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Should I See A Rheumatologist Inspite Of Having Positive ANA Test?
Question: Due to severe pain and swelling in my feet and ankles I finally visited my GP. Lab tests revealed a Positive ANA but all other labs were normal. I have a pacemaker due to s/a node dysfunction and sick sinus syndrome as well as the right side of my heart enlarged by an ASD. MY GP feels my foot pain could be lupus rather than anything having to do with my heart? Should I see a rheumatologist based in the positive ANA? My medical bills are significant. I don't need any unnecessary bills. But I would love relief from this terrible pain in my feet and a few other joints.
Brief Answer:
Is it lupus
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history. I would like to inquire on some more things before commenting further. Firstly I would clarify, Positive ANA does not mean Lupus. ANA can be positive in 7-10 % of the normal population as well without causing any symptoms. Secondly, just foot and ankle swelling with sparing of the hands is also very unlikely with Lupus as it causes more of a symmetrical involvement of the joints than just one set.
SO i just want to ask you a few more details to help us realize the source of the problem:
1. Duration of the pain and swelling?
2. When is it more, during rest or during activity??
3. Does it get better when you sleep and wake up or is it worse?
4. Any associated neck pain or backache??
5. You have mentioned other joint pains, which all joints are involved??
6. Do you experience any oral ulcers/rashes/photosenstivity/hair fall/dry eyes/dry mouth
7. What medications are you taking for your heart condition
Do let me know these queries. Would try to sort it out for you in the best possible way I can
Regards
Dr Naval
Is it lupus
Detailed Answer:
Good evening
Thank you for writing on health care magic
I have gone through your history. I would like to inquire on some more things before commenting further. Firstly I would clarify, Positive ANA does not mean Lupus. ANA can be positive in 7-10 % of the normal population as well without causing any symptoms. Secondly, just foot and ankle swelling with sparing of the hands is also very unlikely with Lupus as it causes more of a symmetrical involvement of the joints than just one set.
SO i just want to ask you a few more details to help us realize the source of the problem:
1. Duration of the pain and swelling?
2. When is it more, during rest or during activity??
3. Does it get better when you sleep and wake up or is it worse?
4. Any associated neck pain or backache??
5. You have mentioned other joint pains, which all joints are involved??
6. Do you experience any oral ulcers/rashes/photosenstivity/hair fall/dry eyes/dry mouth
7. What medications are you taking for your heart condition
Do let me know these queries. Would try to sort it out for you in the best possible way I can
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I also have orthostatic hypotension and for that I take Midodrine 10mg three times daily. That is the only medication I take. My full list of complaints that have continued for about three weeks is as follows:
Both feet hurt terribly with swelling and red lumps.
Hands go numb especially at night or when holding something. Feet also go numb when sleeping and when crossing legs and are tingly
Wrists hurt with right wrist worse which also has lumps
Right Hip feels out of socket
Elbow joints are sore - especially right
Sore spots in odd places that feel like bruises but there is no bruise
Morning headache sometimes with blurred vision
Wake up in a dripping sweat
Hair has thinned in one spot on top left side of hairline it is starting new growth though
Odd forgetfulness and lose track of thoughts easily which is very off for me
Gained 22 pounds since February likely because I'm having a hard time being active.
Get tired very easy
Feel clumsy. I have fallen twice
Mornings are especially hard. I wake with a headache. My feet are in a lot pain especially when I stand. My hands are completely numb with the finger joints very tender. After a few hours things become more tolerable.
I do not have any rashes.
A massage was actually painful
Yoga which I have done for years is now very hard???
Both feet hurt terribly with swelling and red lumps.
Hands go numb especially at night or when holding something. Feet also go numb when sleeping and when crossing legs and are tingly
Wrists hurt with right wrist worse which also has lumps
Right Hip feels out of socket
Elbow joints are sore - especially right
Sore spots in odd places that feel like bruises but there is no bruise
Morning headache sometimes with blurred vision
Wake up in a dripping sweat
Hair has thinned in one spot on top left side of hairline it is starting new growth though
Odd forgetfulness and lose track of thoughts easily which is very off for me
Gained 22 pounds since February likely because I'm having a hard time being active.
Get tired very easy
Feel clumsy. I have fallen twice
Mornings are especially hard. I wake with a headache. My feet are in a lot pain especially when I stand. My hands are completely numb with the finger joints very tender. After a few hours things become more tolerable.
