Questions About Rheumatology Consult
I’m a 31-year-old female, standing at 5'5" and weighing 190 pounds. For over three years, I have been suffering from joint pain and persistent fatigue. My current medications include Synthroid 75 mcg, NP Thyroid 60 mg, Celexa 20 mg, and Wellbutrin 150 mg. I typically consume 2-3 alcoholic drinks per week, and I do not smoke or use illicit drugs. To summarize my situation, despite being on thyroid medication for three years, my joint pain and extreme tiredness remain unresolved. Given my family history, particularly my mother’s rheumatoid arthritis, my primary care physician ran some blood tests in October 2024. The results showed: - ANA 1:640 homogeneous - EBV Ab VCA IgG 21.7 U/mL (normal range: 0-17.9) - EBV nuclear antigen Ab IgG 89.5 U/mL (normal range: 0-17.9) These were the only abnormalities detected in my blood work; my ESR and C-reactive protein levels were within normal limits. I had a follow-up appointment with a rheumatologist today, and she seemed unconcerned about any potential autoimmune issues. She suggested that my joint pain could be attributed to carpal tunnel syndrome, despite the fact that my symptoms affect not just my wrists but also my fingers, ankles, and feet. Additionally, she attributed my fatigue to depression and possible sleep apnea. When I mentioned that I try to exercise when my energy allows—despite the overwhelming fatigue she seemed to dismiss my efforts, rolling her eyes as if she doubted my commitment to staying active. The entire visit lasted less than 30 minutes. Is this a common experience in rheumatology? Should I consider seeking a second opinion, or am I overreacting? I’m feeling quite disheartened by this situation.
Answers (1)
7/11/2025, 3:10:48 AM
OpenHealth AI
I'm sorry to hear about the challenges you're facing with joint pain and fatigue. It sounds frustrating to not receive the clarity and support you need, especially given your family history of autoimmune conditions.
Summary of Main Points:
Your persistent joint pain and fatigue, coupled with elevated antibodies linked to former Epstein-Barr virus infection (EBV), warrant ongoing evaluation. While your rheumatologist attributed your symptoms to carpal tunnel and fatigue to depression, it’s understandable to feel disheartened if you feel your concerns were dismissed. Seeking a second opinion can be helpful if you feel your needs aren't being met.
Explanation:
-
Symptoms and Context: Chronic joint pain and fatigue can stem from various causes, including autoimmune diseases, thyroid issues, or even lifestyle factors. Your symptoms affecting multiple joints and your familial predisposition to rheumatoid arthritis are significant points that deserve careful consideration.
-
Blood Results: The positive ANA test (1:640) can indicate autoimmune activity but is not definitive on its own. Elevated EBV antibodies might suggest past exposure but require further context, as many people have these without significant health issues. Normal ESR and C-reactive protein levels are good signs, suggesting there is no active inflammatory process, but it does not rule out chronic conditions.
-
Rheumatology Experience: Experiences vary widely among rheumatologists, and unfortunately, some patients do feel their concerns are minimized. It's crucial to find a healthcare provider who listens and engages with your concerns thoroughly.
Next Steps:
-
Seek a Second Opinion: If you feel that your concerns were not taken seriously in your recent consultation, consider visiting another rheumatologist. Bring your medical history and previous test results for a fresh perspective.
-
Keep a Symptom Diary: Track your symptoms daily including joint pain levels, fatigue, any patterns you notice, and potential triggers related to exercise or diet. This documented information can be valuable for any future consultations.
-
Explore Lifestyle Adjustments: Focus on maintaining a balanced diet, regular mild exercise tailored to your energy levels (such as walking or gentle stretching), and prioritize good sleep hygiene. These can help manage fatigue and improve overall well-being.
-
Consider Mental Health Support: Since fatigue may also be influenced by mental health, if you feel comfortable, discuss with a mental health professional about how you're feeling. They can help address any underlying issues related to fatigue or stress.
-
Follow-Up on Sleep Disorders: If sleep apnea is a consideration, discussing reference to a sleep study may be warranted, especially if you experience restless nights or daytime sleepiness.
You deserve to feel heard and understood in your health journey. Please know that taking action for your health is important, and it's okay to seek the care and validation you need.
Related Questions
Swelling Beneath My Chin Near the Jawline
18-Year-Old Male: I'm reaching out to any medical professionals who might provide insights into my situation. I've been using marijuana since I was 14, but now, at 17, I'm making an effort to stop and have been clean for 18 days. Recently, I've discovered an unusual swelling located just beneath my chin, behind my jaw. It causes some discomfort when I move, yet it doesn’t feel painful continuously. I'm somewhat anxious that this could be indicative of a more serious issue, especially considering it's positioned near my chin's lymph nodes. Any advice or information would be greatly appreciated as it might help alleviate my worry.
Challenges with Appetite and Discomfort While Eating — Difficulty in Gaining Weight
As an 18-year-old male, I find that I become satisfied after consuming rather minimal amounts of food. This situation presents a considerable challenge, particularly since I only need to have a standard breakfast, lunch, or dinner to feel completely satiated for the remainder of the day. My goal of increasing my weight has made this issue even more complicated. When I limit myself to one meal per day, I often face weight loss or an uncomfortable sensation of fullness that leaves me feeling sluggish. Opting for two meals makes me feel excessively bloated, distracting me from my daily responsibilities. Moreover, I suffer from an unusual issue with my throat, where almost any food I consume causes discomfort, as detailed in the list below. I have contemplated focusing on having just lunch while continuing my weightlifting regimen to maintain my current weight and gradually build muscle. What advice could you offer? Could there be an underlying cause for these symptoms? Lastly, would it be wise for me to consult a healthcare professional? Foods That Cause Discomfort: Bread, flour, pizza, fruits, sugary or starchy items, seed oils, chips, and essentially everything else. Foods That Are Tolerable: Rice, salads, chicken, fish, and vegetables. Overall Symptoms Include: * Quick satiety after normal meals * Challenges in gaining weight * Bloated and lethargic sensations when consuming more than one meal * Persistent throat sensitivity to a wide variety of foods
Should I Seek Medical Attention for Left Ear Pulsatile Tinnitus?
