My ANA test for three years has come back normal, but I continue to get lesions, my hair falls out, and I get sick easily. I have been to two rheumatologists. Both say I do not have SLE, but my family doctor feels I do. What do you think?

I was also told that because I only have discoid lupus, this would not cause any health problems other than with my skin and hair. So why do I have it in my nose and inside both ears? I’m now 33, my bones are brittle, and I have osteoarthritis in my hands and fingers. Help!

DEAR READER: Whew, where to start? Some children have impaired immune systems, making them subject to numerous disorders. My guess is that you were unfortunate enough to fall into that category.

There are a number of forms of lupus, which is an autoimmune disease. Lupus can affect joints, skin, kidneys, brain, heart, lungs and other parts of the body. Common symptoms include skin rash, kidney problems, arthritis and unexplained fever.

Discoid lupus is a chronic skin disorder that shows as a raised red rash that ordinarily appears on the face and scalp but can appear in other areas of the body, including the nose and ears. The lesions may last for days or years and can recur. Some people diagnosed with discoid lupus may develop systemic lupus erythematosus (SLE) at a later date.

Because arthritis is a common complaint, it’s not at all surprising that you have been diagnosed with fibromyalgia, chronic pain in muscles and ligaments.

Pleurisy is swelling of the lung linings that causes pain and breathlessness during inhalation and exhalation. Causes include acute viral infections, such as influenza, and can be the result of autoimmune disorders, such as lupus.

Kidney stones and related infections have numerous causes, including dehydration, obesity, genetic factors and a diet high in protein/sugar/sodium.

Vertigo can be caused by an inner-ear disorder, migraine headache, acoustic neuroma and other causes.
Depression and anxiety can be caused by lupus, fibromyalgia, kidney stones and vertigo. You have a lot on your plate, and it has obviously resulted in a lot of stress. Osteoarthritis, a breakdown of cartilage, causes pain and stiffness of affected joints. The condition is commonly associated with the aging process, but at 33, you are far from old. Treatment is geared toward controlling pain through medication, rest, exercise and protection of the affected joint(s).

Because so many of your symptoms involve pain, I’m inclined to suggest that you be referred to a pain clinic for control or request a referral to a larger diagnostic center, such as the Mayo Clinic. You will learn methods for reducing the level of pain you presently experience that may include water aerobics and yoga. Appropriate medication might be ordered. Once you get that aspect under control, the anxiety and stress levels you are under may be reduced.

To provide related information, I am sending you a copy of my Health Report “Fibromyalgia.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

DEAR READER: I’m glad I could help. I will definitely provide an update as new developments unravel.

To provide related information, I am sending you a copy of my Health Report “Headaches.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 4409-20167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I have had 3 complete blood counts, thyroid and B12 tests, a CT scan of my chest, stomach and pelvis, a colonoscopy, and an endoscopy. I was told I have irritable bowel syndrome (IBS) since my tests have all come back normal. A nutritionist has told me that my body mass is extremely low.

My symptoms vary and can include headaches, increased urination, fatigue, lower stomach cramps, plugged ears, tender stomach, nausea, bloating, gas, loss of appetite, abdominal pain, skipped heart beats, different bowel patterns every day, and high anxiety.

I used to be a very upbeat positive person but now I have very nervous and have many strange thoughts and behaviors. I have an extreme fear of vomiting which sometimes causes me to miss entire meals. I drink coffee every day even if I don’t eat. I have skipped lots of meals because of pain and fear, and even if I feel hungry and can hear my stomach growling, I will ignore.

I am now a very self-centered, depressed person and care only to read about what could be wrong with me.

My doctor told me I could be ill because of my anxiety and has offered medications to try but I refuse them because of the possible side effects.

Could this really be IBS or are my doctors missing something?

DEAR READER:
I believe your problems can all be traced back to one thing: your irrational fears and anxiety. By not eating, you have lost far too much weight, are likely undernourished and your caffeine intake and smoking habit are not helping.

Caffeine is essentially a diuretic which could explain your increased urination. It can also cause or worsen nervousness, anxiety and palpitations. Your bowel patterns are different every day because of your inconsistent food intake. Stomach pain, bloating, tenderness, nausea and gas can be linked back to your inadequate and infrequent eating habits. After a period of not eating anything substantial, your stomach will become unable to properly digest and absorb nutrients.

I believe your best course of action is to seek out a physician, nutritionist and therapist who can all work together to help you understand your fears, develop an appropriate eating plan and monitor you. In my opinion, if there were an underlying physical illness, it would have been found. IBS is unlikely but once you are back on a normal diet, the IBS diagnosis can be confirmed or denied.

You have essentially developed a serious eating disorder. Eating disorders are not about gaining or losing weight, they are about control, fear and other emotional and psychological factors.

You need help. Consider admitting yourself to a facility that specializes in eating disorders where you will have access to physicians, nutritionists and therapists to help you work through this difficult time.

To give you related information, I am sending you a copy of my Health Report “Eating Disorders”. Other readers who would like a copy should send a self-addressed, stamped envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

DEAR READER:
Ativan is used to treat anxiety disorders. It is also unavailable in 100 mg tablets. At that dosage she would have to be taking 50 of the highest dosage pills (2 mg) every day. I highly doubt this is the situation. Perhaps she is taking 1 mg daily. This is something that you need to clarify in case of an emergency. Knowing proper prescription names, dosages, etc. is vital. The same holds true for her Zoloft.

Zoloft is prescribed for panic disorders and as an anti-depressant. It is available in 25, 50, and 100 mg tablets. A general initial dose would be 25 mg per day for the first week, with graduation to 50 mg following that. Periodic evaluation by a physician would determine a necessity for an increase in dosage. Therefore, your mother could certainly be (and in my opinion, most likely is) overmedicated.

Side effects from the two medications are similar. These include confusion, agitation, drowsiness, dizziness, balance/coordination problems, weakness, nausea, and changes in appetite. Ativan carries the very serious side effect of seizures and Zoloft may (usually during initial treatment) worsen depression and increase thoughts of suicide or bodily harm. Also of interest is that Zoloft can adversely interact with Ativan.

I believe now is the time to sit down with your mother’s physician and psychiatrist to explain what is going on and express your concerns that she is being over medicated. If they are unwilling to listen, perhaps it is also time to find a new psychiatrist who will re-evaluate her and hopefully reduce her medications.

To give you related information, I am sending you copies of my Health Reports “Medical Specialists” and “Mental and Emotional Illness”. Other readers who would like copies should send a self-addressed, stamped number 10 envelope and $2 (per report) to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

When I visited my heart specialist following my surgery and told him about the situation, he would only say it was anxiety. He continued to ignore my list of incidences and maintained it was anxiety. I have had anxiety before on various occasions, such as when my car was totaled, but I never had to stop and take deep breaths. I explained that this only began after my stent surgery and that i thought it was something other than anxiety.

Should I ask for a second opinion, or is this normal after receiving a stent? Do I just live with it?

I have had a chemical thallium chloride test. To quote from my family doctor’s report, it said “No definite evidence for ischemia on today’s examination.” I hope this helps you to help me.

DEAR READER: Shortness of breath can be a sign of ineffective contractions of the heart muscle, known as congestive heart failure. It can also reflect anemia and lung problems such as blood clots, emphysema and other disorders. Although your heart workup was normal, you need further testing, and I agree that a second opinion is in order. Ask your family doctor to refer you to an internal-medicine specialist.

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease”. Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.