I do not have any rashes.
A massage was actually painful
Yoga which I have done for years is now very hard???
Brief Answer:
IS it lupus
Detailed Answer:
Good evening
Sorry for the delayed reply. Was caught up in the hospital duty
Well, you seem to have quite number of joints involved. Initially i thought it was only the feet, but the wrists and elbows are equally bad as well. Probably because of the swelling in the wrist, the nerve is getting compressed as well which is causing the numbness and tingling in the finger joints.
All these symptoms with ANA positive can go in favor of a connective tissue disease. Yes, Lupus is one strong possibility.
1. I would like to know how strong is the ANA value. ?
2. Did you get your ESR, CRP rheumatoid factor, Anti CCP antibody and ENA profile done.?
IF ANA is positive, we need to look at these tests as well to characterize the disease we are heading into. ENA will check further 15-20 antibodies positive with ANA and give us an exact clue on what organs we need to monitor. RF and Anti CCP will give us a clue on if it is rheumatoid arthritis or just a connective tissue disease?
3. Lastly I would like to know what medications have they prescribed you for the pain? Cause if lupus is a possibility, you will benefit from low dose steroids
Do let me know these queries
Await your reply
REgards
Dr Naval
IS it lupus
Detailed Answer:
Good evening
Sorry for the delayed reply. Was caught up in the hospital duty
Well, you seem to have quite number of joints involved. Initially i thought it was only the feet, but the wrists and elbows are equally bad as well. Probably because of the swelling in the wrist, the nerve is getting compressed as well which is causing the numbness and tingling in the finger joints.
All these symptoms with ANA positive can go in favor of a connective tissue disease. Yes, Lupus is one strong possibility.
1. I would like to know how strong is the ANA value. ?
2. Did you get your ESR, CRP rheumatoid factor, Anti CCP antibody and ENA profile done.?
IF ANA is positive, we need to look at these tests as well to characterize the disease we are heading into. ENA will check further 15-20 antibodies positive with ANA and give us an exact clue on what organs we need to monitor. RF and Anti CCP will give us a clue on if it is rheumatoid arthritis or just a connective tissue disease?
3. Lastly I would like to know what medications have they prescribed you for the pain? Cause if lupus is a possibility, you will benefit from low dose steroids
Do let me know these queries
Await your reply
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Navel,
I have my lab results but do not understand any of them. The ANA is marked as "-ANA Direct/Positive with a flag. There is something entitled Anti-DNA (DS) Ab Qn with a value of 1.
There are also:
RNP Antibodies 0.4 XXXXXXX Antibodies (greater than symbol) 0.2
Sjogren's Anti SSA 0.2
Sjogren's Anti SSB (greater than symbol) 0.2
There are "NOTES" section beside all of these results. But ANA is the only one with a flag.
My labs also contain results for CBC with differential/Platelet, COMP Metabolic Panel (14), TSH.
I have not been prescribed any medication but rather was told by my GP that I needed to see a specialist given my physical symptoms which she observed and my lab results. I am in a great deal of pain but kept hoping it would pass or was perhaps something from my heart issue that my cardiologist could help with. I contacted my cardiologist and she advised that neither my heart condition or the Midodrine should cause these symptoms and too recommended I see a Rheumatologist. I have spent a great deal of time in hospitals over the last year with my heart issues. I really don't want to see any more doctors unless I must. Thank you for your help.
I have my lab results but do not understand any of them. The ANA is marked as "-ANA Direct/Positive with a flag. There is something entitled Anti-DNA (DS) Ab Qn with a value of 1.
There are also:
RNP Antibodies 0.4 XXXXXXX Antibodies (greater than symbol) 0.2
Sjogren's Anti SSA 0.2
Sjogren's Anti SSB (greater than symbol) 0.2
There are "NOTES" section beside all of these results. But ANA is the only one with a flag.
My labs also contain results for CBC with differential/Platelet, COMP Metabolic Panel (14), TSH.
I have not been prescribed any medication but rather was told by my GP that I needed to see a specialist given my physical symptoms which she observed and my lab results. I am in a great deal of pain but kept hoping it would pass or was perhaps something from my heart issue that my cardiologist could help with. I contacted my cardiologist and she advised that neither my heart condition or the Midodrine should cause these symptoms and too recommended I see a Rheumatologist. I have spent a great deal of time in hospitals over the last year with my heart issues. I really don't want to see any more doctors unless I must. Thank you for your help.
