Do any of you struggle with this? No matter how many hours a night I sleep, whether it's 4, 8, or 12, I'm still just as sleepy. I have a lot of trouble falling asleep if it's at a normal time (go to bed at 11 and can't actually sleep until 3-4), but usually I can conk out for 12+ hours if I fall asleep right after dinner (8-9). My only class atm is from 12:45 to 3:45, so I usually sleep until noon. I always sleep through my alarms, even if they're at the max volume, so my mom has to shake me awake. If she doesn't, I can easily sleep until 2-3pm. I thought it might be an oversleeping issue, but there have been periods of me sleeping 8 hours a day for months and feeling exactly the same, so I don't think that's it. Currently I'm off all psychiatric medications, so I'm only taking 75mg spironolactone for hormonal acne and 20mg cetirizine for allergies. I'm 17 years old. I've got quite the medical history but I didn't see everything as being relevant to this issue. If necessary, I can provide more information on general health history in the replies.
Over the last 6 years I've had numerous repeat blood tests done, and everything is pretty normal. Compiled from all the data:
-Trends low: MCV, MCH, MCHC, IgA serum
-Trends high: Monocytes, RDW, prothrombin time
While these have all been out of range multiple times, my doctor says they're not out of range enough to be anything to worry about. Everything else checked in CBC and CMP tests have been normal. My vitamins are all normal. I doubt I have any thyroid dysfunction given my TSH is always normal and free T4 has only been tested one time. It was slightly out of range (low), but again, my doctor wasn't concerned.
I only go to school for 3 hours, I barely study/have any homework to do, and I don't work, but I still feel like I've just run a 10k after a 10-hour shift every single day. I don't know what's wrong with me. I don't have enough energy to do anything. I wake up, take a quick shower, go to school, either play video games or nap until dinner, and then I go back to sleep. I've been told I just need to exercise more, but I can't really exercise because my heart rate gets dangerously high. My rhr is about 70-80bpm. When I stand, it goes to 120, when I do a casual walk, it's up at 150-160, when I'm walking briskly, it gets to 180, and if I even try to jog for a moment it's at 200-210. This is another thing my doctor didn't think was an issue and she told me to "exercise more." I have an MRI coming up to check for endometriosis (no fibroids or cysts so MRI is the next step), and a colonoscopy for Crohn's (was supposed to get that one done 4 years ago but I was afraid the prep would make me vomit and didn't do it), but nothing is concrete yet. I'm wiped out and honestly ready to give up lol, all my tests are normal yet I've never felt less normal. Any info/advice/etc is very appreciated. Thank you
Edit: Just realized I forgot to add information about overall sleep quality. I can't really breathe through my nose due to constant nasal inflammation (this is gross but when I look up my nose the walls are so inflamed they're pressed together and no air can get through), so I end up drooling and probably mouth-breathing. I don't snore, though. Once again, another thing my doctor doesn't see as an issue

Most things dealing with the liver, kidneys or my protien intake is so off lmao some have gotten better or worse over the months but I'm like actually looking at my trends going...omfg how come no one has told me my body is literally broken?! Like none of these have been right since February and my endo or pcp hasn't mentioned any of it to me. I'm definitely asking at my appointment tomorrow but idk if it's just normal on methamizole to kind of be all wonky in a lot of areas or if I'm generally unwell.
For context I was hospitalized in February at 4 months postpartum with my second pregnancy for thyroid storm, diagnosed with graves a couple days after I left the hospital. So ik my thyroid itself and those numbers were bad, but I never really sat down and looked through my CBC or CMP before. Just assumed if anything was off they'd mention it to me.

