Discussions By Condition: I cannot get a diagnosis.

Brief Questions Please...

Posted In: I cannot get a diagnosis. 5 Replies
  • Posted By: Confused4Now
  • September 19, 2009
  • 04:59 AM

30 year old male.
-Chronic Depression/Fatigue (8-10) years. (and all the psychosis too.)
-Daily headaches (feel like dehydration, but I'm not).
-Physical Symptoms of Extreme Anxiety. (high heart rate, sweating, shaking hands, moderate pain just below sternum, distress).
-History of weight fluctuation, not eating.

Whatever is wrong has been wrong for as long as I can remember. I remember symptoms at age 13 or so, got more serious at 18, severe by 23, and critical at 28, medication has stabilized, but still feel the all the symptoms, some are stil progressing.

Immunglobulin E is 308.
Eosineophil 4.0 %
Amylase Serum is 100.
Otherwise the Stool O & P test was negative.
I have no allergies, nor symptoms of allergic reaction.
Other blood levels were within reasonable ranges. (CBC & CMP).
Urine test indicated bacterial dysbiosis in intestines.

Next step is to see an endocrinologist before Christmas.

Can anyone make sense of this?
Could it be lifelong parasite infection?

I never grew like most kids, and my body/bone structure is tiny compared to my family.

Are there any questions you'd suggest to ask the endocrinologist? Right now, I'm hoping to do more blood work to check Cortisol, Adrenal gland function across the board, and let him work me up and try to find something underneath it all.

Thank you!

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5 Replies:

