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Have Low Grade Fever, Joint Pain, Sore Breast, Swollen Lymph Node Around Neck. Proper Diagnosis?

Posted on Tue, 23 Apr 2013

Question: I am having the following symptoms and can't get a doctor to take me seriously. Low grade fever, body aches (whole body like when you have the flu), joint pain in hands, hips, back, neck; recently (last two weeks), breasts are painful (had a complete hysterectomy in 1980), and my sleep habits have changed dramatically -- used to sleep for 4-6 hours and felt fine. Now I have days when I am so tired I can't function and I sleep so deeply that it scares me sometimes. In addition, I feel as though my lymph nodes, especially around the neck area, are full and when I have massages once a week and my massage therapist focuses on lymphatic massage, the above symptoms tend to get worse and I feel very sick for 1-3 days.

Answered by Dr. Seikhoo Bishnoi (4 hours later)

Hello
Welcome to Health Care Magic

You are a 54 year old other wise healthy female, with history of hysterectomy about 33 years back and cardiac stunting three times in last 6 years. You have been feeling flu like symptoms, low grade fever, body aches, joint pains in hands, hips, back, neck. Also breasts are painful. You are also having change in sleep pattern. Tiredness is also there. Lymphnodes appear to be swollen. Doctors are not checking seriously.
I would like to tell you that you have multiple system complaints and as you have said doctors could not find some serious problem. These type of symptoms may occur with following possibilities-
- One possibility is low hemoglobin. Although it can be easily ignored but low hemoglobin and anaemia is one of important cause of such type of symptoms. I will advise you to to get your Hemoglobin, Vitamin B12 levels checked.
- Other possibility may be Mild depression. It may occur in hypothyroid states also. In both cases such type of symptoms are seen. These type of symptoms are called as somatic symptoms. You should get your thyroid function tests done to rule out hypothyroidism.
- Other thing that may be possibility is Chronic Fatigue Syndrome. Possibility of this disease is very high in your case. It is almost similar to fibromyalgia. Lymph node swelling, tiredness, multiple pains, hot flushes, sleep problems etc are seen. Most common medicines to relieve pain as NSAID like ibuprofen are used for pain relief. Medicines like Duloxetine, Milnacipran etc are used for chronic relief of symptoms. I will advise you to please visit a good Doctor for proper evaluation and opinion regarding such symptoms.

Hope I cleared your query, If you have more questions you can ask again.

Thanks
Dr. Seikhoo Bishnoi, MD
(Consultant Psychiatrist)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Seikhoo Bishnoi (15 hours later)

I appreciate your response very much and am thrilled to learn that there are tests that can be run to help find or rule out these problems. However, with regard to possible chronic fatigue syndrome, what is the normal protocol for confirming or eliminating this as the problem? In other words, are there specific tests or test results that would be looked for. My concern is frankly that in my experience, many doctors like to pick a diagnosis that is kind of a catch all whenever they aren't really sure of the problem. I would simply like to know that if this is the diagnosis, it's a real one and not just one the doctor picked to make me go away. Secondly, if chronic fatigue is the issue and part of the treatment involves ibuprofen type medication, is that even possible when I already have to take blood thinners and 325mg of aspirin each day?

Again, thank you so much for helping.
XXXXXX

Answered by Dr. Seikhoo Bishnoi (36 minutes later)

Hello again

Chronic Fatigue Syndrome is a diagnosis of exclusion. There are no definite tests for this. But once all other possibilities are ruled out then we can go for this diagnosis.
Just to summarize the diagnostic work up-
Total Haemogram (especially for Hemoglobin)
Vitamin B 12 levels (normal is 300-900 but it should be around >450 in you)
Folate levels (low folate common in females)
Thyroid function tests (T3/T4 in lower range and TSH in higher range)
Serum Cortisol levels, and if they come on lower side then go for DST (dexamethasone suppression test) for any glucocorticoid related stress symptoms.

Go for these investigations and if they come normal only then we can think of CFS.

One thing I missed in my last answer is Hot Flushes in pre and perimenopausal females. Due to hormonal changes such type of symptoms may be seen. For such symptoms most of Gynecologists advocate hormone therapy. But hormone therapy has a lot of side effects. I personally prefer to start medicines like Duloxetine and Fluoxetine for this, they control such symptoms easily.

As you are on blood thinners and aspirin I would not advise you to take Ibuprofen. But for control of pain symptoms and other somatic symptoms you can take Duloxetine which is safe with aspirin also and control pain effectively.
Take diet XXXXXXX in Vitamin B12 like animal foods milk, eggs, and if you can take then meat.

Hope I cleared your doubt, If you have more questions you can ask again. If satisfied with answer please review.

Thanks
Dr. Seikhoo Bishnoi, MD

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar