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Doctors' Answers to "Frequently Asked Questions" - Diagnoses

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Lansoprazole & Irregular Heartbeat [posted 12/10/98]
Question: I have been taking Lansoprazole 30mg for about 15 days after about 8 days I notice I started to have pain in my chest, and my heart was beating faster then normal. I went to the doctor had a EKG they said my heart look and sound good, this only happen every once in a while, could Lansoprazole be making my chest and heart beat fast? I never had this problem until I started taking Lansoprazole.

Answer: Wouldn't be common, but, irregular beats are listed in the occasional symptoms of the drug in the PDR. Stop it and see.

Hypoglycemia & TSH Levels [posted 12/10/98]
Question: I have had problems that imitate hypoglycemia. I am also on Synthroid .225 mg. The glucose test revealed that after four hours, my glucose was 52. After five hours, 63. I also had a TSH that was .19. Was the TSH low because of my hypoglycemia or was my hypoglycemia low because of my TSH? Sometimes, when I urinate, there seems to be a sweet smell afterwards. Does this mean anything?

Answer: You are on slightly too much synthroid. But, not enough to usually give any symptoms. Anyways, hypoglycemia would be a rare/non-esistent manifestation of too much thyroid. Do you get symptoms with these glucose's? Also, some people who have hypothyroidism will eventually develop diabetes mellitus and often low sugars are an early manifestation of the DM.

Back Pain Sparked Complete Personality and Diet Change [posted 12/10/98]
Question: My 92 year old mother-in-law, who has been a welcome guest in my home for 28 years, started suffering with back pain about two months ago (prior to back problem she was quite active, knitted, read, went to hairdresser, loved tv). While suffering back pain she quit all activities even watching tv was discontinued and refused to eat proper meals or even get out of bed. She now says back pain is gone but she still will not get out of bed except to walk a few feet to the bathroom and will not eat except for an occasional egg or a little cereal. Still not interested in resuming any of her activities including TV, reading etc., and just lays completely still. Refuses to even consider seeing a doctor and is getting weaker all the time. She now complains of stomach pain which I believe is caused by not eating, her weight has dropped considerably. I would estimate she's now down to less than eighty pounds, from about 95 pounds when first stricken. I don't know what to do for stomach ache but believe if I could stimulate her appetite and get her to eat she will recover for awhile, if not,  I'm afraid I shall lose her in the very near future. Would appreciate some advice,  thank you.

Answer: She needs to see a doctor, don't take no for an answer.

Depression Cause [posted 12/04/98]
Question: My mother is a forty six year old women with arthritis in both of her knee's. She had a  hysterectomy at age twenty five, in the last two months she has been placed on  Serzone 500mg daily and Estrogen for possible perimenopause. I was wondering if  her depression could be a result of her arthritis or is it possible that she is suffering from depression aas a result of menopause. I appreciate any  information you could provide.

Answer: Could be both. We really don't understand the biochemical nature/cause of depression although there is a lot of work at the cellular level in the brain. However, if the antidepressants work, I would stick with them since they have few side effects. By the way a new drug called Celexa is usually similar to Serzone in side effects and usually a little more potent.

Multiple Neurology Problems [posted 12/04/98]
Question: My Mother is 86 yrs old but doesn't look or act  it. She was diagnosed with a brain tumor, and they wouldn't do anything about because of her age. She had open heard surgery when she was 78. She now has a bad or failing heart valve which they say is shrinking. She took a bad fall about 3 yrs ago head first on the cement. Since then she has had this pain in the temple of her head that effects her right eye and seems to come from the back of her neck. Her neurologist has her on 900 to 1200 MG of Neurontin daily and she was on 50 mg  Nortriptylin Hydrochlorid daily for that pain. She is also taking 50 MG  Atenolol and 20 MG Lotensin daily for her heart. She had some problems  awhile back with her heart racing and they added .25 MG Digoxin in the evening, which helped. Her neurologist just changed her to Tramadol HCI  tablets -50 MG (which is suppose to be a pain killer) and told her to go off  the Nortriptylin. Today was the 2nd day off that medication. She was  very nervous like and nausius. Could this be like a withdrawal for her and   shouldn't she be weaned off the Nortriptylin?Also if you have any other information that could help  her it would be greatly appreciated. Thank you  

Answer: Probably the digoxin. 0.25 is a big dose for an older  woman, depending on her size. But, check the level of digoxin in her blood. If above .15 serum level try to keep it between .10 and .15 and her nausea will almost always get better. Nortriptyline doe cause constipaton and may be a factor, even the cause. But, I strongly suspect the digoxin first.