  • What among your symptoms suggests to you that you might have some type of parasitic invasion? There is absolutely nothing among your description that would indicate such pathology. While it may be remotely possible for you to have a pheochromocytoma, even this would be very rare and diagnostic tests are available that would readily detect the presence of such a condition. As for your amylase, it's within range and so is your eosinophil value. In fact, your IgE is only mildly elevated for the average male. The published norms for this lab study can vary greatly and you have to realize that when a technical standard value of 100 or so is listed, this would represent an individual with absolutely no allergic response to anything, a scenario that isn't practical or probable. For the average male, anything less than 250 is unremarkable and even at 308, it wouldn't raise my eyebrows very far in the absence of other requisite criteria. Realize that stress can elevate eosinophil levels to a mild degree because of it's influence on the immune system in general. I don't see anything in these lab values that suggest anything is wrong, certainly not parasitic invasion. Your reference to intestinal "bacterial dysbiosis" as somehow defined by urinalysis, smacks of an evaluation by a holistic or oriental practitioner and I have to tell you that such a conclusion cannot actually be established via a urine specimen. If there were mild indications of bacteria in the urine without other symptoms, then it's most likely due to a poor mid-stream "catch" of the urine to be screened. Bacteria is typically present to some extent within the tip of the urethra and is expelled on forceful urination. This is normal. If the specimen is taken when micturation or urinating is first initiated, however, a contaminated sample often results. The most accurate reference sample is taken during mid-stream of the urination process by means of "catching" a sample during this time period and beyond the point where normal isolated bacteria in the urethra has been cleared via urination. As for the stool sample, this again sounds like the investigative pursuit by a holistic practitioner and these folks often check your urine and stool as though analagous to checking the oil and water in an automobile. The only time we peform a stool analysis is if there is cause to do so. Frankly, based upon your description, the last place I'd be looking is your rectum or colon for the cause. As for your stature, the most likely cause is usually related to GH or growth hormone deficiency if indeed your development would be characterized in such a manner on examination. Clinical tests would have to substantiate such a condition and your visit to the endocrinologist would be an appropriate referral for such investigation. Otherwise, I don't see anything of concern. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • September 19, 2009
    • 11:34 PM
    • 0
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  • Dr. Cottle, I'm grateful for your time and analysis. To answer your questions, my concerns over parasite invasion were based upon fear in general, and the feeling that something is literally sucking the life out of me. Also, common sense told me that the only things that were remotely abnormal in the blood work were the ImE and Eosinophil %. Basic research told me that raised levels of ImE and Eos. were indicative of parasites, among other things. I was not aware the numbers so closely related to normal ranges. Yes, the urine test was with a holistic doctor in another state, in connection with a psychiatric clinic we'd been referred to by a family member. They also claimed to be able to measure serotonin, epinephrine, noreprinephrine, and GABA via urine samples, and wanted to test further based on these. It was a great deal of money poorly spent. Also contributing to my fear was a very unusual habit I have. I've had a long and ongoing behavior of taking scrapes with my fingers/fingernails of the area just inside my rectum, and inhaling the skin/pheremones/chemicals, whatever is there. Its been an behavior for right at 20 years. It is not a fecal issue, and in clearly defending myself, I believe I'm civilized, and hygienically inclined. Otherwise, Dr., the energy drain is tremendous, and if I'm not conscientious, I lose weight and become malnutritioned. Through the support of family and friends, I've been able to keep my head somewhat above water, but again, things have deteriorated very steadily. I have to drink pop to tolerate eating meals, which was never the case before. My breathing has become much more shallow and fast, although I'm not coughing anything up, nor, as I've mentioned, is there asthma. It all just feels very weak. Spirituality has given me some strength, but it never lasts. I am definitely sick with something. For me, the issue now is to simply find something. Something is hurting me, and its very physiological. There is a great deal of pain and discomfort across the board, and my instincts continue to scream at me that something is terribly wrong. I must always face the reality that I could be in a great deal of denial; however, we've investigated every psycholical/psychiatric/relgious avenue over about a seven year peroid, with very little to show, aside from varied opinions and psychotripic medications. Too many sirens going off. I will talk with my family physician, who ordered the Stool O & P, about conventional tests for pheochromocytoma. I'll also discuss the developmental issue with the endocrinologist. If you see anything else you'd recommend checking, I'd be very grateful. These problems don't feel like their going anywhere without some kind of intervention. Thanks! What among your symptoms suggests to you that you might have some type of parasitic invasion? There is absolutely nothing among your description that would indicate such pathology. While it may be remotely possible for you to have a pheochromocytoma, even this would be very rare and diagnostic tests are available that would readily detect the presence of such a condition. As for your amylase, it's within range and so is your eosinophil value. In fact, your IgE is only mildly elevated for the average male. The published norms for this lab study can vary greatly and you have to realize that when a technical standard value of 100 or so is listed, this would represent an individual with absolutely no allergic response to anything, a scenario that isn't practical or probable. For the average male, anything less than 250 is unremarkable and even at 308, it wouldn't raise my eyebrows very far in the absence of other