Mystery Diagnosis: What to ask the Dr.
January 15, 2014 12:27 PM   Subscribe

I've been having weird, horrible, consistent problems - everyday - for about 3 months or longer. I really need to figure out what's going on with me and could use all the help I can get. I can't deal with day-to-day life like this!

Since posting anon ( I don't want my medical details attached to my name) I'll try to get all the relevant details in without being too long winded. Pleas bear with me, I need the hive's help!

Throwaway email:

Female, 23 years old. Married. Never been pregnant. Never had surgery (except wisdom teeth). I have had a stomach scope though. Non-smoker, No drugs, No alcohol, Minimal caffeine (tea), seasonal weeds/mold allergies. 5'4" and 106lbs (have actually gained weight in the past 6 months)

What I know I have:
-Mild blood sugar problems ("borderline" reactionary hypoglycemia - I'm sensitive to blood sugar levels, can't eat high glycemic index foods, and generally run a little low with blood sugar and need to snack and eat regularly.

- Moderate GERD and Mild IBS - Managed with diet and Prolosec Rx. A trigger food is garlic and so I avoid that. I've had stomach problems my whole life, however the IBS started a few years ago.

-General Anxiety - Untreated, I don't have a therapist. I am perfectly willing to seek treatment for anxiety, however I think there is something physiological going on that I want to address first.

What's been going on:
-Symptoms really kicked into high gear when I started my job at the end of Sept. Regular 9-5 office job. I had some anxiety when I first started since it's my first office job (I have over 2 years experience in my field though and the tasks are actually below my skill level.)

-Randomly usually around lunch-ish time, I get these weird episodes. They are similar to a sugar crash/panic attack, however my blood sugar is fine. Episodes include: Lack of focus/cloudiness, heart racing, can't breath/catch my breath, shaky feeling, complete dizziness, light headed, intense stomach pain, nausea, then that leads to kind of a panic feeling. I also sometimes get weird little "pin pricks/raindrops" in my vision, but ONLY sometimes and I can only vaguely notice them if I am looking at something white/light. Kind of imagine feeling like crap all at once.

-General symptoms - Total exhaustion. Lack of focus throughout the day (not used to that at all, I'm usually really focused.) General "feeling like crap". It's hard to do anything but go to work. I then get anxious about going out other than work because I just usually don't feel good at all.

Doctor's Appointment and Results:
- I finally got a doctor's appointment last month. My suspicion was an Iron Deficiency or some kind of anemia. I went to a family practice doctor as a place to start. (I don't have any other regular doctor.) I was able to explain some of my symptoms, but not a full explanation really.

-Ran a full complete blood count and checked thyroid and potassium levels. Those came back "normal" I don't have the results (maybe I can access them online?) so I don't have numbers. I really thought I was iron deficient due to my symptoms.

-Listened to my heart -as it was racing at the appointment. I was put on a 24 hour Holter Monitor to monitor my heart. Results came back that I'm having ventricular contractions. (I'm guessing they mean Premature Ventricular Contractions.) Which can cause the palpitations and are "normal" and to "avoid caffeine and stimulants" ... Great.. I already do that. I still think there is something (besides anxiety) causing the physical symptoms that result in these heart issues. I've never had my heart race or feel like this before. Occasionally? Sure.

Other details:
-My dad also has an arrhythmia, so I'm not surprised about a heart rythim problem, however I feel that it's a symptom of something larger.
-My dad also thinks that these are similar to a migraine. I'm not ruling that out. I had a perscription that caused a yeast intolerance in my teens and that caused migraines, however those were much different and went away after changing meds. Again, if it is migraines, I'd like to know if there's a cause.
-I'm eating enough. I track my calories in an app - to try to rule out just lack of food - and I eat at or more than the recommended calories for my height/weight (about 1600). I have even gained weight and gone up a pant size in the past year.

My Plan & Questions (finally):
-Get another doctor's appointment for further tests/help. I plan to also try to see dietician/nutritionist although I eat well maybe there's something I'm missing? I also want to seek treatment for anxiety and start an exercise routine. (Yoga)

I'm planning on just asking the doctor general things like "What could be causing these symptoms? Who should I see? What tests can be run?" But I'd love more pointed advice and specific quesitons for my doctor. I tend to not ask all the things I wanted since doctors seem to do that rushing thing. So specifics will help me actually ask.

