Unexplained Symptoms: When to Seek Further Medical Evaluation

I don't know what's wrong with me?

Hello Doctor, two months ago I experienced discomfort in my body (my heart sometimes races and beats irregularly, I have difficulty breathing, occasional diarrhea, occasional constipation, and a feeling of abdominal bloating.
Sometimes I experience symptoms of sleep paralysis while sleeping, but the cause has not been identified.
Therefore, I underwent a health check-up, and the results showed some abnormalities: my urine indicated a mild inflammatory response, my average blood sugar level was elevated, and my CA 19-9 tumor marker was 42.02, which is slightly above the normal range.
Recently, I have also been feeling weak, experiencing headaches that improve after a short rest, but these symptoms recur.
I have diarrhea, cloudy urine, frequent episodes of sleep paralysis, and I have lost about 2.5 kilograms in weight.
My lifestyle has involved staying up late more often.
I would like to ask the doctor if there is a possibility of a serious malignant disease and if I need to undergo any further tests.
Thank you.

Hsu, 10~19 year old female. Ask Date: 2019/05/02

Dr. Chen Jiaming reply Surgery

You have described too many nonspecific symptoms, making it difficult to provide a clear direction for diagnosis and treatment (it's not just a single organ issue).
However, "staying up late" itself can lead to various systemic disorders and changes in constitution.
I strongly recommend that you change your lifestyle (get adequate sleep) for a month, and then reassess any remaining symptoms.

Reply Date: 2019/05/02

More Info

Hello,
Thank you for sharing your concerns regarding your health symptoms. It sounds like you are experiencing a range of distressing issues, including irregular heartbeats, gastrointestinal problems, sleep disturbances, and fatigue. Given the complexity of your symptoms and the abnormal findings from your recent health check-up, it is crucial to approach this situation with a thorough understanding and a proactive mindset.

Firstly, the symptoms you describe—such as palpitations, shortness of breath, abdominal bloating, alternating diarrhea and constipation, and sleep paralysis—can be indicative of various underlying conditions. The elevated CA 19-9 tumor marker, while it can be associated with certain cancers, is not specific and can also be elevated in benign conditions, particularly those related to the gastrointestinal tract. Therefore, it is essential not to jump to conclusions without further evaluation.

Your elevated blood sugar levels could suggest the possibility of prediabetes or diabetes, which can contribute to fatigue and other systemic symptoms. Additionally, the urinary findings of mild inflammation may point to a urinary tract infection or other renal issues that could be affecting your overall health.

Given your symptoms and the abnormal test results, I recommend the following steps:
1. Follow-Up with a Specialist: It would be prudent to consult with a gastroenterologist regarding your gastrointestinal symptoms, especially since you are experiencing significant changes in bowel habits. They may recommend further testing, such as an endoscopy or imaging studies, to evaluate your digestive health.

2. Cardiology Evaluation: Since you are experiencing irregular heartbeats and shortness of breath, a consultation with a cardiologist is advisable. They may perform an electrocardiogram (ECG), echocardiogram, or Holter monitor to assess your heart's rhythm and function.

3. Endocrinology Consultation: Given your elevated blood sugar levels, seeing an endocrinologist could help determine if you have diabetes or another metabolic disorder. They can provide guidance on lifestyle changes and potential medications to manage your blood sugar.

4. Sleep Specialist: Your experience with sleep paralysis and fatigue may warrant evaluation by a sleep specialist. They can conduct a sleep study to assess for conditions such as sleep apnea, which could be contributing to your daytime fatigue.

5. Comprehensive Blood Work: Request a complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid function tests, and possibly tests for autoimmune conditions or infections, depending on your physician's assessment.

6. Lifestyle Modifications: In the interim, consider making lifestyle changes that could improve your symptoms. This includes maintaining a balanced diet, staying hydrated, managing stress through relaxation techniques, and ensuring adequate sleep hygiene.

7. Monitor Symptoms: Keep a detailed diary of your symptoms, including their frequency, duration, and any potential triggers. This information can be invaluable for your healthcare providers in diagnosing and managing your condition.

In conclusion, while it is understandable to be concerned about the possibility of a serious illness, it is essential to approach this situation methodically. Engaging with healthcare professionals who can provide targeted evaluations and treatments will be key to addressing your symptoms effectively. Remember, early intervention can often lead to better outcomes, so do not hesitate to seek further medical evaluation.

Take care, and I wish you the best in your journey toward better health.

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