How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Daniel Nelson, MD Your Own Question

Daniel Nelson, MD
Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience:  Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
Type Your Health Question Here...
Daniel Nelson, MD is online now
A new question is answered every 9 seconds

IM VERY WORRIED,MY WIFE IS 46 TAKES SYNTHROID (PAST 25YRS) ...

Resolved Question:

IM VERY WORRIED,MY WIFE IS 46 TAKES SYNTHROID (PAST 25YRS) AND IS HAVING SEVERE LEG PAIN,SIDES & BACK OF THE THIGH AREA,ALSO SOME PAIN IN UPPER RIGHT STOMACH AREA,JOINTS, HAS A NEW BUMP IN UPPER THYROID ON RIGHT SIDE AND HAVING PRETTY BAD HEADACHES LATELY,SHE HAD RECENTLY (6-8 MONTHS AGO? )HAD TESTS DONE TO CHECK FOR CLOTS AND WAS OK,SHE SAID TODAY , OUT OF THE BLUE THE BACK OF HER NECK HAD A STRANGE HOT TYPE SENSATION BUT HAS WENT AWAY ?
Submitted: 6 years ago.
Category: Health
Expert:  Daniel Nelson, MD replied 6 years ago.

Greetings, RONYG1. Thank you for submitting your question(s) to JustAnswer.com in the category of HEALTH. My name isXXXXX I am a licensed physician, trained throughout Internship, Residency/Fellowship at the Mayo Clinic in Rochester, MN in the specialties of Internal Medicine and Critical Care.

This answer will take me a while to address thoroughly. In the meantime while I am preparing information for you, can you tell me what her labs, ultrasound (of what?), blood tests, urine test, thyroid level (did they perform any TSH levels or radioactive iodine uptake studies, or ultrasound of the thyroid?), and any other test results from May 2007 that would be helpful to me.

Expert:  Daniel Nelson, MD replied 6 years ago.

I wanted to begin preparing some of the thoughts for your regarding your wife's symptoms and suggest information that may be useful for you to help her be evaulated efficiently and thoroughly. It seems that we have several areas in concern, so we'll approach them together in a step-by-step manner.

#1 Severe leg pain involving the sides and back of the thigh. You didn't mention which leg, but mentioned that she did have a past workup for clots in her leg but that result was negative. If she has any numbness or tingling, weakness, swelling (especially tight swelling of the calf), redness, tenderness in the calf muscle, I believe that additional workup is needed. If there are neurologic symptoms like numbness, tingling, or weakness, then she may have sciatic nerve impingement (pinched) or have a bulging disc or spinal nerve root impingement ... this would require further evaluation with a good Neurologic examination, and possibly lower back MRI and X-rays. If her symptoms are more leg, thigh, calf-type tenderness along with swelling, redness, or increased warmth, then I would once again be concerned about a possible clot and recommend she be re-evaluated using duplex Venous Ultrasound with check for augmentation, or the gold standard study, which is a venogram. A Venogram is a test where dye is injected into a low vein, such as in the foot, and the deep veins of the leg are viewed using X-rays to check for clotted deep veins.

#2 Pain in her right upper stomach area: This sounds like you mean that she is experiencing pain in her right upper abdomen, just below the right lower rib cage. Do I have this correct? If not, please let me know. This area is predominately muscle wall, and underneath it in the abdomen directly is the liver and gall bladder, if her gall bladder has never been removed. Again, a thorough physical examination along with some lab studies and a possible Liver and Gall Bladder ultrasound may be needed to view this region. I would also have the ultrsonographer look at her other abdominal organs while we are doing this study, including the liver blood vessels, kidneys, aorta, spleen, and pancreas if possible. Has she ever had gall stone disease? Physical examination and these studies would tell me most of what I would be concerned with in this region. If she has accompanying symptoms of pain after eating, nausea, vomiting, right upper abdominal pain radiating to her back or between her shoulder blades or radiating up to her shoulder ridge, then I am more concerned about the gall bladder and pancreas. Other possibilities include an ulcer or inflammation of the stomach or small intestine. These latter processes can be evaluated with upper endoscopy, using a flexible fibre-optic scope to look into the stomach and part of the small intestine.