Rectal Problem [posted 12/04/98]
Question: Everytime I have a bolwe movement it hurts really bad and most of the time it is bloody. The other day when I had one this jelly like substance came out. I was wondering what that could mean and what I should do about it? Thanks for your time.

Answer: Probably a rectal fistula;but, will need a physician to evaluate it.

Muscular Problems [posted 12/04/98]
Question: I have been diagnosed with myotonia congenita (becker's) for about 2.5 yrs now. I have gone to 2 individual neurologists. The EMG came out with only myotonia showing in my left hand after treatment. Along with abnormal flexing associated with the disorder, I have a terrible amount of muscular fatique. Even after the quinine sulfate takes the flexing away, I still suffer from this excruciating pain. It is a burning sensation, similar to lactic acid. It hurts when I move, flex, or even push on the muscle or stretch. Right now, typing at the computer, my forearms hurt like hell. My doctors tell me that terrible pain is not associated with myotonia. Do you think, that I may have another muscular disease on top of it or do you think it may be a misdiagnosis which seems unlikely to me. Nonetheless, it seems that there should be some drug to control the pain. Thankyou.

Answer: Well, it sounds like you need a diagnosis. I might try seeing a Rheumatologist and see if there is another cause for the pain. Approach the problem from a different angle. The myotonia wouldn't be expected to give this type of pain. See a non-neurologist for a different approach.

Sore Throat Problems [posted 12/01/98]
Question: I am a generally healthy 19 year old female. recently, I developed a sore throat, and when I looked at it, there were large white "spots" all over the back of my mouth. I had no other symptoms, other than I was really tired the week before all of this happened (this is normal for me, I   generally get very tired right before I get sick) when I went to the doctor, I thought I had strep and he did test me for it, but he also tested me for mono, and put me on cephalexin. both the mono screen and the strep culture came back negative. could this still be mono or is this something else? the cephalexin was ineffective.

Answer: Most likely mycoplasma or chlymdia which would need a quinolone, macroglide or tetracycline type drug. Testing too early in mono can give a negative test. If you had lymph nodes in your neck, axillae, groin, etc. could be mono-but tested too early. In young adults, I would vote for either viral(no antibiotic will help) or the above diagnosis.

Lower Back Pains [posted 12/01/98]
Question: For the past 10 months I get sharp, stabbing, shooting pains in the lower back, above the kidney area.They last for about 2 minutes. This occurs when I get nervous over a student's misbehavior at school, or once when I saw a car wreck. I can also feel my heart pounding at the same time, can this be a sign of heart problems, even though I have no other symptoms? Can this be caused by the avapro I am taking to control my blood pressure with?

Answer: Lower back pain would be rare/absent in heart disease. About the only circulatory problem that gives low back pain is an abdominal aneurysm, so get this evaluated. As to the situational stress, can't connect this one.

Rash [posted 11/24/98]
Question: My wife had an aneurysm (Intra Cerebral Hemorrhage) on Sept 16, 1998 and underwent a 6 hour operation to clamp the aneurysm etc. After 3 days she was put on a respirator to increase the oxygen level. She developed Pneumonia in both lungs which was treated with antibiotics. After coming off the respirator several days later, she developed multiple emboli in her lungs caused by a DVT in her leg. She was treated with heparin and then weaned to Wafarin over the last 2 weeks or so. She has been on day release for the last 4 days sleeping in the hospital at night. She has been on Phenytoin since the operation and Wafarin for the last 7 days or so. This morning (Oct 18 Sunday) she awoke with a rash on her back, chest, thighs and upper arms. This morning her wafarin level was 2.8. They gave her 4 ml of Waffarin this morning after the rash had appeared. On Saturday (Oct 17 yesterday) they gave her 5 ml of Renitec because her BP was 150/95. She has been taking Renitec for the past several years to control her BP (10 ml). Her only other medication this day was her regular 350 ml of Phenytoin. Now the Doctors are switching her from Phenytoin (Epamutine) to Tegretol (Carbamazipine). Do you have any idea about the cause of the rash?

