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What Do These Blood Reports Indicate?
Question: I HAVE SUFFERED OF FEVER LIKE SYMPTOMS, (MY ENTIRE BODY FEELS LIKE IT IS ON FIRE, BUT ESPECIALLY MY FEET AND HANDS), AND I HAVE SUFFERED JOINT PAINS. LATELY, I HAVE PAIN ON MY LEFT TOE, (IT HURTS WHEN I MOVE IT UP AND DOWN AND HAVE RECEIVED SEVERAL STEROIDS INJECTIONS). I DID SOME ANALYSIS AND THE MOST IMPORTANT FINDINGS ARE THESE: URIC ACID OF 2.0, ASTO, C-REACTIVE PROTEIN AND RHEUMATOID FACTORS ARE NEGATIVE AND MY ESR IS 28 (F: 0-20M). PLEASE TELL ME WHAT I HAVE?
Brief Answer:
CAuse of multiple complaints
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well I would like to ask you a few questions before I can guide you where it is heading. Since you have already been seen by a lot of doctors, would try to narrow down to a few provisional diagnosis and we can work it up from there
1. Do you feel a lot of fatigue all the time? Especially in morning also after waking up
2. Do you have symptoms of dry mouth and dry eyes.? Like a constant urge to drink water especially during meals
3. Any history of weight loss or apetitie loss?
4. When you say fever, how high does it go on the thermometer
5. Do you feel any irritability/forgetfulness/improper sleep/frequent headache/frequent urination?
6. Has Your ANA, Vitamin D levels been checked??
7. Which joints are more painful for you??Have you seen swelling in the joints as well??
As per your blood reports they are mostly normal. Uric acid problem does not affect the females till their menopause. SO you need not be worried about it. I want to look at other causes as it does not look like inflammmation or else you would have responded to steroid injections. Plus your ESR and CRP are normal( 28 is not high), so it also goes against Inflammatory disease.
So do let me know these queries. Would try my best to provide you a direction
Regards
Dr Naval
CAuse of multiple complaints
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well I would like to ask you a few questions before I can guide you where it is heading. Since you have already been seen by a lot of doctors, would try to narrow down to a few provisional diagnosis and we can work it up from there
1. Do you feel a lot of fatigue all the time? Especially in morning also after waking up
2. Do you have symptoms of dry mouth and dry eyes.? Like a constant urge to drink water especially during meals
3. Any history of weight loss or apetitie loss?
4. When you say fever, how high does it go on the thermometer
5. Do you feel any irritability/forgetfulness/improper sleep/frequent headache/frequent urination?
6. Has Your ANA, Vitamin D levels been checked??
7. Which joints are more painful for you??Have you seen swelling in the joints as well??
As per your blood reports they are mostly normal. Uric acid problem does not affect the females till their menopause. SO you need not be worried about it. I want to look at other causes as it does not look like inflammmation or else you would have responded to steroid injections. Plus your ESR and CRP are normal( 28 is not high), so it also goes against Inflammatory disease.
So do let me know these queries. Would try my best to provide you a direction
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Prasad
I do not feel fatigued or tired. But I have constant pain on my wrists. I do have symptoms of dry mouth, not too sure about my eyes and I do not have history of weight loss. As a matter of fact, I am overweight at this point. I measure 5 ft, 1 inch and I weigh 168 lbs. When I say fever, I do not really have a fever, but rather I feel like my entire body is on fire. I am hot, but internally. I am not sweating or have headaches or other fever like symptoms. It is my body that feels like it is very hot. Whenever I touch someone, they mention to me that my hands are warm as if though I have a fever, but like I said, it is not a fever. It is not daily, but it does happen vey often. Sometimes, my feel get so hot, that I wet a towel and wrap it around my feet, in front of a fan or AC to cool off the heat. My internist had recommended that I see an endocrinologist due to these symptoms, but I never did. No I do not feel a frequent urge to urinate and my ANA and Vitamin D levels have not been checked. Last year, I suffered a facial paralysis, but was treated early and didnt hae any permanent damage and I dont think it has to do anything with the pain that I have started to develop on my left toe finger. It hurts on the side and under the toe finger and the pain is spreading up my calves to my knees. The orthopedic surgeon has diagnosed me with tendonitis or a injury of the metatarsosesa ligament or the tibial sesamoid flexor hallucis since it is in that section that I have the most pain. The pain and spasms are extending up in my calves and I feel sometimes a burning and tingling sensation at the bottom of my foot. Apart from pain in my wrists, I do not have pain in my knees. I have been diagnosed with thyroid fever (thyroid tests are normal), rheumatic fever and juvenile artistis ( ASTO, CRP and rheumatic factor are all negative, lupus (lupus test are all negative). I did an MRI too due to the facial paralysis and the doctor says that I might have chiari malformation. Please let me know if you need to see XXXXXXX of my tests. My concern at the moment though is my toe, which limits my quality of life since I cannot walk because I have pain, I cannot jump b/c of fair of injury to the toe finger, no exercise that requires constant movements due to pain and fear of injury. Thank you and I look forward to a diagnosis.
