Discussions By Condition: I cannot get a diagnosis.

Petechiae, bruises, fatigue, shortness of breath ...

Posted In: I cannot get a diagnosis. 2 Replies
  • Posted By: txpacotaco
  • December 17, 2011
  • 05:38 PM

During the summer of 2010 I had multiple angina attacks that resulted in an angiogram. I was diagnosed with a "very mild" coronary artery disease (not life threatening) - I had a blockage in a branch off my main coronary artery. My cardiologist told me it would either heal open, or heal closed, in which case my body would compensate with new blood flow. I have not had any angina since then, but it did make me more alert as far as my health is concerned.

Last March I started working with my regular doctor to try to figure out what was causing some cyclical symptoms (all-over muscle spasms/cramps, fatigue, bone pain, flu-like sinus and cough issues followed by mouth sores and geographic tongue, along with thrush) that started about 3 years ago. These "flares", as I think of them, tend to last about 2 - 3 weeks and I may have a few months in between them. My doctor ran a CBC with differential and noted that I had an elevated WBC, but offered no diagnosis or follow up.

In June, I saw a different doc at the same clinic for a 2nd opinion. She suggested I come back while I was experiencing a flare up for new blood work. In August I did just that, and my WBC was still elevated. My SED rate, CRP and ANA were all normal. I was referred to a hematologist for the elevated WBC.

The hematologist told me some of my blood tests were abnormal (see below), but she didn't see anything to indicate leukemia, and that the elevated WBC meant there was inflammation going on somewhere in my body. She asked me to come back in 6 months for follow-up testing.

A couple of months ago, I suddenly noticed that the lanula on my toenails had turned red, and around the same time I developed vertical red lines on my thumbnails. At this point in time, the red lines are still there and I now have a red "arc" across the top of the lanula on all of my fingernails. Over the past several weeks I have started noticing that I become terribly fatigued during the day, and I am very short of breath. Something as simple as changing our cat's water bowl leaves me out of breath. My arms and legs feel very heavy and ache as though I have been lifting weights. The "normal" cycle of symptoms I had been experiencing hasn't happened this time - instead, everything just seems to be slowly getting worse without letting up. My stomach is extremely bloated and I can't eat very much at any sitting - just a few bites before I feel too full to eat more. (Despite this, I have gained about 15 pounds since June.)

A few days ago I came down with what I think is a minor cold (runny nose, cough). At the same time, I suddenly developed new petechiae on my wrists, but this time, I also developed bruises . These bruises are dark blue and I have a couple on the inside of my right wrist, one just above my right elbow, and another on the back of my right upper arm. My arms have been very achey since these new petechiae showed up. Both my arms and my lefts feel terribly heavy and I feel as though I don't have the strength to lift things. I become out of breath and fatigued even trying to do minor housework (doing the dishes, taking out the trash, etc).

I have tried 3 things to follow up with my doctors:
Have attempted to make an appointment with the clinic I've been going to for years. The doctor never showed up for the first appointment (I have no idea what happened there), the clinic cancelled the 2nd appt. because I'd made it for the same day and they said my symptoms did not indicate an emergency, and the 3rd time I called for an appointment, their phone system hung up on me. I've decided to move to a different clinic here in Austin (I've been with this one for more than 10 years), but can't get in to see anyone until Jan 5.
I saw my cardiologist and he ordered an echocardiogram and a cardiac perfusion scan. I've had the echocardiogram, and am having the other scan on Tuesday (with a follow-up with the cardiologist to discuss results on Wednesday). He said he does not expect the results to indicate any worsening in my CAD status.
I left a message for my hematologist and they've made an appointment for me to get blood drawn on Monday - they'll call me in for a consultation if my blood test results are abnormal.
At 45 years old, I would expect to feel energetic and healthy, but my intuition tells me something very dangerous is happening in my body. I worry about cancer (which runs in my family). I worry about autoimmune disease (my father has a rare form of vasculitis called Wegener's Granulatmatosis). I worry about worsening heart disease (also runs in my family). I want to make sure I'm asking for the right tests and seeing the right doctors, but the situation with my primary care physician leaves a lot of that up to me.

Any suggestions would be helpful. Has anyone else been through something similar?