I (29F, 5'5" 118lbs) feel so depressed and unstable despite a very happy life. I go to a therapist, exercise 4-5 times a week, and have been vegan for 9 years. I do drink relatively heavily (2-4 light beers anywhere from 4-6 days a week) and have for around 3 years now. I am actively trying to cut back by counting how many days a month I don't drink and increasing that day by one every month. I also take 5-10 mg of Adderall a day.
Recently I've noticed not feeling like myself. I'm tired all of the time, I keep having crying spells with seemingly no explanation. Getting out of bed, socializing, do anything just seems harder. As far as physical anomalies go my partner and I have noticed that I'm not only waking up with bruises in random places but they take forever to heal.
I recently found a PCP after not having one for years and at my initial checkup I had blood work done. The doctor ordered a standard CMP serum or plasma and CBC with auto diff but I noticed when getting my results back she also ordered a vitamin d 25-hydroxy test and no other tests for vitamins/minerals. Viewing my results everything tested came back fine accept for:
globulins: 1.8 gm/dL
vitamin D 25-hydroxy: 11.2 NG/mL
Are either of these particularly concerning and/or could explain my psychological symptoms? How much vitamin D do I need to take to get my levels back up? Should I be tested for any other deficiencies based on my symptoms? I hope I'm not looking too far into this but something really just feels not right and I want to feel like myself again.

24f
Went and had hernia repair with mesh this past Friday, hernia was about 4.0cm and they used medium mesh. I developed severe vomiting after surgery and ended up in the ER the same evening after my surgery with my bloodwork and dehydration ended up admitting me for 2 days. My CMP came back with CO2 at 14 & CBC had WBC, RBC, Hemoglobin & Hemograit all high. I was given 5,000mL of fluid continously (per chart I had read the amount) and I kept breaking out into severe welts all over. In recovery they did max me out with nausea medicine and pain medicine (Dilaudid)
I was sent home with a prescription of Norco around 1pm and the ER happened around 530pm that same day. I couldn't stay awake, keep wateice down. The welts happened around 5, covered my arms, legs, chest, stomach. They assumed it was Norco allergy, I never took it at home. Only thing at home I had taken was tylenol 500mg. They ended up giving me benadryl, Epi pen shot and steroids through my iv in the ER before admission. I have been getting the welts daily now and on benadryl since. My arms feel like they're burning inside.
When they happened the first time they didn't itch Now they itch badly when they come on severe which they take about an hour to cover me.
The medication I'm on;
Eliquis 5mg Vit D 50,000 units 2x week Lamtical 150mg Wellbutrin XL 300mg Iron 324mg Cozaar 25mg
After being discharged they also have me using; A Z-pack of Predisone. Toradol as needed for pain (after lots of caution because of my blood thinner, they gave me toradol the entire admission through IV) OTC benadryl & Pepsid
I'm losing my mind. I don't know what to do at this point with the welts and living on benadryl isn't realistic. Is it my blood thinner causing a reaction?

Hello docs! It appears my poor lifestyle choices have caught up with me...I'd like some input on what conditions to look for and general lifestyle advice.
Stats: 43 year-old female; 5'6 tall and weigh 243 llbs (high bmi)
Symptoms:
-bilateral edema focused in calves, started two months ago but calves have been hurting for longer; edema helped but not resolved by a newly prescribed water pill
-high blood pressure for past two years (didn’t know this until a recent dr. appt.)
-A1C 5.9% (pre-diabetic)
-No abnormal results (other than high A1C) from:
BNP B Type Natriuretic Polypeptide CBC CMP Comprehensive Metabolic Panel Hemoglobin A1C (w/ Est Avg Glucose) T4 Free TSH Thyroid Stimulating Hormone Adult and Pediatric
-Urinalysis also returned normal (I’m well-hydrated)
-muscle weakness
-reddish/blueish skin with quite visible blue veins
-pain in calves while walking
-random bruising
-infrequent but painful headaches focused on left side
-I’ve been tired for, like, 8 years; always thought it was depression
-crave shitty carbs constantly
-easily out of breath
Current meds: Vyvanse, Ritalin, Strattera (ADHD - yes, all of them at once, the Ritalin is a 10 mg booster); Zoloft, wellbutrin, Doxepin, water pill (depression/anxiety)
Lifestyle stuff:
-Carb-filled diet, binge eater (I’ve changed my diet to whole foods only since developing edema)
-full-time desk job
-I walk for exercise, but not enough
-Last year, I abused cocaine for around 8 months (quit in Dec.)
-Drank liquor frequently until the edema started
That’s all I can think of. My questions are: what should I focus on to best help myself regain some health? Is there anything besides high blood pressure that my doctor should be looking for? … And, am I, like, about to die of a blood clot to the lungs anytime soon?
Pretty please be kind. I know I have some serious work to do.
TIA!!