Answer: Phenytoin, pretty common problem.

Bruising [posted 11/24/98]
Question: I've been bruising very easily. My family doctor sent me to the lab yesterday for a blood test (6 viles) What could he be looking for?

Answer: Lots of possibilities, usually clotting disorders.

Could Minoxidil Cause My Chest Pain & Vertigo [posted 11/11/98]
Question: I have been using a 2% Minoxidil product for about 18 months and just within the last week or so I have developed a tightness in my chest, a slight increase in my pulse rate, and bouts of vertigo every morning. I stopped using the Minoxidil after a two days of these symptoms. My question is this, I have heard in the past that Minoxidil can cause dizziness in a few rare cases but I am finding it difficult to find statistics on this. How common are these spells of dizziness and what is the intensity? I have met with my primary care physician and since I have been using Minoxidil for such a long period of time, he thinks it is unlikely that this may be a cause of these symptoms. Also, one other potentially significant note, several years ago I had a series of classic migraine headaches (approx. 1 every 6 months for 2.5 years.) But, these new symptoms - vertigo and rapid heart beat-- seem to be so different than my past migraine episodes. I haven't had a classic migraine occurrence in approximately 2 years. My physician thinks these new symptoms are more likely to be associated with a migraine headache than with the minoxidil. I haven't found any relation between vertigo and migraines in medical literature so I'm concerned that this may not be correct. I suspect the Minoxidil as a cause before I suspect the Migraine since the Minoxidil product literature cites this first in its list of warnings. Also, since I'm not familiar with any tie between vertigo and migraines. Any input?

Answer: I agree with your doctor. Minoxidil usually causes problems right away or not at all. Look for another cause, unlikely the migraines also.

Abdominal Pain, Esophageal Immobility & Urinary Tract Infection [posted 11/11/98]
Question: I recently wound up in the ER with severe abdominal pain. After an ultra sound for my gall bladder, an upper gi, and an IVP I was told I have an ulcer. No problem. My question is that the Dr. also mentioned that on the upper GI they found I have a mobility problem with my esophagus. What exactly does this mean? I don't have any symptoms. Also, I get frequent UTI's. The urologist prescribed Macrobid for me but on the bottle it says take 1 tablet 2 times at onset of infection. (100mg). Two days ago I started to feel I was getting one, took the Macrobid and felt fine. But this morning I woke with a raging one, lots of blood, burning, and spasm. Maybe I should take the Macrobid for a few days.

Answer: An esophageal motility problem implies that the coordinated activity of the muscle to push food from your mouth to your stomach is irregular. Often improved with propulsid and sometimes made worse by excessive acid. As to the UTI, you may have started it too late or have a resistant organism.

Blood in Semen [posted 10/28/98]
Question: I found blood in my semen today. I live a healthy lifestyle, am heterosexual and have not put myself at risk. What could cause this?

Answer: Usually a prostate infection or an infection of the collecting system. This should be cultured, a urogenital exam and antibiotics with further evaluation if it persists. Pretty common and usually caused by bowel bacteria migrating to your prostate or semen collecting system.

Do Tender Muscles all Over Mean Bursitis [posted 10/28/98]
Question: I was given a couple of diagnosis. The last one is bursitis with periodical sharp pain in my legs (pain through hip to foot), like electrical shot. I have pain on my right hip, but the sharp unbearable pain was on the left leg also. I have tender muscles ALL OVER my body The medication for reducing inflammation that I have been given lately doesn't help (voltaren and ultram). Should I power walk that I regularly have done for the past 7 years.

Answer: Tender muscles all over your body would not be bursitis which would be an isolated inflammation/pain. Check with a Rheumatologist you need a second opinion.

