Hello,
Thank you for posting your query on DoctorSpring.com
The recorded temperatures come within the range of what is considered normal. The average body temperature of an adult is 98.6 F, generally for adults a fever usually isn’t dangerous until it reaches 103 F or higher. Do you think it’s possible that you have been having heat intolerance (that is being uncomfortable in hot weather or sensitivity to heat instead?
From your description it appears as if the itching has been most problematic for you which has not been responsive to creams, antibiotics or even anti-histamines in the absence of any abnormalities in your extensive workup. Therefore I request you to send a picture of one of your extremities (arm/leg) clicked at the peak intensity of the itching to assess and examine your skin. Are you aware of any recent change in your environment? New detergent / paint/ perfume, anything which could potentially irritate your skin?
Also of the other listed problems, the abdominal pain and fatigue appear to be most distressful. Can you provide more description of the pain? Is it relieved by pain medication? Can you rate it on a scale of 1 to 10? Is the pain continuous or intermittent? Does it move to any other part of your body? You mention that it is located in the lower quadrants of your abdomen, have you noticed any changes in your bowel movement (constipation/diarrhea) or other symptoms such as relief of pain with defecation, joint or eye problems?
Currently two possibilities come to mind with the description that you have provided:
The possibility of an autoimmune disease since these can present in women your age group with multiple symptoms.
Skin conditions such as eczema, psoriasis, scabies, hives.
Once I have a clearer idea, further appropriate testing and treatment can be considered.
Kindly reply with the additional information requested along with a picture which I would like to reassure you would be maintained confidential.
Hope this helps,
Patient replied :
Hello,
I doubt it's heat tolerence because the weather has been pretty cool over these past few months. I'm also indoors 99% of the time, away from the sun. My temperate has been in the range of 99 - 99.8 for the most part, and even though it is low, I feel extremely run down.
Symptomatically, the itching has been the most bothersome when it is moderate-severe, and has been the longest lasting symptom apart from the fever. The dermatologists I have consulted said it doesn't seem to be a topical / skin problem. It's internal. Initially, the itching was more on the feet, calves, and ocassionally the thighs, but over the past month and a half or so, not only has the itching intensified, but it's on my back, stomach, and sometimes even eyes and tongue. It feels as if millions of little bees are stinging me. It's horrible. The environment at home has been the same, and there has been no travel for the past 5 months either. The products I used when the itching started were the same - no change.
A couple of weeks ago, I felt abdominal pain while eating. The minute I ate, my stomach would start hurting. Because I didn't have much of an appetite and didn't eat much, I ignored it. The more omnipresent abdominal pain started a few days ago, and initially it was just on the lower left side. It was a sharp, shooting pain that came and went, but was there more often than not. On a scale of 1-10, I'd rate it about 8. The pain then moved to the right side - same sharp pain, same intensity, and I also started getting severe lower back pain which radiated down to the calves. I haven't taken any pain medication. The itching picked up over the past couple of days, and that sort of distracted me a little from the abdominal pain. I don't have constipation or diarrhea, but I do get a few cramps when passing motion. There's no real relief from the abdominal pain after passing motion. I have been also having aches and pains in the chest, shoulder (left), head and eye (left). There's also a little weakness in the left eye.
I have done an ANA and CRP test to rule out auto-immune, and they were normal. Are the enlarged lymph nodes in the ultrasound report (Multiple lymphnodes are noted as follows:
Right submandibular lymphnode measuring 15 x 10 mm, Right cervical lymphnodes measuring 11 x 5 mm, 5 x 3 mm and 21 x 7mm, Right submandibular lymphnode measuring 10 x 7 mm. No obvious focal lesions seen. Both carotids and IJV appear normal. Thyroid appears normal in size and echogenicity) to worry about? Also, I noticed that the WBC count has been increasing. It was 9180 on Oct 19th, 9830 on Nov 6th, and 10,490 on Dec 1st.
In the picture, the spots are marks from the blisters I had got.
Hello,
Thank you for your follow up.
Firstly, I would like to address your concern of the rising WBC count. The normal range for white blood cell count is 4000-11000 and therefore I would like to reassure you that the absence of an elevated WBC count rules out infection as the source for your problems.
Considering that you have done extensive workup, ordering further tests does not appear prudent. In such cases it is better to attempt to control the symptoms symptomatically.
For the problem of itching, I would suggest the use of a hydrocortisone containing cream or lotion which should hopefully provide itch relief. Begin with 1% hydrocortisone containing cream which is available over the counter. If you buy the cream apply to the affected area 2-3 times a day whereas if you buy it in lotion form apply 3-4 times a day. Following use of the hydrocortisone for 10days, should you experience no relief, kindly follow up with us.
With regards to the abdominal pain, you can take anaspaz (hyoscyamine containing) tablet 0.125mg taken 30-60 minutes prior to each meal. Do this for 5 days and follow up with us so we can know whether the medication is working for you. Before you begin taking this tablet it is important to confirm that you are not currently pregnant (by a pregnancy test) because this medication can harm the fetus.
I look forward to answering any further queries that you may have, hope this helps
Patient replied :
Hello,
The itching is getting worse. It is now present through the day and is very severe. Kindly advice.
Hello,
I can understand that itching (pruritis) especially in the absence of significant labs can make this not only debilitating for you and also a challenge to treat. Since you have tried anti-histamine and corticosteroids without success, scientific studies support the trial of low dose anti-depressant medications as the next medication to try. Please be informed that the anti-depressant (mirtazapine) will increase your appetite and cause gain weight. Should you be willing to try this method, you will need to consult a physician who is willing to write out a prescription for you
Hope this helps, feel free to discuss further.
Patient replied :
Hello,
I have recently been diagnosed with primary hyperparathyroidism (calcium levels have been high since December 2013, and this information was included in the blood reports file), and the endocrinologist says that it could be the cause of the itching.
I have attached an updated file with the latest reports. The doctor recommended that I take Calcinet PTH 30 twice a day for three months as we couldn't localize the adenoma on either the Sestamibi Scan or the neck ultrasound. He has also suggested that I do a Methionine PET scan (but it isn't an urgent requirement).
Please let me know how to proceed.
Admin Message -
Hello,
Your consult has been closed. Either you have utilized more than 3 follow-up queries or your consult is now older than 1 month. If you have further queries, I request you to initiate a new consult. You could consult the same Doctor as well, please mention the same in the new consult.
Hope this communication was fruitful. Wish you good health.
Thank you
In-house Physician
DoctorSpring.com