A 31-year-old woman reports an ongoing issue with pulsatile tinnitus, which she is currently experiencing solely in her left ear. Although she's noticed this condition intermittently before, she hadn’t paid it much mind due to the absence of pain. Recently, however, her curiosity piqued her interest in researching the condition, where she stumbled upon information suggesting it could be serious. Usually, she avoids searching online for health worries, but now she is contemplating whether a visit to the doctor might be warranted. Can anyone advise on the need for a medical evaluation in this case?
Experiencing Heart Palpitations Following Chest Impact
I'm a 17-year-old female who has struggled with tachycardia for several years, having been diagnosed with postural tachycardia syndrome (POTS) about five years ago, although I haven't pursued further testing because I haven't completely lost consciousness. Recently, over the past month or two, I've started to experience sensations of my heart skipping beats, accompanied by difficulty in breathing during these episodes. These occurrences have become significantly more frequent, even when I'm at rest. Five years ago, I underwent a Holter monitor test, which indicated primarily tachycardia with occasional premature ventricular contractions (PVCs), but nothing alarming was found. In early December, I was struck hard in the chest by an elbow while in a mosh pit, which resulted in some pain when taking deep breaths for a few days. My sternum became bruised and slightly swollen, and it remained tender to touch for about two weeks, but this discomfort was manageable. I still feel some soreness when stretching, although it’s not severe. Additionally, I have diagnoses of Crohn’s disease and hypermobile Ehlers-Danlos syndrome (HEDS), and I am currently on immunosuppressants. Given these circumstances, would it be advisable for me to seek medical evaluation, or could these symptoms be considered typical?
Understanding My Experiences with Dissociation and Physical Symptoms
Hello everyone! I'm 15 years old and I’ve been grappling with intense feelings of dissociation recently. About two years back, I experienced what I now refer to as a "silent seizure" for the first time. It happened around 2 PM while I was at school in the band hall. Suddenly, I found myself zoning out completely; I was just sitting there, disassociated from reality, until it dawned on me that I couldn’t seem to reconnect with my surroundings. Feeling lost, I turned to a friend and anxiously asked, "Where am I?" She chuckled, unaware of the seriousness of my situation, but I stood up and wandered out of the classroom, aimlessly walking towards the bathrooms. The sensation was akin to being in a dream—you know you’re somewhere, yet you can’t fully engage with the moment for what felt like 5 to 10 minutes. Strangely, I even had the feeling of observing myself from above as I moved through the halls, like a scene from a dream. In a state of panic, I contacted my mom. By the time I managed to leave school, my mind was clearing. She took me to her workplace where a colleague checked my blood sugar levels, revealing it was low. I had eaten that day, so this was unexpected (especially since my mother also faces issues with low blood sugar). This occurrence was unprecedented for me; thankfully, I haven’t faced such low levels since then. In the following weeks, I experienced intermittent dissociative episodes, prompting me to visit a doctor. I underwent blood tests, an electrocardiogram (EKG), and a routine examination. Everything appeared normal, except I was diagnosed with anemia—something my mother and sister also deal with. I walked away from that appointment without any real explanations, and after a while, the episodes subsided—thankfully, a relief. FAST FORWARD TO NOW: (15 years old) (Potentially relevant context) Recently, I’ve been enduring severe heart and chest discomfort. I’ve been noticing irregular heartbeats, sporadic strong pulsations, and sharp pain localized in my heart region and upper right chest. Lying on my side can be quite painful, and sometimes I struggle to take deep breaths. I make it a priority to get a full eight hours of sleep each night, I take daily vitamins, and I’m actively involved in competitive cheerleading, maintaining a healthy fitness level for my height and weight. We sought medical advice again, underwent numerous tests, and, once more, everything checked out fine. My heart was deemed healthy, and all other measurements were satisfactory. Initially, we suspected anxiety might be a factor, but my mom is hesitant to consider antidepressants, believing that my age may limit treatment options. She has recommended that I hydrate more and practice breathing exercises (which is somewhat ironic since I struggle to breathe when these pains occur, yet I don’t argue). UPDATE: During practice today, I unexpectedly experienced my first "silent seizure" episode in two years. It was more disconcerting than I recalled. I lost track of my location again and couldn’t re-engage with reality. It felt as if I was observing those around me from a dream-like vantage point. This realization frightened me, thinking that I had moved past these episodes. It took about ten minutes for me to regain my awareness of my environment. Additionally, this week, I noticed moments of dissociation, albeit not as intense as previous episodes. I found myself vacantly staring, and my vision felt oddly lazy, frequently. It's worth noting that I do not have a lazy eye. I plan to document these occurrences meticulously, and if they persist, I will consult my doctor again. Meanwhile, if anyone has suggestions about what might be happening to me, I would greatly appreciate it. Is this potentially linked to anxiety? I’m genuinely confused about my condition!