Brief Answer:
Toe Pain
Detailed Answer:
Good evening
Sorry for the late reply. Was caught up in hospital duty.
Thanx for your detailed reply. I have gone through all the history.
Well yes if you could post the results it would be helpful. That will give me a fair idea on what all work up has been done for your symptoms and what all is pending, so we can take it from there.
The toe pain can be very frustrating and it is very unusual for just the toe to be affected that badly. Considering you are only 40 years, there is a very little chance it could be due t Gout. Gout pain normally doesnt last so long and subsides itself. 2nd possibility, we need to see is if there is any stress fracture which is causing you continuous pain not getting relieved with any pain killers. 3rd possibility, is Dactylitis that is, inflammation of the toes ( joint + tendon) which normally gives the toes a sausage shape. It is a high possibility of it as well considering you have pain in the other joints and tendons as well.
That is a more common diagnosis with Psoriatic arthritis or Enthesitis related arthritis.
What I would like to know here is:
1. How much benefit you get from the pain killers or steroid injections( was it given intra articular/intramuscular)
2. I would like to see the X ray of the toe along with your other blood reports to know what exactly is going on. If you could click a picture of the toe affected, that would be very helpful. I can rule out dactylitis at least.
3. If nothing is conclusive, we will need an MRI of the foot to see what exactly is going wrong. But lets keep that as a last option..
4. Also supplement your diet with Vitamin D supplements which would help reduce the body ache and the joint pains.
DO upload the results and the xrays along with the Foot pic. I will get back to you and we can narrow down on further diagnosis as it is a bit hard to pin point the correct one without examining the patient. But never the less, we can narrow it down to the most suitable one
Await your reply
Regards
Dr Naval
Toe Pain
Detailed Answer:
Good evening
Sorry for the late reply. Was caught up in hospital duty.
Thanx for your detailed reply. I have gone through all the history.
Well yes if you could post the results it would be helpful. That will give me a fair idea on what all work up has been done for your symptoms and what all is pending, so we can take it from there.
The toe pain can be very frustrating and it is very unusual for just the toe to be affected that badly. Considering you are only 40 years, there is a very little chance it could be due t Gout. Gout pain normally doesnt last so long and subsides itself. 2nd possibility, we need to see is if there is any stress fracture which is causing you continuous pain not getting relieved with any pain killers. 3rd possibility, is Dactylitis that is, inflammation of the toes ( joint + tendon) which normally gives the toes a sausage shape. It is a high possibility of it as well considering you have pain in the other joints and tendons as well.
That is a more common diagnosis with Psoriatic arthritis or Enthesitis related arthritis.
What I would like to know here is:
1. How much benefit you get from the pain killers or steroid injections( was it given intra articular/intramuscular)
2. I would like to see the X ray of the toe along with your other blood reports to know what exactly is going on. If you could click a picture of the toe affected, that would be very helpful. I can rule out dactylitis at least.
3. If nothing is conclusive, we will need an MRI of the foot to see what exactly is going wrong. But lets keep that as a last option..