25f, 143lbs, take sertaline and buspar daily, no smoking or drinking.
i had some stomach issues in march and had an upper endoscopy on 3/21 that showed SIBO and mild gastritis. the SIBO is pretty well under control now, but i weighed 153lbs at my endoscopy appointment and weighed in at 143lbs this morning (5/14). i’ve had bloodwork and i’m vitamin d deficient (levels were 15) and i’m supplementing now, but everything else (cbc, cmp, thyroid, lipase, iron, b12) is “grossly normal.”
i did have a very stressful end of march and entirely of april (stomach issues that prompted the endoscopy, had to get a new car unexpectedly, caught a stomach bug from work, had to get a root canal, my anxiety got worse) and i definitely haven’t been eating enough as stress has a tendency to turn off my appetite. my period was also a week late this month which i’m assuming was due to stress delaying my ovulation. could this weight loss be a result of just the stress or does it warrant investigating further? thanks in advance!!!

First, thanks for reading. Also if this question does not belong here, please let me know/point me in the right direction. I, 28F, will be establishing care with a new PCP in late June. I have not been to the doctor since at least 2020 or 2021 due to financial strain. In the last 1-3 years I have developed symptoms that concern me such as, sensitivity to the cold (my hands physically hurt, no color changes), hair loss, rapid weight gain (gained 40lbs+ since June 2023), joint pain in hips since Feb 2024, and I have always experienced fatigue. Additionally I have been on hormonal birth control for at least 8-10 years. I stopped taking mental health medications (effexor and straterra) in July 2023, and the only thing I am taking is birth control and OTC pain meds (Advil) as needed. I have a little over a month before my appointment, should I stop taking birth control? Particularly before getting labs done. I plan to ask for labs including a CBC, CMP, and Thyroid testing. Thyroid issues run in my family, my mother alone had 3 autoimmune disorders so that is kind of my focus. Would this be enough time for my body to return to baseline?
Any insight is appreciated!

First, thanks for reading. Also if this question does not belong here, please let me know/point me in the right direction. I, 28F, will be establishing care with a new PCP in late June. I have not been to the doctor since at least 2020 or 2021 due to financial strain. In the last 1-3 years I have developed symptoms that concern me such as, sensitivity to the cold, hair loss, rapid weight gain (gained 40lbs+ since June 2023), joint pain in hips since Feb 2024, and I have always experienced fatigue. Additionally I have been on hormonal birth control for at least 8-10 years. I stopped taking mental health medications (effexor and straterra) in July 2023, and the only thing I am taking is birth control and OTC pain meds (Advil) as needed. I have a little over a month before my appointment, should I stop taking birth control? Particularly before getting labs done. I plan to ask for labs including a CBC, CMP, and Thyroid testing.
Any advice or insight is appreciated!

