I am a 23-year-old female. I have positive ANA, chronic fatigue, and lightheadedness. Also, inflammation markers are elevated. I currently take Adderall 20 mg twice a day, and Prozac 40 mg once in a day. And I also performed laboratory tests like CBC, LDH, and CMP.
I have gone through your query. There seem to be some doubts about the reports, and I would like to know the history in some more detail.
As per the history:
1. Since how long have you been experiencing fatigue? Is it worse during the day or at night? Did it start after a viral infection?
2. Do you experience any dry eyes or dry mouth?
3. Do you have any recent hair fall which has worsened?
4. Do you have any history of fever, weight loss, and appetite loss?
5. Do you experience mood swings, irritability, and forgetfulness??
6. How well do you feel in the morning?
I would like to know these details to understand that we are dealing with fibromyalgia or autoimmune disorder, as they have already started you on Fluoxetine and Adderall. At your age, I want you to continue them for a long. As for the reports (attachment removed to protect patient identity), I found the liver function test and the LDH high. They do seem to be improving from the last one, which made me wonder. Did you add any new medicines, or did you have a viral infection recently, which is improving now? ANA (antinuclear antibody) though positive, titer was not very significant, but it is a lot observer-dependent. The only thing I could not find was ESR (erythrocyte sedimentation rate) and CRP (C-reactive protein) to be sure is there any systemic inflammation going on or not. Do let me know these queries. Sorry for too many questions, but that is how I approach a case to help sort it out.
Thank you so much for your reply.
I have noticed the fatigue for months now. I feel exhausted and unable to focus. I saw a hematologist, and he thought it was my iron deficiency anemia, so I had an infusion. Sometimes I have dry mouth. My hair is fragile and has mild hair loss. I have no history of fever, weight loss, or appetite loss. All the time, I do not ever want to leave my house, and I feel very irritable. In the mornings, I will be too exhausted, and it takes a lot for me to get out of bed. I make sure that I go to bed by 9:30 to limit blue light. I started the Prozac four months back, and my doctor previously brought me up to a high dose pretty quickly now 60 mg once a day. Now I am currently taking 40 mg once a day.
With the COVID-19 around and our rotations there, it gets heavy at times.
I have gone through your reports (attachments removed to protect patient identity) and the old summary of the discharge. I feel more or less the diagnosis of fibromyalgia remains intact. You had a period of deranged liver functions, which probably looks either post-viral or fatty liver, and they seem to be improving. The rest of the inflammatory markers, which were done earlier, seem fair. ANA at 1: 80 I will not give too much weightage, but yes, we have to monitor the liver functions to be sure if it is not autoimmune hepatitis.
As for the management of fibromyalgia, Prozac is the right drug, but along with it include a bit of yoga and meditation, and all these medicines will stop working after a while, and you will feel you are reaching the same level again. We always prefer a one to one conversation with the patient, which helps determine the root cause of problems. At times having an insight of what could be the possible stressor for it does help us remove it. As you have a whole life ahead, my suggestion would be to plan a holistic approach for your treatment and eventually cut down on medications.
As of now, do not worry. You did not seem to be having any connective tissue disease. My only monitoring would remain for your liver functions to be sure you are not developing autoimmune hepatitis.
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