Brief Answer:
Blood reports review
Detailed Answer:
Dear XXXXXXX
Oh yes, that s why I was wondering as Lupus in male is a bit of a less possibility.
I have gone through your blood reports. It seems a bit awkward the way the tests have been performed with the ANA. REst all your results are quite good.
ANA is positive, but what matters more is the titres and the pattern. It has to be checked by Immunofluroscence Assay( IFA) to get the exact significance. As 1: 40 can be positive but may not have that much relevance as 1: 160. So the titres does imply a lot.
Secondly, it is very unusual to have totally normal ESR and CRP when you have so much pain and swelling going on. These 2 are the inflammatory markers which shoot up early indicating there is some form of inflammation going on. But since they are totally ok, it brings us down to the Examination part. The evidence of swelling and warmth and tender on touch does hold signify that the arthritis is due to inflammation. If examination is conclusive, the results may not matter then.
So, I would say we are a bit stuck here as your symptoms and blood reports dont match. I would suggest, you take an opinion from Rheumatologist and let them examine your joints and co relate if it really fits with ANA or not. Till then if you can get ANA( IFA) done by the recommended method, it would be more beneficial.
I hope the information was useful. If you could attach the pictures of your swollen joints, that would be a bit more helpful
Do let me know for more queries
Regards
DR Naval
Blood reports review
Detailed Answer:
Dear XXXXXXX
Oh yes, that s why I was wondering as Lupus in male is a bit of a less possibility.
I have gone through your blood reports. It seems a bit awkward the way the tests have been performed with the ANA. REst all your results are quite good.
ANA is positive, but what matters more is the titres and the pattern. It has to be checked by Immunofluroscence Assay( IFA) to get the exact significance. As 1: 40 can be positive but may not have that much relevance as 1: 160. So the titres does imply a lot.
Secondly, it is very unusual to have totally normal ESR and CRP when you have so much pain and swelling going on. These 2 are the inflammatory markers which shoot up early indicating there is some form of inflammation going on. But since they are totally ok, it brings us down to the Examination part. The evidence of swelling and warmth and tender on touch does hold signify that the arthritis is due to inflammation. If examination is conclusive, the results may not matter then.
So, I would say we are a bit stuck here as your symptoms and blood reports dont match. I would suggest, you take an opinion from Rheumatologist and let them examine your joints and co relate if it really fits with ANA or not. Till then if you can get ANA( IFA) done by the recommended method, it would be more beneficial.
I hope the information was useful. If you could attach the pictures of your swollen joints, that would be a bit more helpful
Do let me know for more queries
Regards
DR Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Naval,
Sorry, I was tied up in meetings this afternoon.
I have uploaded some pictures for you to see the inflammation in feet and ankles. I didn't have any of the knots on my wrists. My hands also turn blue when holding things. And as you can see I have a spot of hair that has fallen out. Thank goodness it is now growing back. I also tried to attach pictures of what my feet, hands and hair look like normally. The severe inflammation lasted about a week and one-half. it seems to have died down some now. However, my feet are still very sore, especially in the mornings. My hands too are still numb and tender in the mornings. I also remain very tired.
My GP ordered the blood work. I called her office today to ask your questions. Her staff advised that her blood work was preliminary based upon her observation of my conditions and that it would be best for the specialist to run his own preferred test.
I hope the pictures are helpful to you.
Regards, XXXX
Sorry, I was tied up in meetings this afternoon.
I have uploaded some pictures for you to see the inflammation in feet and ankles. I didn't have any of the knots on my wrists. My hands also turn blue when holding things. And as you can see I have a spot of hair that has fallen out. Thank goodness it is now growing back. I also tried to attach pictures of what my feet, hands and hair look like normally. The severe inflammation lasted about a week and one-half. it seems to have died down some now. However, my feet are still very sore, especially in the mornings. My hands too are still numb and tender in the mornings. I also remain very tired.
My GP ordered the blood work. I called her office today to ask your questions. Her staff advised that her blood work was preliminary based upon her observation of my conditions and that it would be best for the specialist to run his own preferred test.
I hope the pictures are helpful to you.
Regards, XXXX
Brief Answer:
Arthritis
Detailed Answer:
Dear XXXXXXX
I have seen the pictures you posted. It has been more than helpful.
