Unexplained Symptoms: A Guide to Family Medicine Insights

Q: Unexplained Symptoms: A Guide to Family Medicine Insights

Dear Mr. Ah Sheng： 1. Complete right bundle branch block： For middle-aged individuals, this is generally not a major concern. If you have any questions, please consult a cardiologist. 2. Bilateral apical pleural thickening： This is a common finding on chest

Many physical ailments?

Hello Dr.
Hsiao,
I have been experiencing many bothersome symptoms in my body, and I have been unable to find relief due to the unknown causes.
It started seven years ago with discomfort in my lumbar spine, which later progressed to swelling in both legs.
After the swelling subsided, the skin color turned dark (which has now spread to my calves).
A cardiologist specializing in peripheral vascular issues mentioned that aside from slight vascular aging, there are no significant problems, and I do not have diabetes.
However, over the past few years, my symptoms have increased.
Sometimes after eating, I feel dizzy (especially after sweet soups), my hands and feet are often cold, and I feel that my overall blood circulation and muscular systems are not functioning well.
My vision has become blurry, and I occasionally have unexplained bruises, along with uneven nails.

Due to the multitude of symptoms, I was unsure which specialist to consult, so I recently underwent a comprehensive health check-up.
I was initially worried about diabetes or other issues, but the results showed some deficits.
When I researched these abnormalities, I found that they were either not significant or very vague.
Therefore, I have listed the abnormal findings below and would appreciate your help in identifying which of these abnormalities might be related to my discomfort.
I have been struggling to find the cause of my symptoms for several years, and it has been quite distressing.

1.
Complete right bundle branch block
2.
Bilateral apical pleural thickening
3.
Mild lumbar scoliosis
4.
Hypertrophic changes in the lumbar spine
5.
Low potassium levels
6.
Elevated thyroid-stimulating hormone (TSH)
7.
Mild gastroesophageal reflux disease (GERD)
Thank you, Dr.
Hsiao.

A Sheng, 40~49 year old female. Ask Date: 2018/05/18

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Ah Sheng:
1.
Complete right bundle branch block: For middle-aged individuals, this is generally not a major concern.
If you have any questions, please consult a cardiologist.
2.
Bilateral apical pleural thickening: This is a common finding on chest X-rays and is generally not a major concern.
If you have any questions, please consult a pulmonologist.
3.
Mild lumbar scoliosis and hypertrophic changes in the lumbar spine: These are also common changes in individuals over middle age and are generally not a major concern.
If you have any questions, please consult an orthopedic surgeon.
4.
Mildly low potassium and elevated thyroid-stimulating hormone (TSH): If the deviations are not significant, this is generally not a major concern.
If you still have questions, please consult an endocrinologist.
5.
Mild gastroesophageal reflux disease (GERD): This is a common issue in modern society.
It is recommended to quit smoking, reduce alcohol intake, and avoid coffee and tea.
If you have any questions, please consult a gastroenterologist.
6.
If you have already visited various specialists and still do not have a definitive answer, and if you don’t mind, please consider consulting a psychosomatic medicine or psychiatry specialist, as many psychosomatic disorders can manifest as various physical discomfort symptoms.

Reply Date: 2018/05/18

More Info

Hello! Thank you for reaching out with your concerns regarding your unexplained symptoms. It sounds like you have been dealing with a complex array of health issues for quite some time, and I can understand how frustrating it must be to not have clear answers or effective treatments. Let's break down your symptoms and the findings from your recent health check-up to see how they might be interconnected.

1. Cardiovascular and Circulatory Issues: You mentioned experiencing cold extremities and dizziness after eating, particularly with sweet foods. These symptoms could indicate issues with blood circulation. The slight aging of your blood vessels noted by the vascular specialist could contribute to these symptoms, as reduced circulation can lead to coldness in the hands and feet. Additionally, if you have any underlying conditions such as anemia or thyroid dysfunction, they could exacerbate these symptoms.

2. Musculoskeletal Concerns: Your history of lumbar discomfort and the findings of mild scoliosis and hypertrophic changes in your lumbar spine suggest that there may be structural issues contributing to your discomfort. Chronic pain in the back can lead to compensatory changes in posture and movement, potentially affecting your overall mobility and circulation.

3. Gastrointestinal Symptoms: The mention of mild gastroesophageal reflux disease (GERD) could explain some of your discomfort after eating. GERD can cause symptoms such as dizziness and discomfort, especially if you experience acid reflux that affects your esophagus. It’s also worth noting that certain foods can trigger these symptoms, and sweet foods may lead to increased gastric acid production, resulting in discomfort.

4. Endocrine Factors: The elevated levels of thyroid-stimulating hormone (TSH) suggest that you may have an underactive thyroid (hypothyroidism), which can lead to a variety of symptoms, including fatigue, weight gain, and cold intolerance. This could also explain some of your circulatory issues and the feeling of coldness in your extremities. It’s essential to follow up on this with your healthcare provider, as thyroid dysfunction can significantly impact your overall health.

5. Electrolyte Imbalance: The noted low potassium levels can lead to muscle weakness, cramps, and potentially affect your heart rhythm. It’s crucial to address this with your physician, as maintaining proper electrolyte balance is vital for overall health.

6. Neurological Symptoms: The unexplained bruising and changes in your nails could indicate underlying issues with blood clotting or circulation. It’s essential to discuss these symptoms with a healthcare provider who can evaluate your blood counts and possibly refer you to a hematologist if necessary.

Given the complexity of your symptoms, it may be beneficial to take a multidisciplinary approach. Here are some steps you can consider:
- Follow-Up Appointments: Schedule follow-up appointments with specialists, including an endocrinologist for your thyroid issues, a gastroenterologist for your reflux symptoms, and possibly a rheumatologist if you suspect any autoimmune conditions.

- Comprehensive Blood Work: Ensure that you have comprehensive blood tests done, including a complete blood count (CBC), metabolic panel, thyroid function tests, and possibly tests for vitamin deficiencies or autoimmune markers.

- Physical Therapy: Consider physical therapy for your lumbar spine issues, which may help alleviate some of your discomfort and improve your mobility.

- Dietary Adjustments: Work with a nutritionist to identify any food triggers that may exacerbate your symptoms, particularly regarding your reflux and dizziness.

- Mental Health Support: Given the chronic nature of your symptoms, it may also be beneficial to seek support from a mental health professional. Chronic health issues can lead to feelings of frustration and anxiety, and having a support system can be invaluable.

In conclusion, while it can be overwhelming to navigate multiple symptoms and specialists, taking a systematic approach can help you identify the underlying causes of your discomfort. Don’t hesitate to advocate for yourself and seek the answers you deserve. Your health is a priority, and with the right support and interventions, you can work towards feeling better. Thank you for sharing your concerns, and I wish you all the best on your journey to improved health!

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