Needed Diagnosis [posted 8/14/98]
Question: I don't know what is wrong with me. My symptoms are dizziness, occasional nausea, occasional chills, feeling of faintness, weakness, fatigue, slight pressure in the forehead and around the eyes, and loss of appetite. The symptoms have lasted for one week now.

Answer: I need more information. Sounds possibly like a sinus infection, but could be a systemic viral infection. You'll need to see your doctor.

Adverse Reaction To Medications? [posted 8/12/98]
Question: I am trying to find the reason for a recent emergency room visit. I am currently taking phendimetrazine, for a short period of time, about 2 months. I take one 35 mg tablet per day. I also take echinacea and goldenseal, somewhat inconsistently. 24 hours prior to my visit, I took both, and took the echinacea the morning of my visit. I am also allergic to ibuprofen and 24 hours prior I had taken a ketoprofen. My visit started with severe cramping due to diarrhea, while in the bathroom, I experienced my heartbeat racing and reverberating through my entire body and was having difficulty breathing due to an extremely heavy and tight feeling in my chest and body. I ended up on the bathroom floor until help arrived and was barely able to move or to talk. I was diaphoretic and very swollen in face and extremities. No hives. This lasted approximately an hour until the symptoms started to subside. I was given oxygen at the scene by paramedics and this did not seem to help, neither did my keeping my head down below my heart or lying on the bathroom floor with legs elevated. I have had hypoglycemic episodes and near fainting episodes and this was not similar. The ER stated that my vassal nerve could have been agitated, and I know nothing of this nerve or it's effects. My blood sugar was also slightly elevated, to 164 and then down to 123 about 15 minutes later. My EKG and blood work, aside from the glucose, was all wnl. Do you have any information for me to help me understand what happened? My husband feels it was a panic attack, as he has them. However, I have seen him go through them and he is much more functional than I was and I am a firm believer in biofeedback and tried confidently at the time to bring my heart rate down, only to have it speed up. I kept a clear head and tried many things to feel better. I am very interested in finding out what this was and also to rule out the medication regimen as a possible source.

Answer: Hard to know. The ketoprofen is not a good idea, depending on your "allergy", since it is a similar drug. What did they find at the ER? I need some more information.

Needed Diagnosis [posted 8/11/98]
Question: I have been plagued with problems since childhood. I have had surgical repairs for a hernia, two dislocating joints, insertion of cervical sutures for all pregnancies after losing my first two through premature birth, two liver biopsies, removal of my gall bladder and tonsils. I am severely myopic, have had severe glandular fever and a long history of elevated liver function tests, with still no proper diagnosis of the problem. Recently I have been diagnosed with severe fibromyalgia, ulcerative esophagitis and colitis, Gilberts syndrome, arthritis, peripheral neuritis, trigeminal neuralgia and a host of other abstract things. I have a weakly positive antinuclear antibody test with a speckled pattern, a constantly elevated ESR reading. My doctors feel that I am just one of those unlucky people, but I really feel that I may have a connective tissue problem, because of my history. What scares me most is that I get these huge blood blisters under my tongue and have many petechia/spider naevi all over me. Do you have any ideas? I have been to so many different specialists and have a fabulous G.P. She feels that I have a problem with blood vessel fragility.

Answer: You need to go to a doctor who will try to tie some of these diagnosis under one umbrella. A Rheumatoloigist or a good diagnostic internist would be my choice. Ask around to find the best diagnostic internist in town - the best place to find out is to ask the Chief Medical Resident at the Department of Medicine at any Residency training program. This will usually be at a medical school, but may be at any teaching hospital. Find the best gun in town.

General Medicine - Diagnoses [posted 8/6/98]
Question: How do you know what is wrong with a patient when you can't look inside their bodies?

Answer: Start with a good history. Some things cause certain symptoms. Second, a good physical examination to go with the history. Lastly, lab studies to confirm your thoughts and/or imaging studies, CT scan, MRI, etc. These last ones actually do "see" inside the body. However, experience and a good history will answer your problem 75% of the time.

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