Your Symptoms: Which Specialist to Consult for Unexplained Illness?

Family medicine issues?

Hello Doctor: Since June 30th, I have been experiencing alternating sensations of cold and heat, feeling extremely uncomfortable in air conditioning, and sweating profusely.
At times, I also feel a burning sensation in my arms and shoulders.
I visited a local clinic, and the doctor diagnosed it as a gastrointestinal flu.
After taking the medication prescribed by the clinic, I experienced a sensation of coolness that seemed to move around my body, affecting my legs, fingers, and cheeks intermittently.
I consulted an infectious disease specialist, but they could not determine the cause.
Later, I went to another clinic where I was prescribed steroids.
After taking one pill, I experienced coldness in my left hand; however, the sensation of coolness moving around my body decreased the following day.
Currently, for three consecutive weeks, I feel uncomfortable whenever I am in an air-conditioned environment during the day, but I do not feel cold under direct sunlight, except for sweating at the back of my head, while other areas sweat less.
At night, I experience fever, palpitations, waking up, measuring my temperature (between 36.2°C and 36.5°C), sweating all over, feeling cold, trembling, going back to sleep, and then feeling feverish again.
I would like to know which specialty I should consult for this condition.
Thank you!

ken, 40~49 year old female. Ask Date: 2017/07/17

Dr. Chen Taicheng reply Family Medicine

● Fluctuating temperatures can indeed be a sign of infection, but it is possible that the infectious disease specialist's examination did not reveal significant abnormalities at that time.
● Symptoms such as fever at night, palpitations, and sweating, in addition to the previously mentioned infections, should also consider conditions like hyperthyroidism, arrhythmias, abnormal blood pressure, endocrine tumors (such as pheochromocytoma), inflammation, medications, as well as fluctuations in blood sugar levels and panic attacks, which can present similarly.
● It is recommended to visit a family medicine, endocrinology, or infectious disease specialist for further evaluation.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department cares about you~

Reply Date: 2017/07/17

More Info

Hello,
Thank you for reaching out with your concerns regarding your unexplained symptoms. Based on your description, it sounds like you are experiencing a complex set of symptoms that could be indicative of several underlying issues. Given the variety of symptoms you mentioned, including fluctuating temperatures, sweating, and sensations of heat and cold, it is essential to approach this situation methodically.

First and foremost, it is advisable to consult with a primary care physician (PCP) or a family medicine doctor. They can perform a comprehensive evaluation of your symptoms and medical history. A PCP is well-equipped to assess a wide range of health issues and can help determine if your symptoms are related to an infectious process, an autoimmune condition, or perhaps even a neurological issue. They may also conduct initial tests, such as blood work or imaging studies, to rule out any serious conditions.

If your PCP finds that your symptoms may be related to a specific system in your body, they might refer you to a specialist. Here are a few specialists that could be relevant based on your symptoms:
1. Infectious Disease Specialist: Since you initially saw an infectious disease doctor, if your symptoms persist or worsen, it may be beneficial to revisit this specialist. They can further investigate any potential infections that might not have been identified during your previous visits.

2. Neurologist: If your symptoms include neurological manifestations, such as the burning sensations in your arms and shoulders or the coldness in your left hand, a neurologist can evaluate for conditions like neuropathy or other nerve-related issues.

3. Endocrinologist: Given the symptoms of sweating, heart palpitations, and temperature regulation issues, it may be worthwhile to consult an endocrinologist. They specialize in hormonal and metabolic disorders, which can sometimes lead to symptoms like those you are experiencing.

4. Rheumatologist: If there is a suspicion of an autoimmune disorder, a rheumatologist can help diagnose and manage conditions that could cause systemic symptoms, including temperature dysregulation and fatigue.

5. Psychiatrist or Psychologist: If your symptoms are accompanied by significant anxiety or stress, consulting a mental health professional may also be beneficial. Sometimes, physical symptoms can be exacerbated by psychological factors.

In addition to consulting the appropriate specialists, it is crucial to keep a detailed record of your symptoms, including when they occur, their duration, and any potential triggers (like exposure to air conditioning). This information can be invaluable for your healthcare providers in diagnosing your condition.

Lastly, while waiting for appointments or further evaluations, consider lifestyle modifications that may help alleviate some symptoms. Staying hydrated, managing stress through relaxation techniques, and maintaining a balanced diet can support your overall health.

In conclusion, start with your primary care physician, who can guide you through the process of identifying the right specialists based on your symptoms. It’s important to advocate for yourself and seek the care you need to understand and manage your health effectively. I wish you the best in your journey toward finding answers and relief from your symptoms.

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