Need help with Mystery Illness--Possible Sjogren's Syndrome??

Posted by DerbyFever @derbyfever, Jul 6, 2011

I apologize for the length but felt it necessary to give some description of what’s been going on–if anyone has ANY suggestions, I’d love to hear them and would be very grateful!!

I am a 40-yr old female and am currently a patient at Mayo (Rochester). I’m usually a high-energy, Type A, productive type although my life has been turned upside down with a mystery illness I developed around mid-March. Prior to that I’d had a sinus infections, treated with Levaquin, which didn’t seem to help. At the time I wondered whether the infection had progressed into a viral infection.

For a couple weeks I thought I was having a hard time recovering but then the symptoms progressed triggering a cascade of events unlike anything I’ve ever experienced: dizziness/disorientation (not vertigo), uncharacteristically debilitating fatigue (bedridden for days & couldn’t even go downstairs for a week), very weak, heart rate seemed to increase with any physical exertion, and what finally triggered me to see a Dr. was short-term memory problems. The memory problems were becoming more severe & frequent, and after a major incident I knew something was definitely wrong. I was also having a perpetual mental fog–difficulty concentrating and performing ALL life functions. At times it was like an altered state of consciousness & I had no concept whether minutes or hours had passed. At other times the fatigue was so severe I had trouble sitting up, holding my head up, or even keeping my eyes open.

To sum things up, here were some of the specialists I saw and their diagnostic impressions:
ENT–noticed poor coordination/balance and great difficulty walking straight line–felt it was either neurological or metabolic
Otolaryngologist–noticed nystagmus & blood pressure dropped upon standing; referred me to a cardiologist
While waiting for cardio. appt., I stumbled upon the only thing that seemed to help–I started adding salt & water to my diet and each day the dizziness subsided until it was completely gone at 10 days.
Cardiologist–gave echo, electrocardiogram, and Tilt Table Test. Told me to continue salt & water. On TTT at 11 minutes (< nitro) my systolic blood pressure dropped to 43 (baseline of 130) and my heart rate was 58. The test was immediately stopped and I was given IV saline. Diagnosis of neurocardiogenic syncope (aka vasovagal syncope, aka neurally mediated syncope). Dr. prescribed me midodrine but had poor response, tried raising and lowering dose over next few weeks but unsuccessful. Began suspecting adrenal dysfunction or Addison’s Disease, put me on Florinef. Not sure if this helped as I developed another sinus infection (again treated w/Levaquin & again seemed ineffective & possible progression into virus?)

In the process of all this my husband took me to the ER 3 times (4/1, 5/20, & 6/9–I was admitted for 2 nights on 6/9). In retrospect now, each time the IV saline solution helped although symptoms (in one form or another) returned, presumably when the saline left my body. On 5/29 horrible piercing back pain set in and while I was in the hospital 6/9 I was diagnosed with C-Diff. This of course depleted my body further of fluid although I got a steady dose of IV saline during my inpatient stay. Despite being discharged w/C-Diff, I felt better than I had in months & cleaned the house, enjoyed doing laundry, etc. It was then I started putting together that administration of IV fluid seemed to bring great improvement (the more the better) until it tapered off. 5 days after my discharge, I could almost “feel” the effects of the fluid leaving my body setting in (not sure if it’s dehydration or what??) and–determined not to plunge into the depths of the horrible symptoms again, I began consuming lots of Pedialyte. This–along with the Florinef (I think) helped.

While hospitalized the ACTH provocation test was administered to me although did not indicate Addison’s. The caveat, however, is the tech who drew my blood was too “busy” to make the draws at the proper times. The 30 minute was drawn at 43 minutes, the 60 minute was drawn at 75 minutes. My aldosterone was very low (1) but cortisol increased appropriately (albeit barely making the gains required).

My Drs at home have hypothesized everything from partial complex seizures to cervical spine d/o. I put all my hopes in the Mighty Mayo Clinic pinpointing my problem but after being here 10 days, I’m no further along in finding answers. In fact, I’m more frustrated at this point than when I arrived here. I’ve seen a Mayo cardiologist (who repeated the echo & electrocardiogram as well as a 24-hour Halter) who is emphatic that I do NOT have neurocardiogenic syncope and must be released from the “clutches” of a cardiologist. However, other than saying a cardiologist cannot help me, he had little other suggestion or help to offer me.