Abnormal blood tests in August I mentioned above:

WBC = 13.1 (ref 4.8 - 10.8)
Monocyte % = 1 (ref 6.0 - 12.0)
Eosinophil % = 0.00 (ref 0.9 - 2.9)
HCT = 48 Spun (ref 37.0 - 47.0)
MCH = 34.3 (ref 27.0 - 31.0)
MCHC = 32.7 (ref 33.0 - 37.0)

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  • I have had some similiar issues. I have just posted my first post -Catnip- so check that out. So many doctors send us to speciailist and the specialist says it is nothing with your "heart" and dismisses you. When you make a new appointment try to get into an Internal Medicine Specialist. they are considered primary care (like a general practioner), but they have done some additional training. make sure they are Board Certified. this means they passed the test to call themselves an IM specialist. Take your records with you. Your WBC were high, which is most indicative of an infection, could be viral or bacterial. There are other reasons, but we usually look at infection first. You only listed some of the differential (these are the different types of white blood cells). Different amounts of different white blood cells help them diagnose the problem. I suspect they will rerun everything you have from 6 months ago, including the ANA, CRP, and ESR. I would ask for a more complete work up. They need to look at your electrolytes, and liver enzymes. They refer to these in some places as chem panels. Different things like electrolytes out of whack can cause some of your symptoms. Even if they don't explain things they have to check them first.I have the same issue with bleeding/bruises. Ask the hematologist about von wildebrands disease. You can have fairly normal clotting times, but be missing or low on a clotting factor that can cause bleeding. There are a lot of these factors and bleeding and clotting is complicated. You wont get fast answers on that and be prepared for giving lots of blood. Even if the hematologist finds nothing there are some diseases that cause bruising so make sure to mention this to all your doctors. Take a picture with your phone if you have to. Thats what I do so they can see the details.I am also SOB with exertion with no answers. But they need to check this. Probably an x-ray. They will ask if you have had asthma (have you?), any lung disease in your family. Also, are you around anything corrosive, asbestos, 2nd hand smoke. All this stuff needs to be rules out. They may do pulmonary funstion tests (breathing tests takes about an hour). they should also walk you around with a pulse oximeter on your finger to see if you oxygen levels go down when you walk. Make sure they understand the extent of your shortness of breath, it sounds extensive.Hope this helps. I'm not a doctor, but I can try answering some things for you. Good Luck,Catnip
    Catnip821 1 Replies
    • December 21, 2011
    • 00:35 AM
    • 0
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  • Thanks, Catnip. I read your post and I wish you well on your journey to finding a doctor who can help you. It must be doubly frustrating to be a healthcare professional yourself and be unable to find a solution. How I wish there were clinics that specialized in having multiple practitioners help the same patient at the same time.For myself, I have an update - although it's an embarrassing one. I didn't mention in my post that I have smoked (a pack a day) since I was 10 years old, or that I have been a heavy drinker off and on for the past decade or so. In fact, I had been drinking up to a six pack of beer every day for the past few months. I did tell each doctor about this, although my hematologist was the only one who suggested it could be related to my symptoms. In fact, she warned me that if I continue my lifestyle I'm looking at an early death and that she figured my blood tests would probably show that I was in liver failure. That got my attention for about five minutes but, because she didn't come up with a diagnosis, I put it out of my mind as soon as my blood test results related to my liver came back normal, and the hematologist seemed to as well.A little over a week ago I finally did some research online about petechiae and alcohol abuse and immediately found a scholarly article about the subcutaneous impact of alcohol abuse. The article mentioned just about every outward symptom I mentioned, plus a few others I did not. I immediately cut way back on my drinking (nothing at all for 5 days, but a couple of drinks out last night and tonight). The shortness of breath and the feeling of my arms and legs being too heavy ceased by day 3 without alcohol. Almost everything else remains the same, but of course nothing much would have changed in such a short period of time. I guess it sounds odd to say, but I really hope alcohol is behind everything I've been experiencing because it's (hopefully) within my control.I am the kind of person who wants to understand how my body works and why it is doing what it's doing. I ignore most aches and pains - I don't even normally go to the doctor if I get a bad cold. So when I do go to my doctor and ask for help, what I'm really asking for is a complete inspection. I'm really saying: run tests until you can tell me what is causing the symptoms I'm describing to you. It's OK with me if the doctor explains (as the article I read did) that my symptoms are common manifestations of alcohol abuse. It's OK if the doctor wants to run more tests because the tests she's run aren't giving her the answers she needs. What frustrates me, and you described it well in your own post, are doctors who don't explore, explain, or follow up.I'm replying to your post as well, because my Dad's experience with autoimmune disorder could be helpful to you. But for my own story, I did want to post this update. Thank you for your reply.
    txpacotaco 3 Replies
    • December 24, 2011
    • 07:31 AM
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