Dr. Richard C. Rhiew, MD

Hello, You seem to have a multitude of symptoms which are not related, but having low iron could explain many of them including migraine, fatigue, sleep problems, restless legs, depression and anxiety. You should try and expedite the referral to a specialist. Often you can be put on a waiting list and if someone else cancels their appointment, you might be lucky enough to get called in to replace that patient. Cancellations occur all the time. Sometimes you can choose a different doctor who might have more availability and another option is to see a PA or NP. Its not ideal but specialized PAs and NPs are often quite good because they are only working in 1 type of specialty and can be almost as knowledgeable as the specialists. Also its often easier to get evaluated by the PA or NP and if your case is significant enough, you will often be able to get a quick evaluation that day by the specialist if the PA or NP feels you need the physician for evaluation. You will most likely need to get further lab testing. Im not sure what else was checked at the Mayo Clinic but likely you will need to be checked for celiac disease which causes malabsorption and iron deficiency. You are a bit older than most patients diagnosed with celiac disease but it needs to be checked.There are several vitamin deficiencies that should also be checked and thyroid levels as well to be thorough. If you have not had a colonoscopy, that might also be recommended for colon cancer screening as well as to check for possible gastrointestinal bleeding. You dont have any obvious symptoms but you can have intermittent bleeding that can cause low iron as well as intermittent anemia. I hope this helps and I wish you the best.

Hello, Your symptoms are not that specific and you did not describe any prior symptoms or events. Its very hard to answer you without more details. However, I will try to give you some ideas. Along the rib cage there are obviously rib bones, so if you had an injury you could have a rib fracture. Other than your diabetes and your age I have no idea about your general health. For some people prone to osteoporosis, even mild physical stress can cause fractures. Osteoporosis is less common among men especially men under the age of 70. Fractures are associated with severe pain, exacerbated by movement when the ends of the bones rub against each other. That is why immobilization such as a brace or cast often relieves pain in a fracture. If your pain is worse with movement, then its possible the pain is due to bone or muscle such as a sprain. Sprains can be caused by acute injury such as fall but also by repetitive overuse. If its a sprain, rest will eventually heal this. Use of acetaminophen Tylenol and NSAIDs like ibuprofen may help to relieve the pain. Be careful with NSAIDs if you have high blood pressure, coronary artery disease or history of stroke, or history of acid reflux or ulcers. You should also be careful of kidney disease since diabetics and older patients often have some degree of kidney disease. Topical creams can sometimes help as well as application of heat andor ice for musculoskeletal pain. The rib cage also covers the lungs. Usually you would have other symptoms such as cough, wheezing, difficulty breathing with a lung problem such as asthma, COPD, pneumonia, bronchitis. However its possible to have pain alone as a symptom in unusual cases. If you have any symptoms of an infection such as nasal discharge and congestion, sore throat, runny nose, headache, fever, then you might consider the possibility of an infection. If you have a history of smoking, consider COPD. If you have had asthma or history of eczema andor hay fever, then consider asthma with bronchoconstriction. Rarely people can get blood clots in the lungs, caused pulmonary embolisms or emboli, and those can cause pain as well as difficulty breathing. These are often associated with lack of mobility hospitalized bed bound patients or injury to the legsrecovery from leg surgery status post a hip replacement. The kidneys are located in the mid back but the ureter travels a path that mirrors the ribcage before descending into the bladder. Kidney stones and kidney infections can cause pain although it is usually a waxing and waning type of pain but it can be severe. If you have any other associated symptoms such as back pain, nausea, abdominal pain, painful or frequent urination, blood in the urine, then you need to consider a kidney problem. The liver and gallbladder are located beneath the ribs in what is known as the Right Upper Quadrant of the abdomen. Liver problems generally do not cause pain but its possible. Gallstones can cause pain but usually associated with eating. Nausea, vomiting, abdominal pain, and sometimes fever are associated. You need to see a health care provider. If your pain is severe, you should go to an ER in case this is something life threatening.

Well that is not normal at all. This could indicate damage to the kidneys or anywhere along the urinary tract including the ureters and bladder, even the urethra. Blood could be from inflammation, infection, tumors. Tissue is more serious. You need to contact your doctor and give a urine sample for urinalysis with reflex to urine culture to do basic analysis and also check for infection if indicated and probably basic CBC complete blood count and BMP basic metabolic panel or CMP comprehensive metabolic panelas a start. You should also consider seeing a urologist for further evaluation which will likely involve imaging such as CT scan and/or ultrasound, as well as possible more invasive testing such as a cystoscopy camera on a small tube that is inserted into the bladder.

Hello, The rash often associated with early Lyme disease can be associated with other conditions, including tick bite hypersensitivity reaction, southern tickassociated rash illness STARI, nummular eczema, granuloma annulare, and tinea corporis. So it's possible your rash was not due to Lyme disease. Also Lyme disease testing is not that great, which is why repeat testing is often recommended if Lyme disease is suspected. If you had a spinal tap, then the testing for Multiple Sclerosis is different than the Lyme disease testing performed on the spinal fluid. Also I will assume you had an MRI of the brain and spinal cord if you may have Multiple Sclerosis. Again the MRI imaging results will be a bit different for those conditions. Understand that no test is perfect. Your symptoms are consistent with Multiple Sclerosis other than the joint pain, which is a bit atypical and could actually be indicative of Lyme disease as well as some other conditions such as neurosarcoidosis. If your vision problems were intermittent episodes of double vision, that is classic for Multiple Sclerosis.

You should not have to go to an ER for this unless you have severe bleeding and may need a blood transfusion. Also if you have severe pain, you might need to go to the ER to get pain medication. Usually you just need to see your usual primary care provider.

