Question: Hi there. Haven't felt well for months. Low grade fevers (come and go- but present pretty much daily), severe fatigue (normally I'm the energizer bunny), headaches, jaw pain, bone and joint pain, weakness, get exhausted even when doing nothing, fatigue hits in weird waves where I'm wide awake watching a really intense movie lets say that I'm into and next thing you know I'm falling asleep. Rest doesn't help me feel less tired. Weight loss, little appetite, but eat the same as always (very healthy diet- organic, clean, no preservative or hormones or sorbitols etc.)...Night sweats. Bruising really easy. Nausea here and there. Sometimes I eat and I feel very uncomfortably full when I've only had a couple bites. Aside from body hurting everywhere, theres really tender pain under right breast (have had the pain there before and docs always said nothing to be concerned with)... I have a BK amputation which came after years of surgeries on that leg, foot for a limb that all docs agree should have been amputated the night of the auto accident I was in. 6 years after many surgeries half my foot was amputated due to areas on bone that never healed no matter how many bone graphs and surgeries we'd done, and it became necrotic. They also fused my ankle. A year later the leg was amputated below the knee after learning they didn't get all the necrosis from foot and caused nerve damage and pain was a lot worse. Lot of healing issues. Developed c diff at that time and wreaked havoc on my system. Meds didn't improve things. Finally ended up having a FMT (fecal transplant) which saved my life. No relapses of that. Pain got worse and worse after BK amputation and kept telling Docs I could feel something in my stump in 2 places. They would say just knots etc, from the muscles. Finally they did an MRI and found 2 large neuromas (one was 6cm and one was 3cm) it was only 7 months after the BKA surgery which is unheard of since they grow at rates on 1mm per year... All very weird stuff. Got those removed a year ago. Still have very severe stump pain but doesn't feel anything like it did when neuromas (nerve tumors) were in there. Just hurts all the time. Worse when sun sets. I have no idea how much of this is relevant to my question, just giving you brief but long history, haha. I've had tonsils removed, appendix, and gallbladder as well. Tumors a couple times. Had cancer in throat (pharynx) 15 years ago, tumor was removed and full recovery. I have a complex cyst in left kidney. 2cm x 1.6cm. Mammos always see things that concern them, but then do US after and they say nothing to be concerned about. Okay so here we are now been sick for months. 4 weeks ago after our insurance finally got straightened out I saw my new PCP (just moved to AZ from Maui) she did her exam and said I had an infection and prescribed zithromax (pack-5day dose)... It def helped clear up my ears and sinus issues. But still felt like crap, still so fatigued, headaches, fever didn't go away, general blah feeling, and body just hurts all over. I figured maybe just a flu or virus which is why antibiotics didn't knock it out. My husband sick same time. He finally went in and was diagnosed with bronchitis and ear infection, and given pack as well. F/u in 3 days no improvement and they ran a bunch of bloodwork and Doc felt strongly he has Valley Fever. Saw same doc after he did, and he didn't feel that was what I was going through or that it was a virus or flu because it had been months at this point. He ran same blood work to check. Hubbies came back excellent, no flags. Still awaiting the one they culture or whatever for the valley fever but his EOS levels were excellent, as were mine... My bloodwork however came back with a low WBC 3.5 and ABS Neut also low, along with elevated billrubin levels. I had the same blood work up that first doc ordered 2 weeks before, same results. Changed by a number or two but still the low WBC and such. The lab ranges differ on Lymph %... One shows normal range is 10-45 and the other shows as 10-55 and my result came back 50.7% on the last one, but was only 38% on 1st one. So that didn't flag on either since the 38% was on the labs range of 10-45% and the 50,7% result was in that labs range of 10-55. So I don't know how much that one matters... Anyway. I am extremely concerned that I have a low WBC, Low Neutrophils, and elevated billirubin along with all these other symptoms and have not felt right for months now, worsening since October. I will start to feel better and just have the fatigue and headaches mainly and weakness and body pain, but then a couple days later it all hits way harder. Same with night sweats, they would stop, then I'll wake constantly drenched throughout the night for weeks in a row. My thyroid and all the other blood work was fine, as was cholesterol levels, blood pressure, etc... Having had cancer before, I'm concerned. Having lost my grandpa to Hodgkins lymphoma decades ago, I'm concerned. My parents are both perfectly healthy and no health issues. All grandparents have passed away. Grandpa in early 40s from Hodgkins lymphoma and my other gradnparents- gramma bladder cancer, grandpa prostate cancer. 3 aunts with Breast cancer, and one with breast and lung cancer...
Also X-ray showed no pneumonia or signs of valley fever that was taken this week at urgent care. Sorry for so lengthy... I am just clearly concerned by not feeling so well for so long and now these blood results. I have had tons of surgeries and blood work was always fine. My normal WBC levels were in the 8s... Last year I had WBC low on 3 separate tests, but as all other levels were normal and no other flags, they attributed it to the nerve tumors in my stump and my body fighting that and didn't feel it necessary to have me see a hematologist or oncologist. Now I have the lower WBC again but also have a new flag with the ABS Neut and the billirubin being elevated. I have an appt with my Doc (PCP) on Tuesday to f/u with these results. I certainly don't want more antibiotics and Urgent Care Doc agrees not the thing to give me. Should I be asking Doc to refer me to hematologist and/or oncologist? Or are there other tests to run to see what's going on further first? My concerns are that most things cause elevations in WBC now lower. And all I know of that causes lower is leukemias, lymphomas, and auto immune disorders. Any feedback or help or guidance you can offer would help me greatly. I don't normally worry about anything. Thus far I've always been dead on instinctually when feeling that something isn't right in my body. And something is not right. I'm the person everyone describes as the happiest human being they've ever known. I don't feel myself at all though lately. I went through months and months of Doctors telling me it was nothing when I had cdiff and hadn't been diagnosed. telling me it was IBS, or effects of going off pain meds, something I'd done dozens of times with all my surgeries, lol. I knew something was wrong and finally one doc listened, did a colonoscopy and told me thank God I listened to my instincts and didn't take the anti diarrhea pills that PCP prescribed me, cause it would have caused my colon to explode. I said I didn't know what the hell I had but I knew it was trying to get out (30x a day on the toilet- lol)... I knew bottling up whatever it was could not be a good idea. I felt toxic... Just as when the tumors were in my stump I felt like something was there that didn't belong there. This is very different, cause I can't nail down one place. I hurt everywhere and feel like my whole body is off. I don't have one place that hurts. It hurts all over. There is the pain under right breast and flank pain on left side (Docs say 2cm complex cyst would not cause any pain, but I hurt there for so long and that is what finally got them to do the MRI and find the cyst, which at that time was only 1.3 x .9 cm)... I think I'm very sensitive to changes and foreign things in my body. Ok there is my novel for you. :)

