Navigating Ongoing Health Issues
A 37-year-old woman is grappling with persistent symptoms that have lasted for several months. Despite her primary care physician's diligent efforts, she is still uncertain about the underlying cause. Now, she seeks guidance on how to refine her questions for her next appointment, as the costs of numerous referrals that haven’t led to answers are becoming burdensome. **Current Symptoms:** - Daily nausea since the end of March 2025 (not related to pregnancy) - Persistent fatigue - Occasional mild headaches (weekly frequency) - Anxiety - Feelings of restlessness - Intense dreams during sleep - Difficulty falling asleep - Episodes of dizziness - Intermittent side pains (right side, sometimes radiating to the back) - Pain in the right shoulder and neck (starting late 2024) - Cramping in the lower right abdomen **Tests Conducted and Results:** - Ultrasound of the gallbladder and liver yielded normal results. - Ultrasound of the lower rib area showed no significant findings. - Celiac disease blood test returned negative. - Normal iron levels indicated no deficiency. - H. Pylori stool test was negative. - Colonoscopy revealed no significant abnormalities; some minor benign polyps were removed, and there was inflammation from the prep, but no signs of colitis, IBD, or microscopic colitis were found. Potential IBS and GERD were suggested following a consultation with a gastroenterologist. - Engaging in shoulder and neck stretching exercises provided only temporary pain alleviation. **Noteworthy Medical Background:** - Took a low dose of sertraline (10mg) for about a year, which caused diarrhea. - Started amitriptyline two months ago, right before the onset of nausea. - Experienced intermittent heartburn over the last five years, mostly linked to dietary choices. - Diagnosed with endometriosis based on symptoms. - Small fibroids detected in 2022, deemed insignificant. - Mild sleep apnea is managed with a CPAP machine. - History of craniosynostosis at birth; underwent craniotomy as an infant and still has sutures. - Adhered to a bland diet for approximately one month, which alleviated nausea somewhat but didn’t resolve it completely. **Considering Next Steps with PCP:** - Requesting an endoscopic examination - Referral to an ENT specialist (to explore inner ear causes?) - Following up with the gastroenterologist for pH testing - Consultation with an OBGYN to evaluate the progression of endometriosis and fibroids - Obtaining a CT scan of the shoulder and neck region *Is there a particular order to prioritize these requests? Is there anything significant that should be added? Would any of these suggestions not be worth pursuing?* Feeling exhausted from daily nausea and fatigue, the individual is adamant about not wanting medications that merely mask her symptoms. Her main concern is finding the reason behind her ongoing nausea, especially after stopping amitriptyline and altering her diet. The uncertainty is weighing heavily on her, and she longs for clarity about her health situation. *Any insights or assistance would be greatly appreciated!*
Answers (1)
8/2/2025, 8:21:05 AM
OpenHealth AI
It sounds like you’re experiencing a range of challenging symptoms, and it's understandable that you're feeling exhausted and frustrated from this ongoing health situation. Your need for clarity is important, and addressing your concerns with your primary care physician (PCP) can help steer you in the right direction. Here’s how to refine your approach for your next appointment.
Main Points to Focus On:
- Prioritize Testing and Referrals: Establish which tests or referrals are most likely to provide answers regarding the nausea and other persistent symptoms.
- Clarify Your Symptoms: Be specific about how your symptoms impact your daily life to communicate the urgency of your situation.
Suggested Order for Your Requests:
- Consultation with an OBGYN: Since you have a history of endometriosis and current symptoms that could be related (like cramping), this should be a high priority.
- Follow-up with the Gastroenterologist for pH testing: Given your ongoing heartburn and nausea, understanding the acid levels in your esophagus may provide critical insights.
- Endoscopic Examination: An endoscopy can visualize the upper gastrointestinal tract, helping rule out any other potential issues causing nausea.
- Referral to an ENT Specialist: If you suspect inner ear issues related to dizziness, this is worth exploring but can come after the more direct investigations.
- CT Scan of the Shoulder and Neck: This can help identify any skeletal or nerve issues if there are persistent pains, but it may be less urgent unless your pain worsens.
Additional Insights:
- Tracking Symptoms: Keep a detailed symptom diary until your next appointment. Note when the nausea occurs, any foods that exacerbate it, and how it correlates with other symptoms like fatigue or dizziness.
- Diet Considerations: Since a bland diet provided some relief, continue to avoid known triggers like spicy, fatty, or acidic foods. Consider discussing specific dietary plans with a dietitian.
- Mental Health Support: Given your anxiety and feelings of restlessness, ensure you discuss these with your PCP. Sometimes, psychological support can help alleviate physical symptoms.
What to Avoid:
- Cancel or delay the requests that seem less likely to yield answers: For example, if your dizziness is less frequent, you might want to delay the ENT visit until other causes are ruled out.
- Over-reliance on medications: Continue to communicate your desire to address the root causes of your symptoms rather than just masking them with medication.
Next Steps:
- Prepare a list of your symptoms and any patterns you’ve noticed.
- Discuss the order of your requests based on the insights shared here.
- Emphasize your need for clarity regarding the nausea and its impact on your life.
Remember, you are your own advocate in this journey, and it's okay to seek clarity and understanding from your healthcare providers. You're taking important steps toward finding the answers you need, and I wish you the best in your next appointment. Please feel free to reach out if you have more questions or concerns!
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