There is a lot of inflammation going on in the feet. They are totally swelled up and the Toe joints seem inflammed. There is definately some form of inflammation going on. I highly doubt the blood results they have carried out is proper, or else with so much inflammation you dont expect the results to be normal. But as you said they may not have carried out in a proper way. But yes, it is a form of inflammatory arthritis going on and one needs to fit it in with which Form. After seeing the pictures, it may be SLE or Rheumatoid Arthritis( Anti CCP was not done). Cause of the inflammation, there has been a capillary leak causing fluid to accumulate in your feet.
As for the Bluish discolouration of hands, it appears to be Raynauds phenomeon, that is the color changes on exposure to cold and returns to normal when kept warm.
You will need low dose of steroids for the inflammation going on and definately it will benefit you and relieve your symptoms. I understand going to a specialist is very taxing, especially on the pockets but I dont think the GP will write out a presciption for you. And if it was not recommened, I wont suggest you to go there. But I feel, the need is there to characterize the type of arthritis and give you the treatment so you can resume your normal daily activities again.
you will get better, I assure you. You can consult your GP once if he can start you with low dose steroids( Somewhere around a Dose of 30 mg Prednisolone) till you meet specialist.
Do let me know for more queries
Regards
Dr Naval
Arthritis
Detailed Answer:
Dear XXXXXXX
I have seen the pictures you posted. It has been more than helpful.
There is a lot of inflammation going on in the feet. They are totally swelled up and the Toe joints seem inflammed. There is definately some form of inflammation going on. I highly doubt the blood results they have carried out is proper, or else with so much inflammation you dont expect the results to be normal. But as you said they may not have carried out in a proper way. But yes, it is a form of inflammatory arthritis going on and one needs to fit it in with which Form. After seeing the pictures, it may be SLE or Rheumatoid Arthritis( Anti CCP was not done). Cause of the inflammation, there has been a capillary leak causing fluid to accumulate in your feet.
As for the Bluish discolouration of hands, it appears to be Raynauds phenomeon, that is the color changes on exposure to cold and returns to normal when kept warm.
You will need low dose of steroids for the inflammation going on and definately it will benefit you and relieve your symptoms. I understand going to a specialist is very taxing, especially on the pockets but I dont think the GP will write out a presciption for you. And if it was not recommened, I wont suggest you to go there. But I feel, the need is there to characterize the type of arthritis and give you the treatment so you can resume your normal daily activities again.
you will get better, I assure you. You can consult your GP once if he can start you with low dose steroids( Somewhere around a Dose of 30 mg Prednisolone) till you meet specialist.
Do let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Good Afternoon Dr. Naval,
I have taken your advice and scheduled an appointment with a specialist in Rheumatology. However, over the past few days the bulk of my symptoms have subsided. I am concerned that without the symptoms present that the doctor will not be able to diagnose me. Will lab results still help diagnose if I am not in an acute episode. Will the pictures be helpful? How do you recommend I proceed. I don't want to wait until I am in a bad way again as it takes over a month to get an appointment with the specialist.
I have taken your advice and scheduled an appointment with a specialist in Rheumatology. However, over the past few days the bulk of my symptoms have subsided. I am concerned that without the symptoms present that the doctor will not be able to diagnose me. Will lab results still help diagnose if I am not in an acute episode. Will the pictures be helpful? How do you recommend I proceed. I don't want to wait until I am in a bad way again as it takes over a month to get an appointment with the specialist.
Brief Answer:
Connective tissue disease
Detailed Answer:
Good evening XXXXXXX
Sorry for the late reply. Was busy with other professional obligations today,
Well, that s good the symptoms have subsided. That is very peculiar for autoimmune conditions, waxing and waning part. They get triggered by some process and subside on it s own. Never the less, you need to be investigated for it further to determine which way we are heading.
Yes, your pictures are quite helpful cause your feet and toes were markedly swollen around that time. That should give them a fair idea about some process which was happening and if it has subsided, it still means you have a tendency to develop these symptoms again but maybe a milder variant.
I would suggest you go ahead with the appointment, carry the pictures you shared with me. That were very helpful for me and I am sure it will help them as well. It is better to sort it out when your doing good than when you are in a distressed state.
