instruction: hello doctor I have had many years of health problems including severe joint pain inability to lose weight chronic fatigue transient pains and abdominal pains that seem to come and go in cycles sometimes lasting for days or even months I have a medical phobia so have not been to the doctor unless it was an emergency but over 20 years ago I ended up going to the er and had several tests I was told I had lupus osteoarthritis cos and thyearoid issues I have tried to treat myself and pain naturally over the years with a healthy lifestyle and natural aids but the pain finally became so bad over the last couple of years that I have gone to some appointments I was referred to a rhuematologist that did blood work and said I was fine except low vitamin I told the new doctor about the early diagnosis and she said it was probably wrong but she would run blood test anyway when the test results came back she said I did not have an autoimmune problem and I was fine except that I had low vitamin I have a copy of the test results that look like there are some problems to me and based on her reviews and my personal experience with my health I would very much like a second opinion I am taking xanax when needed some tests are attached I have also had an mri that showed osteitis pubis fatty liver and mild bladder inflammation
output: hello I have gone through your history and blood reports I found a few abnormalities which I would like to ask a few more details on and also some more questions pertaining to your problem which would help us reach a conclusive diagnosis do you experience any dry eyes or dry mouth when the pain comes is it more in the nights or day do you experience fatigue in the morning hours as well any recent mood changes with irritability any history of forgetfulness as for the blood test major abnormalities I found were low vitamin positive ana but the titer is very low and further end is negative which excludes an autoimmune cause but your cop reactive protein is a bit high at the last report so there was an infection going on that time or any other symptom as your last cop was mostly normal as of now I do not think you have lupus my diagnosis is going towards fibromyalgia but would like to confirm after knowing these further queries only