Age: 6.5 Sex/Neuter status: spayed female Breed: Staffordshire terrier mix Body weight: 75 lb History: masticatory muscle myositis, no flares for over a year, recent dental cleaning and 4 extractions, frequent UTIs Duration: 1 mo Your general location: SE USA
Signs: intermittent vomiting x 3 weeks, every few days, sometimes kibble or just saliva -intermittent diarrhea, no blood -eating/drinking normally, playful
Vet visit for vomiting 2 weeks ago -X-ray showed possible blockage. Repeated next day fasting, no blockage + Free fluid in abdomen That night we saw her back paws were swollen
Next day: CBC - Normal - hct/hgb slightly elevated CMP low protein/albumin. Ultrasound: mass on the spleen, fluid aspirated from abdomen was blood. It was presumed hemangiosarcoma - chose emergency splenectomy.
Good news in surgery: Mass was not a hemangiosarcoma. "Small nodule on tail end of spleen covered in omentum, mass appears to be normal. The tissue is not friable or bleeding " No biopsy or spleen removal. Declined to do intestinal biopsy or further explore liver. Intestines were slightly red and distended. Pros and cons discussed with the vet before closing.
GI panel sent to Texas A&M - low B12, otherwise WNL O&P negative
Now highest on the differential is IBD + protein losing enteropathy. Four days ago started a hydrolyzed protein food. Yesterday started prednisone, and mycophenolate and B12 injections. Edema/ascites - resolved. No vomiting. Diarrhea intermittent - worse every time we get back from the vet.
Question: the vet is recommending an ultrasound with a specialist to determine what is on her spleen and we are undecided because 1) the cost 2) if the recommended treatment is surgical, we can't do that again.
I'm interested in what others think we should do regarding the u/s.

33 year old female. 5'7" 155lbs. I take 60mg of fluoxetine and 1 loratadine daily.
Starting March 18th I had fatigue/headache, just feeling unwell and I noticed both of my feet were numb. I thought I had pinched a nerve or just sat on them funny, but the pins and needles feeling has remained constant since then. The general sick feeling went away and I was just trying to ignore my feet.
Then May 1st I started feeling sick again. Headaches, major fatigue, sore throat, cough. I went to my PCP on May 3rd. I tested negative for covid and strep. She also ran blood work - CMP (nonfasting), Vitamin B12, TSH, CBC, and magnesium, everything came back normal. She also did a general exam with reflexes and whatnot. Since nothing showed on the bloodwork, she referred me to a neurologist for the feet neuropathy.
I have to wait until the end of September to see a neurologist, but I'm still feeling quite ill. I've burned through all my sick days.
The last few days I've been having a constant headache, fatigue, sore throat, lack of appetite, nausea and some dizziness, no fever, however, I have been living on Tylenol.
On May 13th I went to my doctor's office, my PCP was not in, the PA I saw said she thought I had an upper respiratory infection and prescribed me doxycycline. She said I had a little drainage in my left ear that may be causing the vertigo. She also said my B12 was on the low side of normal, so she recommended I try B12 supplements while we wait for the neurologist appointment.
I didn't ask for a prescription or anything. I understand antibiotics don't work for viruses.
Do you think antibiotic actually going to help my headache/fatigue/sore throat or is this their way of getting me out of the office?
Thanks.

This is a weekly thread for those who haven't been diagnosed, but still have questions about the diagnostic process. Please read the posting guidelines and rules! Everyone is welcome to contribute, and this is a safe space.
QUESTIONS ARE LIMITED TO 400 WORDS
____________________________________________
Please read this before posting as it may answer some of your questions:
If you use the search bar at the top of Reddit and make sure it’s set to lupus, it will search just the subreddit for your keywords. That way you can get the full breadth of questions and answers. This isn’t to say that you can’t ask questions in the general forum.

ANA tests

Positive ANA does not equal lupus! While more of a rule out screening (negative ANA = very unlikely to have SLE). Upwards of 15-20% of healthy individuals in the population at large will have a positive ANA. Only about 10-15% of people who have a positive ANA will later be diagnosed with SLE.