requisite criteria. Realize that stress can elevate eosinophil levels to a mild degree because of it's influence on the immune system in general. I don't see anything in these lab values that suggest anything is wrong, certainly not parasitic invasion. Your reference to intestinal "bacterial dysbiosis" as somehow defined by urinalysis, smacks of an evaluation by a holistic or oriental practitioner and I have to tell you that such a conclusion cannot actually be established via a urine specimen. If there were mild indications of bacteria in the urine without other symptoms, then it's most likely due to a poor mid-stream "catch" of the urine to be screened. Bacteria is typically present to some extent within the tip of the urethra and is expelled on forceful urination. This is normal. If the specimen is taken when micturation or urinating is first initiated, however, a contaminated sample often results. The most accurate reference sample is taken during mid-stream of the urination process by means of "catching" a sample during this time period and beyond the point where normal isolated bacteria in the urethra has been cleared via urination. As for the stool sample, this again sounds like the investigative pursuit by a holistic practitioner and these folks often check your urine and stool as though analagous to checking the oil and water in an automobile. The only time we peform a stool analysis is if there is cause to do so. Frankly, based upon your description, the last place I'd be looking is your rectum or colon for the cause. As for your stature, the most likely cause is usually related to GH or growth hormone deficiency if indeed your development would be characterized in such a manner on examination. Clinical tests would have to substantiate such a condition and your visit to the endocrinologist would be an appropriate referral for such investigation. Otherwise, I don't see anything of concern. Best regards, J Cottle, MD
    Confused4Now 3 Replies
    • September 20, 2009
    • 01:19 AM
    • 0
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  • Well, I don't believe denial has as much to do with the issue as whether or not you are forming an accurate assessment of your problem. First of all, it's critically important to understand that physical symptoms can exist in the absence of physical disease. The second critical factor is the accurate ability to differentiate between unfamiliar physiological changes from symptoms associated with disease or illness. Here is but a brief example that might best illustrate my point. Stress can cause tension headaches. It's a fact and countless people suffer from them on a daily basis. It's a physical symptom in the absence of actual physical disease. Some people will treat the symptoms with aspirin or tylenol and go about their day, while some will misinterpret the muscle tension and subsequent pain as a sign of a space-occupying mass such as a tumor in the brain. This latter group does so for two basic reasons. Their apprehension and fear establishes irrational thoughts which tend to reveal themselves as equivalent to "gut instinct." The second reason is that they base their worry on information to which they are not exposed by formal medical training and experience, but rather by general information provided to the lay community concerning signs and symptoms of a brain tumor. Since pain is one of the symptoms, the cause is very likely to be a tumor rather than a tension headache because the headaches are regular or the pain is unlike other headaches they've previously experienced. Stress can also cause gastrointestinal dysfunction. It's a fact and countless people suffer from it on a daily basis. It too, is a physical symptom in the absence of actual physical disease. It's a functional disorder. Many people also treat their symptoms with over-the-counter preparations and go about their day, while some begin to believe that something more sinister is at work. Countless tests produce no results and yet these persons remain convinced that something physical is robbing them of their quality of life. As they become more worrisome over the fact that nothing can be found, their anxiety and apprehension grows worse and along with it, the physiological change being construed as symptoms. So the point here is not to question whether you are in denial, but rather from a purely logical standpoint whether it's possible for you to accurately identify a long-standing parasitic infection in the absence of the requisite training and experience, moreover, based alternatively upon a strong feeling. Medical science holds no audience to subjective influence where the practice of medicine is concerned. The truth and accuracy which underlies most scientific disciplines is most often found to be counterintuitive. In other words, scientific confirmation requires sterile objectivity based upon evidence which remains fixed in the presence of scrutiny. The requisite solution here is not within the unbridled realm of anything at all is possible, but rather strictly within the objective confines of what is probable. There is no need to defend yourself with regard to divulging a compulsory action which might understandably be construed by most to be abnormal or deviant. It's presence, however, does provide insight into reasons for which your belief patterns have been established regarding your healthcare concerns. It's important to realize that simply because the act as described may, by its nature, be associated with feces in no way confirms it to be the product of copromania. The actual origin of obsession and subsequent compulsory activity is oftentimes unrelated to overt and observable factors and many a practitioner has been quickly lured to misguided notions by failure to look past incidental circumstances and likwise establishing direction based upon salient features rather than searching out the innocuous. For it is the seemingly harmless aspects of underlying origin that more often establish the causal relationship as a result of distortion by the affected individual. By my discourse here, I don't necessarily advocate evaluation and treatment under the heading of psychiatry and will be quick to tell you that in more instances than not, my referral of patients to the specialty have resulted in a poor decision based upon the encounter and treatment plan that typically ensued. I am also not a fan of using psychotropics as means to solve the problem. What I do suggest here is that you take a long second look at the history of your symptoms and consider whether your instincts may be incorrect based upon some rather unavoidable contradictions. In