:confused:My girlfriend is presenting with general body symptoms.
She has had several tests performed by the VA, however the lack of attention received and the growing intensity and changing of of her symptoms have us concerned whether the VA has made a competent diagnosis.
Patient Age - 71 Ht 5'2" Wt 140
History -benign lesion on breast - lesion removed. She underwent a 5 year course of tamoxifen ending about 3 years ago.
High Cholesterol - taking prescribed simvastatin.
She was very active, dancing, working, gardening.. always on the go.
However a few weeks ago she started feeling lethargic, loss of energy. Sleeping a lot. Became short tempered.
Suddenly, overnight... she woke up in the morning and couldn't move arms or legs. Couldn't stand or walk. Complained of knee pain and soreness.
She went to the emergency room, (VA) and was
admitted to the Naval Hospital for an overnight stay.
Vital signs were normal
HR - 77; BP 141 / 79; RR 16; T 98.9; Sp02 96%
wbc 8.4, hgb 14.5, plt 165, N 81.5%
C-Reactive Protein tests showed an elevated level of CRP 18.8 ESR 95
Neurological examination was negative.
They took a plate film of the knees showing b/l osteoarthritic changes with small joint space effusions. equal bilateral
That's it.... she was given acetaminophen (325mg) and sent home after 12 hours of observation.
That was on January 30/31 2010.
Three days later she received a call saying she tested positive for Lyme disease and immediately started antibiotics for lyme disease (see notes below)
She spends a lot of time gardening and always complains about attracting mosquitos. There are a lot deer in the backyard... this is suburbia, deer hunting is prohibited, the deer population is totally out of control. So lyme
disease is understandable as a partial diagnosis.
She started treatment on February 04, 2010
A 28 day course of vibramycin (doxycycline) 100mg 2x daily (oral).
Acetaminophen 325 mg 2 tablets every 4 hours. (Tyenol)
Naproxen 500 mg 2x daily. (Naprosyn)
PriloSEC (omeprazole) 20mg 1x daily for upset stomach.
Her symptoms are progressing getting worse and new ones are appearing. The VA primary care provider is not returning phone calls (we had a recent series of snowstorms here which shut down the VA Medical Center).
Her feet are swollen
Her left shoulder is exceedingly painful to the touch, even a slight touch and she will cry out in pain.
She is not ambulatory, can't walk, can barely get out of bed.
Mentally, she is alert, cognitive, no fever, no complaints about hypertension (she was told to temporarily discontinue taking her medication.) No irregular heartbeat,
Everything seems to be normal except for joint pain, soreness, lethargy, inability to stand, lack of strength.
As mentioned, we have been trying to get in contact with the primary care provider again this is a naval medical center so she gets to see whoever is on duty.... there has been no followup since first diagnosis and syptoms seem to be getting progressively worse.
What do you think ?? The only diagnosis so far was Lyme's disease, her
lab tests came back positive, however they said that does not explain
the symtoms and feel there might be other factors involved, however have not performed or even suggested anything.
Are there other tests which should be done to rule out other causes ??
Should she be getting a second opinion from a specialist or a generalist ?
Her pain medication , Tyenol and Naprosyn seem to be the bare minimum and are not doing anything to alleviate the pain. Should she be requesting a stronger pain medication (tyenol #3, darvocet).???
What to do next ??? Has anyone experienced a similar situation before ??
Thanks in advance for your opinion.