- What should I ask my doctor, specifically, to try to figure this out?
- Is there something that jumps out at you as a path that I should explore?
- If this has happened to you, what was it? What helped?

Thank you all so much. Email my throwaway if I missed something.
posted by anonymous to Health & Fitness (37 answers total) 6 users marked this as a favorite
General Anxiety - Untreated
Symptoms really kicked into high gear when I started my job at the end of Sept
Total exhaustion. Lack of focus throughout the day
weird episodes. They are similar to a sugar crash/panic attack
heart racing, can't breath/catch my breath, shaky feeling, complete dizziness, light headed, intense stomach pain, nausea

You need to see a psychiatrist because you have an anxiety problem. You need to treat the anxiety first, not the other way around. Anxiety can have lots of physical manifestations, like all the things you've mentioned here. Anxiety is physiological.

Your psychiatrist will order a complete work-up to make sure the anxiety is not related to something like your thyroid. They will then treat your anxiety. I would bet that most of these feelings your having will subside with treatment for your anxiety.

You should ask your doctor to please refer your to a psychiatrist.
posted by Lutoslawski at 12:32 PM on January 15, 2014 [28 favorites]

Your GP can prescribe anxiety meds, if you think anxiety is contributing to this. I take 20mg of Celexa every day and it helps a LOT!

Try that first, see if it doesn't help.

Another thought was Gut Bacteria. I heard this on NPR a couple months ago. It's interesting, to be sure, but kind of esoteric and definitely the Zebra in the herd of anxiety horses.
posted by Ruthless Bunny at 12:35 PM on January 15, 2014

Anxiety is at least part of this. But have you had a sleep study done? Or had a middle ear / vertigo check done?
posted by strixus at 12:39 PM on January 15, 2014

weird episodes. They are similar to a sugar crash/panic attack
heart racing, can't breath/catch my breath, shaky feeling, complete dizziness, light headed, intense stomach pain, nausea

IAMYD (or anybody else's doctor) but it sounds a lot like Carbon Monoxide poisoning.

The symptons.
posted by popcassady at 12:47 PM on January 15, 2014 [1 favorite]

One way to see if there is carbon monoxide poisoning is to look at your gums. If they're bright red, that's a sign.

You can get a carbon monoxide detector and bring it to work to see if there are dangerous levels of Carbon Monoxide.

If is it, though, most everyone in your office would be suffering from it, not just you.
posted by Ruthless Bunny at 12:49 PM on January 15, 2014 [1 favorite]

If is it, though, most everyone in your office would be suffering from it, not just you.

Again, IAMYD, but being, 5'4 and 7 1/2 stone, CO may have more of an affect on you than others.
posted by popcassady at 12:52 PM on January 15, 2014 [1 favorite]

re: Carbon Monoxide, check to see if there are any boilers/generators nearby. They may be inadequately ventilated. Also, as you say it usual comes on around lunchtime, perhaps you are being exposed to the car fumes of people going on their break.
posted by popcassady at 1:06 PM on January 15, 2014 [1 favorite]

Might be worth looking into Postural Orthostatic Tachycardia Syndrome (POTS), or another Orthostatic Intolerance issue. POTS is basically a rapid/dramatic increase in heart rate to try and keep blood flowing through the body.

It can have more dramatic effects when standing, especially standing still. For me, when it's bad (my symptoms vary), and I stand still for a few minutes my heart races, I get dizzy (with visual spots), my limbs feel heavy, I get a hot flush in my trunk, and cold tingly hands and feet, I get nauseous, my brain just shuts the hell down, and eventually I start to tremble. There might be more symptoms I'm forgetting, in short, it's intensely unpleasant. In other situations, sitting, standing/walking etc. the symptoms are more mild (but still debilitating), basically exhaustion and lack of mental clarity. When my POTS is bad, it effects my work, even though my job is primarily a desk job.

Situationally it can be especially noticeable when standing in lines, and it's common for folks with POTS to have a tendency to fidgit, squat or lean over a grocery cart to try and help keep the blood going where it needs to go. I also find museums REALLY difficult, because of all the motionless standing.

Also, I have reactionary hypoglycemia as well and I feel like my blood sugar being out of wack (as it is if I'm eating much in the way of carbs), exacerbates the POTS.

And you may have anxiety issues, BUT if you consistently feel like shit in common life situations, that anxiety can be because, hey, you're about to do something that makes you feel like shit, so *warning, warning*.