#3 Joint pains. These again would need a good physical exam to see if the joint pains are inflammatory, degenerative, or possibly rheumatologic (like rheumatoid arthritis and related immune mediated arthrits conditions). Plain film X-rays may be of some help in this instance. If there is fluid built up in the joints, I would want to examine that fluid for crystals (*like gout or pseudogout), cells (type and number), culture for infection, and possible treat directly depending on the results.

#4 New bump on the upper right thyroid, headaches, neck flushing sensation: I am a bit focused on the bump here. It is essential that she be examined, completely and thoroughly from top to bottom. If a thyroid nodule is present, I would generally perform thyroid function studies like TSH, T3, T4, free T3 & T4, and obtain an ultrasound to characterise the nodule if I felt it present. If it's a cyst, I would either watch it or drain it and look at the cells under a microscope. If it's a solid nodule, a thyroid uptake study would be needed to see if the thyroid nodule is producing thyroid hormone or not. If it is, that is a bit reassuring to me. If it is not taking up iodine, that is concerning to me. She simply needs a competent and comprehensive examination.

If costs and bills are a concern for you, there may be a resource that can help:
http://ask.hrsa.gov/pc/ is an excellent resource for you to find free or affordable healthcare in your city or region.

Thank you for visiting JustAnswer.com's Health Information. I hope that all of your concerns have been addressed and that your experience here was positive and helpful. We truly do care a great deal that you are completely satisfied with the information provided, so click ACCEPT only when you are satisfied and comfortable that your question has been adequately addressed.

If you have a new or different question for us, please don't hesitate to come back or submit a new question. It has been a pleasure helping you. Your FEEDBACK is very important to me.

Customer: replied 6 years ago.
THANK YOU DR. NELSON,YOU OBVIOUSLY DISPLAYED TO ME GENUINE SINCERITY, AND PUT SOME TIME & EFFORT INTO YOUR ANSWER TO A PROBLEM THAT EXISTS IN THE LIFE OF SOMEONE TO WHOM YOU DO NOT EVEN KNOW,GOD BLESS YOU FOR THAT. DR. I, ALSO DID QUITE A BIT OF RESEARCH AND FOUND THAT FIBROMYALSIA FITS HER LIST OF SYMPTOMS TO THE TEE. EVEN WITH A CHILDHOOD TRAUMA LISTED AS A POSSIBLE TRIGGER,ALONG WITH THE ROLE THAT STRESS IN GENERAL, PLAYS CONCERNING THE UPS AND DOWNS OF THE SEVERITY OF THE SYMPTONS,SINCE WE ARE PRESENTLY EXPERIENCING AN OVERWHELMING ARAY OF SERIOUS PROBLEMS INCLUDING A, SOON TO PASS AWAY OF A PARENT,SHE HAS ALLWAYS BEEN VERY DELLICATE WHEN STRESSFULL ISSUE ARISE, HER NON ABILITY TO CONTROLL HER EMMOTIONS HAS ALLWAYS SEEMED TO DETERIORATE HER HEALTH. I KNOW ITS A DISEASE CLAIMED BY MANY PEOPLE WANTING A WAY TO BE CONSIDERED DISSABLE, OR OTHER REASONS SINCE IT IS NOT A DISEASE,THAT IS CONSIDERED "BLACK & WHITE" OR OBVIOUSLY DIAGNOSED.NOT THE CASE WITH MY WIFE WE SEEK NOTHING EXCEPT SOME MEDICAL RELIEF OF HER ILLNESS, WE'VE BEEN CHASING AN ANSWER FOR YEARS. WITH MANY ATTEMPTS TO REMEDY,GALL BLADDER REMOVAL,LYPOLMA CISTS REMOVED   , DEPRESSION TREATMENTS, TESTING FOR BLOOD CLOTS, FEMALE REPRO ORGAN PROBLEMS ETC, IS FIBROMALGIA THE SMOKING GUN ? COULD IT BE ? PLEASE RESPOND...........RON
Expert:  Daniel Nelson, MD replied 6 years ago.