Here at Mayo I saw a neurologist (which I requested before coming here) who is similarly emphatic that there is nothing neurologically that can explain my symptoms. She had me go through the Autonomic Reflex Screen yesterday; I had no further appts. with her but pleaded with her nurse to call me with the results. The test showed suppression of postganglionic response although the Dr. suspects this was caused by taking Tylenol PM the night before and recommends retaking the test when I’m T-PM free for 3 days.

Meanwhile we thought we had a *breakthrough* when a Dr. from back home called to give me the results of an overnight oximetry test I’d taken pre-Mayo. My O2 levels were normal although I had an avg. of 15.5 episodes of sleep apnea per hour (over 6 hours, with a max. of 35 in hour 4). My Dr. at home recommended an overnight sleep study so I’ve been doing everything to try to get this done while we’re here at Mayo. I was fortunate enough to be called on a wait list (called a “checker” here at Mayo) yesterday to see a Dr. in the sleep d/o dept. for a consult. He looked at the results, talked to me for a bit, and assured me he is certain that I do not have sleep apnea. He showed me that my O2 levels did not fluctuate during the oximetry test and was not impressed at all with the test showing my episodes of sleep apnea. He pretty much discounted those results altogether since it was from a home health clinic (his words not mine), there was no explanation of the results on the forms, and the description of the test itself was vague. From that he concluded it to be invalid & did not recommend a sleep study.

So now I’m in no man’s land as far as understanding what in the world is going on inside my body. A couple Drs. here have suggested post-viral fatigue syndrome and have referred me to the fibromyalgia clinic (where I’m spending my days as a checker since the 1st appt isn’t for several weeks). The one common thread that seems to persist, however, is FLUID. I feel that surely that must mean something to someone…I had to stop the Florinef a couple of weeks ago prior to coming to Mayo (I’ve also stopped the salt tablets). Although I wasn’t convinced it was helping, I am now that I’ve started to to regress since I’ve discontinued it. From my own research on what conditions can cause chronic dehydration, Sjogren’s Syndrome seems to keep coming up.

Is anyone familiar with this? If so, what kind of specialist would I need to see? A rheumatologist? Opthalmologist? I didn’t think my severely dry eyes had anything to do with the current symptoms but I’m now wondering. I’ve had severely dry eyes my entire life and have been using Rx Restasis for several years. (I had LASIK in 2001 and the Drs. told me my eyes were so severely dry I should actually reconsider having the surgery.) I also have severely dry throat & am hoarse a lot (I don’t smoke or drink) and have to drink continuously water during meetings at work just to continue making presentations. This disorder seems to be elusive for any Drs. that I’ve seen thus far.

Thanks so much for taking the time to read this and if you have any ideas, I’d love to hear them.

DerbyFever

Have you been tested for SLE?? I have experienced similar symptoms in the past when flaring as I have SLE, Sjogrens, and Antiphospholipid so I am unsure as to which disease was contributing to the symptoms. As far as which specialist to see for Sjogrens I see a rheumatologist but, as I said I also have SLE which is in the rhuematology field of study. I hope they can figure out what is going on and if you have not been tested for lupus/SLE I would certainly have that done ASAP as it can cause all of the symptoms you have described and when under control you will never feel 100% but, it is very tolerable.

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Have you ever researched the short and long term possible side affects of Levaquin? Sounds like your problems started after taking it and are very similar to comments on the web. Good Luck

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I’m so sorry you’re going through all this! Please contact me at any time for support. I understand how frustrating it is to have a chronic illness and to search for an accurate diagnosis and treatment. I have Postural Orthostatic Tachycardia Syndrome which is caused by a problem with my autonomic nervous system. I was tested and treated in June at the Mayo Clinic in Rochester (my POTS team consisted of Nurse Practitioner Carter in Women’s Cardiology, Dr Osborn in Cardiovascular Electrophysiology, and Dr Fealey in Autonomic Neurology). I also have a problem retaining fluids, and I was prescribed Florinef. My autonomic problem causes my body to not retain the fluids I consume so I have to take extra sodium. The side effects of Florinef were pretty bad, so I don’t take it, and instead I consume 3-4 grams of sodium per day in addition to 2-3 liters of fluid per day. Per the Mayo Clinic team, the best way to get sodium in the diet is by pickles and V-8 juice. They’re full of sodium and it works great.

I also have episodic extreme fatigue, and it’s caused by cerebral hypoperfusion, which is caused by my POTS. My fatigue gets better when I am well hydrated, have a good amount of sodium in my body, and I wear compression garments.

My condition causes a lack of vaso-constriction, so my blood pools in my arms and legs instead of going to my head and brain, so I need the fluids and salt and compression garments to help with vaso-constriction.

I’m not sure if you have POTS, but they have a great POTS clinic at the Mayo Clinic. I’ll keep you in my prayers, and please know that you’re not alone in your quest for answers.

Liked by julesg67

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From personal experience and diagnosis, the key may be low sodium as you stated you felt better on saline IV–This is key to the beginning of Cushing’s Syndrome or Addison’s. Check out the symptoms of each. Each have to do with excretion of cortisol (either high or low) can zap you of you sodium/electrolyte balance and bring on fatigue(crushing fatigue) and brain fog. A good endocrinologist should be able to pick up on this. Both diseases are rather rare–and many times just aren’t considered. Hope this helps as I suffered for 8 years before getting a diagnosis.

Liked by julesg67

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@cclong

Have you been tested for SLE?? I have experienced similar symptoms in the past when flaring as I have SLE, Sjogrens, and Antiphospholipid so I am unsure as to which disease was contributing to the symptoms. As far as which specialist to see for Sjogrens I see a rheumatologist but, as I said I also have SLE which is in the rhuematology field of study. I hope they can figure out what is going on and if you have not been tested for lupus/SLE I would certainly have that done ASAP as it can cause all of the symptoms you have described and when under control you will never feel 100% but, it is very tolerable.

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I am also sorry you have had to go through all those things! I, too, have had a somewhat similar experience over the last 10 years. I was diagnosed with Fibromyalgia in 1998 by a very good Rheumatologist and have been treated for that til present and ongoing. Recently though, I saw another very good Rheumatologist and was diagnosed with Sjogren’s Syndrome. He said I did not have SLE, but the chronic dry eyes (they feel like sand in my eyes) and chronic dry mouth and many other symptomes were indicative of Sjogren’s. He put me on Plaquinil (generic form) and after about 4 months I feel some better, but not where I want to be. I have both Central and Chronic Obstructive Sleep Apnea and that causes me more problems than anything. I have had several sleep studies and I cannot sleep without a BiPAP machine without paying consequences. I hope you find out what is wrong, I know you are tired, but keep up hope and never give up, that is what keeps us going. I too have the chroinic fatigue and it is worse than all the other. Just keep doing what your heart and body tells you and get to the right doctor by process of elimenation! God bless you in your quest ot find the answers! And, oh, also, with Sjogren’s you see a Rheumatologist, and have to keep regular appointments with a dentist and opthamologist for treatment of the dry eye and tooth decay. I hope some of this may have answered your questions or given you encouragment.

Liked by jodyalbright

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@cclong

Have you been tested for SLE?? I have experienced similar symptoms in the past when flaring as I have SLE, Sjogrens, and Antiphospholipid so I am unsure as to which disease was contributing to the symptoms. As far as which specialist to see for Sjogrens I see a rheumatologist but, as I said I also have SLE which is in the rhuematology field of study. I hope they can figure out what is going on and if you have not been tested for lupus/SLE I would certainly have that done ASAP as it can cause all of the symptoms you have described and when under control you will never feel 100% but, it is very tolerable.

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can either sjorgrens or addisons disease cause elevated liver enzymes….

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i too have alot of these symptoms but also added to the list es elevated liver enzymes, so i do not know if either sjogerns or addissons or cushing syndrome causes this….does anyone know, can they raise liver enzymes….thanks to all.

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My fiance was diagnosed with Sjogren’s Disease by Richard L. Scher, MD : Department / Division-Surgery / Otolaryngology-Head and Neck Surgery. http://www.dukehealth.org/physicians/richard_l_scher. And also was referred to Patricia L. Lugar, MD, MS Department / Division Medicine / Pulmonary, Allergy, and Critical Care Medicine.http://www.dukehealth.org/physicians/patricia_l_lugar.

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@cclong

Have you been tested for SLE?? I have experienced similar symptoms in the past when flaring as I have SLE, Sjogrens, and Antiphospholipid so I am unsure as to which disease was contributing to the symptoms. As far as which specialist to see for Sjogrens I see a rheumatologist but, as I said I also have SLE which is in the rhuematology field of study. I hope they can figure out what is going on and if you have not been tested for lupus/SLE I would certainly have that done ASAP as it can cause all of the symptoms you have described and when under control you will never feel 100% but, it is very tolerable.

