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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45195
Experience:  Board Certified Physician
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Hi this is a follow-up question to one I asked on 21/3/14 titled

Customer Question

Hi this is a follow-up question to one I asked on 21/3/14 titled 'hi I've been feeling unwell and excessively tired for a year' unfortunately due to a tech glitch I can't view this question or the answers.

I have been feeling progressively worse since then and am now at my wits end about where to go from here. It is severely impacting my ability to live a normal life. I am stuck in bed the majority of the time, either asleep for 18+ hours at a time or barely able to sit up due to dizziness and feeling so weak. I do get up and walk/sit in garden when I can manage it but this is getting increasingly rare. I have diabetes and my medication does not seem to make any difference to my sugar levels, currently I run around 10-12mmol/l but I don't notice any difference in how I feel whether they are high or low, my diabetes nurse says my feeling I'll is not due to the diabetes as my last hba1c a month ago was 7.5% , however my gp says it's all to do with the diabetes and I am going round in circles from one to the other!!!
I basically need some advice as I am due to see my gp tomorrow and would like to know what I should be asking from him. Here is a list of tests I've had done already and where I have them the results :

Hba 1c 7.5%
TSH 0.4 (slightly below lab range)
T3/t4 normal
Postural hypotension test normal
Bp 130/90
Urine neg for all but glucose
Vitamin d low, now on supplements
Vitamin b12 284
Lft normal except alt still at 90, no change
Bone profile normal
Fbc normal
Serum protein raised at 8

I suffer alot of leg pain and my feet get so swollen and hot the skin feels like it will split, my heartrate is consistently 110+ even at rest when I am relaxed, the worst symptoms are of feeling extremely drowsy and dizzy, and a feeling of constant 'brain fog' any slight exersion makes it all a hundred times worse. I am starting to feel like a hypochondriac but surely this is not normal for a previously healthy 33 year old. Please advise on what I should ask my doctor tomorrow because I'm really hitting a blank and he sends me round in circles.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.

Dr. David :

This is Dr. David

Dr. David :

you should ask your GP to do ANA and ESR testing to check for autoimmune disorders.

Dr. David :

you could have a thyroiditis as well. ask to check anti thyroid antibodies.

Dr. David :

you could have Atrial fibrillation. you need a heart EKG and a cardiac echocardiogram ultrasound scan of your heart.

Dr. David :

have you had your iron and B12 and folate and vitamin D levels checked?

Customer:

Hello thank you for your reply, I have had an ecg which was normal except fast heartrate. I will ask the gp for ANA and ESR, he seems to have a 'wait and see' approach to the thyroid but I can push the matter with him. Iron is normal, had vitamin d, was low am on supplements, b12 was 284 and I'm not sure about folate. Would it be worth asking for parathyroid and cortisol tests? I think the serum protein was to do with inflammation in the body? That came back abnormal at 8, high for the lab range. I forgot to mention I also have gallstones, was diagnosed via ultrasound scan 5 years ago, had flare ups every few months but not too bad, last 6 months I have pain in that area constantly.

Dr. David :

cortisol abnormalities are actually very rare.

Dr. David :

if your blood calcium levels are normal, then most likely your parathyroid hormones are normal.

Dr. David :

if your TSH level is 0.4, this could be normal, or you could be boarderline hyperthyroid, which can cause fast heart rate.

Dr. David :

that is why I suggested testing for anti thyroid antibodies to check for hashimotos thyroiditis.

Customer:

Yes, last time I had it done before it was 1.6 that was 3 months before, so it has gone down

Dr. David :

I see.

Customer:

Okay I will ask thank you for your help.

Dr. David :

you are welcome

Dr. David :

best of luck to you

Dr. David :

I hope you get some answers

Dr. David :

if done for now

Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45195
Experience: Board Certified Physician
Dr. David and other Medical Specialists are ready to help you
Customer: replied 2 years ago.

Hi just a quick question, could some of the symptoms I am suffering from be due to chronic stress or depression? Or is it just likely they have made things worse or harder to cope with? My doctor commented and it sounded like he thinks alot of it just the diabetes and psychological. Feeling very confused. I have a very very unstable stressful home life, and nil in the way of social support.

Customer: replied 2 years ago.

My question remains unanswered.

Expert:  Dr. David replied 2 years ago.
some of your symptoms could be due to chronic stress or depression. this can also make other symptoms worse as well.

your hemoglobin a1c is way too high

you might need to go on insulin to help control your sugar levels

your TSH levels are boarderline too low, this could be a real issue

so your symptoms could be more than just stress
Customer: replied 2 years ago.

I had thyroid antibodies checked that came back normal, also a test to see if the statin I am on has caused muscle tissue breakdown, all negative. Not sure what to ask for from my gp, they said they would send me for scan as my liver ALT levels are still around 90 but this hasn't been actioned. I have spent the last week doing as much as I can to get up out of bed and take gentle exercise but suffer major muscle pain and fatigue after minor exertion. A short walk around my local supermarket left me so tired I slept for all the afternoon, evening and night.

Expert:  Dr. David replied 2 years ago.
you need a liver scan and possible liver biopsy

have you had ANA and ESR testing for autoimmune disorders?

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