Ask the Doctor: Hyperydrosis on Face and Head – New Chronic Fatigue Syndrome Symptom or Something Else?

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This week’s question is answered by Richard Podell, M.D., MPH a graduate of Harvard Medical School and the Harvard School of Public Health, has been treating patients with ME-CFS and Fibromyalgia for more than 20 years.

A clinical professor at New Jersey’s Robert Wood Johnson Medical School, Dr. Podell sees patients at his Summit, NJ and Somerset, NJ offices.

Q: I am a 68 year old male with progressive CFS since ’94. I am now hypogonadal, have idiopathic peripheral neuropathy, Chronic Lymphocytic Leukemia (dx’d 2001, indolent, no treatment, Rai scale 0). Plus I have complete blockage of one carotid artery. My question : After the slightest exertion I have hyperydrosis on face and head with concomitant temp rise to 99.6 from my very normal 98.6 degrees. I am dripping sweat right now. WHY? Any thoughts?

A: Thank you for writing. You’ve developed a new symptom, and are not sure where to turn for help. My key message is this: while this might all be a flare up of your CFS, it’s critical that you and your doctors assume first and foremost that the cause is something else. Ruling out all other plausible dangerous diagnoses should be the prompt priority.

You want your physician to imagine that you don’t have CFS, and for arguments sake, that your leukemia is still in perfect control. (Please double check with your oncologist on that.) Make that assumption and then ask what conditions can cause ongoing low gradefever, sweats, and reduced tolerance for exertion?

The list is a long one, but, your internist or family doctor has to act quickly to rule out those that are dangerous–that we can’t afford to miss.

For example, a heart valve infection–bacterial endocarditis. Serial blood cultures and an echocardiogram need to be done promptly whenever there’s n unexplained fever thats gone on for weeks.

For example, tuberculosis–a chest x-ray and/or a TB skin test is required.

For example, congestive heart failure–where the heart’s ability to pump blood is compromised. Again a chest x-ray is needed.

Your doctor knows the list of most common causes. The key is to get the doctor to focus on the fact that this is a change in your normal symptoms AND that until other causes are ruled out you cannot assume this is due to your CFS.

If you have a doctor you know and trust, and most importantly, who knows and trusts you, that’s the place to start. The first step is that they take you and your change of symptoms seriously. Or, if you can quickly get to an infectious disease specialist that’s a good choice. Your problem might or might not be an infection;but ID specialists are experienced evaluating patients who have ongoing fevers. If you consult with a family physician or internist, all else being equal, see one who still admits regularly to the hospital.

Primary care physicians who don’t go to the hospital might be more easily lulled into the false confidence that this is just a passing virus and need not be taken seriously You want someone who has a high index of suspicion for less common but more serious conditions–that you can’t afford to miss. Let’s hope not, but unless the doctor starts with that premise, then the more serious possible causes might tend to be ignored.

Please let us know what your doctors find.

Richard Podell, MD, MPH
Summit, NJ

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Note: This information has not been evaluated by the FDA. It is generic and is not meant to prevent, diagnose, treat or cure any condition, Illness or disease.

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