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What Causes Eye Pain, Blue Toe Nails And Fatigue?
Question: My 18 year old son just had some labs done and is experiencing symptoms of eye pain,blue toe nails, fatigue. I glanced over previous labs and discovered his Protein,Albumin,Creatine,hematocrit all have been high or AB for at least 4-5 years. He has high frequency deafness on one side, was born with a heart murmur that closed within a few months after birth. His white blood cells are low as well as absolute neutrophils. He has a history of fatigue,dizziness and depression and although in the top 5% at school, has a tough time "thinking". His t3 uptake was elevated a few years back. Recently he told me he is a transgender woman and a week ago started taking spironlactone and lexapro. He intends to increase the spironlactone and begin hormones in the near future. I am concerned about his health and currently to not have a primary doctor. What type of doctor would be a good choice to start with?
Brief Answer:
Hi I would recommend an endocrinologist to start with
Detailed Answer:
Hello mam,
I did review your concern. I can understand that you have gone through a lot and
you are very brave person.
I would recommend that you consult an endocrinologist to start with since he wants to start medications to change his internal hormonal status and an endrocrinologist is the best person who can guide him with right advice and also help you with proper initial investigations. Spironolactone can cause hyperkalemia is a side effect and also water loss and hyponatremia and hence it is to be used with caution and also when rightly indicated.
so I would recommend you to consult an endocrinologist who will chart out the best options available for him. Later on a gender identity therapist who are psychologists trained in helping transgender oriented persons might be of help for long term treatment options. Our main focus should be his overall healthy life ahead.
I hope this helps
wish you all the best.
Let me know if you have any more questions or concerns.
Sincerely,
Dr Parth Desai
Hi I would recommend an endocrinologist to start with
Detailed Answer:
Hello mam,
I did review your concern. I can understand that you have gone through a lot and
you are very brave person.
I would recommend that you consult an endocrinologist to start with since he wants to start medications to change his internal hormonal status and an endrocrinologist is the best person who can guide him with right advice and also help you with proper initial investigations. Spironolactone can cause hyperkalemia is a side effect and also water loss and hyponatremia and hence it is to be used with caution and also when rightly indicated.
so I would recommend you to consult an endocrinologist who will chart out the best options available for him. Later on a gender identity therapist who are psychologists trained in helping transgender oriented persons might be of help for long term treatment options. Our main focus should be his overall healthy life ahead.
I hope this helps
wish you all the best.
Let me know if you have any more questions or concerns.
Sincerely,
Dr Parth Desai
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you. Should I be worried about the labs or blue nails? I will look for an endo on our plan.
Brief Answer:
Hi I would recommend the following-
Detailed Answer:
Hi thank you for your reply query
I need to look at the lab reports more closely as in terms of the exact values and aberrations for normal to comment on them.
Blue toe nails especially if accompanied by bluish tinge on tongue would arise suspicion of cyanosis which can be due to multiple issues.
First of all if he has shortness of breath along with blue nails, an echocardiogram is advisable to rule out cyanosis due to heart issues( since he also had when he was very young)or lung issues requiring at least a chest x-ray. Other reasons could be due to local factors slowly blood flow or due to some rare types of hemoglobin causing mild non symptomatic cyanosis and that requires a hematologist consult with hemoglobin electrophoresis.
High protein and albumin in serum are not much of worry, but if there is consistently high creatinine (depends on average values) then a renal function tests are also indicated to know whats wrong with the kidneys. But I need to look at the complete reporst to better advice further tests and possibilities. I would recommend you to upload the reports here and I can have a look at them.
I know it sounds too much of tests but we have to stay positive and take every bit as a challenge as you have been taking till now.
I hope this helps
Wish you all the best.
Let me know if you have any more concerns or questions mam.
Sincerely,
Dr Parth Desai.
Hi I would recommend the following-
Detailed Answer:
Hi thank you for your reply query
I need to look at the lab reports more closely as in terms of the exact values and aberrations for normal to comment on them.
Blue toe nails especially if accompanied by bluish tinge on tongue would arise suspicion of cyanosis which can be due to multiple issues.
First of all if he has shortness of breath along with blue nails, an echocardiogram is advisable to rule out cyanosis due to heart issues( since he also had when he was very young)or lung issues requiring at least a chest x-ray. Other reasons could be due to local factors slowly blood flow or due to some rare types of hemoglobin causing mild non symptomatic cyanosis and that requires a hematologist consult with hemoglobin electrophoresis.
