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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54154
Experience:  GP in the United States
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I've been under feeling unwell for about 11 months now. Over

Customer Question

I've been under feeling unwell for about 11 months now. Over that period of time I've had various infections, including an xray confirmed pneumonia last April, 2 atypical pneumonias various sinus infections, lab confirmed UTI which took 3 antibiotics to clear. I have to date on going high blood pressure (I didn't have this before a few months ago) a pulse rate of 90+ at times. I've had 10 antibiotics since last April. What is the most concerning for me is that in those 11 months I had a temp for 48 hrs only and that was about a month ago. Even when I had the xray diagnosed pneumonia I had no cough, no temp, no breathlessness. I didn't feel very sick. I attended the doctor because of the crackling in my lungs which was ongoing for 6 days. A possible atypical was diagnosed retrospectively based on bloods taken in Jan when ALT & AST were raised x3 and Gamma GT also raised. On that day I had high blood pressure and palpatations and polyuria. About 5 weeks ago there was a query over possible legionella. I was hospitalised 3 weeks ago for tests. A chest & abdo CT confirmed previous pneumonia but nothing else. Bloods indicated neutropenia. While in hospital I insisted on further testing. I injured my wrist 3 years ago and after 3 xrays which I was told were all clear, I had a MRI which showed an undisplaced fracture and bone edema. I was told by an orthopaedic doctor that this edema was abnormal in that the injury was an old injury. Bone edema would be normal in a fresh injury but not in an old injury I was told. While I was in the hospital I pushed for further tests and a PET scan revealed the only abnormality was infact my wrist. I had a needle biopsy on fluid and its gone for culturing. After all the antibiotics I don't believe it will culture. Bot***** *****ne I still feel unwell. The first time I was neutropenic was last June, and from there on and off until August. Ive had a lot of blood tests in the past month and all except 2 have had various low neutrophil levels with the lowest 0.9. The discharge plan is that I have nothing wrong with me and apparently be reassured I that - but I'm not. That I wait for a culture result. All my symptoms are on my left side. Headaches, earache, arm pain breast pain. rib pain. All these area show puffiness or slight swelling when there is pain, ongoing nausea sometimes with vomiting diarrhoea, off/on breathlessness as well as the raised BP an pulse, sweats, fatigue, while I was in the hospital I was seen by a haematologist after the neutrophils dropped to 0.9. He said there was nothing in my blood results to suggest an underlining cause, but would see me in 2 months for a bone marrow biopsy if the neutropenia didn't resolve. I didn't see him again even when it dropped to 0.9 the second time. I was told originally all my symptoms were normal after pneumonia and I just needed to rest (I feel so bad at times that I can barely get out of bed) Now that the wrist has come into play I'm told its possible osteomyelitis and my body was fighting an ongoing infection and that the fluid drawn was similar to lancing a boil and that it would most likely resolve. That they infection was sending out poison into my blood stream for a long time now. My neutrophils are 1.89 today which is ok I appreciate that but I know they have dropped like a stone in a few hours and given the lack of a temperature or other obvious symptoms i'm concerned that about becoming ill. All I have to go on is that I feel bad every day but sometimes I feel really bad and that is not enough to convince my PCP even with the neutropenia. My question is I think - should the bone marrow be moved up?
Submitted: 6 months ago.
Category: Medical
Expert:  Dr. Phil, MD replied 6 months ago.

Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Expert:  Dr. Phil, MD replied 6 months ago.

have you had an immunologic workup done?

Customer: replied 6 months ago.
I was told all was in order
Customer: replied 6 months ago.
I've been checked for Lymes disease Wilsons disease and a whole host of unusual and rare conditions apparently. Ive even had a spinal tap
Expert:  Dr. Phil, MD replied 6 months ago.

specifically what tests did you have for immunology?

Customer: replied 6 months ago.
I'm sorry I cant help you there. I don't know specifically, just that they were done and I was told they were fine
Expert:  Dr. Phil, MD replied 6 months ago.

Okay thank you.

1)yes you are correct. The bone marrow needs to be done ASAP. No one has this many infections without something else going on

2)if you haven't seen an actual immunologist I am skeptical the workup is complete

Full immunological workup is needed to exclude an immune deficiency.

let me know if you have other questions.

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Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54154
Experience: GP in the United States
Dr. Phil, MD and 2 other Medical Specialists are ready to help you
Customer: replied 6 months ago.
I was admitted to hospital under a pulmonologist. I attended him first time last June following x ray confirmed pneumonia. other than him, I say the haematologist after I dipped to 0.9. I didn't see him again even though I dipped again to 0.9. I was 16 days in hospital - 8 in isolation due to the neutropenia. while I am 1.89 today, 3 days ago I was 1.35.So could the bone marrow edema while caused originally by the injury, now be causing the neutropenia? or is the bone marrow infected and I'm using up neutrophils quicker than I can make them?what would an immunologist do differently to the haematologist?What would they be looking for in the bone marrow biopsy?
Expert:  Dr. Phil, MD replied 6 months ago.

It could be from the injury. Yes

The immunologist is much better at looking for an immune deficiency

the hematologist is just looking at the bone marrow and blood

Very different

They would be looking for leukemia in the blood or a pre leukemic disorder

Customer: replied 6 months ago.
I assumed that leukaemia was ruled out so what symptoms or tests are involved to rule out pre leukaemic conditions?If they were ruled out also where would I be then?
Expert:  Dr. Phil, MD replied 6 months ago.

The bone marrow biopsy would be the only test

You would then be in need of seeing an immunologist to look for an immune deficiency

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