As to specifics, this kind of thing might show up on a holter test, but it might not. There are different kind of OI issues, some with different characteristics. But also if you are unconsciously avoiding situations which create the really dramatic heart rate jumps (standing for long periods, standing still) then it might not show up. There is a pretty decent "test" you can do at home (I've had dr's administer it in office as well), called the Poor Man's Tilt Table Test. Here's one place describing how to do it. But basically you lay down till your heart rate is stable/steady, then stand perfectly still, taking your blood pressure every minute and recording the numbers. I think if you're heart rate jumps something like 30bpm in 10 minutes you "qualify" (congrats! that sucks!). Mine was usually a 40-50bpm jump (my highest was a 70bpm increase) within 3 minutes, and I don't think I was ever able to go past 8minutes because I felt so sick.

This is a lot more then I initially meant to write, because it could be totally off base, but just in case. And if you want more info, feel free to memail me.

Good luck.
posted by pennypiper at 1:09 PM on January 15, 2014 [4 favorites]

I don't know if it's carbon monoxide or not, but it could be at home and you're feeling the effects a few hours after you leave.

Other than that, all I can say is you need to aggressively pursue a diagnosis. IANAD but going to a psychiatrist first (a medical doctor with a prescription pad, not a therapist) first sounds like advice I would follow. But what do I know.

Basically none of us here can tell you anything useful. This is a job for someone qualified. Keep pushing!
posted by tel3path at 1:10 PM on January 15, 2014

...Or had a middle ear / vertigo check done?

Good thought, but this is almost certainly not vertigo or an ear issue (which manifests as a room-spinning dizziness lasting anywhere from seconds to days, with or without hearing changes/ringing).
posted by robstercraw at 1:13 PM on January 15, 2014

Symptoms really kicked into high gear when I started my job at the end of Sept. Regular 9-5 office job. I had some anxiety when I first started since it's my first office job (I have over 2 years experience in my field though and the tasks are actually below my skill level.)

The sickest I've been in years was at a job in which I was largely overqualified and nobody would give me any budget to get even the basic chores done, so I had very little to do. The stomach pain - flat-out burning pain, but with no burping or acid urps or nausea - was daily, toward the end. I had the only panic attack I've had in probably 6 years or more there. My throat constantly felt like it was about to close up. I was barely sleeping.

Now, I was under a lot of stress at the time. My husband was unemployed, we'd just moved 1500 miles for that dumb-ass job, two of my dogs were trying to kill each other.

I quit that job and got one that was hard and hectic and high customer service stress and my one employee gave notice and moved away as soon as I started. And aside from the stomach burn (which dropped down to occasional and then rare events until my husband got a job and it went away), all my symptoms were gone in a couple of weeks.

Try treating the anxiety so you can focus on any symptoms that remain.
posted by Lyn Never at 1:16 PM on January 15, 2014

CO poisoning that strikes every day transiently at lunchtime, regardless of her location? No, I really don't think so.

Your nonspecific symptoms could all be due to anxiety/panic attacks, although all other medical causes should also be investigated. The fact that your BMI is below normal weight is concerning unless it's always been that way. You mentioned a lot of GI symptoms and triggers to symptoms from foods. I think it would be worth discussing this with a gastroenterologist, although I wouldn't delay scheduling an evaluation for anxiety for it.
posted by treehorn+bunny at 1:16 PM on January 15, 2014 [9 favorites]

I have migraines and anxiety. The migraines usually strike around the same time of day, and fluorescent lights are a huge trigger. But to me, you sound like you're having anxiety issues, not migraines.
posted by headspace at 1:44 PM on January 15, 2014 [2 favorites]

It sounds like dealing with the anxiety may relieve most if not all of your symptoms. After all, it's the only untreated known health condition you have and it would account for all of your symptoms, including the physical ones. I know that I personally have had experiences with my anxiety level spiking at the same time each day (in the evenings for me). It will probably make it easier to assess for other issues once the symptoms being caused by anxiety are being treated. Make an appointment with a psychiatrist/therapist in addition to your appointment with your primary care doctor.
posted by fox problems at 1:48 PM on January 15, 2014 [1 favorite]

When you say these symptoms happen around lunch time do you mean they happen during/after you eat? If so, could it be a food-triggered migraine? Not all migraines present as pain in the head - some of the way you describe how you feel and what happens to your vision reminds me a lot of my migraines.