Dear Ron,

I appreciate the additional insight and information. Fibromyalgia is a possibility. It is indeed real, however, it's real once all of the other "bad things" that can have its constellation of symtpoms have been ruled out. Some doctors arrogantly dismiss it as a garbage can diagnosis. I, instead, view Fibromyalgia as a distinct condition that has specific criteria that are necessary to diagnose it, once the more serious conditions that overlap in symptom complex are ruled out. The American College of Rheumatology established the diagnostic criteria for Fibromyalgia in 1990, and are outlined in the links below:

http://snipurl.com/1yu3o (shortened link)
http://www.rheumatology.org/publications/classification/fibromyalgia/fibro.asp

And it is available as an embedded PDF here:
http://snipurl.com/1yu3s (shortened URL)
http://www.rheumatology.org/publications/classification/fibromyalgia/1990_Criteria_for_Classification_Fibro.asp

Also, as mentioned in the diagnostic criteria themselves, you can have other conditions and STILL have Fibromyalgia. I, like many of her other physicians in the past that have seen her in person, are always concerned when we hear of pain in specific locations and lumps or bumps on organs. We go into a protective mode of "Frst Do No Harm," so the conditions that can be life-threatening and very serious are always evaluated first ... while Fibromyalgia, if indeed present, may well indeed have been present all along. That's not to say that gall bladder problems, lipomas, and thyroid nodules should be ignored if indeed she does meet both of the essential criteria for diagnosis of Fibromyalgia (FM).

Over this medium, the Internet, I feel a bit like the many physicians who have preceeded me in your wife's care ... I overwhelmingly have concern that many of the things you describe could be very serious, and they need to be taken seriously. This doesn't exclude her from being evaluated for FM by someone familiar with the specific ACR 1990 Diagnostic Criteria necessary for its diagnosis.

Your initially posted question was that you were very worried about your wife's many symptoms. I am, too. I really want her to have a thorough history, physical examination, and the immediate life-threatening conditions like blood clots in the leg and thyroid nodules looked into promptly. I am very biased having come from a Mayo Clinic training background, because our history, physical examinations, assimilation of prior tests, coordination of new tests, and consultatory mechanism are such a well-oiled machine that ALL of your, and her's, concerns and questions would be addressed in one swoop. It would be a busy week, but we would look at her health from every angle -- from serious things to be ruled out, to FM. That is not to give FM any less importance or weight in this process, because if present, it IS IMPORTANT to you and to her. There are treatments available for it. There are lifestyle changes than can help cope with it. It requires follow-up and reassessment just like any other condition. I hope that you understand that FM is just as important to me as the thyroid nodule, but in this venue here on JustAnswer.com, I just have to present those immediately threatening conditions first and foremost. With FM we have a little more time, but I agree with you, it is possible. Only a competent physician with an understanding of the 1990 ACR Criteria can make that diagnosis.

That being said, the leg pain and thyroid nodule remain concerns. I still believe that she needs a single excellent phsician who can coordinate everything she might need through history and physical examination, to labs, studies, and consults. Let's get everything under one umbrella and treat everything that needs treating ... and as you astutely pointed out, that may very well include FM if she meets those criteria. I hope this is something that can be achieved in a timely and well coordinated fashion. You and you wife would ALWAYS be welcome at the Mayo Clinic. She and you need answers to yet unexplained problems.

God Bless you and your wife, Ron. I sincerely XXXXX XXXXX information is helpful. If you have other questions or concerns, please don't hesitate to ask. I am leaving for Chicago on business in an hour or so, but should be back to monitoring my questions on Monday. Take care. Be well.

Daniel Nelson, MD, Doctor (MD)
Category: Health
Satisfied Customers: 258
Experience: Licensed MD. Mayo Clinic Rochester trained physician in Internal Medicine - Critical Care Medicine.
Daniel Nelson, MD and 4 other Health Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery