Hello, San Diego friends! I had my first appointment with a new doctor, Dr. Shikhman at the Institute of Specialized Medicine in Sorrento Valley. He takes Anthem Blue Cross insurance and has quite a long waiting list- it can take a few months to get in to see him, so be prepared for that. Part of the reason why the waiting list is so long is because he's very good, he's basically the go-to guy for chronic illness in Southern California. He has more of a holistic lens; he's a big proponent of the gluten free diet to reduce inflammation, and uses alternative therapies to treat diagnoses derived via western methods. He used a heat-sensing camera to note down places of increased inflammation within my body, and then gently palpated these areas and my joints just like other physicians do. He then used an ultrasound to get a look at both of my knees, both of my shoulders, and my thyroid and lymph nodes near my jaw. This was my first time ever having an ultrasound, and it revealed a lot! Turns out that both of my knees have medial and lateral meniscus tears, most likely because of my time as a dancer prior to life with chronic illness. There's also a cyst hanging out in my right knee, which could be the source of the pain and weakness that I was attributing to CFS. Dr. Shikhman said that he saw evidence of Lyme Disease in the bone and tendons of my knees, although he didn't say specifically what the indication was. The ultrasound of my shoulders revealed similar injuries to my knees, likely acquired during dancing, as well as some calcification that shouldn't be present in a woman of my age. My shoulders don't hurt me at all, so we decided to set that aside as a separate issue (but this is information about my body I wouldn't have otherwise had! And as I become older, taking care of these joints to reduce wear and tear and prevent instability will become essential). My lymph nodes were ever so slightly inflamed, suggesting that an infection is being suppressed my my immune system, but a combination of illnesses are weakening it so that we see symptoms that would not be present in a young person with only one infection and a healthy immune system. We believe that there are two or more illnesses at work in my case; one that was genetically inherited or picked up over the course of normal life, but had no impact on my health because it was dormant or my immune system could easily deal with it, and then a second illness that I was recently exposed to that overwhelmed the immune system or "triggered" expression of the genetic condition. The conditions are most likely a combination of Lyme Disease, Sjogren's Disease, Cat Scratch Disease, and the Epstein-Barr Virus. I've had another battery of blood tests sent out for testing, and we'll see if any of them tell us something new. All in all, my first appointment with Dr. Shikhman was a much greater success than any previous doctor's appointment. Hopefully this will continue as the lab work comes back and we either come closer to diagnosis or have to continue digging. I felt that he really listened to my story, he wasn't patronizing or dismissive, nor did he make the implication that i was suffering from 'women's problems' or was making things up. I believed that he would explore every avenue to diagnose me, even ones that conventional doctors wouldn't think to do or would give up rather than pursue. I would recommend him to anyone in the San Diego area who is looking for a new doctor to help treat chronic illness. I'll also try to update this thread as I continue to work with him!