Do let me know for more queries
Regards
Dr Naval
Connective tissue disease
Detailed Answer:
Good evening XXXXXXX
Sorry for the late reply. Was busy with other professional obligations today,
Well, that s good the symptoms have subsided. That is very peculiar for autoimmune conditions, waxing and waning part. They get triggered by some process and subside on it s own. Never the less, you need to be investigated for it further to determine which way we are heading.
Yes, your pictures are quite helpful cause your feet and toes were markedly swollen around that time. That should give them a fair idea about some process which was happening and if it has subsided, it still means you have a tendency to develop these symptoms again but maybe a milder variant.
I would suggest you go ahead with the appointment, carry the pictures you shared with me. That were very helpful for me and I am sure it will help them as well. It is better to sort it out when your doing good than when you are in a distressed state.
Do let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr. Naval,
In preparation for the visit the doctor asked me to bring my pertinent medical records. I have gathered them and in preparation went through and pulled lab results during my hospitalizations regarding my heart issue. I have uploaded them for your review as I am curious what some of the "flagged" results are. Particularly, a high Neutrophil and a low Lymphocyte result over the course of several months. Also, a basophil result low potassium issue. Are any of these indicative of an autoimmune problem?
In preparation for the visit the doctor asked me to bring my pertinent medical records. I have gathered them and in preparation went through and pulled lab results during my hospitalizations regarding my heart issue. I have uploaded them for your review as I am curious what some of the "flagged" results are. Particularly, a high Neutrophil and a low Lymphocyte result over the course of several months. Also, a basophil result low potassium issue. Are any of these indicative of an autoimmune problem?
Brief Answer:
Neutrophils and lymphocytes
Detailed Answer:
Good evening XXXXXXX
I have gone through your reports. They are mostly ok. You need not worry about neutrophils and basophils. Neutrophils are the most important cells in the blood and they normally are in substantial amount to protect the body against the germs. 71 % is quite ok. Your TLC is fine, so you need not worry too much about it. Laboratory machines would flag anything out of their range, which creates a confusion for the patient.
2. Low lymphocyte counts are known for lupus but they are not that bad here( 22 %). So if neutrophils are high, lymphocyte counts automatically go low as the total has to be 100.
3. Same with Basophils, they dont play much part in the body.They have not been considered as a part of autoimmune disease.
So these are mostly ok. We need the other autoimmune work up more..
Do let me know for more queries
Regards
Dr Naval
Neutrophils and lymphocytes
Detailed Answer:
Good evening XXXXXXX
I have gone through your reports. They are mostly ok. You need not worry about neutrophils and basophils. Neutrophils are the most important cells in the blood and they normally are in substantial amount to protect the body against the germs. 71 % is quite ok. Your TLC is fine, so you need not worry too much about it. Laboratory machines would flag anything out of their range, which creates a confusion for the patient.
2. Low lymphocyte counts are known for lupus but they are not that bad here( 22 %). So if neutrophils are high, lymphocyte counts automatically go low as the total has to be 100.
3. Same with Basophils, they dont play much part in the body.They have not been considered as a part of autoimmune disease.
So these are mostly ok. We need the other autoimmune work up more..
Do let me know for more queries
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your response Dr. Naval. Unfortunately, you are viewing the wrong lab reports. While I uploaded all of my labs results over the past year several times (I was hospitalized 3 times for my heart) your system kept removing them from our conversation. I contacted your help desk and they had me email the lab results to an email address for you this morning. The labs over the year reflect high Neutrophils up to 75.6 and low lymphocyte down to 14.7. They also show low potassium (that has been an issue for me for a few years now) and a eGFR of 60 that they flagged. Additionally, there were findings of low carbon dioxide and high chloride. I have no idea what that means. My glucose was also high. But it is usually actually low.
I have a cousin with an autoimmune issue who is sick and in pain most of the time. I don't know what hers is? She advised that it took her several years to get diagnosed. She says that the specialists usually give a few minutes of talk, look at the labs and send you away if everything doesn't add up in the initial visit. She states it took her several years to collect the labs and symptoms to get the relief she needed.
While I am feeling much better, I am still not 100%. The mornings are still difficult for me. I awake with a headache, my back hurting right between my shoulders, my hands are numb and stiff and my feet just simply hurt. When I exercise my feet and legs go numb. I am thankful the severe pain is gone.
