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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest remedies for persistent dizziness and fatigue

Answered by
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Dr. Kakkar S.

Dermatologist

Practicing since :2002

Answered : 8168 Questions

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Posted on Tue, 4 Apr 2017 in Skin Hair and Nails
Question: hi I have been struggling with chronic illness for nearly 2 years with extreme hot and cold especially at night itchy skin lethargy muscle weakness occasionally numb hands and feet dizziness and weird food intolerance is I have had to go organic and alcohol free for a while now and even though I have changed my diet diet radically I am still not improving and I have lost 20 kilos over the last year 10 of those since December so I am now currently at 69 kilos do I have insulin sensitivity or thyroid issues perhaps the doctor is stumped and won't send me to a specialist although I feel I need an endocrine specialist the dietitian it didn't help I am nearly 47 and postmenopausal since 42 so I have a handle on menopause and this ain't it I have had numerous tests my tsh was .4 in August and I am currently waiting for results for the T3 T4 etc but my doctor seems to think I am fine but I am obviously not fine and I desperately need someone to do something before I end up a skinny rate with no energy to fight anything
doctor
Answered by Dr. Kakkar S. 1 hour later
Brief Answer:
Need more information

Detailed Answer:
Hello. Thank you for writing to us

I am dr.kakkar (dermatologist).
I have gone through your query and I have noted your concern.
I have also reviewed your discussion with Dr. XXXXXXX
Unexplained weight loss, fatigue, muscle weakness, dry eyes and costochondritis makes me suspect a connective tissue disorder. Has that been considered and have you been investigated for that?especially considering that rest of your lab tests have turned out to be normal and cancer has been looked for and excluded.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 42 minutes later
hi I was actually looking for an endocrinologist because I'm pretty sure it is thyroid and perhaps insulin related as I get extremely hot and extremely cold on and off all day and worse at night and sometimes when I eat I feel very cold and sick and sometimes I feel very hot and sick so I'm keeping a food diary now and my eyes go very strange when I am hungry or sometimes when I have eaten something too and when I exercise my heart rate goes up dramatically and I get chest and neck and jaw and head pain
doctor
Answered by Dr. Kakkar S. 9 hours later
Brief Answer:
Need an internal medicine consult as well in view of possible CTD

Detailed Answer:
Thank you.

I think you have tested normal for both thyroid function and blood glucose.
Some of your symptoms like feeling hot and cold could be related to postmenopausal syndrome but it is hard to explain such drastic weight loss.
I would suggest that you also consult an internal medicine specialist and I would definitely like to consider a possibility of a connective tissue disorder (CTD) in you, probably a mixed connective tissue disorder or Sjogren's syndrome and therefore I would suggest that you get a test for ANA, U1RNP antibody, anti-SSA antibody and anti-SSB antibody in order to either confirm or rule them out.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 4 hours later
hmm my singing voice is fine... quite excellent in fact.... no hoarseness at all.
... no dry throat. eyes have been better since my original contact 3 months ago with the help of castor oil..... they hardly ever bother me at all now.... the chest and neck and jaw pain come on strongly when I exert myself. the chest pain was almost OK for a little while.... but seems to be back with a vengeance in the last few weeks. the pain seems to travel from my left side chest to my throat.... it feels tight and uncomfortable pressure in my throat on left side... my jaw hurts in my back teeth when affected. I have not noticed bleeding gums.... a lower fructose diet and sticking to very simple foods had helped the stomach cramps after eating..... when I eat something that disagrees with me, I get (most often) a cold sweat. sometimes a hot sweat. My chest pain became worse a few days after trying the FODMAP diet. I ate a lot of XXXXXXX and bokchoy in that time. A lot of greens. my heart rate goes up and my chest/jaw/neck hurts with even gentle exertion.... like tidying the bedroom for an hour... this summer I was doing some swimming for therapy and that seemed to help but things have deteriorated in recent weeks.... I have not had any stress tests for my heart. Could they have missed ANGINA in several ecg's ?

I had real hot flushes during the first few years of my menopause. My current overheating and freezing chills at night are not the same as then. Would angina explain the weight loss?

Starting to wonder how sick I need to get before my gp sends me to a specialist of any kind. I can only afford to loose another 5 kilos before I am painfully thin....

my daily diet is
caffeine free tea and 2 raw sugars with lactose free milk x 3 XXXXXXX per day.
2 slices of organic gluten free toast with avocado and pepper.
1 small cup of organic brown rice puffs with lactose free milk no sweetener.
2 pieces of fruit - usually Banana and half a paw paw.
Dinner is usually a skinless baked chicken thigh with mixed veg and sometimes with rice or potato.

Does this seem enough calories for a reasonablely inactive person?

yes.... a few mild bouts of mouth ulcers over the the duration of the illness.... yes most definitely tender lymph nodes in breasts and underarms and groin.

I have very little faith left in doctors.... especially gp's .... I want to insist to my current gp that I be referred to a specialist but uncertain which to ask for.

My last thyroid test was August. I know that the basic test is not always conclusive so waiting for the rest of my thyroid results. I don't understand why the the normal result of between .5 and .6 has been reduced to .3 in Australia only .... seems counterproductive.... for patients anyway. covers the government's backside nicely however.... knowing fluoride causes thyroid issues as well as other things....

The chest pain gets much worse when I get angry. Feels like I am having a heart attack when I become enraged by the lack of professionalism in the gp's I have wasted my time and money on in my local area. I am not the least bit anxious about anything much .... including my health..... only legitimately concerned...
so definitely not a hysterical woman with anxiety..... nothing Freudian going on.

my eye lids go tight and weird several times a day.... that is my only eye issue that is noteworthy at this time.

are there any CTD's that would explain all of these symptoms together? or angina perhaps? I feel feint if I do not have regular food also.

doctor
Answered by Dr. Kakkar S. 31 hours later
Brief Answer:
Your need additional investigations pertaining to CTD

Detailed Answer:
Hi.

I apologise for a late reply.
Symptoms of a connective tissue can be vague and are often multisystem in nature. A CTD once suspected (sometimes a diagnosis of exclusion) need to be confimed by appropriate investigations like ANA, specific antibodies like U1RNP (for mixed connective tissue disease), levels of muscle enzymes (muscle weakness and pain), RA factor, anti-SSA, anti-SSB etc.
History of mouth ulcers is significant for suspecting a CTD, so is history of unexplained weight loss and decreased apetite.
You definitely need a referral to an internal medicine specialist. He would also look into any possibility of Angina as a cause of your chest pain. Though, I doubt angina would have caused such significant weight loss.
I can understand your frustration for lack of any diagnosis for so long but sometimes the diagnosis is not clear cut and the diagnosis may be made over a period of time as symptoms evolve.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kakkar S. 1 hour later
thank you just one more question what is an internal medicine specialist and how do I ask my doctor to refer me please?
doctor
Answered by Dr. Kakkar S. 18 hours later
Brief Answer:
You can again request your GP

Detailed Answer:
Hello.

An internal medicine specialist is one who has devoted at least 3 years of post graduation in studying adult medicine specifically learning how to prevent, diagnose and treat adult diseases and therefore have a wide ranging knowledge of complex diseases affecting adults.
Of course your GP has reasons for not refering you because your tests have shown nothing abnormal but you can again politely request your GP to refer you to an internal medicine specialist for a check up because your symptoms are wide ranging and are'nt getting better over time.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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