### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I had a pacemaker put in last July but lately my hips, back and neck muscles ache and I get short of breath and dizzy when I get up. I am usually the energizer bunny, (ask my great grand-kids,) BUT NOW AM FEELING MY 76 YEARS all the time. went to water aerobics this morning, but doing housework and laundry now, took 2 ibuprofen but have to lay down for a few minutes. Aches don t stop and am walking with a noticeable limp!!!! JANICE.

### output:

Hello Janice! Welcome and thank you for asking on Chat Doctor! I passed carefully through your question and would explain that it is important performing a comprehensive differential diagnosis, between different possible causes that may lead to such clinical scenario: - heart failure-chronic anemia- an inflammatory disorder-vitamin D deficiency- orthostatic hypotension (especially considering the fact that getting up makes you feel dizzy). Are you taking any statins? They could also lead to muscle pain and fatigue. Coming to this point, I would recommend consulting with your attending physician for a careful physical exam and some tests: - a chest X-ray study- a cardiac ultrasound and a resting ECG-complete blood count for anemia-blood electrolytes- liver and muscular enzymes (ALT, AST, LDH, CPU)- vitamin D levels- PCR, ESR for inflammation. A Head Up Tilt Test should be done in case of suspicions of possible orthostatic hypotension. If you are taking any statins, I would recommend stopping them for a short period of time. You should discuss with your doctor on the above issues. Hope you will find this answer helpful! Kind regards, 