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I have not been tested for SLE but have an appt. in August with a rheumatologist so will inquire about it. Another Dr. mentioned SLE/lupus as well so it sounds like I definitely need to follow up in that area. Thanks for the info. Out of curiosity, does Sjogren’s cause dehydration in your case??

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@cclong

Have you been tested for SLE?? I have experienced similar symptoms in the past when flaring as I have SLE, Sjogrens, and Antiphospholipid so I am unsure as to which disease was contributing to the symptoms. As far as which specialist to see for Sjogrens I see a rheumatologist but, as I said I also have SLE which is in the rhuematology field of study. I hope they can figure out what is going on and if you have not been tested for lupus/SLE I would certainly have that done ASAP as it can cause all of the symptoms you have described and when under control you will never feel 100% but, it is very tolerable.

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Thank you, LaNita, I appreciate the words of encouragement! I just completed a sleep study and the good news is all looks normal in that regard in my case. I saw my opthamalogist on Friday and he did feel like my condition fits Sjogren’s and has referred me to a rheumatologist (who I will see in August). I’ve been using Restasis eyedrops for years and just had my 2nd set of tear duct plugs implanted. It is exactly as you said–like sand in my eyes–just calling it “dry eyes” doesn’t really convey what it feels like. At times the only relief is to simply close my eyes otherwise the burning & sandpaper feeling is too much.

Another wrench in the whole matter…I saw my cardiologist yesterday and he does NOT feel it’s Sjogren’s. Ugh!! He agrees that the central concern seems to be my body’s inability to hold on to the fluid. Since my post, I’ve gone off the fluorinef but had to resume it since my symptoms of fatigue & generally just being “out of it” began to take hold again. I think this time I started the fluorinef early enough to start the really bad downward spiral from taking over. The ? is what would cause my body to chronically lose fluid? My cardio. doesn’t seem to think Sjogren’s would do that…Any thoughts on this since you’ve been living with Sjogren’s and FM? Thanks for your help & encouragement!

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@april43079

My fiance was diagnosed with Sjogren’s Disease by Richard L. Scher, MD : Department / Division-Surgery / Otolaryngology-Head and Neck Surgery. http://www.dukehealth.org/physicians/richard_l_scher. And also was referred to Patricia L. Lugar, MD, MS Department / Division Medicine / Pulmonary, Allergy, and Critical Care Medicine.http://www.dukehealth.org/physicians/patricia_l_lugar.

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Thanks for this info., April. Do you mind me picking your brain in regard to your fiance’s Sjogren’s?? I’m curious to know, other than the obvious dry eyes & mouth, what other symptoms does he experience? The question I’m having is about my generally chronic dehydration throughout my body. My opthalmologist does feel I meet the criteria for Sjogren’s although I just saw my cardiologist yesterday and he doesn’t seem to think that Sjogren’s would cause dehydration…It’s getting frustrating, like I’m watching a game of medical ping pong…only I’m the ping pong 🙁

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@mariah1

From personal experience and diagnosis, the key may be low sodium as you stated you felt better on saline IV–This is key to the beginning of Cushing’s Syndrome or Addison’s. Check out the symptoms of each. Each have to do with excretion of cortisol (either high or low) can zap you of you sodium/electrolyte balance and bring on fatigue(crushing fatigue) and brain fog. A good endocrinologist should be able to pick up on this. Both diseases are rather rare–and many times just aren’t considered. Hope this helps as I suffered for 8 years before getting a diagnosis.

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Thanks, Mariah, and yes, Addison’s was something that has been considered. I do seem to fit the bill for adrenal fatigue. However, when I was hospitalized they did the “high dose” of ACTH provocation and it wasn’t indicative of Addison’s BUT the endo. wants to do a lower dose ACTH provocation and see how I do on that. I personally don’t know the difference, but there must be…At this point just getting a definite answer would be a good thing. Sorry to hear you suffered for so long though am glad you finally did get a diagnosis.

