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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What Causes Severe Leg Pain And Fatigue And Nausea?

49 yo Female with History of Breast cancer, 3 yrs post chemo, Hashimoto s, obesity, GERD, depression and restless leg syndrome. Having sever leg/foot pain when I walk. Also moderate to sever abdominal pain, all 4 4 quads, bloating, burning, nausea decrease appetite. Fatigue. Have been on Nexium for years but recently stopped. Have tried carafate, no relief. Have been having the epigatric pain for over 2 months. Changed my diet. Cut out sodas and started Paleo diet. Mild relief at first but not now.
Mon, 10 Apr 2017
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General & Family Physician 's  Response
Hello, thank you for your question. This is a complex, multifactorial problem with many potential contributors. Do you smoke? Do you drink alcohol? Are you in a high stress environment? These three factors are commonly associated with gastritis, or inflammation of the lining of the stomach. You are already on an Anti-acid medication Nexium, which is a great medication, but what dose are you on? Many times we can titrate up to provide additional relief. Other thoughts:

1) Cut out spicy food from your diet
2) Cut out eating large, fatty meals
3) Do not eat late at night
4) Sleep with a pillow so your head is approx. 30 degrees tilted up
5) Get tested for infections, particularly H. pylori bacteria, which can be detected using a Breath Test or a Blood test. If positive, you should be on a triple therapy of Antibiotics and Anti-acid therapy.
6) Another common cause of gastritis are problems at the sphincter that controls ins and outs into the stomache. Relaxation of this sphincter is important for proper gut motility, as its its location. Excessive relaxation or malposition, such as occurs in Hiatal Hernias, can cause many of your symptoms. Tests that can be performed include overnight esophageal pH monitoring and Ultrasound of the Abdomen to assess for hernias and other problems, such as Gallstones.
7) Irritable Bowel Syndrome is commonly associated with depression and pain disorders like Fibromyalgia. These are difficult to treat conditions and should be evaluated properly by a medical professional rather than discussed online.
8) Other causes of leg pain at rest can include cardiovascular diseases, like peripheral vascular disease and diabetic neuropathy. An arterial ultrasound of the lower extremities can diagnose this condition. Also, given your history of Chemotherapy, many of the drugs used are notorious for causing a neuropathy that is not reversible. I would recommend you discuss this with your monitoring Oncologist, as well as the possibility of gastroparesis from the chemo as well, which can cause delays in food moving through your GI tract.
9) Hashimotos thyroiditis is also associated with many other auto-immune conditions that can affect the muscle and general metabolic state. Given your fatigue and history of Hashimotos, it is important to check your thyroid levels (TSH, Free T3 and T4) regularly and have your physician adjust your medication as necessary.
10) There are many medications that have been used for restless leg syndrome. Assuming you have tested negative/normal for all of the etiologies I have mentioned above, you can try 1) Melatonin 2) 5-HT 3) Iron (make sure you check that your blood counts are not anemic as this is a common cause of restless leg syndrome in females) 4) Lyrica Rx 5) Gabapentin Rx 6) Clonidine Rx
11) Always be vigilant for Breast cancer recurrence, which can cause fatigue, weight loss and many other symptoms. You should be on a medication like Tamoxifen for at least 5 years and get at least a yearly mammogram for surveillance.


These are just a few of the total possible recommendations for your ailments. I recommend you seek additional consultation in person for you symptoms and a proper work up be undertaken.

Dr. Marco
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What Causes Severe Leg Pain And Fatigue And Nausea?

Hello, thank you for your question. This is a complex, multifactorial problem with many potential contributors. Do you smoke? Do you drink alcohol? Are you in a high stress environment? These three factors are commonly associated with gastritis, or inflammation of the lining of the stomach. You are already on an Anti-acid medication Nexium, which is a great medication, but what dose are you on? Many times we can titrate up to provide additional relief. Other thoughts: 1) Cut out spicy food from your diet 2) Cut out eating large, fatty meals 3) Do not eat late at night 4) Sleep with a pillow so your head is approx. 30 degrees tilted up 5) Get tested for infections, particularly H. pylori bacteria, which can be detected using a Breath Test or a Blood test. If positive, you should be on a triple therapy of Antibiotics and Anti-acid therapy. 6) Another common cause of gastritis are problems at the sphincter that controls ins and outs into the stomache. Relaxation of this sphincter is important for proper gut motility, as its its location. Excessive relaxation or malposition, such as occurs in Hiatal Hernias, can cause many of your symptoms. Tests that can be performed include overnight esophageal pH monitoring and Ultrasound of the Abdomen to assess for hernias and other problems, such as Gallstones. 7) Irritable Bowel Syndrome is commonly associated with depression and pain disorders like Fibromyalgia. These are difficult to treat conditions and should be evaluated properly by a medical professional rather than discussed online. 8) Other causes of leg pain at rest can include cardiovascular diseases, like peripheral vascular disease and diabetic neuropathy. An arterial ultrasound of the lower extremities can diagnose this condition. Also, given your history of Chemotherapy, many of the drugs used are notorious for causing a neuropathy that is not reversible. I would recommend you discuss this with your monitoring Oncologist, as well as the possibility of gastroparesis from the chemo as well, which can cause delays in food moving through your GI tract. 9) Hashimotos thyroiditis is also associated with many other auto-immune conditions that can affect the muscle and general metabolic state. Given your fatigue and history of Hashimotos, it is important to check your thyroid levels (TSH, Free T3 and T4) regularly and have your physician adjust your medication as necessary. 10) There are many medications that have been used for restless leg syndrome. Assuming you have tested negative/normal for all of the etiologies I have mentioned above, you can try 1) Melatonin 2) 5-HT 3) Iron (make sure you check that your blood counts are not anemic as this is a common cause of restless leg syndrome in females) 4) Lyrica Rx 5) Gabapentin Rx 6) Clonidine Rx 11) Always be vigilant for Breast cancer recurrence, which can cause fatigue, weight loss and many other symptoms. You should be on a medication like Tamoxifen for at least 5 years and get at least a yearly mammogram for surveillance. These are just a few of the total possible recommendations for your ailments. I recommend you seek additional consultation in person for you symptoms and a proper work up be undertaken. Dr. Marco