my experience, there is very little that a professional can do in creating change in the mind of person wherein such influence is needed. You must be able to initiate the appropriate direction by establishing the distinction between what constitutes fact from the irrational beliefs which over time have come to better gain your allegiance. You've come to trust in the least accurate basis for making logical decisions. My professional opinion here, based upon what I've read in your postings, is that you are misinterpreting the physiological changes associated with stress and anxiety disorder as signs of underlying physical disease. You need to realize that chronic stress can cause a person to feel extremely ill and yet no disease in the classical sense ever manifests. Realize that as the condition continues over time, more advancing changes occur in the body's response to the stress and anxiety, which for most patients in this situation is unwittingly interpreted as advancement of the disease for which they believe has been responsible all along. There is indeed "something to find," but it's highly unlikely to ever be found in the context of a diagnostic laboratory test or evaluation. It's present in your psyche and you will have to determine how to best approach the matter in order to begin unravelling the network of belief patterns and practices which have culminated over time to reach the level you describe contemporarily. You'll do best by working to consider whether it's possible that your collective instincts and approach to the situation are in error and that subjective influence, together with extremely distorted belief patterns, actually constitute no degree of accuracy where your health is concerned. Once you're comfortable with this conclusion, then you can begin to discover what has occurred that led you to this present day point. You'll be fine and I'll share with you here that although I'm now retired, I was at my profession for more than 40 years, during which time I encountered hundreds of patients with your same symptomatology and perspectives. For you own sake, consider evaluating your circumstances from the standpoint of simply being one of countless others just like you rather than something altogether unique and unreachable. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • September 20, 2009
    • 05:49 PM
    • 0
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  • Dr. Cottle, I believe I understand what you are saying. Everything you are telling me, and from the feedback I've gotten from professionals who know more than me, say that its psychiatric in nature. I understand we can only test what is rational and probable. I also understand that a byproduct of mental illness is often hypochondriac tendencies. If all those things be the case, here are my concerns. My morale is at an all-time low. I've done everything asked of me for 7 years, with few results. The antidepressants are not sufficient, and I've lost jobs, relationships, and many other things that are continuing to mount. I'm in the midst of losing another incredible job because of my failure to perform, and where I don't find any reassurance, is that my efforts to take responsibility all this time have benefitted me very little. People are in the interest of protecting themselves, at whatever cost. Many friends have left, and no longer respond to me. The symptoms continue to get worse, as do the consequences, and so I get frustrated when people say "You'll be fine". That has not been the case, and I've been totally compliant. I sleep for 15 hour intervals, and I'm extremely unhealthy and disorganized. I've cried out for help in every way I know how. The result is usually a finger pointed, telling me that I'm not doing my part, or a brief stay in a psychiatric hospital. I've learned to keep my mouth shut. I once had great faith, but I can't see God anywhere. I'm on the RIGHT medications, we've tried everything, and I'm not getting better. Everyone seems to have an opinion, and no one a solution; yet I'm stuck here with this mess I didn't ask for, and a life that is essentially wasted. I can't hurt myself, because that is supposedly extremely selfish, and I don't want to risk biblical consequences of doing so. So I'm suck here without a solution, while people tell me how good God is. If he's so, Good, there would be a solution to this. Antidepressants, mood stabilizers, antipsychotics, aren't sufficient to treat it, nor is talk therapy, Cognitive Behavioral therapy, 12-step programs, church group, or taking responsibility. The reason I keep looking for a medical solution is because everything else isn't working, and its not even close. You start to question everything when nothing works, and people tell you its your fault. Thank you for your time; its a thoughtful service you provide on this site, and your information has been helpful.
    Confused4Now 3 Replies
    • September 21, 2009
    • 04:42 PM
    • 0
    Flag this Response
  • 30 year old male.-Chronic Depression/Fatigue (8-10) years. (and all the psychosis too.)-Daily headaches (feel like dehydration, but I'm not).-Physical Symptoms of Extreme Anxiety. (high heart rate, sweating, shaking hands, moderate pain just below sternum, distress). -History of weight fluctuation, not eating. Whatever is wrong has been wrong for as long as I can remember. I remember symptoms at age 13 or so, got more serious at 18, severe by 23, and critical at 28, medication has stabilized, but still feel the all the symptoms, some are stil progressing. Immunglobulin E is 308.Eosineophil 4.0 %Amylase Serum is 100. Otherwise the Stool O & P test was negative. I have no allergies, nor symptoms of allergic reaction.Other blood levels were within reasonable ranges. (CBC & CMP). Urine test indicated bacterial dysbiosis in intestines. Next step is to see an endocrinologist before Christmas. Can anyone make sense of this? Could it be lifelong parasite infection? I never grew like most kids, and my body/bone structure is tiny compared to my family. Are there any questions you'd suggest to ask the endocrinologist? Right now, I'm hoping to do more blood work to check Cortisol, Adrenal gland function across the board, and let him work me up and try to find something underneath it all. Thank you!Sounds like pheo or addisions or cushings. But I'd bank on the pheos. I disagree with most doctors that anxiety is a illness. I believe it is a symptom of something that is wrong in your body. They need to figure out the cause.
    Anonymous 42,789 Replies
    • October 19, 2009
    • 01:39 AM
    • 0
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