Since my Mayo post I went off the fluorinef (per the Drs who agreed with trying this approach) and after 10-14 days I began to slowly show symptoms of an oncoming crash. On the 2nd day of the downward spiral I resumed the fluorinef and I’ve been functioning GREAT. So it definitely seems to be a problem with my body’s difficulty with fluid retention. My opthalmologist is thinking Sjogren’s though my cardio disagrees and still going through more testing with endo for Addison’s. I can’t wait to have resolution so I can move forward in my life. Thanks for your help & insights 🙂

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@krista

I’m so sorry you’re going through all this! Please contact me at any time for support. I understand how frustrating it is to have a chronic illness and to search for an accurate diagnosis and treatment. I have Postural Orthostatic Tachycardia Syndrome which is caused by a problem with my autonomic nervous system. I was tested and treated in June at the Mayo Clinic in Rochester (my POTS team consisted of Nurse Practitioner Carter in Women’s Cardiology, Dr Osborn in Cardiovascular Electrophysiology, and Dr Fealey in Autonomic Neurology). I also have a problem retaining fluids, and I was prescribed Florinef. My autonomic problem causes my body to not retain the fluids I consume so I have to take extra sodium. The side effects of Florinef were pretty bad, so I don’t take it, and instead I consume 3-4 grams of sodium per day in addition to 2-3 liters of fluid per day. Per the Mayo Clinic team, the best way to get sodium in the diet is by pickles and V-8 juice. They’re full of sodium and it works great.

I also have episodic extreme fatigue, and it’s caused by cerebral hypoperfusion, which is caused by my POTS. My fatigue gets better when I am well hydrated, have a good amount of sodium in my body, and I wear compression garments.

My condition causes a lack of vaso-constriction, so my blood pools in my arms and legs instead of going to my head and brain, so I need the fluids and salt and compression garments to help with vaso-constriction.

I’m not sure if you have POTS, but they have a great POTS clinic at the Mayo Clinic. I’ll keep you in my prayers, and please know that you’re not alone in your quest for answers.

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Krista,
Thank you, thank you, thank you!! I have ecome familiar with POTS through my own medical research. I’m taking salt myself (1 gram of pure salt twice daily) and drinking lots of water. They aren’t inclined to think POTS for me but I’m still going through testing to find out exactly what “it” is. Thanks again for your awesome support and if you have any other insights please send them my way. Take care!!

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@glutenfreegloria

Have you ever researched the short and long term possible side affects of Levaquin? Sounds like your problems started after taking it and are very similar to comments on the web. Good Luck

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I have not but will do so. That’s concerning…at the same time, there would be an easy remedy–never take Levaquin again 🙂 Thanks for the heads up!

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@april43079

My fiance was diagnosed with Sjogren’s Disease by Richard L. Scher, MD : Department / Division-Surgery / Otolaryngology-Head and Neck Surgery. http://www.dukehealth.org/physicians/richard_l_scher. And also was referred to Patricia L. Lugar, MD, MS Department / Division Medicine / Pulmonary, Allergy, and Critical Care Medicine.http://www.dukehealth.org/physicians/patricia_l_lugar.

