Brief Answer: There are many possibilities. Detailed Answer: hi and welcome to health care magic, You have been going through a lot at a young age. I will answer the queries one by one. 1. Regarding the breast lumps: It seems that you may be having fibroadenosis. It is a benign condition but it may cause pain. A fine needle aspiration biopsy does not need any incision or cut. It is done using a needle under local anesthesia. So I suggest that you consult a surgeon and discuss this in consortium with a pathologist as the biopsy will be done by a pathologist. This will help confirm the diagnosis and rule out cancer. 2. The gastrointestinal symptoms: The dehydration, constipation burp, chest pain are all most probably due to problems with digestion. This can be attributable to your job and the night wakings and compounded by the hernia that you had as a child. The chest pain is most likely due to burping and indigestion but I advocate a cardiac evaluation and an ECG for every patient with chest pain to rule out any problems directly in the heart. The hot and cold flashes and body ache suggest an endocrine cause that is some hormonal dysfunction or may be due to anemia as you are already having thalassaemia. 3. The blood levels: Your hemoglobin levels are slightly on the lower side and the blood picture suggests iron deficiency. This can be corrected by taking iron and B complex supplements along with good source or proteins like a boiled egg daily to increase the hemoglobin. 4. The severe pain during periods: There are many causes of chronic pelvic pain: The common ones are infections and endometriosis and both will most likely not be detected on ultrasound. Adhesions due to hernia may also cause pain and again will not be seen on ultrasound. Adenomyosis may also produce pain. Please do not think that this is pain of cancer. You are very young and the ultrasound is not showing anything. Kidney stones also produce severe pain. At this point of time I suggest that you see a gynecologist and get a pelvic examination if possible as endometriosis may be detected. A diagnostic laparoscopy will help in looking inside the abdomen and direct visualization of any pathology. Before that please also see a surgeon and get the hernia and renal stones ruled out. If the mass is palpable during periods, try to get an appointment at that time so that the signs are visible more clearly. If an invasive procedure is not desired a CT / MRI scan of the whole abdomen and pelvis may help clarify matters. I would also suggest a thyroid test for the hot and cold flashes and fatigue, body ache. Please do not think about cancer now. You are young and have a big life ahead of you. First try to rule out common things and then the uncommon ones can be tested. You will need help of specialists from multiple disciplines as you have multiple issues. But these will get sorted out. Just have a step by step approach and all this will end. Hope this satisfies your query. Thanks for using HCM. Feel free to ask any more questions that you may have. Dr Madhuri Bagde Consultant Obstetrician and Gynecologist

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Brief Answer: Your queries are welcome Detailed Answer: Hi XXXXXXX I checked your reports, I tried to view them but all are the same, a presription of 3rd march 2014. I am not sure if they are the same or some problem with my computer. Can you upload them again or just type the main points. The prescription of 3rd is a routine one given for infection contains antibiotics and drugs for acidity and vomiting. It would have helped a lot if an opinion from a physician was available. It is true that iron is not given in thalassaemia as patients usually have iron overload. However your reports show an iron deficiency which is contradictory to what is expected in thalassaemia. If the diet is also low in iron, an iron deficiency anemia will complicate matters. This was the reason I suggested iron. Also if you are taking drugs for thalassaemia, they decrease iron, so if there is excess chelation, again will lead to anemia. Please get a peripheral smear done from a good pathologist to see the shape and morphology of the red blood cells as this will help to determine if iron deficiency is present. The sore throat may be a viral infection, the lack of appetite is due to the drugs you are taking. I suggest you take a capsule vizylac twice a day to improve the appetite and restore the gastrointestinal bacteria. The bodyache may be due to thalassaemia or viral or both. Tablet etova P once a day with milk will help you. If there is nasal congestion a decongestant like cetrizine once day, warm saline gargles and steam inhalation will help. If the symptoms persist despite that you may need investigations and an antibiotic other than the one you have taken and must visit a doctor. Now for the thalassaemia. I suggest that you see a hematologist or a physician MD Medicine. The low iron needs evaluation as you may need to decrease the dose of your chelating drug if any. So do this as soon as possible as the physician will also help you with your respiratory infection. The urination indicates a urine infection and you have already taken ofloxacin that is helpful in that. If the symptoms are still there, get a urine test done. About the weight, alas there is no other way to loose it except controlling the diet and regular exercise. I suggest that you add sprouted beans and cereals to your diet if you are a vegetarian. Protein powders with milk also improve protein intake. Please avoid food rich in oils and sugar and eat vegetables low in oils. I have already advised a gynecologist examination for the ovarian cyst as it may be related to endometriosis if it is causing so much pain. Please do not hesitate to ask. It is a pleasure to answer your queries and I am here to help you always. Cheer up. You will get over all this just do it step by step. First deal with the infection, than the thalassaemia and than a surgeon and gynec opinion preferably during periods for examination of lump. Hope I was able to help. Thanks for using HCM. Have a good day. Dr Madhuri

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