Tests used in diagnosing lupus

• anti-dsDNA - anti-Double Strand DNA is sometimes automatically tested for, but may need to be ordered separately. This test, when highly positive (2-3 times max cut off at least) is almost exclusively seen in SLE. However, only about 30% of SLE patients have this antibody. It's great if it's there to confirm diagnosis, it does not rule out diagnosis if it is absent.
• ENA Panel - Extractable Nuclear Antigen panel, usually automatically done if ANA comes back positive
• anti-Sm - Anti-Smith. Typically included in the ENA panel. This is another antibody, that when highly positive, almost always means SLE, but only about 25% of SLE patients have this antibody.
• RNP - Anti-Ribonucleoprotein. Typically included in the ENA panel
• anti-chromatin - Anti-chromatin is a relative newcomer in diagnostic testing for SLE and probably will NOT be ordered automatically. Its exact utility in diagnosis is still being determined.
• Apl panel - Antiphospholipid Antibody Panel, which consists of 3 tests:
  • LA - lupus anticoagulant
  • aCL - anti-cardiolipin antibodies
  • Anti-β2GP - anti-beta 2-glycoprotien antibodies
• CBC - Complete Blood Count, some abnormalities in WBC, RBC and PLT counts can be significant.
• CMP - Comprehensive Metabolic Panel, here the doctors are generally looking for kidney dysfunction (GFR, BUN/CR).
• ESR - Erythrocyte Sedimentation Rate, this is a nonspecific inflammation marker.
• CRP- C-Reactive Protein, another nonspecific inflammation marker.
• C3 - Compliment C3
• C4 - Compliment C4
• CH50 - Compliments, Total, these are part of the compliment system, which is a tertiary part of the immune system.

Also, if you suspect you have a rash, getting a biopsy of it done at a dermatologist’s office can be helpful as the pathologist can identify histological evidence of lupus.

Diagnostic Process

ACR Diagnostic Criteria on lupus wiki
The rheumatologist/PCP will take a detailed history. I highly recommend writing down as many of your symptoms as possible, especially focusing on the symptoms you have that are in the American College of Rheumatology diagnostic criteria for lupus - see link above.
Include all your symptoms, but I would make those at the top of the list. Write down how long they’ve been going on, anything that makes them better or worse, and how much they impact your life. Do they prevent you from dressing yourself, eating/cooking, bathing yourself, doing hobbies, meeting your obligations?
ANA varies from person to person and doesn’t necessarily correlate with disease activity. Anti-dsDNA is more indicative of disease activity and can be elevated prior to and during a flare. Symptoms can also come and go, and over time you may develop additional symptoms. If you scroll through the last week of posts or so, there are a few posts that will have pretty detailed answers to your questions from multiple community members so you can get a better sense of just how full on fickle lupus can be.
Here are some good posts, one is other people experiences in general, the others are rashes (warning: some are particularly severe):
User community diagnosis experiences
This is a malar rash
Photosensitive Lupus Rash
SLE Malar rash
QUESTIONS ARE LIMITED TO 400 WORDS

• Shorter questions get more feedback
• Use ChatGPT to summarize your question if you don't know what to leave out

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Medical history:
Hello I’m 19 F AFAB I’m 5’2 and 210 pounds. I am diagnosed with Hypothyroidism, Hirsutism, Depression, anxiety, and adhd. I really struggle to take my meds but I am prescribed, Prozac (80mg), seroquel (50mg), lamotrigine (50 mg), levothyroxine (maybe 5 or 0.5 mcg), spironolactone (100 mg), nexplanon implant, and tretanoin 5% gel. But to be honest I only take the seroquel regularly for sleep and the tretanoin. Last checked months ago in range vitals, and I have cbc, differential, and cmp results linked.
https://ibb.co/pPXBxNy https://ibb.co/hWZpKtq https://ibb.co/7tktRyY
My fraternal twin is a type 1 diabetic, my father is a type 2 diabetic (as well as maternal and paternal grandfather), and my mother has Hashimoto’s disease
Background:
Over the past year I’ve struggled with fatigue and a lot of infections: bronchitis (for 2 months), Covid, several viral infections, sinus and ear infection, swimmers ear, pink eye, athletes foot/ringworm, and other body rashes and infections. I lived in a dorm this year and spent a lot of time around people so I mostly assumed it was that, but I was sick much more often than my friends. About a month ago I’ve been getting increasingly nauseous, lightheaded, and headaches. I chalked it out to finals stress but now that I’m back home I’m not so sure. My hirsutism is also getting worse. The nausea spells are more common in the morning (no possibility of pregnancy and I also will get sweating shivering and shakes. When I was getting another nausea spell tonight I drank around 4-5 oz of orange waited 15 and felt a lot better. I’m worried because other than extreme weight loss I have a lot of similar symptoms to my twin pre-diagnosis. Since I am overweight if it were diabetes would type 2 be more likely? I just want opinions if these issues might be diabetes thank you!
(P.S. I will be trying to see a doctor but I don’t want to ruin Mother’s Day plans so on Monday maybe)

