Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on HCM!


I carefully reviewed your lab tests and would explain that judging from the above results there is no reason for your increased fatigue: there is no anemia, no leukocytosis (a marker of acute inflammation), or any other hematologic disorders.

From the other side, increased citomegalovirus & EBV IgG, but negative IgM antibodies (as your doctor has confirmed) are a marker of a a previous infection, not an actual.

Coming to this point, I would recommend some clues t oconsider:

- It is true that your viral (CMV & EBV) infection is considered a past infection, but it is also true that in certain individuals (especially with a more vulnerable immune system) it may reactivate after being latent for a long period of time, and may be demonstrated with flu like symptoms, fatigue, pneumonia, myalgia, neuropathy. In this regard, I would advise discussing witrh your internal or infectious disease doctor for reviewing the viral infection status. Certain antiviral and symptomatic therapy would be beneficial. Certain viral, immunological and other lab tests should be checked (including also, PCR, ESR, CPK, AST, ALT).

- As you have a history of allergy and respiratory symptomatology, I would recommend performing a pulmonary function test (for excluding any insidious pulmonary dysfunction, bronchial hyperreactivity, etc.).

- Also, the currently prescribed medications (sertraline and xanax) may exert similar clinical symptomatology (fatigue): sertraline up to 16% of cases and xanax up to 35% of patients. I recommend discussing with the prescribing physician on the possibility of reducing or stopping those drugs in case of improved underlying simptomatology (anxiety, etc.)

Hope to have been helpful to you!

In case of any further uncertainties feel free to ask me again.

Kind regards,

Dr. Iliri

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Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

I would explain that PCR and ESR are indicators of inflammation. Increased levels are a sign of inflammation, which could also be related to an active infection.

CPK are muscular enzymes, which are indicator of muscular damage.

AST and ALT are liver enzymes which are elevated in disorders that affect the liver.

I recommended performing these tests in order to exclude a reactivation of EBV infection (which can lead in increased levels of the above tests).

Anyway, they exclude other disorders too.

They do not indicate something serious, but help determine the possible cause of your symptomatology. Treatment of the primary cause leads to normalization of these parameters.

I would also recommend performing thyroid hormone levels for possible thyroid dysfunction and cortisol plasma levels for the examination of the adrenal gland. These tests help exclude possible hormonal causes that may lead to similar symptoms.

From the other hand chronic fatigue can be a sign of depression and uncontrolled anxiety. If all the above mentioned tests result normal, you should discuss with your doctor on the possibility of making some changes to your actual therapy.

Hope to have been helpful!

Best wishes,

Dr. Iliri

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Brief Answer:
I would explain as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

Cortisone is an ant-iinflammatory drug, and it can reduce the levels of PCR and sedimentation rate.

I would recommend performing these tests after a week, because of possible interfering of cortisone intake with the lab results.

Hope to have clarified some of your uncertainties.

Regards,

Dr. Iliri

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