4. Also supplement your diet with Vitamin D supplements which would help reduce the body ache and the joint pains.
DO upload the results and the xrays along with the Foot pic. I will get back to you and we can narrow down on further diagnosis as it is a bit hard to pin point the correct one without examining the patient. But never the less, we can narrow it down to the most suitable one
Await your reply
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor, I was not ready to close the discussion, but I was gathering the documentation to send to you for your review. Anyway, I have the papers and will be attaching those as soon as I find the way to do so,
Brief Answer:
Further discussion
Detailed Answer:
Good evening XXXX
I was wondering when you didnt reply. Was trying to narrow down the diagnosis in the best way I could. You can contact the help desk people here and they will help you out. Either they will email me the attachments or upload it here.
Await your reply
Regards
Dr Naval
Further discussion
Detailed Answer:
Good evening XXXX
I was wondering when you didnt reply. Was trying to narrow down the diagnosis in the best way I could. You can contact the help desk people here and they will help you out. Either they will email me the attachments or upload it here.
Await your reply
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi, I have provided some attachments. Please review them.
Brief Answer:
Attachments reviewed
Detailed Answer:
Good evening
Thank you for your reply. Sorry had a long duty today, so got delayed in replying
Your results have been fairly ok so far. Except for minor alterations in the Complete blood count, all of it has come out negative. Some of them are a bit old, but never the less most of them have been in normal limits. As such in the past and even with 2013 results, there does not look like any evidence of lupus.
But since your toe symptoms have been recent, it will be worth while we get an X Ray done to see where exactly is the problem. Is it some form of injury or bone swelling underneath?Repeating your ESR, CRP at this stage would give us a better clue if it is inflammation or degeneration...Plus as mentioned before, supplement urself with Vitamin D levels.That would take care of your fatigue
Do let me know if you have the X ray done. I still would like to see an X ray of the foot to see why the toe is bothering your daily life style.
Await your reply
Regards
Dr Naval
Attachments reviewed
Detailed Answer:
Good evening
Thank you for your reply. Sorry had a long duty today, so got delayed in replying
Your results have been fairly ok so far. Except for minor alterations in the Complete blood count, all of it has come out negative. Some of them are a bit old, but never the less most of them have been in normal limits. As such in the past and even with 2013 results, there does not look like any evidence of lupus.
But since your toe symptoms have been recent, it will be worth while we get an X Ray done to see where exactly is the problem. Is it some form of injury or bone swelling underneath?Repeating your ESR, CRP at this stage would give us a better clue if it is inflammation or degeneration...Plus as mentioned before, supplement urself with Vitamin D levels.That would take care of your fatigue
Do let me know if you have the X ray done. I still would like to see an X ray of the foot to see why the toe is bothering your daily life style.
Await your reply
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
I will get the x-ray done. However, did you get pages 12, 13 14, up to page 17. They were the more recent tests. I sent a pic of the toe too, where I had marked an X where it hurts. Additionally, i noticed whilst going over my previous tests that the ESR has always been high, in every test that I have ever done it is above the range. Not too high, but above the range. Can you please explain why you asked if I experience dry mouth often?
Brief Answer:
Raised ESR
Detailed Answer:
Good evening
Hey I did not get the pages after page 10. So could not review your last results. Even the toe picture did not get through. Could you try it once more or you might mail it to YYYY@YYYY . I can look at it and get back to you.
Well, the ESR has been on the borderline mostly( 20-25) which is quite ok. ESR as we know can vary with food intake, infections and lab to lab variations are known. If we suspect a connective tissue disease or inflammation, We expect it to go up to 40-50. That gives us a better clue to the ongoing process. Dont be worried about it :)
Dry mouth I wanted to know to rule out Sjogrens syndrome. It is a lupus like syndrome, but usually mild and it can cause lot of fatigue, malaise, joint pains. It is usually a slow progressing disease and takes upto 8-10 years to finally come out. With Sjogrens we can have ANA negative, but dry eyes and dry mouth have to be present which can be confirmed by salivary gland biopsy. So i wanted to review your last results if anything had come up this time. The previous ones, didnt look too conclusive.
