Hi and thanks for the query,

I understand it could be very disturbing, especially when in pain and having to have some lack of sleep too. It is important to know for how long you have had fatigue. the origin of this fatigue could be from different levels. SLE can cause anemia, and routine control of the blood hemoglobin level in lupus in very important. I would therefore suggest you get a complete blood count done, and in case of anemia, adequate supplementation of Iron be done. Kidney lesions in SLE could cause a decrease in secretion or erythropoeitin, a hormone very vital for synthesis of red blood cells. A kidney lesion could also therefore explain anemia. Kidney function tests to assure its integrity, measurement of blood Calcium and Vitamin D levels could be very useful. A follow up with a rheumatologist for SLE is vital for periodic reevaluation and updating of the management plan.

have you had any serious stressful psychological events lately? this is a key proponent in lack of sleep. Being at ease, motivated, doing exercise could be of great help.

It might be important to know and charateterize the specific type of diaphramatic hernia.It could be congenital (from birth) as stays without any symptoms in most patients. It could also be acquired thrpugh trauma or other events. I your case, if you have started experiencing pain in the upper breast, it might be very important to ensure that the chest pain is not from other causes first, before associating it to the hernia. A careful assessment of the breast on its own by your physician is necessary. Other common local causes of chest pain like infections and lung disease be checked for. Cardiac causes of chest pain (pericarditis, angina for instance ) must be carefully considered. It might be necessary to know if you are hypertensive or not, or have a family or hereditary diseases.

Proposing an adequate management plan deserves a careful clinical examination and laboratory testing. A review by your rheumatologist is of utmost importance. Excluding other causes of chest pain before ascribing the pain to the diaphramatic hernia is important. As I mentioned, 60 to 70 % of people with this hernia could lead purely normal lives.

Book an appointment with your rheumatologist and a thoracic surgeon or pulmonologist, for an appropriate clinical review. For now, you really need not worry. A good vegetable XXXXXXX diet, more fruits, exercise, distraction, rest and sense of positive thinking for a better tomorrow could be of immense help. Thanks and hope this helps. Do not hesitate asking any specific questions if need be. Wishing you good health and kind regards.

Bain LE, MD.







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Hi and thanks for the update,

It s reassuring that the SLE is well managed. With respect to the diaphramatic hernia, it requires an in depth evaluation by a specialist. Respiratory distress is an important symptom this pathology. Its absence might require the test to be run again, and the opinion of a cardiothoracic surgeon.

I recommend a proper clinical evaluation by a cardiothoracic surgeon and a repeat chest X XXXXXXX His opinion shall be key for further management. With respect to the tiredness, other causes of tiredness like anemia, inadequate intake of fruits, vegetables, lack of particular vitamins, inadequate sleep and rest and stress/depression should be carefully considered.

Thanks again and feel free asking me any further questions you might wish to ask. I shall be honored making my little contribution to your well being. Wishing you the best of health and kind regards.

Bain LE, MD.

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Hi and thanks as I await hearing from you soon. Best of health and kind regards.

Bain LE, MD.

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