I have 4 children and work full time. We have a very active outdoor lifestyle. While I understand that I don't have a lot of control over my what health issues I am struck with (I learned this with my heart over the last year) I do have control over how I let it effect my life. I am trying to be as prepared as possible for this appointment on the 16th so I can get the very most out of the doctor's time with me as I have found it takes months to get in with these types of doctors. My cardiologist was able to get me in within the month this time.
Please let me know your thoughts over how these labs might help me and any other ideas you have to get prepared for this appointment. My children are so worried after what we've gone through over the last year with my heart to now see me limping and having difficulty doing the things we always do.
Regards, XXXX
PS - I noticed you are from XXXXXXX One of my dearest friends is too from there. She is in the States now but her parents, Om and XXXXXXX remain. What beautiful people and a wonderful city.
I have a cousin with an autoimmune issue who is sick and in pain most of the time. I don't know what hers is? She advised that it took her several years to get diagnosed. She says that the specialists usually give a few minutes of talk, look at the labs and send you away if everything doesn't add up in the initial visit. She states it took her several years to collect the labs and symptoms to get the relief she needed.
While I am feeling much better, I am still not 100%. The mornings are still difficult for me. I awake with a headache, my back hurting right between my shoulders, my hands are numb and stiff and my feet just simply hurt. When I exercise my feet and legs go numb. I am thankful the severe pain is gone.
I have 4 children and work full time. We have a very active outdoor lifestyle. While I understand that I don't have a lot of control over my what health issues I am struck with (I learned this with my heart over the last year) I do have control over how I let it effect my life. I am trying to be as prepared as possible for this appointment on the 16th so I can get the very most out of the doctor's time with me as I have found it takes months to get in with these types of doctors. My cardiologist was able to get me in within the month this time.
Please let me know your thoughts over how these labs might help me and any other ideas you have to get prepared for this appointment. My children are so worried after what we've gone through over the last year with my heart to now see me limping and having difficulty doing the things we always do.
Regards, XXXX
PS - I noticed you are from XXXXXXX One of my dearest friends is too from there. She is in the States now but her parents, Om and XXXXXXX remain. What beautiful people and a wonderful city.
Brief Answer:
Lab results
Detailed Answer:
Good evening XXXXXXX
Yeah, I still cant see the reports you have posted. The old ones are coming. Even my email doesnt have the new ones. Well, low lymphocytes can be a feature of lupus but it is never 2 specific for it. Rather most people overlook it as well. But Low potassium is something one needs to address. As you mentioned your chloride levels are high. Could you check your results for Bicarbonate as well? It would have been done with the CO2 and Chloride levels. Secondly, did you ever get any episode of weakness of the limbs??
Oh man, your apprehension for the appointment is like a student going for an exam. To get the maximum output in the allotted time. :) I really dont know why it is so difficult there to get these stuff sorted out. Here in XXXXXXX you can visit 3 rheumatologist in a weeks time and get all the laboratory results and everything sorted out. But yes, since you are better do show them the pictures of the joint and feet swelling you had. (2) Request them to get your ENA profile, complement levels done to know if it is really connective tissue disease (3) Do get it sorted out why your potassium is low as Lupus can affect the kidneys causing Renal tubular Acidosis( low potassium, low bicarbonate and high chloride).(4) Also ask if you need to start Hydroxychloroquine. It may not be lupus but can be Undifferentiated Connective tissue disorder( since it may not fit in with all the features of Lupus).
I am sure they will pick it up, but yes these would be the things I would like to sort it out.
Lol thanx for the XXXXXXX comment. Well, yes it is nice but lot of people move from here to STates. But yeah , medical facilities you can avail quite easily here.
Do let me know for any more doubts. Would be happy to sort it out
REgards
Dr Naval
Lab results
Detailed Answer:
Good evening XXXXXXX
Yeah, I still cant see the reports you have posted. The old ones are coming. Even my email doesnt have the new ones. Well, low lymphocytes can be a feature of lupus but it is never 2 specific for it. Rather most people overlook it as well. But Low potassium is something one needs to address. As you mentioned your chloride levels are high. Could you check your results for Bicarbonate as well? It would have been done with the CO2 and Chloride levels. Secondly, did you ever get any episode of weakness of the limbs??