Where specifically would they pet scan? They dont just do a full body right? Isnt it one specific area like when mris cts or US are done? Based on the low wbc and low neutrophils how would they know where to look ?

Would leukemia not be a possibility as well ? Something pet scan wouldnt track yes? Would liver or the bile duct be a possibility as well with the billirubin also elevated? Im just looking for more info on what is most likely at play and to be best armed to advocate for myself when i see pcp on tuesday. Is it safe to assume that with these 3 flags on bloodwork that pcp should refer me to hematology and/or oncology? I very much appreciate your insight and opinions. The more info i have the better i can help myself and help make sure doctor doesnt just brush this off as has happened to often with previous docs and the nightnare our healthcare on maui was.

Ok thank you for your help. Couple last questions... My billirubin is elevated but i dont look jaundice at all. Pale yes, yellow no... Also my gallbladder was removed many years ago. Would this have any effect on bile duct or are they removed with it?
Ok so bone marrow biopsy and pet scan are the best bext steps. Got it. It would be unlikely yes that what has been seen as a complex cyst and all of the smaller things they have noted in breasts but then say arent worrisome could be at play and would effect the lower wbc, low abs neut and elevated billirubin correct? The most obvious culprits wirh my labs and symptoms would be some time of lymphoma pr leukemia correct? Could an auto immune disorder do be causitive?