Do send me the remaining pages and the pictures
Await your reply
Regards
Dr Naval
Raised ESR
Detailed Answer:
Good evening
Hey I did not get the pages after page 10. So could not review your last results. Even the toe picture did not get through. Could you try it once more or you might mail it to YYYY@YYYY . I can look at it and get back to you.
Well, the ESR has been on the borderline mostly( 20-25) which is quite ok. ESR as we know can vary with food intake, infections and lab to lab variations are known. If we suspect a connective tissue disease or inflammation, We expect it to go up to 40-50. That gives us a better clue to the ongoing process. Dont be worried about it :)
Dry mouth I wanted to know to rule out Sjogrens syndrome. It is a lupus like syndrome, but usually mild and it can cause lot of fatigue, malaise, joint pains. It is usually a slow progressing disease and takes upto 8-10 years to finally come out. With Sjogrens we can have ANA negative, but dry eyes and dry mouth have to be present which can be confirmed by salivary gland biopsy. So i wanted to review your last results if anything had come up this time. The previous ones, didnt look too conclusive.
Do send me the remaining pages and the pictures
Await your reply
Regards
Dr Naval
Above answer was peer-reviewed by :
Dr. Prasad
Hi, I have provided some attachments. Please review them.
Brief Answer:
Reports reviewed
Detailed Answer:
Good evening XXXX
I hope you are doing good. I finally got all the results and have reviewed them.
1. With the blood reports, the last Complete blood count was ok. ESR is 28, but I wont stray much importance on it as the last CRP was negative. It does not fit in with inflammation happening in the toe or any other connective tissue disease which i was thinking. Never the less, it cant be ruled out.
2. I reviewed your last year reports( October 14). They had a slight elevation of liver enzymes( SGOT, SGPT). It may be due to fatty liver but you should repeat it once to check if they are increasing or they are stable
3. As for the toe, there does not look like any swelling in the joint( examination would be more useful). But I would suggest a simple X ray of the foot to see if the joint has an Osteoarthritis changes. Probably because of the weight, it is unable to take the pressure. Till then you can try with simple analgesics like Tylenol, Use soft shoes and dip in your feet in hot water twice daily for 5 minutes. It should eventually subside. But yes weight reduction is a must. Once the pain is better, you can start exercising.
As for all the symptoms you have been experiencing, the blood reports have mostly been good. When the reports are mostly normal, we need to look at the other conditions. I would suggest you go through this topic and see if your symptoms match.. If they do, I think we have a diagnosis as you have already been subjected to lot of tests and scans.
Kindly read up on www.rheumatology.org--> Patient education--> Fibromyalgia
Do let me know what you feel. Will update you more on it, once we are sure your symptoms match with it
Regards
Dr Naval
Reports reviewed
Detailed Answer:
Good evening XXXX
I hope you are doing good. I finally got all the results and have reviewed them.
1. With the blood reports, the last Complete blood count was ok. ESR is 28, but I wont stray much importance on it as the last CRP was negative. It does not fit in with inflammation happening in the toe or any other connective tissue disease which i was thinking. Never the less, it cant be ruled out.
2. I reviewed your last year reports( October 14). They had a slight elevation of liver enzymes( SGOT, SGPT). It may be due to fatty liver but you should repeat it once to check if they are increasing or they are stable
3. As for the toe, there does not look like any swelling in the joint( examination would be more useful). But I would suggest a simple X ray of the foot to see if the joint has an Osteoarthritis changes. Probably because of the weight, it is unable to take the pressure. Till then you can try with simple analgesics like Tylenol, Use soft shoes and dip in your feet in hot water twice daily for 5 minutes. It should eventually subside. But yes weight reduction is a must. Once the pain is better, you can start exercising.
As for all the symptoms you have been experiencing, the blood reports have mostly been good. When the reports are mostly normal, we need to look at the other conditions. I would suggest you go through this topic and see if your symptoms match.. If they do, I think we have a diagnosis as you have already been subjected to lot of tests and scans.
Kindly read up on www.rheumatology.org--> Patient education--> Fibromyalgia
Do let me know what you feel. Will update you more on it, once we are sure your symptoms match with it
Regards
Dr Naval
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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