Going abroad where I’ll have access to testing at low cost.
Beyond annual physical/standard labs (CBC, CMP, A1C, lipids/cholesterol, vitamin D), what labs would you request if there was no barrier to entry?
So far, I’m thinking - lipo(a) and ApoB tests for heart disease risk - celiac test
Appreciate any suggestions

First off - I know TRT doesn't cause prostate cancer.
Would you do TRT / are the benefits worth it to you if you were high risk for prostate cancer?
I'm 38 and my dad got it in his mid 50s and ultimately passed away from it at 62. I'll be 100% honest I haven't done any hormone panels yet because I never considered TRT due to my high risk for developing it.
All of my standard bloodwork cbc/cmp is really good. I recently started exercising again and have lost 40lbs. But I still feel off (typical low T symptoms) and I have some suspicions.
Again, I know I need to get hormone panel done first and go from there ... BUT I'm seeking your guys opinions on how you would approach it if you were high risk.
Appreciate your thoughts.

26f 5'11" 180lbs
Congenital long QT syndrome -- History of cholecystectomy, acute pancreatitis and pseudocyst with pleural effusions 14 months ago -- History of alcoholic liver damage (no alcohol for 1.5 years) -- Long-standing depression&anxiety
Meds: gabapentin (anxiety), Trintellix, nadolol, Wellbutrin, Ambien, Buspar, B12, Zyrtec. I do vape THC daily.
Went to ER twice this week, first for the shortness of breath and the second time for the leg numbness. They found nothing. Fluids don't help anything. I just went to my PCP and they also found nothing.
Symptoms which have started in the last 1-2 weeks: occasional vomiting; constant "air hunger" and chest pressure; very easily winded when moving, talking, or bending over; loss of sensation in right shin; low fever 99.5-100.0; headache and neck pain; restless legs; sore muscles; intense brain fog (difficulty finding words, mixing up random words); irritability.
Symptoms which started months ago but have gotten much worse in last week: nausea, appetite loss, diarrhea, pounding but slow heartbeat in eyes/ears/torso, lightheadedness, fatigue.
I had urinary burning so I was on ciprofloxacin from 5/2 to 5/6 but then they told me to stop taking it as I was negative for UTI. Burning went away.
I don't know if it's worth mentioning I recently found mouse droppings in my car which concerns me for those kinds of infections. I brought that up to my doctor and they said something about possible allergens/mold, but said there's "no way to test for those other exposures".
Tests in the last week: CBC+diff, CMP, lipase, D-dimer, urinalysis/culture, B12, COVID/flu swab, chest x-ray, EKG. In the past few months: TSH, ESR, CRP. All normal. Waiting on a lung function test. No other tests.
I understand this is complex for reddit but I'm at a loss as to what to do next! Thank you.

