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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Medical
Satisfied Customers: 10897
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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Wanna be doc, finished MS-1 here, Trying to figure out why

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Wanna be doc, finished MS-1 here,

Trying to figure out why get a weird "fatigue" and proximal anterior thigh weakness with moderate exercise. Can also get lightheaded but never fainted in my life. The weird fatigue is almost similar to description of hypoglycemia (but not).
I've been through with other doctors and now trying to come up with a likely differential.

29/M
Levothyroxine, no other meds
History:
Three months ago dx with sub-clinical hypothyroidism. Three months later, mid-normal levels of TSH, fT4, and T3. If the exercise intolerance was from this, should we expect some reduction in symptoms with normal levels at this point?

Holosystolic murmur best heard in the upper right sternum. Increased supine. And pretty sure decrease with Valsalva (semi hard to do on self). Had a echo about 7 years ago and only should trival MVP or regurg (can't remember which) and stress was also done about 7 years ago. Normal EKG as recent as of fall 2012. The exercise symptoms have been around before this point. With these old findings, does it rule out cardio?

Neurological exam yielded no abnormalities.

I've also self tested the use of a glucose meter and no decrease in blood sugars during the fatigue.
Also pulse ox shows no decrease in O2 saturation before and after exercise.
Blood work has been ran during my past and is always normal except for chronically slightly (and very slightly) elevated ast/alt.
My resting heart rate is about 55-60 (bradycardia) and resting BP is normally around 105/60 on average. Testing my BP after exercise once today showed 140/60 on automatic machine.

RickMD :

Hi. My name isXXXXX completed an Internal medicine internship in NYC and have two decades of clinical experience. How can I assist you today?

RickMD :

One of the risks of being a medical student is that you tend to try to diagnose yourself and worry that you have all of the horrible things you are learning about. We have all gone through this.....

RickMD :

The best thing you can do is just not worry about this....you are fine.

RickMD :

If you still think you need the billion dollar workup, then you should walk over to the internal medicine department and grab one of the Attending physicians, perhaps even the Chairman of Internal Medicine, for a "hallway consult".

RickMD :

Does this make sense to you?

RickMD :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

RickMD :

Best of luck on your next 6+ years of training. Being a doctor is a wonderful privilege.

RickMD says:
6:56 AM
Hi. My name isXXXXX completed an Internal medicine internship in NYC and have two decades of clinical experience. How can I assist you today?
6:57 AM
One of the risks of being a medical student is that you tend to try to diagnose yourself and worry that you have all of the horrible things you are learning about. We have all gone through this.....
6:57 AM
The best thing you can do is just not worry about this....you are fine.
6:59 AM
If you still think you need the billion dollar workup, then you should walk over to the internal medicine department and grab one of the Attending physicians, perhaps even the Chairman of Internal Medicine, for a "hallway consult".
6:59 AM
Does this make sense to you?
6:59 AM
I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
7:00 AM
Best of luck on your next 6+ years of training. Being a doctor is a wonderful
Customer: replied 3 years ago.

It is quite possible I'm just fine. The only worry I have is that it's hard to make up the feeling of the exercise intolerance I've had for years. I might be wrong, but when I exercise I get that thigh weakness, but also the point where I feel sick (light headed, nausea, feeling "off"). It even come from a brisk walk after about 15 minutes (but not to same degree).

Andrew,

It is very possible that you are fine. I really wouldn't put too much thought into the symptoms you are having. Trying to diagnose them yourself, even if you were an Attending Physician with 30 years of clinical experience, is a bad idea -- let alone after one year of medical school :)

If you are worried, consult with a full-fledged doctor. But, in my opinion, you have nothing to worry about from what you have posted.

Good luck on year two -- it is a real ball-buster :(

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

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