I am getting recurrent diarrhea, nausea, fatigue and much more. What is the reason?

Question

Hello doctor,

I am having some recurrent symptoms:

Nausea (intermittent).
Diarrhea.
Extreme fatigue (daily).
Severe insomnia even on Ambien (falling asleep faster but still waking up three times a night, and I always wake up exhausted).
Muscle weakness, especially in the arms.
Low exercise tolerance.
Cold sensitivity.
Dry skin and hair; hair loss has gotten worse since surgery.
Brain fog and forgetfulness 95% of the time.
Eye pain and blurriness (intermittent).
Anxiety and depression after oophorectomy.
Dizziness, intermittent when standing for longer.
Bone pain in the shins, hips, and hands.
Joint and muscle pain (better now on Cymbalta).
Frequent urination.

My weight before five months was 226 lbs, and my current weight is 179 lbs (47 lbs lost in 5 months). No stomach pain with rare constipation.

I have attached my laboratory report.

Kindly assist.

Answer 1

Hello,

Welcome to icliniq.com.

I have read the attached reports. (attachment removed to protect patient identity).

The red blood cell count, hemoglobin, and HCT (hematocrit) are slightly raised.

So secondary polycythemia seems most likely.

The smoking habit, heart problems, chronic lung disease, and dehydration are some of the causes for it.

You have a repeated diarrhea history. So, diarrhea can cause dehydration, and that is the reason for secondary polycythemia.

You need to maintain hydration with lots of water, at least two to three liters per day.

You need to investigate with endoscopy or CT (computed tomography) colonoscopy, virtual colonoscopy like investigations for further workup for diarrhea.

Stool routine, microscopic examination, and culture should also be done.

Diarrhea can cause electrolyte loss in fluid, so muscle weakness and bone pain can occur.

I suggest you take Vital Z (oral rehydration salt) with water to replenish the lost electrolytes.

You need to investigate SGPT (serum glutamic pyruvic transaminase), urea, creatinine, serum vitamin D, and serum TSH (thyroid-stimulating hormone) estimation as well.

You can revert back once all reports are done.

Thank you.