Hey everyone! We are stumped and I (38F) feel like my husband (37M) is getting the brush off and I'm hoping you all can help out. We are just looking for a direction.
Sorry in advance, it's a long post.
Background:
37 y/o caucasian male, 5'7", 138 pounds Employment: back of house pizza shop NKDA PMHx: ADHD Former smoker (5 years, vapes now) Marijuana use (via vape) Medications: Adderall 25mg daily Omeprazole 20mg daily in AM (new) Sucralfate 1gm, 4 times daily before meals and at bedtime (starting tomorrow 5/10)
December 25, 2023- We woke up for Christmas morning god awful early, because kids. Around 7:30/8am, while my husband was drinking his coffee (8-10oz cup with 4oz International Delight) when he felt that he needed to have a BM (normal for the time of day). While having the BM, he noticed a burning and pressure in the upper right quadrant. After he was done with his second or third BM (unusual for him), he came downstairs and was notably sweaty and pale. He told me at that time he didn't feel well, then disappeared upstairs in the bathroom for the remainder of gift opening. Afterwards I went to check on him and he had told me he had vomited. At this time, I thought he had a GI bug, so I gave him the "set up" and left him to it while I did Christmas with the kids. Afterwards he says that after he went upstairs, he was experiencing burning right upper quadrant pain (that was cyclical in intensity and at it's peak 8-9/10 pain) with pressure and nausea/vomiting due to the intense pain/pressure in the area (relieved by belching). He was also experiencing extreme fatigue (sleeping all day except when pain was at its peak or he was vomiting) but restless due to the pain. This persisted for 36 hours and he started on the BRAT diet, however he did get over confident and hungry and downed 3 PBJ sandwiches before bed (contrary to my protest). The next day the symptoms returned and we brought him to the ED. He left with a diagnosis of enteritis and 2 days later he was without pain and pressure, but extremely fatigued for another 2 days. During this time, no one else in the home was sick and my husband never had a fever. He was instructed to take a 14 day course of Omeprazole (in addition to his adderal). Overall the episode lasted 5-6 days Labs: (I have access to all values and will only list those out of range unless asked for more info) CMP- Bili total 1.9H Sed rate- WNL CBC- WBC 11.3H Urine- +ketones trace albumin US- Neg CT- 1. Fluid-filled nondistended small bowel loops are nonspecific but can be seen with gastroenteritis. 2. No evidence of appendicitis.
Meds tried: Mylanta and viscous lidocaine - no change Zofran- no change
Meds given at ED: Fluid Ketoralac- no change Morphine- significant change to pain, but not pressure. Sweating and paleness resolved.
March 11, 2024- My husband woke to get the kids ready after I had gone to work. He started drinking his coffee (same as above) and around 7:30/8am, he started with the same symptoms- burning cyclical right upper quadrant pain that induces nausea and vomiting, sweaty, pale, fatigued, restless due to pain and belching to relieve pressure. After dropping off our youngest, he went to the ED. EKG was negative. Labs not totally WNL, but minimally out of range in the white blood cell components. When I met him at the ED, his blood pressure was WNL and his heart rate would dip to 32 while he was awake and in pain. No imaging was done at this time and we were sent home with no answers except that he wasn't going to die (that day). On day 4, the symptoms had improved, pressure remained, and he stuck very closely to the BRAT diet (bullion broth and toast/bread). The symptoms returned, despite sticking to the BRAT diet and he returned to the ED on 3/15. The doc repeated the CT scan (which was negative), and labs (see below). He had a few suggestions, but ultimately he was discharged home. Overall the episode lasted 5-6 days *Important to note: he had not had any marijuana for about 4-6 weeks before this episode started Labs (3/11): CBC- WBC 11.7H neut#- 10.1H neut- 86%H lymph- 9.3%H CMP- bili total 1.9H Labs (3/15) CBC- WBC 11.7H neut 10.1H lymph 9.3L mono 3.8L CMP- bili total 1.9H Urine- neg
Meds tried: Omeprazole 20mg daily- no change Mylanta and viscous lidocaine- no change Zofran- no change Compazine- minimal relief
Meds tried at the ED: Fluids Mylanta and viscous lidocaine-no change (induced vomiting) Zofran- no change Ketoralc- no change Morphine- significant change to pain, but not pressure. Sweating and paleness resolved, pain remained resolved.
Shortly after, his PCP referred him to GI and they did an endoscopy. Endoscopy was negative and the GI diagnosed him with GERD. After asking questions about the diagnosis, the GI then suggested he have a cardiac work up based on the fact that he reported it as burning pain.
4/10- We went to his PCP who suggested it could be abdominal migraines and gave an abortive medications to try at the first onset of symptoms. He also referred him to cardiology for a stress test to rule it out for sure.
4/29- Symptoms returned in the same manner between 7:30/8 am, and with no coffee: burning pain and pressure in the upper right quadrant, nausea/vomiting caused by pain, belching, pale, cool, sweaty. My husband had been on the omeprazole faithfully since the last episode. I insisted he go to the ED (more freaked out by the GI's suggestion of cardiac cause), but also because his home blood pressure read 210/91 with a heart rate of 42. EKG was negative, labs as below. After the dose of morphine, his pain resolved and the pressure persisted until Friday morning- no nausea/vomiting, pale, cool or sweaty and minimal extreme fatigue (only slept for 2 days!). He did note to me that at some point towards the end, he had multiple BM's that were bright green/yellow and DARK brown (not bloody). Labs: WBC- neut# 10.2%H mono 0.2L neut 92.7%H lymph 5.4%L mono 1.5%L CMP- creat 0.6L (BUN ok) Bili total 1.8 H -direct 0.3 -indirect 1.8H Lactic 4.1CH -repeat lactic 2.6H Lipase 10L
Meds tried at the ED: Fluids (3 liters) Zofran with Morphine- significant pain relief Morphine- continued pain relief
We then called the GI who continued to be insistent on the cardiac work up (stress test scheduled for this Monday). They prescribed Carafate 1G to take with the omeprazole. After I requested, they ordered a HIDA scan.
HIDA scan today- negative. Ejection fraction of 88%.
Notes: The night before his December episode, we had Chinese food and a spicy pizza, but other than that no unusual consumption. He has coffee every morning, and the last episode he didn't even have a coffee. The most recent episode he did resume marijuana consumption. He has about 5 alcoholic beverages a week (hard seltzer). He has been trying to gain weight, so he has increased his caloric intake, adding nuts and breakfast (after coffee), but also more frequent meals- but generally at the pizza shop. At home we are largely gluten free because our youngest has Celiac's Disease (negative TTIGA within the last year). About 1 rockstar daily, but has decreased consumption after second episode.
We have no idea what to do next. We are apprehensive about putting this in GI's hands because it feels like they're just brushing it off. So I turn to the reddit hive mind to see if anyone has encountered this.
Thank you so much for taking the time to read and search your mind. I REALLY appreciate it. Feel free to ask me any follow up questions. I have access to the majority of his records through his portal.