I also agree that you need to get a psych evaluation for your anxiety. No matter what the other problem is, anxiety is going to make it worse.
posted by joan_holloway at 1:57 PM on January 15, 2014 [1 favorite]

Are you always doing the same thing when the symptoms happen (sitting at your desk, in the lunch line, getting up/sitting down, walking outside...?)

If you were feeling this when getting up/down, I would hypothesize low blood pressure, since your symptoms can overlap with those of low blood pressure/fainting.
posted by troytroy at 1:58 PM on January 15, 2014

I also came in to suggest POTS, you might want to check that out with a cardiologist.
posted by HuronBob at 1:59 PM on January 15, 2014

I have migraines and anxiety. The migraines usually strike around the same time of day, and fluorescent lights are a huge trigger.

Me too. I also have episodes exactly like those you describe in your OP. They happen way more frequently when I have to go into my office (with its fluorescent lights, recirculated air, etc.) And, I think it may be possible you are indeed also having migraines in conjunction with some sort of anxiety/panic attack. Contrary to popular opinion, you don't necessarily have to get a terrible headache to be having a migraine. As for what to do about it, the three things I'd suggest are 1.) making sure you're always well hydrated, 2.) make several opportunities throughout the day to relax your shoulder/neck and facial/jaw muscles, and 3.) consider anti-anxiety meds. A few months ago I started taking propranolol primarily as a migraine prophylactic and my anxiety (and many of the weird pre-migraine episodes, etc.) are flat-out gone.
posted by hapax_legomenon at 2:16 PM on January 15, 2014 [1 favorite]

It sounds like one thing it might be is Panic Disorder, which is an anxiety disorder. The link is not the greatest; often, the only fear you are consciously aware of is the fear that something is really, really physically wrong with you. It is actually your mind causing your body to react as if something is wrong. It's really common in younger women and can be triggered by life changes (like starting a new job). It's also really treatable, and in most people, it passes before very long.
posted by Miko at 2:52 PM on January 15, 2014 [1 favorite]

If you are experiencing a physiological problem, and also experiencing some amount of anxiety, then you should consider making an effort to deal with the anxiety in order to expose the physical symptoms that are not caused by the anxiety. If symptoms caused by anxiety are also present, they will make it harder to diagnose you. Ask your doctor about a trial run of low-dose daily Xanax or something similar. Whatever symptoms remain will be more likely to relate to a potential physiological issue.
posted by prefpara at 2:52 PM on January 15, 2014

Lots of vitamin deficiencies, thyroid issues, blood sugar issues, exposure to anything that slows oxygen or breathing or blood flow WILL cause anxiety!

Advice to see a psychiatrist and get anxiety meds seems premature until other, physical. causes are ruled out. Don't let any doctors guess and prescribe without objective tests/proof of diagnosis. Promise? OK.

IANAD, but for example, I was recently reading that stuff like Prilosec strips your body of certain vitamins (magnesium? iron? I don't remember!!) and it was a bit of an irony, because one of the symptoms of this vitamin deficiency was heartburn!

So yeah. If you are super thin (you are very thin, at 5' 6" getting below 110 lbs almost put me in the hospital) then you may have malabsorption issues, or whatever.

Surely ongoing IBS and GERD isn't good for your overall health long term.

Have you tried a gastrointestinal specialist?

Seek further medical tests. Your first doctor's visit was not sufficient to rule out ANY causes, IMHO.

New doctor. Write down your symptoms like you did here so a doctor can better assess what tests you might need.

Good luck.
posted by jbenben at 2:56 PM on January 15, 2014 [2 favorites]

My anxiety attacks manifest very much like this, very physical symptoms, and one of the things that's helped a lot is Inderal, in addition to a very occasional benzo. And when I'm generally anxious, I sleep worse, and I feel worse because I'm sleeping worse, and the panic attacks happen more often, and it's an awful cycle. They can be triggered by little weird things, and it's entirely possible that just a mild blood sugar dip could do it, though. CBT helps me but even when my mind is totally in the right place my brain still has random freakouts, which is why I have meds.

Not that it couldn't also be other stuff, but I wouldn't go looking for other things when you haven't yet sought anxiety treatment and this matches up very heavily with the symptoms of the anxiety disorder you know you have.

