Persistent Health Issues: A Guide to Family Medicine Concerns

Frequent health issues?

Since March, I have been feeling unwell and have seen eight doctors so far.
It all started one afternoon when I suddenly experienced pain in my lower right abdomen near the groin, so severe that I couldn't stand up straight, along with gastrointestinal discomfort.
My mother helped me schedule an appointment with a family physician.
After auscultation, the doctor said there were no abnormalities (perhaps because I wasn't in pain at that moment?), and prescribed some gastrointestinal medications (antacids and anti-flatulent).
They also arranged for urine and stool occult blood tests, which came back mostly normal, except for urine ketones at 3+.
I recall that the test was done five hours after breakfast, during which I had not eaten anything and hardly drank any water.
That morning, due to poor appetite, I only managed to eat half of a serving of an egg pancake.
During that time, I was feeling quite unwell and was only eating about one-third of my usual rice intake.
Could this be the reason for the high urine ketones? Although the doctor issued another test order, my mother thought it was due to my reduced breakfast intake and the five-hour gap since eating, so she decided against further testing.
However, after researching online, I found that the presence of urine ketones could indicate diabetes, which made me somewhat anxious.
Yet, my symptoms don't completely align with diabetes; I have suspected increased urination, but only when I'm not sweating, and I tend to drink a lot of water, needing to urinate every 0.5 to 1 hour.
When I sweat, I often don't feel the urge to urinate and don't drink or eat excessively, which should rule out the possibility of diabetes, right? Does a urine test also check for glucose? If there were a real possibility of diabetes, wouldn't the doctor have mentioned it instead of saying that if it happens again, we should check for kidney issues? Recently, I have been frequently feeling dizzy, even getting lightheaded just walking up from the first to the third floor, let alone squatting down and then standing up, which makes me feel like I'm going black in front of my eyes.
Is this a symptom of anemia?

Ballet, 10~19 year old female. Ask Date: 2017/05/30

Dr. Chen Taicheng reply Family Medicine

● The diagnostic criteria for diabetes include four standards: (1) Fasting blood glucose ≥ 126 mg/dL, (2) Two-hour blood glucose ≥ 200 mg/dL after a 75 g oral glucose tolerance test, (3) Random blood glucose ≥ 200 mg/dL with symptoms of hyperglycemia, (4) Hemoglobin A1c ≥ 6.5%.

● Fasting urine tests can cause an increase in urine ketones.
Given your age, the likelihood of diabetes is low; if you are concerned, a fasting blood glucose test can rule out diabetes.
Urine tests can also detect urine glucose, but in early diabetes, urine glucose may not show significant abnormalities.

● Feeling faint is not necessarily a symptom of anemia; anemia is just one possible cause.
The experience of seeing black when standing up from a squat is more indicative of orthostatic hypotension.
You may consider visiting a family medicine clinic for further evaluation, including testing for anemia.

● Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department cares about you~

Reply Date: 2017/05/30

More Info

Dealing with persistent health issues can be a daunting experience, especially when multiple medical consultations yield inconclusive results. Your situation, characterized by abdominal pain, gastrointestinal discomfort, and concerning lab results, warrants a comprehensive understanding of potential underlying conditions and the importance of effective communication with healthcare providers.

Firstly, the right lower abdominal pain you experienced could stem from various causes, including gastrointestinal issues, urinary tract problems, or even gynecological conditions, depending on your gender. The fact that the pain subsided by the time you saw the family doctor may have made it challenging for the physician to identify the issue. It’s essential to note that abdominal pain can be transient and may not always present during a medical examination.

The lab results indicating the presence of ketones in your urine (3+) suggest that your body might be in a state of ketosis, which can occur when the body breaks down fat for energy instead of carbohydrates. This can happen due to inadequate food intake, prolonged fasting, or certain medical conditions, including diabetes. However, the presence of ketones alone does not confirm diabetes; it is merely a marker that requires further investigation. Typically, urine tests can measure glucose levels, and if your doctor suspected diabetes, they would likely have ordered additional tests, including blood glucose levels.

Your concerns about diabetes are valid, especially given the symptoms you described, such as increased urination and thirst. However, the absence of other classic symptoms, such as significant weight loss, extreme fatigue, or persistent hunger, may suggest that diabetes is less likely. It’s crucial to communicate these symptoms to your healthcare provider, who can then decide whether further testing is warranted.

The dizziness you experience, particularly when moving from a seated to a standing position, could indicate orthostatic hypotension, which is a drop in blood pressure upon standing. This can be related to dehydration, anemia, or other cardiovascular issues. Given your reduced appetite and food intake, it is plausible that you might be experiencing some degree of anemia, which can lead to fatigue and dizziness. A complete blood count (CBC) would be beneficial in assessing your hemoglobin levels and overall blood health.

In managing your health concerns, it is vital to maintain open lines of communication with your healthcare provider. If you feel that your symptoms are not being adequately addressed, consider seeking a second opinion or asking for a referral to a specialist, such as a gastroenterologist or an endocrinologist, who can provide more focused care based on your symptoms.

Additionally, keeping a detailed diary of your symptoms, dietary intake, and any other relevant factors can help your doctor better understand your condition. This information can be invaluable during consultations, allowing for a more tailored approach to your diagnosis and treatment.

Lastly, if you are feeling overwhelmed or anxious about your health, do not hesitate to seek support from family, friends, or mental health professionals. Chronic health issues can take a toll on mental well-being, and having a support system can make a significant difference in your overall experience.

In summary, persistent health issues require a proactive approach to diagnosis and management. By advocating for yourself, maintaining clear communication with healthcare providers, and seeking support when needed, you can navigate this challenging journey more effectively.

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