For about 25 years I have had 3-4 episodes/year of my palms and soles
being covered with tiny vesicles that itch terribly, last 5-7 days. 
Ten years ago during routine blood work, was found to have elevated
liver enzymes (5x). Complete workup including liver biopsy, no cause
found.  (do not take Tylenol or drink alcohol, not overweight).  In
last six months have had two episodes of tingling/numbness in lower
leg, episode of blurry vision (3 days), some incontinence of bowel and
bladder, extreme fatigue.  Complete and thorough blood workup again,
only revealing the elevated liver enzymes again.  42-year-old WF,
always extremely healthy, and even when enzymes were 5x elevated, no
problems whatsoever.  But lower leg/knee problems and extreme fatigue
now really bothering me.  I think my doc thinks I am just a whiner. 
Where do I go from here?  I have been tested for hepatitis, thyroid,
diabetes, arthritis, immune disorders, and recently had a nerve
conduction test on lower leg - all normal. Any of this related, or do
I just ignore and quit bugging my doc (have seen him twice in four
months).  DPM

Dear DPM,

You may not be just whining. While the symptoms you describe may not
be anything, symptoms such as you describe as well as other vague
symptoms such as fatigue, weight gain and unusual body aches can all
be indicators of one of many autoimmune diseases. While you mention
that you have been tested for some immune diseases, you should know
that according to a recent article in Shape magazine that discusses
autoimmune diseases with American Autoimmune Related Disease
Association (AARDA) founder, Virginia Ladd, getting a correct
diagnoses for an autoimmune disease takes on average four to five
years and four to five different doctors. Because the symptoms are
often so vague, they are frequently dismissed as non-existent or
psychological. Many such diseases are difficult to test for, which
compounds the problem. A survey of patients with autoimmune diseases
conducted by the AARDA discovered that almost 50 percent of
respondents were labeled hypochondriacs or chronic complainers in the
earliest stages of their illness. Ironically, the class of medical
professional most likely to suggest the first correct diagnoses was a
mental health professional.  Some common autoimmune diseases include
Graves' disease, rheumatoid arthritis, pernicious anemia, lupus and
multiple sclerosis. Almost 75% of autoimmune disease sufferers are
women.

A second possibility that matches your description is heart disease.
Numbness, blurred vision and extreme fatigue are all common with heart
failure. In addition, because the liver gets a fixed amount of cardiac
output changes in liver function are also not uncommon in congestive
heart failure... although I'm not sure that the typical profile
matches exactly what you describe. Nonetheless, a basic test such as
an ECG\EKG is simple and inexpensive, so you may want to discuss it
with your doctor if you feel this may be a possibility.

Finally, fortunately or unfortunately (depending on how you look at it
:-) ) many of the symptoms you describe can indeed be indicative of
more everyday things: such as severe stress. With all this in mind,
the best thing you can do is get a second opinion from a different
doctor. You know your own body better than anyone else ever will; and
while you certainly don't want to be up at night worrying needlessly,
if you feel there may be a problem then by all means you have the
right to have someone else take a look at you. In the meantime, if the
symptoms are bothering you a lot consider keeping a journal. Try to
note when your symptoms occur or become more severe, and if there seem
to be any pattern or triggers (there may not be). This will help you
be more able to answer the doctor's questions when you see another
physician.

Other than that, try to take good care of yourself. As a culture,
modern society does not eat, exercise or sleep as healthfully as the
human body needs to operate efficiently. Many of us know we need to
reduce the stress in our lives or eat more nutritiously, but very few
of us do it. Proper self-care can help many people feel better,
healthy or otherwise.

If you need any clarification, don't hesitate to ask. Good luck, and I
hope you feel better soon.

-Spot


"Diseases Doctors Misdiagnose," by Dana Hudepohl. Shape, (March 2003).

Dear DPM,

Yikes.  Get a new doctor.  If you can get access to an academic
institution in a major city, this may help since you have an unusual
case.  Do not give up - keep pushing until they can either figure it
out or help you (these do not always go together).  Although I'm not
an anti-breast implant freak, I have known of cases with some similar
symptoms in which silicone implants were involved.  If you have these,
find someone who specializes in such patients.

Just whining?  No.  Good luck.

JCG

This is a long shot, but have you been tested for Rocky Mountain
Spotted Fever? One of the characteristic signs is a macular rash on
the palms of the hands and soles of the feet. Elevated liver enzymes
are also present in RMSF.

Hi Dmp,

 Just wantyed to add my 2 cents.  Please don't give up...my mother
went through a very similar situation.  For 2 years she went
from dr to dr, with numness, tingling...fatigue....blurry
vision...sluring of words....no one could find anything....she was
hesitant
to go out, in case symtoms hit & then....she'd go weeks with no
symptoms, back to normal.  Since Drs had ruled out so many things
they told her to go see a shrink....she literally thought she was
going crazy.  A strong support system was crucial, we knew there
was something wrong and we reasured her that she was not going crazy
and that we just had to keep on looking f or the root cause.
Alas, after 2 very long years she was diagnosed with MS.  She went to
the 100's Dr....an MS specialist in Miami who in 3 seconds
flat told her it was MS and confirmed it with an MRI and other tests. 
It has now been another 2 years and she is doing great.  They put
her on some amazing medicine (shots once a week) and she is living
again and an insparation to us all.  Please..please Dmp...don't
give up....if you have to see 500 doctors..do it....you are NOT
whining....but if you have to kick and scream and..yes..whine to make
them hear your pain....DO IT.....you deserve it!!!  God Bless!!!

If I were you and wanted an answer, this is what I'd do:

Pick out a dermatologist in advance.  Preferably a good one in private
practice with a hospital affiliation, not just an acne/dermabrasion
guy.

Then, wait until the rash broke out on your palms again.  At that
time, immediately go to the dermatologist's office, and tell the
receptionist you'd be willing to self-pay for an appointment TODAY to
have this looked at.  If you can have this conversation while the
doctor is in earshot, so much the better.

Then just show the doctor the rash.  She'll likely start asking you
about the other symptoms, and then you can tell her.

Sounds like some type of dermatitis.  Get yourself to a good
dermatologist.  Also, I would recommend dumping any doctor who does
not appear to be taking your concerns seriously.  Sometimes, docs
don't know, but they should be humble enough to acknowledge this, and
not shift the blame to your psychological state.