(Seriously avoid daily use of benzos except as a last resort. Not that it doesn't help some people, but they're one of the hardest things to get back off once you're doing that.)
posted by Sequence at 2:57 PM on January 15, 2014

Some of your symptoms do sound like the physical manifestations of anxiety. I used to get a lot of these - plus things that I would never have thought were anxiety based, like aching joints, but went away once anxiety was managed.

Have you asked the dr to do a test for ferritin levels? You can get symptoms of anemia without having anemia - if your ferritin levels are low it means you aren't able to store iron adequately.
posted by Dorothea_in_Rome at 3:11 PM on January 15, 2014

You mentioned a yeast intolerance when you were younger. Have you considered that you may be suffering from candida overgrowth? It can cause the symptoms you list. The occurrence of symptoms around lunch time, when you've no doubt ingested sugars of some kind (which feed candida albicans), makes me think this may be food and/or yeast related.

Sadly, most regular Docs will look at you like you sprouted a 2nd head if you inquire about Candida. A Naturopath is vastly more knowledgeable, IMHO, about it.
posted by stubbehtail at 3:34 PM on January 15, 2014

To answer jbenben's question: Prilosec strips the body of Vitamin B12 (ask me how I know!)

Regarding your issue, I wanted to throw yet another potential cause on the table which may sound kind of woo-woo: food sensitivity. Reading your post brought back memories of what my life was like a decade ago. I had an undiagnosed sensitivity to a particular very common US food for years. (Corn. It is in EVERYTHING. No, even more than you realize.) Symptoms included: acid reflux, anxiety, exhaustion, hypoglycemic reactions, and it was getting progressively worse. (For example, your lunchtime reaction, which could be a page from my diary at the time.) Doctors treated all this stuff with drugs, drugs and more drugs, continually upping the dosage. Then I saw a nutritionist, did something called an "elimination diet" and found out what caused my problems. It literally changed my life - and apparently my personality, according to people who were spending a lot of time with me at the time.

I have a couple of friends who had similar symptoms, did an elimination diet and found they also had food sensitivities, but to other things. (Nightshades, wheat, anchovies, respectively.) Trust me, if you do an elimination diet and you are sensitive to a food, YOU WILL KNOW, mostly because when you reintroduce the food you will get incredibly sick. And hey, if it doesn't turn up any results, you've just eaten a healthy, nutritious and kinda boring diet for six weeks, which will make everything after taste all the yummier!

You do have to go to the right nutritionist, however. Many doctors still believe that if you react to a food it's psychosomatic. Call around to a few nutritionists if you can.
posted by rednikki at 3:46 PM on January 15, 2014 [2 favorites]

You can get CO monitor/alarm for pretty cheap, and use it at home or office.

Try eating a breakfast with some protein and some fiber, maybe an egg and some oatmeal and dried fruit, in case it's low blood sugar.

Many women benefit from taking vit. D, so maybe add 250/day for several weeks.

A good general approach to anxiety is to have regular exercise, ideally outside, and to spend 20 mins. a day meditating or in quiet reflection.

All these things are low to no risk and generally beneficial. Good luck.
posted by theora55 at 5:13 PM on January 15, 2014

In addition to the wise comments above on anxiety, POTS, and food elimination: let go of the idea of Just One Answer.

I wouldn't move to a new doctor yet, but I would set aside some time at the next appointment to discuss what your diagnosis and treatment plan will be. How many things will you be ruling in/out? If you have to get referred to a p-doc, will your initial doc work together with them? Even if you can't find any answers, what care will the doc provide?

Human bodies are complicated. It's quite possible for one person to have food sensitivities AND migraine AND anxiety AND stomach pain as well. I hope that it's just one easy thing, and you're feeling better soon. But even if it's not, I hope you can build a working relationship with your doctor.
posted by Jesse the K at 5:38 PM on January 15, 2014 [3 favorites]

What I notice, working an office job, is that I notice everything. I sense what's happening with my body, on a minute-by-minute basis, in a way that I rarely do when I'm otherwise running around out in the world or even sitting around at home. Rule out the carbon monoxide thing; if it's not that, it sounds like you might be having a blood-sugar dip or spike around lunchtime, feeling generally weird as a result, then getting a panic attack from dwelling on the weird physiological feeling. Or you might be having migraines with an aura (the raindrop dots), possibly triggered by lighting, computer use, diet, eyestrain, fatigue. Or you're focusing on work, especially a computer monitor, for long periods of time and unconsciously holding your breath (actually a common problem). Or you're getting some kind of orthostatic hypotension, maybe when you stand up to get your lunch after sitting for a long time, which would also explain swimmy dots in your field of vision. I've definitely been there on all counts!

