Brief Answer:
Looking forward to hearing from you ma'am

Detailed Answer:
Hello ma'am and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. Your symptoms are slightly vague and either reaching a diagnosis would be difficult or there be more than one underlying cause for your symptoms.

But based on the current presentation and the tests conducted, I would lean towards a gastrointestinal (GIT) abnormality. Most GIT abnormalities present with the following symptoms:

+Loss of appetite
+Burning sensation or cramping in the upper or lower abdominal region
+Heart burn
+Regurgitation of food or liquid into the mouth
+Bitter taste in the mouth at times
+Irritation to certain types of food (especially spicy food, fried food, oily food, fatty food, etc.)
+Headaches (due to the increased acid content in the stomach)
+Increased flatulence and burping
+General poor sense of well being
+Nausea
+Vomiting
and a few others. I would greatly appreciate it if you would write back to me with a response to how many of the above mentioned symptoms you have, just for my better understanding.

Low vitamin D levels can result in body pains and aches, and generalized weakness but not majority of your above mentioned symptoms. Depending on the level of your vitamin D, either oral supplements or injectables should be advised.

The toenail and fingernail fungus is totally unrelated, and should be treated with topical anti-fungal preparations.

I would also like to ask if you have a family history of diabetes or any other such chronic conditions? Have you checked your blood glucose profile, if not please do so; if you have then please write back to me with the results.

+How many litres of water do you consume each day?
+Was your hemoglobin level normal?
+Are you menopausal or peri-menopausal? If yes, then have you checked your sex hormone levels? If yes then please do share them, if not then please do get it checked. Any symptoms relating to your reproductive system or menstrual cycle?
+Any oral ulcers, soreness in your mouth, or numbness or tingling anywhere in your body?

I look forward to hearing from you in order to help you further. Please do not hesitate to write back to me with any further information that can help me help you.

Best wishes.

---

Brief Answer:
A few suggestions

Detailed Answer:
Hello once again ma'am.

Thank you so much for your help.

As mentioned earlier, it does seem like you could possibly have more than one underlying condition. I recommend the following:

+Vitamin B12 levels to be checked to rule out/confirm a deficiency which can be caused due to some intestinal abnormalities as well
+24-hour pH monitoring to check on acid reflux which can also be causing many of your symptoms
+Please check hemoglobin and sex hormones
+Serum amylase
+Serum lipase

I do believe the above listed tests should provide us with some interesting information which should make a diagnosis more easy and accurate, do please consider getting them done and/or speak to your doctor about them.

Could you also tell me about any diarrhea or constipation or their appearance intermittently that you may be experiencing? If so, please do describe since when and how often they appear without the presence of associated fever.

Also, if you have had constipation or diarrhea do you notice it after consuming any specific types of foods? (e.g. popcorn, dairy products, gluten-products, tea, coffee, carbonated drinks, etc.)

I would like you to know that I am always here to help, so please do not ever hesitate to write back to me for any further clarifications, I am always here to help.

Best wishes.

---

Brief Answer:
Thank you ma'am, that information helped

Detailed Answer:
Hi ma'am.

Thank you so much for that information.

Yes, your response does help especially because it points more towards a lower GIT issue, which is what I was suspecting among other conditions, but I do agree with you that this does seem like a lower GIT problem.

Have you ever had a colonoscopy conducted? A colonoscopy should be conducted when your symptoms are present, which helps to check for abnormalities in your lower GIT and confirm the diagnosis. If at all you had a colonoscopy in the past and it was not fruitful, it was probably because your condition was not aggravated and thus not presenting.

The type of stool described by you along with many other symptoms points towards conditions like irritable bowel syndrome, inflammatory bowel disease, diverticulosis, etc.

To the list of investigations I have requested you to have in my previous response, I would like to add 'colonoscopy', please do get these conducted as they will all help to at the least narrow down our search for the cause for your symptoms, and hopefully even help diagnose your condition.

Best wishes.

---