained on diagnosing and treating your condition
Detailed Answer:
Hello and welcome to "Ask a Doctor" service,
I carefully read your query and understand your concern with having symptoms and not being able to find a cause and treatment for it. This is often devastating for both the patient and the medical providers.
EBV may be a cause of exhaustion and some of the symptoms you are having may be caused by it but there are tests that prove if you are having this infection can be conducted to make sure if you have this infection or not.
On the other hand, EBV may cause chronic fatigue syndrome which is diagnosed if fatigue is for more than 6 months and the patient does not have other causes for it. So, it is an exclusion diagnosis.
It is important to make sure to exclude other conditions such as autoimmune conditions, uncontrolled hypothyroidism, multiple sclerosis, fibromyalgia, Lyme disease, depression, etc.
Your dose of Armour is so little, normally it is started at 30 mg and continued at 60-120 mg. If you have not had a TSH done in the last 3-6 months I would recommend you to repeat it and if TSH is over 5 then you will need to adjust the dose of Armour. Hypothyroidism is a potentially major cause of fatigue and the rest of the symptoms you mention and needs to be ruled out as the cause.
As for the Lyme disease and autoimmune conditions, blood tests for Lyme disease and also CBC, ERS and ANA can be done.
Multiple sclerosis has a very small chance of being the cause of your symptoms (mostly weakness). A visit with the doctor (neurological examination) may confirm the weakness and lead to further needed examinations (sometimes MRI of the brain and spine is indicated if findings suggest multiple sclerosis).
If all the tests and examinations come out normal and the thyroid's drug dose does not need to change then depression can be considered. The careful physical examination will also give clues on the presence or fibromyalgia (this is treated similarly to depression as well).
In this case, your doctor may give you a questionary to fill and try to score your depression which will guide further treatment.
Psychotherapy, medications (citalopram, sertraline, mirtazapine, etc) and a healthy lifestyle are generally the treatments recommended in this case.
It is important in cases when patients have complaints that are difficult to diagnose that they continue the follow up with the same doctor. This is because this way steps can be followed one by one towards diagnosis. Changing medical providers will bring confusion and delay the diagnosis.
To conclude:
- your symptoms are very wide and not specific to certain conditions, thus there are several conditions that may be considered as the cause.
- confirming that you are having the right dose of thyroid medications is necessary is thyroid can be a cause of your symptoms if it is not working properly
- some other tests are recommended to rule out infections (Lyme Disease, EBV) or autoimmune conditions to rule out these diseases. A good neurological exam is needed as well (to rule out multiple sclerosis of fibromyalgia).
- It is very likely you may have had these tests done but just to be sure, you need to have tests to check your general health such as lipids, creatinine and electrolytes, and liver function tests (ALT, AST, Bilirubin, etc).
- if all tests and examinations come out normal then stress and depression or chronic fatigue syndrome can be considered and treatment for this can be implemented (there are clear criteria to diagnose these and generally the treatment is similar).
- it is important to not change medical providers frequently so you can have a more full evaluation and timely diagnosis and proper treatment.
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Kind regards,
Dr. Antoneta Zotaj,
General and Family Physician
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
A step by step approach explained on diagnosing and treating your condition
Detailed Answer:
Hello and welcome to "Ask a Doctor" service,
I carefully read your query and understand your concern with having symptoms and not being able to find a cause and treatment for it. This is often devastating for both the patient and the medical providers.
EBV may be a cause of exhaustion and some of the symptoms you are having may be caused by it but there are tests that prove if you are having this infection can be conducted to make sure if you have this infection or not.
On the other hand, EBV may cause chronic fatigue syndrome which is diagnosed if fatigue is for more than 6 months and the patient does not have other causes for it. So, it is an exclusion diagnosis.
It is important to make sure to exclude other conditions such as autoimmune conditions, uncontrolled hypothyroidism, multiple sclerosis, fibromyalgia, Lyme disease, depression, etc.
Your dose of Armour is so little, normally it is started at 30 mg and continued at 60-120 mg. If you have not had a TSH done in the last 3-6 months I would recommend you to repeat it and if TSH is over 5 then you will need to adjust the dose of Armour. Hypothyroidism is a potentially major cause of fatigue and the rest of the symptoms you mention and needs to be ruled out as the cause.
As for the Lyme disease and autoimmune conditions, blood tests for Lyme disease and also CBC, ERS and ANA can be done.
Multiple sclerosis has a very small chance of being the cause of your symptoms (mostly weakness). A visit with the doctor (neurological examination) may confirm the weakness and lead to further needed examinations (sometimes MRI of the brain and spine is indicated if findings suggest multiple sclerosis).