That’s a very good question. The bottom line is we do not know. There are many animal studies , usually in rats or nerve tissue obtained from rats, that demonstrate nerve regeneration secondary to exercise . However human beings are not rats and there are no good studies that show the same effect of exercise on nerve regeneration in humans. Part of that may be due to much longer nerves in humans. There are probably other reasons as well.

I think exercise is still good to do. Even if it doesn’t help nerve regeneration, there are many other benefits from exercise including increased circulation, muscle tone and flexibility.

There is no single most effective pain relief for sciatica or any specific pain. There are multiple treatment options for sciatica, but individual responses will vary. The effectiveness of a treatment option may depend on the nature of the sciatica. For example, physical therapy can be quite useful if the sciatica is due to muscle strain and spasm. This will likely not be effective if you have severe arthritis with spinal stenosis (narrowing) that pinches the nerve.

There are many types of medications for sciatica including NSAIDs (e.g., ibuprofen, Aleve), steroids (e.g., prednisone), muscle relaxants (e.g., cyclobenzaprine), opioid pain medications (e.g., hydrocodone), non-opioid pain medications (e.g., gabapentin, a seizure medication, and duloxetine, an antidepressant). You should see a provider for further evaluation which might lead to possible cause of the pain and the most appropriate treatment option.

That’s a good question . For your particular case I don’t know. However human body temperature should not usually be above 99 degrees. Temperature over 103 has been associated with hyperthermia and death. 143 degrees is way too hot but it’s an isolated area. Still I think there should be concern of potential elevation in body temperature and dehydration. You should probably limit the amount of time you are in contact with the device, take breaks between use for instance. Also you might consider an insulated surface between your body and the laptop to prevent excess heat transfer.

I have never heard of any cases of harm from using a laptop in the way you do but you don’t want to be the first. If microwave popcorn can cause severe lung damage, then anything is possible.

There probably isn’t a fast way to quit any addiction. However if you are truly motivated, you might be able to quit sooner than most people. Chantix is a medication that can help a lot and you don’t have to quit all nicotine once you start this. It can be expensive although most commercial health insurance plans cover this and depending on your state of residence, there might be some special coverage to help you quit smoking. If you go on Chantix I recommend staying on this as long as you can, at least 6 months, studies show that the people who stay on the medication the longest are the most successful at remaining nicotine free.

That’s an excellent question! Snoring is not the same as sleep apnea although people with sleep apnea often snore. Sleep apnea is much more serious since this causes people to stop breathing and lack of oxygen can have significant effects such as daytime sleepiness, falling asleep while driving, and possibly heart problems like pulmonary hypertension.

From your description, I do not think you have sleep apnea. If you have any of the symptoms I mentioned of sleep apnea or someone has seen you stop breathing, you might need to get tested.

Children can have the same signs and symptoms as adults with Lyme disease. Additionally they may have more subtle symptoms such as difficulty sleeping, visual problems or light sensitivity, and cognitive or behavioral issues such as poor concentration, anxiety, restlessness and even paranoia or hallucinations.

Hepatitis C has been called The Silent Epidemic. Almost no one has symptoms until it is severe and then it's obvious the liver has a problem. I strongly recommend you get a blood test for the hepatitis C virus antibody (HCV Ab).

Diabetes medication typically does not cause feelings of sleepiness or laziness. However any medication may cause unusual side effects. Very low blood sugar can cause a sensation of weakness but usually also causes nausea and cold sweats. Very high blood sugar typically causes increased thirst and increased urination but could cause sedation, even a coma with extremely uncontrolled diabetes.

You should check your blood sugar routinely to monitor this. You might need to discuss a change in medication with your medical provider.

If you have an injury to a ligament or tendon, such as an ankle sprain, you will weaken that part of your body. This will make you more prone to future injuries. That is the most likely explanation. Some people are born with a tendency to ligament and tendon injury but that is less common.

This could be several things, but most likely either acid reflux (GERD or gastroesophageal reflux disease) or gallstones. Acid reflux usually occurs about an hour after eating, but can be sooner and is often associated with spicy foods, alcohol, tomatoes, and carbonated beverages. Gallstones are often exacerbated by fatty foods and symptoms can occur much sooner, 15 minutes or less.

You could try changing your diet and/or trying over-the-counter H2 blockers like Pepcid or proton pump inhibitors like Prilosec. Serious conditions like an ulcer or even stomach or esophagus cancer can also cause similar symptoms, so you may need to see a doctor for testing. Gallstones can only be cured with surgery. Your doctor will refer you if testing shows that.

Generally after any surgery a clear liquid diet is the first diet e.g. clear broth, jello. Then advance to solid foods as tolerated but he should avoid high fat foods after gallbladder surgery since removal of the gallbladder will reduce the bile that helps with fat digestion. The liver still makes bile so eventually this might not be a problem although some patients have chronic problems after surgery.

Because of your sun sensitivity I would advise oral vitamin D supplements daily. Sun block prevents almost all UVB.

Fevers are usually due to infections. However other things can cause this such as autoimmune diseases, reactions to medications ( and other substances), and even cancer. It's possible you have a viral infection if your only symptom is a fever and the onset is recent. In that case your symptoms should resolve in 1 to 2 weeks. I did have a patient with high fevers up to 103 once and after a full work-up with lab tests and radiology tests, he got better with no diagnosis. We just assumed it was a virus since he was fine. If you have any other symptoms or your symptoms persist, you should see your doctor for further evaluation.

Yes. Strep throat is an infection of the throat due to a bacteria. Enlarged tonsils often make a person more prone to infections, especially tonsillitis, but removal of your tonsils does not prevent infections from happening. This sounds like you need to see a healthcare provider so I hope you did.