I try to ignore these expert questions in SH because of this, but the reality is that there are several expert questions in the exam that I failed yesterday. (~%70 in SH).
I'm trying to apply and understand the mindset but it obviously hasn't worked for me.
What part of the mindset can I use for this question? Why is using BOTH a Ishikawa and pareto chart a better answer? According to the answer in bold below a brainstorming session could be the first step in solving the problem.
Question: A project is challenged by a multitude of problems resulting in defects and stakeholder complaints. The project manager has been contemplating a quick and effective approach to address the problems.
Which two actions should the project manager take? (Choose two)

1. A.Gather the project team members and have a brainstorming session.
2. B.Refer to the organizational process assets (OPAs) to assess lessons learned.
3. C.Use a trend analysis to engage some of the project team members.
4. D.Use an Ishikawa diagram to help identify the problems.
5. E.Use a Pareto chart to identify how the challenges of the project should be addressed.

Solution: D and E. Use an Ishikawa diagram to help identify the problems. and Use a Pareto chart to identify how the challenges of the project should be addressed.
The Ishikawa/fish-bone diagram can be used in a systematic identification of problems as well as their origins. The output of this exercise could be used to develop the Pareto chart to indicate the 20% of the cause problems which when addressed would eliminate 80% of current challenges.
This question and rationale were developed in reference to:
Mastering Project Time Management, Cost Control, and Quality Management (No Date) Randal Wilson//Chapter 14/ [Item Cause-and-Effect Diagram
Also known as a fishbone diagram or Ishikawa diagram, this diagram evaluates a noncompliance condition for potential root cause. Figure 14.1 illustrates a cause-and-effect diagram in which the noncompliance condition is placed at the far right and lines are drawn to the left to progressively allow for various potential failure modes to be recorded and evaluated. Cause-and-effect diagrams are commonly used in conjunction with brainstorming to determine root cause analysis.