If all the tests and examinations come out normal and the thyroid's drug dose does not need to change then depression can be considered. The careful physical examination will also give clues on the presence or fibromyalgia (this is treated similarly to depression as well).
In this case, your doctor may give you a questionary to fill and try to score your depression which will guide further treatment.
Psychotherapy, medications (citalopram, sertraline, mirtazapine, etc) and a healthy lifestyle are generally the treatments recommended in this case.
It is important in cases when patients have complaints that are difficult to diagnose that they continue the follow up with the same doctor. This is because this way steps can be followed one by one towards diagnosis. Changing medical providers will bring confusion and delay the diagnosis.
To conclude:
- your symptoms are very wide and not specific to certain conditions, thus there are several conditions that may be considered as the cause.
- confirming that you are having the right dose of thyroid medications is necessary is thyroid can be a cause of your symptoms if it is not working properly
- some other tests are recommended to rule out infections (Lyme Disease, EBV) or autoimmune conditions to rule out these diseases. A good neurological exam is needed as well (to rule out multiple sclerosis of fibromyalgia).
- It is very likely you may have had these tests done but just to be sure, you need to have tests to check your general health such as lipids, creatinine and electrolytes, and liver function tests (ALT, AST, Bilirubin, etc).
- if all tests and examinations come out normal then stress and depression or chronic fatigue syndrome can be considered and treatment for this can be implemented (there are clear criteria to diagnose these and generally the treatment is similar).
- it is important to not change medical providers frequently so you can have a more full evaluation and timely diagnosis and proper treatment.
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Kind regards,
Dr. Antoneta Zotaj,
General and Family Physician
A step by step approach explained on diagnosing and treating your condition
Detailed Answer:
Hello and welcome to "Ask a Doctor" service,
I carefully read your query and understand your concern with having symptoms and not being able to find a cause and treatment for it. This is often devastating for both the patient and the medical providers.
EBV may be a cause of exhaustion and some of the symptoms you are having may be caused by it but there are tests that prove if you are having this infection can be conducted to make sure if you have this infection or not.
On the other hand, EBV may cause chronic fatigue syndrome which is diagnosed if fatigue is for more than 6 months and the patient does not have other causes for it. So, it is an exclusion diagnosis.
It is important to make sure to exclude other conditions such as autoimmune conditions, uncontrolled hypothyroidism, multiple sclerosis, fibromyalgia, Lyme disease, depression, etc.
Your dose of Armour is so little, normally it is started at 30 mg and continued at 60-120 mg. If you have not had a TSH done in the last 3-6 months I would recommend you to repeat it and if TSH is over 5 then you will need to adjust the dose of Armour. Hypothyroidism is a potentially major cause of fatigue and the rest of the symptoms you mention and needs to be ruled out as the cause.
As for the Lyme disease and autoimmune conditions, blood tests for Lyme disease and also CBC, ERS and ANA can be done.
Multiple sclerosis has a very small chance of being the cause of your symptoms (mostly weakness). A visit with the doctor (neurological examination) may confirm the weakness and lead to further needed examinations (sometimes MRI of the brain and spine is indicated if findings suggest multiple sclerosis).
If all the tests and examinations come out normal and the thyroid's drug dose does not need to change then depression can be considered. The careful physical examination will also give clues on the presence or fibromyalgia (this is treated similarly to depression as well).
In this case, your doctor may give you a questionary to fill and try to score your depression which will guide further treatment.
Psychotherapy, medications (citalopram, sertraline, mirtazapine, etc) and a healthy lifestyle are generally the treatments recommended in this case.
It is important in cases when patients have complaints that are difficult to diagnose that they continue the follow up with the same doctor. This is because this way steps can be followed one by one towards diagnosis. Changing medical providers will bring confusion and delay the diagnosis.
To conclude:
- your symptoms are very wide and not specific to certain conditions, thus there are several conditions that may be considered as the cause.
- confirming that you are having the right dose of thyroid medications is necessary is thyroid can be a cause of your symptoms if it is not working properly
- some other tests are recommended to rule out infections (Lyme Disease, EBV) or autoimmune conditions to rule out these diseases. A good neurological exam is needed as well (to rule out multiple sclerosis of fibromyalgia).
- It is very likely you may have had these tests done but just to be sure, you need to have tests to check your general health such as lipids, creatinine and electrolytes, and liver function tests (ALT, AST, Bilirubin, etc).
- if all tests and examinations come out normal then stress and depression or chronic fatigue syndrome can be considered and treatment for this can be implemented (there are clear criteria to diagnose these and generally the treatment is similar).
- it is important to not change medical providers frequently so you can have a more full evaluation and timely diagnosis and proper treatment.
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Kind regards,
Dr. Antoneta Zotaj,
General and Family Physician
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Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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