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I COMPLETELY HAD TYPED U BACK OVER A PAGE WORTH AND LOST IT!!! SO I APOLOGIZE, BUT FOR NOW I WILL ANSWER YOUR QUESTION, CONCERNS, ETC.. FIRST OFF I’D LIKE TO PASS ON TO YOU THAT I KNOW MYSELF FIRST HAND THAT DEALING WITH THE PING PONG OF MEDICAL DOC IS VERY FRUSTRATING. I SUFFER FROM CHRONIC BACK PAIN DUE TO SCOLIOSIS, HAD SPINAL FUSION TO CORRECT WHEN I WAS 15, AND NOW HAVE DISC PROBLEMS BELOW THE FUSION, AND GOD ONLY KNOWS WHAT ELSE, BUT BASICALLY LIVE WITH PAIN EVERYDAY AND HAVE FOR OVER 15YRS NOW. I REFUSE TO TAKE PAIN MEDS, CHOOSING MASSAGE THERAPY, ETC.. INSTEAD. I HAVE LITERALLY HAD DR’S REFUSE TO ESTABLISH/TREAT ME AS A PATIENT AND I HADN’T EVEN WALKED IN THEIR OFFICE, THIS WAS THEIR DECISION BASED ON MY MEDICAL RECORDS. THEREFORE, WHAT I AM GETTING AT IS UNFORTUNATELY THIS DAY IN TIME WE HAVE TO ADVOCATE FOR OURSELVES FIRST AND FOREMOST. SINCE I WORK IN THE MEDICAL FIELD MYSELF AS A CERTIFIED OCCUPATIONAL THERAPY ASSISTANT, I WILL ADMIT I AM CAN BE A DR’S WORSE NIGHTMARE SINCE I NOT ONLY WORK IN THE MEDICAL FIELD, BUT HAVE MEDICAL KNOWLEDGE AS WELL. ALSO, JUST LISTEN TO YOUR BODY, ONLY YOU KNOW WHEN YOUR BODY IS TRYING TO TELL YOU SOMETHING ISN’T RIGHT AND WHEN YOU FOR EXAMPLE NOTICE A PATTERN, FOR LACK OF BETTER WORDS, WITH SYMPTOMS, ETC… DO YOUR RESEARCH AND DON’T GIVE UP! SO TO ANSWER YOUR QUESTION ABOUT DEHYDRATION. HE HAS TOLD ME THAT HE HAS NOTICED EVEN MORE RECENTLY THAT KNOW MATTER HOW MUCH HE DRINKS THAT HE IS VERY THIRSTY AND THAT HIS MOUTH AND THROAT ARE EXTREMELY DRY, TO THE POINT THAT YOU CAN VISIBLY SEE THE WHITE PASTE THAT FORMS ON HIS TONGUE AND AROUND HIS LIPS. HE MOSTLY DRINKS H20 AND A TEA DRINK SIMILAR TO CRYSTAL LIGHT, AS I HAVE EXPLAINED TO HIM THAT CAFFEINATED BEVERAGES WILL ONLY DEHYDRATE HIM MORE AND SINCE SJOGREN’S CAN CAUSE DENTAL PROBLEMS, THEN HE LIMITS HIS SUGARY DRINKS TOO. HE HAS ALWAYS HAD PROBLEMS WITH NEEDING TO DRINK FLUIDS OFTEN, BUT THIS HAS BECOME CHRONIC TO THE POINT THAT HE DRINKS SO MUCH THAT HE IS LITERALLY HAVING TO URINATE 2-4TIMES IN AN HOUR. HE ALSO RECENTLY HAS BEEN HAVING MORE PROBLEMS WITH SLEEPING AT NIGHT DUE TO HAVING TO GET UP TO DRINK SOMETHING AND ALSO BECAUSE HE HAS BEGUN TO HAVE PROBLEMS WITH FEELING LIKE HE IS CHOKING WHEN HE LIES DOWN. VERY SCARY! WHEN THE DR’S AT DUKE DIAGNOSED HIM THEY WEREN’T SURE WHETHER HE MAY HAVE MULTIPLE PROBLEMS GOING ON. ONE DR MENTIONED HIM POSSIBLY HAVING SOME SORT OF CHRONIC TISSUE DISORDER, AS HE HAS PROBLEMS WITH THE TISSUES IN HIS NOSE AND THROAT AND USE TO HAVE SEVERE, CHRONIC NOSEBLEEDS, THERE ARE HOLES IN THE TISSUES OF HIS THROAT/NOSE AS IF THE TISSUE IS DEGENERATING AND ONE DR DESCRIBED HIS NOSE AS LOOKING LIKE RAW HAMBURGER MEAT. HE HAD A TONSILLECTOMY THE SUMMER ON 07′ AND TO THIS DAY THE SURGICAL SITE HAS STILL NOT COMPLETELY HEALED AND HE HAD TO HAVE 2 ER VISITS POST SURGERY DUE TO HEMORRHAGING FROM THE SURGERY, ONCE EVEN FLAT-LINING AND HAVING TO BE SHOCKED BACK DUE TO THE AMOUNT OF BLOOD HE LOST. THIS ALL TOOK PLACE A FEW MONTHS BEFORE WE MET, SO I DIDN’T GO THROUGH ALL OF THIS WITH HIM, HIS PARENTS DID. HE ALSO HEALS SLOWLY IN GENERAL, WHETHER SMALL WOUND ON HIS HAND, ETC… AND GETS SICK VERY EASILY. I CAN HAVE THE COMMON COLD AND HIS SYSTEM TURNS IT INTO SEVERE STREP THROAT OR HIS THROAT WILL SWELL UP AND BE VERY PAINFUL AND HE WILL BE VERY TIRED AND JUST LOOK PALE AND SICKLY, FEVERISH, ETC… SO VERY APPARENT THAT AS WITH SJOGREN’S HIS IMMUNE SYSTEM IS SHOT. SO MUCH 4 SHORT REPLY, LOL! I HOPE THIS HELPS AND PLEASE KNOW DO NOT HESITATE TO ASK ME ANYTHING. IF YOU’D EVEN LIKE TO TALK OVER THE PHONE, OR VIA EMAIL, JUST LET KNOW. HOPE YOU CAN FIND THE ANSWERS YOU NEED AND THE RIGHT MEDICAL PROFESSIONAL TO HELP YOU, SOON!
TAKE CARE, APRIL

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