Have you actually tested your blood sugar when these episodes occur, or are you assuming that it's not blood sugar? And are you taking any medications with meals that you can feel kicking in or wearing off, even subtly? Or could your tea have more caffeine in it than you think, or are you drinking more of it than usual, or at different times than usual? The caffeine could contribute to both panic attacks and the heart issue. Re: a potential food component, if you're eating enough, then at least in part, this might have to do with what you're eating or when you're eating. Have you changed your diet or eating habits at all in the new environment? If you suspect blood-sugar issues, you might need to look into the glycemic index of the things you're eating and find a way to balance that out.

Blood tests to ask for: A1C (for diabetes/blood-sugar issues), thyroid and parathyroid (for perpetual tiredness), and levels of other vitamins and minerals, such as calcium and vitamin D. Also, how's your blood pressure? And does this happen on the weekends, too, or just when you're at work? Those are all things to consider. I hope you can pin this down!
posted by limeonaire at 5:46 PM on January 15, 2014 [1 favorite]

Just a thought. How is your eyesight? By any chance do you have a stigmatism? At your new job are you relying a lot more than usual on either your close up or long range vision?
posted by WalkerWestridge at 5:48 PM on January 15, 2014

Just as anecdata, when I have had panic/anxiety attacks, they have been very much like this. The symptoms were pretty much entirely physical, and I never felt particularly anxious at the time (except maybe about what I was physically experiencing.) I've gotten to the point of blacking out from breathing problems and calling 911, and it was all just anxiety. When the paramedics came, the only thing they found was arrhythmia. Your symptoms seem really familiar, so like others, I really suggest you treat the anxiety first, then see if there are still physical problems.
posted by catatethebird at 6:32 PM on January 15, 2014 [1 favorite]

Anxiety IS physiological. If you have a diagnosed anxiety disorder, it's highly likely that your anxiety stems from an imbalance in your brain chemistry.

I understand where you're coming from. I just thought I was weak and sickly, and that's why I was nauseous and tired all the time. I started an SSRI for what I thought was situational anxiety and my life got WORLDS BETTER.
posted by chainsofreedom at 6:43 PM on January 15, 2014

Mod note: From the OP:
Follow up to some questions:
-Weight: I meant to include this originally. I am a very slight and petite woman. I have actually gone up a pants size. (I’m a women’s 2/4) No doctor has ever said anything about my weight other than “Maybe only take half of these pills at a time because you’re small.” I’m just built very tiny.

-CO: I just picked up a CO detector. My apartment is fine. I don’t think it’s CO as I share a corner office and my officemate is pregnant. I think she’d be affected.

-Blood Sugar – Yes, I check my blood sugar when this has happened, because it felt like a sugar crash. It’s always been normal.

- Diet/Eating/Caffeine– I’m totally cool with investigating other intolerances. I can’t eat garlic because it flares up my IBS. The yeast intolerance was due to medication and the symptoms went away within hours of eating bread (and after switching meds). These symptoms kind of start, and I feel “off” the whole day. I ate the same thing yesterday and today up until noon and yesterday I had a major episode, and today it wasn’t as bad. (And I do really keep track of proteins, carbs, and glycemic index of foods. I eat eggs (1 whole and 1 white), hash browns, and sometimes low-sodium bacon for breakfast. As far as caffeine, it happens whether I have tea with caffeine or not. I had herbal tea yesterday when I had horrible symptoms (it’s not a new tea, I’ve had it for years). I eat often throughout the day. Breakfast at 8 am, snack around 10, early lunch at 11 to 12, late lunch at 2, and probably a banana and a fruit cup in there too and that's just before I get home.

-Eyesight – I’m 20/20 and 20/15. Never had sight problems. That was checked a couple years ago.

- Sometimes happens on weekends. I think some of that may be due to anxiety. But I also don’t get up and go out for 8+ hours on weekends so my schedule and habits are different.