High protein and albumin in serum are not much of worry, but if there is consistently high creatinine (depends on average values) then a renal function tests are also indicated to know whats wrong with the kidneys. But I need to look at the complete reporst to better advice further tests and possibilities. I would recommend you to upload the reports here and I can have a look at them.
I know it sounds too much of tests but we have to stay positive and take every bit as a challenge as you have been taking till now.
I hope this helps
Wish you all the best.
Let me know if you have any more concerns or questions mam.
Sincerely,
Dr Parth Desai.
Above answer was peer-reviewed by :
Dr. Raju A.T
We were told Mark had a heart murmur when born that resolved in three months after birth. He was born on 10/6/96 and my original due date was at the end of the month.
Mark has a history of migraines. They were at their worst in 4th grade, 2007. No longer present.
Mark has had a history of high frequency hearing loss in one ear. He didn’t pass hearing tests early on in elementary through high school. An MRI was done that showed normal internal auditory canals.
There was an incidental note of cave septum pellucidum.
The ENT had no answers for his hearing loss.
Mark’s shoulder is double jointed. On the same side he has a hip issue.
Mark has had trouble with fatigue, dizziness and depression. Thanks again.
Mark has a history of migraines. They were at their worst in 4th grade, 2007. No longer present.
Mark has had a history of high frequency hearing loss in one ear. He didn’t pass hearing tests early on in elementary through high school. An MRI was done that showed normal internal auditory canals.
There was an incidental note of cave septum pellucidum.
The ENT had no answers for his hearing loss.
Mark’s shoulder is double jointed. On the same side he has a hip issue.
Mark has had trouble with fatigue, dizziness and depression. Thanks again.
Brief Answer:
hello I would recommend the following
Detailed Answer:
Hello mam.thank you for your reply query and the reports.
I did have a look at the reports and I believe mild increase in hematocrit, protein and albumin are due to mild dehydration and so can be the trace ketones in urine.
I would recommend regularly monitored fluid intake. If he is having increased urination then he needs to be investigated for polyuria.
Mild proteinuria is significant if it is found in a repeat urine test within 1 month and then might require a renal biopsy to see the cause of proteinuria.
i believe his murmur would have been patent foramen ovale or patent ductus arteriosus seen in prematurely born children and that must have healed on its own. so recently developed blue nails does need a repeat echocardiography and chest xray if not done recently.
Rest of his investigations seem fine, but with all this problems I am suspecting if there is likelyhood of any genetic disorder (especially with double jointed shoulders, hearing loss and migraine attacks in childhood) and I would recommend a consultation with a geneticist to know if these constellation of problems can be grouped in one syndrome and what problems can occur in the future potentially that can be avoided by appropriate precautions.
I hope this helps mam
Let me know if you have any more questions or concerns.
wish your family all the best.
sincerely,
Dr Parth Desai.
hello I would recommend the following
Detailed Answer:
Hello mam.thank you for your reply query and the reports.
I did have a look at the reports and I believe mild increase in hematocrit, protein and albumin are due to mild dehydration and so can be the trace ketones in urine.
I would recommend regularly monitored fluid intake. If he is having increased urination then he needs to be investigated for polyuria.
Mild proteinuria is significant if it is found in a repeat urine test within 1 month and then might require a renal biopsy to see the cause of proteinuria.
i believe his murmur would have been patent foramen ovale or patent ductus arteriosus seen in prematurely born children and that must have healed on its own. so recently developed blue nails does need a repeat echocardiography and chest xray if not done recently.
Rest of his investigations seem fine, but with all this problems I am suspecting if there is likelyhood of any genetic disorder (especially with double jointed shoulders, hearing loss and migraine attacks in childhood) and I would recommend a consultation with a geneticist to know if these constellation of problems can be grouped in one syndrome and what problems can occur in the future potentially that can be avoided by appropriate precautions.
I hope this helps mam
Let me know if you have any more questions or concerns.
wish your family all the best.
sincerely,
Dr Parth Desai.
Above answer was peer-reviewed by :
Dr. Prasad
Can we get a referral to an Endocrinologist or geneticist?
Brief Answer:
Hello mam, I believe you will have to direct a question to specialist
Detailed Answer:
Hello mam,
I believe you will have to direct the specific question to the specialist doctor in the panel.
let me ask the healthcare magic customer care if they can do it for you meanwhile from my side
thank you
sincerely
Dr Parth Desai.
Hello mam, I believe you will have to direct a question to specialist
Detailed Answer:
Hello mam,
I believe you will have to direct the specific question to the specialist doctor in the panel.
let me ask the healthcare magic customer care if they can do it for you meanwhile from my side
thank you
sincerely
Dr Parth Desai.
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Neel Kudchadkar
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