I'm in a lot of pain and want to know why.

• About two years ago I started having various health issues, and since then, it's all gone downhill. It's also become clear that I need to switch doctors, so I'm asking you, Metafilter, to help me prepare for the new doctor. What's wrong with me? You are obviously not my doctor! Me: female, mid-twenties, childless. Around two years ago, I started to have IBS-type symptoms (bloating, cramps, irregular BMs, heartburn, gas, etc) as well as frequent yeast and urinary tract infections. Then I started getting painful, achey joints (hips, knees, shoulders, elbows, hands and feet; all day, but especially after the gym, after sitting in a certain position for a while, and upon waking up) and killer back pain. Even more recently, I've had facial (jaw, eye, and even overly sensitive teeth), painful cramps/"charlie horses" that radiate from my hip, down my leg, and to my foot/toes in my left leg only. And within the last few months, I've started getting pretty extreme vertigo (I think that's the right term for it) when walking down stairs. Also probably not related but noteworthy: 1. I'm klutzy; I frequently walk into doorways, cabinets, tables, etc. I drop things frequently. This goes way beyond normal klutziness, though. I've walked down a straight hallway and hit the wall. I just have terrible balance and coordination. 2. My periods are NIGHTMARES, especially emotionally. I recently took out my NuvaRing and was in tears for NO REASON less than three hours later. This is common for me at PMS time even without birth control. 3. Talking is exhausting. This is a weird one, but I can't see you get out more than a "paragraph" without being winded, especially if I'm doing other things like walking around or cooking (nothing particularly extreme, here). Today I was merely sitting in a chair giving someone instructions and I was almost immediately out of breath! 4. I'm very weak. I ride my bike to work everyday on the same route for about a mile each way, and have been doing so for 5+ years. It's still really tiring and challenging for me. I joined a gym and, although I think my cardiovascular health is fairly good (I can do the elliptical for 45 minutes and "run" about 5 miles), the next day I am WRECKED. Like, I can barely get out of bed due to muscle and joint pains. I'm not doing anything other than the elliptical, and sometimes I do it for as little as 30 minutes. It gets worse if I go back to the gym the next day or the day after, and it gradually gets back to normal (to joint paint and weakness, not so much muscle pain) if I stop going altogether. Problems I know I have or have had for as long as I can remember: 1. Vitamin b12 deficiency (diagnosed) 2. Very low blood pressure/heart rate, which has resulted in fainting on several occasions. I still get dizzy and light-headed, but I've been able to control the fainting for a few years. (diagnosed) 3. Wolff-Parkinson-White syndrome (occasional episodes of rapid heart beat). I've been to a cardiologist as a teenager, but only wore a monitor for a day. My younger sister wore one for a month and they figured out that she has Wolff-Parkinson-White syndrome, which was corrected via catheter ablation. I'm 99% certain I have this, but it's not been diagnosed. (FWIW, this sister is 6 years younger than me, and I was complaining of these symptoms well before she could talk.) 4. I've also had variations in my thyroid, from hypothyroidism (medicated with Synthroid) to hyperthyroidism. I'm switching doctors for a number of reasons. I think she is way, way too busy (she's ALWAYS on vacation and it's impossible to get an appointment with her), and because I also think that she is quick to dismiss some of my issues. She will often shrug something off (like yeast infection symptoms, complaints of joint pains and cramping, facial pain) and say something like "I'm not sure why that would be happening. You've stumped me." It's really quite astonishing. I've stopped taking new issues to her because I'm not sure how seriously she even takes me anymore. And on that note, I suppose my symptoms could be psychosomatic, but I haven't noticed a correlation between my symptoms and the stress in my life. In fact, other than feeling like crap all the time, my life has gotten monumentally better in the last few years as far as personal relationships and my career are concerned. I really have no troubles, and I have tons of wonderful people around me. And I find being in the hospital, getting blood work done, and talking to near-strangers about my issues all pretty humiliating, so I'm not exactly in this for kicks or attention. My goal is go to a new doctor with some ideas. I'm hoping that I don't have anything serious going on and that I can get to the bottom of this and start feeling better. When looking at my stupidly extensive list of woes, does anything stick out to you? Again, I know you aren't my doctor, and I have an appointment to see a doctor to discuss all this with her. But I nee help collecting my thoughts, because googling endless lists of symptoms with no focus or knowledge is pretty useless. My symptoms have begun to make daily things really exhausting, and even getting into work feels monumental. I'm trying to stay positive, but it's hard. Thanks for your help! ouchithurtsdoc [at] gmail [dot] com

• Answer:

  Not all primary care physicians are created equal. It sounds to me like your PCP should be an http://en.wikipedia.org/wiki/Internal_medicine, not a family doctor or general practitioner. The former specialize in the diagnosis and treatment of disease, particularly multi-systemic diseases. The latter focus more on overall, routine wellness, maintenance of low-severity chronic conditions, administering annual physicals, etc. Internists are also more likely than family doctors or GPs to have extensive connections with specialists and their own hospital privileges. Each has their place, and if you're basically healthy, a family doctor or GP will be fine. But you're not. So you need to go to a doctor who deals with sick people, i.e. an internist. You should also probably try to go to an internal medicine practice in a big hospital, preferably a university hospital, rather than some county hospital outpatient clinic. You've got some real issues. You want to talk to people with the experience and resources to take those seriously. You're probably going to need a referral to a specialist too. It sounds to me like you might need, at least, a consultation with a gynecologist (lady bits), a gastroenterologist (GI tract), a cardiologist (heart/blood pressure), an immunologist (auto-immune possibilities), and a pulmonologist (lungs). All of which your internist will be able to provide (or eliminate) once he's worked you up.