Which Specialist Should I Consult? Recommended Tests?
I’m a 29-year-old female seeking advice on my health concerns. Since July 2024, I have been experiencing constipation, a shift from my usual diarrhea and gastritis. A recent colonoscopy yielded normal results aside from some hemorrhoids. However, my abdominal discomfort has intensified, and a gastroscopy has revealed erosive gastritis affecting both the fundus and body, alongside a biopsy indicating ectasic capillaries. Previously, I was only diagnosed with antral gastritis, which has now resolved. Additionally, I no longer have my gallbladder, and a scan shows kidney stones in both kidneys. I have also started to suffer from daily headaches and neck pain on one side. An MRI of my brain indicated "punctate areolae of microvascular gliosis" at the junction of both hemispheres, leading a physiatrist to suggest that I might have cranio-cervical instability (CCI). New symptoms include blood pooling in my extremities, episodes of erythromelalgia, and multiple instances of seborrheic keratosis. My hormone levels appeared normal, though my DHEA-S was measured at 600 (with a reference range of 1200 to 3600). I often experience tingling in my extremities, despite having normal results from an electromyography (EMG). A capillaroscopy indicated capillary ectasia, slow flow, and some mild tortuosity. My antibody panel returned normal results, but I suffer from dry eyes, a dry nose, a dry mouth, and have swollen lymph nodes (the largest measuring 1.5 x 1 cm). My blood tests generally show normal results, apart from elevated fibrinogen levels (430, whereas the normal range is 150-350), and fluctuating platelet counts. At times, my bilirubin is elevated due to Gilbert's syndrome, and potassium levels have been low on occasion. Other symptoms I face include rash due to adrenaline, severe fatigue, rapid heartbeat, dizziness, and tinnitus in one ear. I also have joint pain, especially in my knees, where an MRI indicated subchondral edema of the patella and patellofemoral syndrome. Although it may not be directly related, my joints exhibit hypermobility, and I have a long-standing allergy to mold, pollen, and dust mites, often leading to rhinitis. Recently, my nails have been undergoing changes, resembling Terry's or Lindsay's nails, and I have a reddish-violet spot on my hand that fades under pressure, described in a biopsy as perivascular dermatitis though it remains unchanged after a year. What types of specialists should I visit for these issues? Additionally, which tests would be helpful in diagnosing my conditions further? I appreciate any insights you might have!
Answers (1)
3/31/2025, 4:01:09 PM
OpenHealth AI
It sounds like you’re dealing with a complex set of symptoms that span multiple systems in your body, and it’s understandable to feel overwhelmed. Your concerns about gastrointestinal issues, persistent headaches, skin changes, and other systemic symptoms all point to the need for a thorough and coordinated approach to care. Here’s how you might move forward:
Key Points:
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Specialists to Consult: Given the range of symptoms, a multidisciplinary approach may be needed, including:
- Gastroenterologist: To further evaluate your gastrointestinal symptoms and manage your gastritis and constipation.
- Rheumatologist: For the joint pain, potential hypermobility issues, and your symptoms that could suggest an autoimmune or connective tissue disorder.
- Neurologist: For your headaches, tingling in extremities, and potential concerns from your MRI.
- Endocrinologist: To address hormone levels and any metabolic concerns given your symptoms.
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Recommended Tests: Further testing can help clarify your diagnosis:
- Complete Blood Count (CBC): To monitor your fluctuating platelet counts and overall blood health.
- Thyroid Function Tests: As thyroid dysfunction can cause fatigue, joint pain, and heart palpitations.
- Autoimmune Panel: Since you have several systemic symptoms and capillary ectasia, tests for autoimmune markers could be useful.
- Abdominal Ultrasound: To assess your kidneys and potential kidney stones further.
- MRI or CT Scan of the cervical spine: If cranio-cervical instability is confirmed or suspected as a cause of your neck pain and headaches.
Next Steps:
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Schedule Appointments: Start by scheduling appointments with a gastroenterologist and a rheumatologist, as they can help you address your primary symptoms and begin a coordinated evaluation of your overall health needs.
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Maintain a Symptom Journal: Keep track of your symptoms, including when they occur, their severity, and any triggers you notice. This can offer valuable insights to the specialists.
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Consider Dietary Modifications: Since you have gastritis and constipation, consider a diet higher in fiber (fruits, vegetables, whole grains) and adequate hydration. Avoid irritants like spicy foods, caffeine, and alcohol.
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Monitor Your Symptoms: Keep an eye on your symptoms like joint pain, headaches, and any new findings, and communicate these effectively with your healthcare providers.
Conclusion:
You are navigating a complex health situation, but by involving the right specialists and doing additional testing, you will be able to clarify your diagnosis and develop an effective treatment plan tailored to your needs. Remember, each step forward is progress, and support is available throughout this process. Don't hesitate to reach out for help when you need it!
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