Oh man, your apprehension for the appointment is like a student going for an exam. To get the maximum output in the allotted time. :) I really dont know why it is so difficult there to get these stuff sorted out. Here in XXXXXXX you can visit 3 rheumatologist in a weeks time and get all the laboratory results and everything sorted out. But yes, since you are better do show them the pictures of the joint and feet swelling you had. (2) Request them to get your ENA profile, complement levels done to know if it is really connective tissue disease (3) Do get it sorted out why your potassium is low as Lupus can affect the kidneys causing Renal tubular Acidosis( low potassium, low bicarbonate and high chloride).(4) Also ask if you need to start Hydroxychloroquine. It may not be lupus but can be Undifferentiated Connective tissue disorder( since it may not fit in with all the features of Lupus).
I am sure they will pick it up, but yes these would be the things I would like to sort it out.
Lol thanx for the XXXXXXX comment. Well, yes it is nice but lot of people move from here to STates. But yeah , medical facilities you can avail quite easily here.
Do let me know for any more doubts. Would be happy to sort it out
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Dr. Naval,
Me again! Sorry to drive you nutty. But yes, it is very difficult to see a specialist in the South Florida area of the States. I called 5 Rheumatologist and the earliest I originally could get in was 2 months. My cardiologist intervened and got me an earlier appointment. Its the same with endocrinologist -- almost impossible to see one of them within a 3 month range.
In any event, I have uploaded the other labs once again. For the time being they appear to be there. However, yesterday they kept disappearing. Your help desk had me email them to YYYY@YYYY this morning to forward on to you.
I do not see any result for Bicarbonate. As for weak limbs. Yes, that is an issue for me. I have several issues with my heart and get extremely weak and even unable to move sometimes. The last two times I have been transported to the hospital, my Pacemaker has recorded episodes of long pauses. I have also had low potassium that the hospital replenishes when I am there.
Does the GFR reading of 60 mean anything? Under every reading it sets out this dissertation about stage 2 kidney disease. I'm not sure if that is in general or applies directly to me. Also, another result with comments is D-Dimmer. Mine is noted as high at .52 with notes regarding DVT ? These same labs show a high for Mono and Osmolality.
I have educated myself as much as possible to make good use of the time I will be given by the doctor. Most times I listen to them and go home having no idea what really happened. That is why I ended up flat-lining last year and in emergency surgery. I was told that my heart stopped for 8 second and had been stopping routinely for 5 seconds and more for months. I just accepted it as me being tired as I am very active. I don't want to make the same mistake again. Hence me signing up on your website.
Thanks so much for your patients in helping me understand things.
Regards, XXXXX
Me again! Sorry to drive you nutty. But yes, it is very difficult to see a specialist in the South Florida area of the States. I called 5 Rheumatologist and the earliest I originally could get in was 2 months. My cardiologist intervened and got me an earlier appointment. Its the same with endocrinologist -- almost impossible to see one of them within a 3 month range.
In any event, I have uploaded the other labs once again. For the time being they appear to be there. However, yesterday they kept disappearing. Your help desk had me email them to YYYY@YYYY this morning to forward on to you.
I do not see any result for Bicarbonate. As for weak limbs. Yes, that is an issue for me. I have several issues with my heart and get extremely weak and even unable to move sometimes. The last two times I have been transported to the hospital, my Pacemaker has recorded episodes of long pauses. I have also had low potassium that the hospital replenishes when I am there.
Does the GFR reading of 60 mean anything? Under every reading it sets out this dissertation about stage 2 kidney disease. I'm not sure if that is in general or applies directly to me. Also, another result with comments is D-Dimmer. Mine is noted as high at .52 with notes regarding DVT ? These same labs show a high for Mono and Osmolality.
I have educated myself as much as possible to make good use of the time I will be given by the doctor. Most times I listen to them and go home having no idea what really happened. That is why I ended up flat-lining last year and in emergency surgery. I was told that my heart stopped for 8 second and had been stopping routinely for 5 seconds and more for months. I just accepted it as me being tired as I am very active. I don't want to make the same mistake again. Hence me signing up on your website.
Thanks so much for your patients in helping me understand things.
Regards, XXXXX
Brief Answer:
Lab results review
Detailed Answer:
Good evening XXXXXXX
I didnt know it is so hard to meet the Specialist in States. But thats good you have an appointment scheduled and if anything it will get sorted out.
I got the reports finally and went through the 2 sets of reports: 31.7.14 and 25.9.14.
