Brief Answer: An internists opi opinion needed. Detailed Answer: Hi and thanks for the query, The breathing problem would deserve a careful clinical evaluation. It might be necessary to note if you have any history of lung disease, lung cancer in the family or if you have been a smoker. A physical examination and a chest X ray, coupled with a cardiac ultrasound should be able to orient the proper cause of these symptoms. Asthma and other obstructive lung diseases could present as such, as well as heart conditions. Hoarseness of the voice, especially of recent onset is generally associated to viral infections and upper respiratory tract infections. However, persistence or absence of such a history should compel a proper evaluation of the throat by an ENT specialist. Cysts at the level of the throat, swelling or at times tumors are not very rare causes of voice hoarseness, especially amongst singers. A history of smoking is important in this case too. It might be necessary to note which muscles or joints are mostly affected by pain or tiredness. In case these are proximal muscles or joints (shoulders, pelvic girdle), it is possible that this should be polymyalgia rheumatica, a disease that responds so well to steroids. Other rhuematologic joint conditions however have to be excluded, especially in case a strong family history of such diseases is nboted. Rheumatoid arthritis, lupus, mixed connective tissue disease. Measuring lupus markers, erythrocyte sedimentation rate and the rheumatoid factor are important and strong markers that could give much inside into the possible causes of the joint pain. Depending on what type of joints are affected, the distribution whether symmetric or not and specific pain characteristics, a specific diagnosis can be made. It is important to keep a string morak. Exercise, interacting with trusted friends and seeking advice from a psychologist could help you, prevent you from being anxious or get into a state of depression. Such a state could predispose to memory problems. Taking drugs like Gamalate B6 have proven very helpful in some persons with memory problems. A proper review by an internist, in my opinion, would be a good initial step for a holistic appreciation of your health status. Do feel free asking follow up questions in case you got specific concerns that you feel should be addressed. You are more than welcome. Kind regards as I wish you the best of health. Dr Bain

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