Dr. Hive - help with dd21

[Night Elf]

She's been combating fatigue for quite some time. She says she feels drained all of the time. It's affecting her daily functioning. She's taking a full load of classes at college and is working part-time 2 hours a day each weekday. She cries at least once a day, sometimes multiple times, because she doesn't feel like she can make it any longer and just wants to go home and lay down. She goes to bed early and is in bed 8 - 9 hours but she says she doesn't feel she actually got any sleep. She's also complaining of sweating a lot. She is overweight but I don't know how much. I'd say a lot. She won't share her weight. 

She just had a physical and the doctor did tests but everything came back normal. The only thyroid test she did was a TSH and it was within the normal range. Her Vitamin B12 is within normal range. Only her IRON SAT was a low. It was 18% and the normal range begins with 20%. The doctor told her it was not a problem. The doctor gave her a referral for a sleep study. Dd complains of being congested all of the time and her girlfriend says she snores, so the doctor is wondering if she's not getting a good night's sleep. She hasn't yet made the appointment but she promised me she will because she's interested to know if the sleeping issue is the problem.

What else should I be looking for? I'm at the end of my rope. She's about a 90 minute drive from me so it's not easy for me to go to her doctor's appointments with her. Is there a specialist I should take her to? We don't need referrals for specialists.

[Ann.without.an.e]

Something that commonly stays manageable until about 20-22 is PCOS.  She would need a full hormone workup during a very small window in her monthly cycle to check hormones. 

DD just went through this at 20.  She was just exhausted, gaining weight, felt really off and cloudy headed.  She felt depressed and didn't know why.  We found out that her hormones were completely out of whack because of PCOS.  Her doctor didn't prescribe birth control though (which often makes PCOS worse in the long run), she went a different route.  DD has her life back!

Edited September 26, 2019 by Attolia

[catz]

I would follow up on the sleep study.  I'd ask about fibromyalgia symptoms and see if the doctor that did the physical think that might be worth following up on (did she have blood tests for inflammation?).  I might consider trying a wholistic doc.  I'd follow up on hormone stuff.  I might encourage her to try keeping a food diary with the congestion and record food eaten and sleep patterns/any other symptoms.  Has she had allergy testing?  Does she have digestive system issues?

But the other thing I would say is anxiety and depression (or other mental illness) can be exhausting and often come hand in hand with chronic health issues.  And autoimmune and mental health are often tightly bound systems.  More so in some people than others.  I'd push hard for her to follow up on this end of it too - both therapy and pharmaceuticals.  When I was struggling with a chronic health issue, working on this first gave me a much clearer head to continue following up.  And mental health issues can manifest as physical symptoms in some people.  If she is literally weepy every day, this is worth following up on too.  

[Night Elf]

She's on birth control pills. The only digestion problem she has is frequent burping.

Who do we ask about testing for PCOS? Her primary physician or her GYN?

[geodob]

The sleep study could provide the real answer.

[wintermom]

That is a huge load to bare on a daily basis with full-time studies and 2 hours work. It may have been sustainable for a short while, but seems to be catching up with her physically and mentally. Can she go part-time at school or cut back on the work hours?

[Night Elf]

1 hour ago, wintermom said:

That is a huge load to bare on a daily basis with full-time studies and 2 hours work. It may have been sustainable for a short while, but seems to be catching up with her physically and mentally. Can she go part-time at school or cut back on the work hours?

We're thinking about the part-time school. She refuses to give up her job. They've already worked with her to take her down from the company minimum of 16 hours per week to the 10 hours a week she's currently working. They absolutely do not want to lose her and have bent rules for her more than once. I'm the one who suggested she drop classes this semester. She's slated to graduate May 2020 but if she goes part-time it will delay her graduation by a year. She's not sure how she feels about that. She talked to her therapist yesterday about it and the therapist told my dd that dd needed to think about her health and what was best for her in the long run. So IOW, she supported the idea of dropping classes. DD has an appointment with her school adviser today to talk about it. The school adviser already exchanged emails with dd and assured her she didn't need to be going full-time to continue getting her scholarship or to be in her special program that has her working on her graduate degree early. I worried that program was what was causing her so much stress but she said the graduate level courses were not really more difficult than her undergraduate courses. So, basically she'd drop 3 of her 4 classes for this semester and play it by ear for Spring semester. There is a special 2-class sequence she has to take to graduate. The first class is Fall semester and the second is Spring semester. She needs to stay in those for sure. I told her she could drop only 2 classes if she didn't want to drop down to only 1 class. I'm hoping she and her adviser work out a plan today.