1. There was a low reading of potassium and Lymphocytes in the month of July but during the next stay it had improved. Maybe it was low cause of the sickness you were experiencing that time which caused all the alteration in lab results. The sort of weakness due to low potassium is mainly unable to get up from the squatting position. The weakness you experienced may have been due to the heart issue.
2. The GFR mentioned is more than 60( >60), which is quite normal. So you need not be worried about that. Either way this is not a correct method to calculate GFR. Plus your kidney functions are totally normal. So you should be good with it.
3. The D Dimer report I could not find. It is a very non specific test and may have been raised at the that time due to the illness. But constant elevation is something to be evaluated. It can even be raised with cardiac problem.
I would suggest you focus with your doctor more on the recent advances, with the recent pictures and the ANA report co relating with the symptoms. We need to get the maximum out of it.
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Lab results review
Detailed Answer:
Good evening XXXXXXX
I didnt know it is so hard to meet the Specialist in States. But thats good you have an appointment scheduled and if anything it will get sorted out.
I got the reports finally and went through the 2 sets of reports: 31.7.14 and 25.9.14.
1. There was a low reading of potassium and Lymphocytes in the month of July but during the next stay it had improved. Maybe it was low cause of the sickness you were experiencing that time which caused all the alteration in lab results. The sort of weakness due to low potassium is mainly unable to get up from the squatting position. The weakness you experienced may have been due to the heart issue.
2. The GFR mentioned is more than 60( >60), which is quite normal. So you need not be worried about that. Either way this is not a correct method to calculate GFR. Plus your kidney functions are totally normal. So you should be good with it.
3. The D Dimer report I could not find. It is a very non specific test and may have been raised at the that time due to the illness. But constant elevation is something to be evaluated. It can even be raised with cardiac problem.
I would suggest you focus with your doctor more on the recent advances, with the recent pictures and the ANA report co relating with the symptoms. We need to get the maximum out of it.
Do let me know for more queries. Would be happy to help out
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Naval,
Thank you for all your help. It has helped me determine what I should prepare to take with me to the doctor. I had been feeling so much better but woke this morning with my ankles swollen and with a great deal of pain. Gosh, I hope the doctor can fix this. I am again walking with a limp which upsets the children and makes a long day at work even more difficult for me.
My appointment is on XXXXXXX 16th. I believe that you have given me all the information you can and then some actually. In the event I have questions after I see the doctor, can I seek you out through this website? Or after I close our conversation will I then be directed to another doctor in the future?
You are already familiar and it would be easier to speak with you rather than update a new doctor.
Kind regards, XXXXX
Thank you for all your help. It has helped me determine what I should prepare to take with me to the doctor. I had been feeling so much better but woke this morning with my ankles swollen and with a great deal of pain. Gosh, I hope the doctor can fix this. I am again walking with a limp which upsets the children and makes a long day at work even more difficult for me.
My appointment is on XXXXXXX 16th. I believe that you have given me all the information you can and then some actually. In the event I have questions after I see the doctor, can I seek you out through this website? Or after I close our conversation will I then be directed to another doctor in the future?
You are already familiar and it would be easier to speak with you rather than update a new doctor.
Kind regards, XXXXX
Brief Answer:
Further REview
Detailed Answer:
Good evening XXXXXXX
Oh it is back again?? But that is good one way that the doctor can at least see it and figure it out. I hope you get it sorted out in 1 visit and start the medications as desired.
Oh yes, feel free to contact me when ever you want. I would like to know what exactly the Rheumatogist thinks about it and what medications they give you for the relief.
For contact, there is a direct question option available but that will be a bit more costly. Instead of that, YOu can mention my name in the query when you ask, so the moderator will direct it to me and we can get in touch with it.
Good luck with the appointment.
I will pray you get it sorted out and get back to your life style again
Regards
Dr Naval
Further REview
Detailed Answer:
Good evening XXXXXXX
Oh it is back again?? But that is good one way that the doctor can at least see it and figure it out. I hope you get it sorted out in 1 visit and start the medications as desired.
Oh yes, feel free to contact me when ever you want. I would like to know what exactly the Rheumatogist thinks about it and what medications they give you for the relief.
For contact, there is a direct question option available but that will be a bit more costly. Instead of that, YOu can mention my name in the query when you ask, so the moderator will direct it to me and we can get in touch with it.
Good luck with the appointment.
I will pray you get it sorted out and get back to your life style again
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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