-Gastro – I have seen a gastro doc. I’ve had stomach problems my whole life (I had an ulcer at 4 years old, a barium swallow at 12, zantac/prilosec after that, then I was off meds for a long time, then about 3/4 ish years ago I had a stomach scope. He pretty much said “Your symptoms sound like IBS and your stomach scope shoes GERD. Take Prilosec.” I had failure to thrive as a baby and was put on formula so my stomach has always sucked, even from birth.

Thanks for all these ideas and encouragement. Keep them coming! My next move will probably be to seek a psychiatrist and then follow up with a dietician and possibly other tests. I’m all for treating my anxiety (why isn’t there an off switch? I mean I literally have nothing to be anxious about…) However I am very resistant to medication as I have a very sensitive system and don’t generally have good reactions to medication.

I’m not saying it’s not all because of anxiety, but having had anxiety my whole life, I just feel like something else is “off.” Ya know?
posted by restless_nomad (staff) at 6:48 PM on January 15, 2014

I agree with you that "something else is off." The trouble with anxiety as a diagnosis is it's a chicken-and-the-egg thing: Is the anxiety causing the physical problems or are the physical problems causing the anxiety? Anxiety is very real, but it's also the catch-all diagnosis for all sorts of strange symptoms that can't be easily identified otherwise - and, again, if something's physically wrong with you that's causing these problems, you're going to be anxious - of course.

The fact that you've had so much stomach trouble all your life, even from infancy, is a red flag to me. IBS is another sort-of blanket diagnosis - all it really means is that your colon is irritated when they look at it - but why is it irritated? Most people with IBS have flares from time to time and then it eases up for a bit, but there are tricks they have to learn to manage their own condition in order to prevent flare-ups. IBS is a chronic condition, thought to be autoimmune, and it requires vigilance to hold it down.

One thing I'm certain of is that after all these years of gut problems, you're malnourished in some areas. You may be dealing with pernicious anemia from an inability to absorb enough B12 or folic acid from your food - that's not all that uncommon, but it's not the only possible answer. Every sort of nutrient is absorbed in a different way in a different place in your gut and many of the vitamins you take in can't be utilized without the cooperation of other vitamins, so if you're unable to absorb one thing it can interefere with all sorts of others. And, over the years - which is your situation - you come up seriously deficient in one or more things; most of the time, deficiencies only have a minor affect on our bodies, that we can identify anyway, but after a long enough time, there will be damage and symptomatology that can't be ignored. I think this is where you are right now.

The fact that you have intense stomach pain at this time every day triggers another thought for me: Even if you've had stomach tests before, you need to have them again. You're describing a peptic ulcer pretty clearly and that needs to be ruled completely out and right now. When they found my ulcer it was near perforation and I came (this) close to surgery - I had no idea I had a stomach ulcer, but I was taking Mylanta by the cup every evening at work, at my meal-time on swing shift. Does Maalox or Mylanta stop the pain, or ease it? In my own case, my ulcer produced a gnawing pain, almost like my stomach wanted to growl but couldn't quite do it. It hurt, but it wasn't murderous pain like I thought a stomach ulcer would be.

There are autoimmune disorders that can cause the malabsorption of nutrients that you're having, so it can be serious, but usually things like this can be handled once the condition is sorted out and all things that annoy your gut identified and avoided, a prescription for something that works, and supplemental vitamins for those you need. I doubt you'll find the nutritional workup with a regular M.D., but you need a GI scope of your stomach now, so see that gastroenterologist now. Then see an alternative medicine/holistic doctor about the rest.

The problem with beginning with anxiety meds as I see it is that they may very well cover the symptoms you're having, help you ignore them and carry on, etc. Which is fine, if that's safe, but when your body is speaking as loudly to you as yours is, especially with your history, you need more than a way to just bypass the problem - even more than a way to just quiet it down so you can have some rest.

One other thing: You mentioned that a cardiac exam found "just an arrhythmia." Honey, no arrhythmia is normal - no it's not. A couple of them are fairly common, such as PACs (premature atrial contractions) and PVCs (premature ventricular contractions), but others are serious, indeed. Anxiety can surely cause palpitations, but so can illness. PACs and PVCs usually make themselves known as skipped beats - an irregular heartbeat - and that can make a person woozy and sweaty and very anxious. There are disorders of the electrical conduction system of your heart that can show up in a young woman - heart stuff isn't automatically limited to old people. I urge you to get a cardiac consultation to confirm that your arrhythmia is an innocent one.

