Question: My 17-year-old daughter has been a type 1 diabetic since age 10. Around that time she also developed terrible reflux, for which she is on highest dose PPI. Over the last 6 months her body temperature has been fluctuating; lately she has been having temperatures of 93 and 94 (we have checked using 2 different thermometers). Over the last 6 months she has been increasingly fatigued and has been checked several times for mono (all negative). She now has terrible night sweats, too. Last week she developed a large painful cyst on her labia, which I thought was Bartholin's. However, the OB/GYN at our local hospital said it is simply a bad case of vulvitis (the doc actually took photos, as the swelling extended up into the vagina). The cyst had completely receded by the time the OB/GYN saw her, but it shows up daily with itching and pain. She takes medication for endometriosis but also has dyspareunia, feeling strong pain in her side with sex (making me wonder about adhesions). She contracted C.diff last year and has had alternating constipation with diarrhea for years. I was worried it was a first Crohn's presentation but they did a scope and said it was just self-limiting colitis. Over the past year she has developed regular staph infections on her scalp, shoulders, face, and knees. She gets very frequent migraines (since childhood) with aura. At age 11 she had an appendectomy for what turned out to be mesenteric adenitis.

Her father and I are getting desperate. We live in Canada with an overtaxed healthcare system in a city with just 1 hospital. I feel that the doctors are sick of seeing us and they have written us off as being nuts. We do not have an endocrinologist in our city. Please, please confer with colleagues and help my daughter. I realize insulin sensitivity is a factor. I have also had them test her for celiac, Addison's, and a host of other issues. It is possible she has Lyme disease, too.

Hello doctor:
It is my understanding that type 1 diabetes is an autoimmune disorder. In Canada, these issues are examined by endocrinologists. Please direct me to a different specialty if there is another type of doctor who would be better suited to address the issues I mentioned in my letter:

•     Type 1 diabetic since age 10, brittle
•     GERD since onset of diabetes
•     Migraines since childhood, increasing in frequency and duration
•     Possible allergy to limes and lemons
•     Frequent vision disturbances when moving, even while sitting.
•     Mesenteric adenitis, resulting in appendectomy
•     Chronic staph infections over the last 2 years (shoulders, knees, face, back of scalp).
•     Endometriosis (possible adhesions?)
•     Dyspareunia
•     Vulvitis with cysts that grow and recede
•     Extremely low energy; recently diagnosed with low thyroid, often thought to have mono
•     Alternating constipation and diarrhea
•     C. diff
•     Frequent fevers with no apparent cause
•     Thermal regulation
•     Night sweats

Thank you for any help you can offer,
XXXXX

I forgot to mention that she has recently been started on synthetic thyroid (Synthroid) medication.