Best of luck to you - please let us know how this all comes out.
posted by aryma at 8:10 PM on January 15, 2014 [1 favorite]

I'm inclined to think it's either an anxiety/panic thing or you have an arrhythmia that the holter didn't pick up. PVCs aren't a big deal, lots of people have them and never even know, but you might be having something else like paroxysmal atrial fibrillation that you just happened to not have while you were wearing the holter. It happens. Seeing a therapist/psychiatrist to rule out anxiety is a good idea. You don't necessarily need medication for anxiety, cognitive behavioural therapy is pretty great at treating anxiety disorders for a lot of people.
posted by supercrayon at 9:34 PM on January 15, 2014

A couple of years ago my HR and BP, which had previously been normal, were suddenly elevated all the time. I started having strange palpitations and SVT out of the blue. Why? After two ER visits, a holter monitor, and an event monitor, the Drs settled on inappropriate sinus tachycardia and paroxysmal SVT. It's not that big a deal - I quit caffeine, I'm taking medication for it, and now it's under control - but until I had a sense of was going on, it seemed like I was either having serious cardiac events of some kind or sudden panic attacks (new to me either way). After a big SVT episode I would be exhausted, and the first two were terrifying. I get migraines, too, by the way.

It sounds like your situation is somewhat different in detail, but may be simmilar in one way: the trick for me was distinguishing between anxiety as an underlying cause and anxiety about WTF is happening?!. Particularly in response to medical people asking about stress or anxiety, try to do your best to be forthcoming and don't minimize, but rather see if you can discriminate between peaks of anxiety that may have come before an "episode" or increased anxiety you may be experiencing afterward (or in general) as a result of your health concerns.

Folks here are right to point to anxiety as a potential and even likely cause of your symptoms. This may be the case, but it also may be that your tendency toward anxiety in response to (other) symptoms is amplyfying whatever is happening - especially with respect to your cardiovascular system - and making it difficult to tell just what's going on.

For me what helped during the diagnostic process what letting go of the need to pin down exactly what disease process was at play RIGHT NOW I HAVE TO KNOW WHAT IF WHAT IF - I'd had several ECGs, surely I wasn't going to drop dead - and work on trying to get my autonomic nervous system as "chilled out" as possible in between "episodes" of whatever it was. To my way of thinking, if the answer was anxiety then hey, great news, I've got a head start dealing with that... alternatively, if something else in my body is discovered, those anti-anxiety tools might come in handy down the road. Once my doctors and I could see that I wasn't having panic attacks the correct treatment became evident, but if the opposite were true I think I would have been able to accept that as well.

I hope this helps a little, and that you feel better soon. One thing I found was that as soon as I began "paying attention" to my heart it was very difficult to ignore even the most minor deviation from normal. Once you have been reassured that there are no acute problems this tends to fade away; if not, I think that would also point toward anxiety.
posted by onshi at 8:46 AM on January 16, 2014 [2 favorites]

I know you think you eat enough, but can you try eating more substantial foods, like fats? Maybe some Kefir (good for your inner tubes!) and nuts as a snack instead of or with fruit? I'm around your same size and I laugh in the face of an apple as a satisfying snack. My inferno metabolism burns that right up. So try eating a little "heavier" and see if that helps with the bodily stress. Also try to get on the very limited sweets train if you aren't already on board with that.

If that helps a bit but you still have anxiety, pursue treatment with meds.

Also try to get up at every available opportunity at work. Sitting is boring, crazymaking, and unhealthy. Get up, walk to the sink and fill a cup with water. Get up and walk to the copy/ fax/ scanner for each time you need to do it instead of holding everything to get up and do in one swoop.
posted by WeekendJen at 10:07 AM on January 16, 2014

You had a gastroenterology appt 3 or 4 years ago, but you've been having "weird, horrible" GI symptoms for the past 3 months.... Consider that your appointment years ago has no bearing on what is going on right now. If your prior GI doctor didn't explain things well/wasn't thorough, don't go back to him. IBS is a diagnosis of exclusion.

Just talking to a psychologist or psychiatrist does not mean you have to try anti anxiety meds, but if that person thinks such meds would help you, it seems to me you'd have little to lose and a lot to potentially gain by giving them a trial. If they are not for you then you look at other options. Just remember that those types of meds don't work quickly and for a fair shake you have to give them a few weeks to work. Good luck!
posted by treehorn+bunny at 10:58 AM on January 17, 2014

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