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Parasympathetic Nervous System Disorder
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Parasympathetic Nervous System Disorder

To Whom May Be Concerned:
(An open letter to Nerulogists)

I am looking to engage in a dialogue with a Neurologist who has a particular interest in the interaction and behavior of the Sympathetic and Parasympathetic Nervous Systems. I am looking for anyone in the field who is willing to take the time to read my hypothesis (outlined below), and either assist me with further research or draw on their knowledge to highlight its flaws. Either way would be a positive result because it would move me forward in the treatment of my own debilitating conditions, which I believe are directly connected to the behavior of these nervous systems.
The condition described in this hypothesis, for which I have loosely coined the term 'PSND', or 'Parasympathetic Nervous System Disorder', relates to a variety of debilitating conditions suffered by a significant percentage of the population. Including: anxiety disorders, asthma, chronic fatigue syndrome and ADHD.

I am not a scientist or trained medical practitioner, but I have spent much of the last year consulting with the relevant specialists and studying up on the areas of medicine that relate to this hypothesis. I have also carried out extensive testing and treatment trials on myself, with some very interesting results.

Before I outline my hypothesis, it would help to provide a little bit of history to show how I made these discoveries and ended up arriving at this point.

I have suffered from total nasal congestion for most of my life. After multiple surgeries, my current ENT recently recommended an 80% inferior turbinate resection, which, luckily, I rejected (due in most part due to the information I found on the emptynosesyndrome.org website). This information was then echoed by a second ENT surgeon who, after completing a distinguished fellowship in the USA, now finds it 'horrifying' that these surgeries are still routinely carried out. The reason for this relates directly to the nose's interaction with the parasympathetic nervous system, as I will describe below.

Since then I have spent the past several months researching the why and how behind this puzzling problem and behind my own constant physical discomfort relating to my dysfunctional nose.

What I have discovered was startling to myself, and to many of scientists and doctors that I have discussed it with.

For the past several years, and up until about 6 months ago I suffered from Generalised Anxiety Disorder, a condition which dramatically lowered my quality of life. To all intents and purposes, I am now cured of my anxiety condition. I can say this because I no longer have panic / anxiety attacks and it does not control my lifestyle in the way that it used to. My 'cure' came from gaining a full understanding of the true nature of how anxiety works psychologically, and, more importantly, physically in my body. This was achieved through my education in an anxiety clinic, cognitive therapy with psychologists, my own research, but finally though reading the "Linden Method" book. This is, I believe, the closest thing to an effective single treatment for anxiety conditions.

Nevertheless, despite overcoming the erroneous psychological habits that were necessary to sustain a chronic anxiety condition, I still found that I experienced many of the physical sensations associated with it. It's just that they no longer disturbed or concerned me. In recovered sufferers these sensations usually pass over time as the individual stops fearing them and breaks the 'fear - sensation - fear' cycle. I waited patiently for my amygdala and nervous system to come into balance, and for the base level of my anxiety and nervous system arousal to be returned to 'normal' levels. But this did not happen. It lowered, but did not adjust to the extent that I would have hoped.
Little did I know, that in my particular case the anxiety cycle had been backwards from the beginning. For me it was not a 'fear - sensation - fear' cycle, but 'sensation - fear - sensation'. It was the egg and not the chicken that had come first. So that, despite having overcome the psychological aspect of an anxiety disorder, I was still experiencing the physical sensations that had led to it in the first place.

The proof of this came when I found that my constant physical discomfort was suddenly and dramatically lessened after testing a new nasal congestion treatment.
This led me on a further journey of discovery that has taken me to my current hypothesis, which I will outline below:

At this moment I am trialling some treatment options that I believe may help treat some of the underlying physical causes of anxiety / stress / insomnia / chronic fatigue symptoms and sensations in myself and in a certain percentage of sufferers worldwide.
My hypothesis supposes that the root cause of some anxiety symptoms is an imbalance in the overall nervous system operation. An over-activation of the sympathetic nervous system coupled with an under-activation of the para-sympathetic nervous system can lead to excessive adrenaline and cortisol production, and can lead to constantly heightened levels of arousal and anxiety.
I believe that this can be as a direct result of certain physical conditions, specifically hypertrophy of the nasal mucosa. The nasal mucosa contains clusters of parasympathetic nerve receptors, and I believe that sufferers of complete and permanent nasal congestion (or conditions such as Empty Nose Syndrome) may not be experiencing adequate activation of the parasympathetic nervous system, leading to increased stress and anxiety-like symptoms and sensations.
I am carrying out tests on myself to see if treating my nasal congestion (either through direct submucosal nasal surgery and / or through treating related conditions, such as GERD and LPRD) can lead to a quantitative reduction in these symptoms .

In recent times, it has been suggested by many ENT specialists that chronic Gastro-Esophageal Reflux Disease can lead to irritation and significant hypertrophy of the nasal mucosa. Having undergone menometry and ambulatory PH testing, I have been diagnosed with severe GERD. My hope is that undergoing a Nissen Fundoplication to reduce my reflux should in turn reduce my nasal congestion enough to allow airflow to pass over my turbinate mucosa and to stimulate the parasympathetic nerve receptors. If the blood tests confirm this, it would further add weight to this hypothesis.
If, as I suspect, I am 'cured' of my constant physical discomfort, insomnia, asthma and stress symptoms, then I hope to use these findings, including my blood chemical snapshots, to prove my hypothesis and help further research into this area. This should also add further weight to the still controversial theory of "empty nose syndrome". I would be very interested to see the blood chemistry analysis results for current sufferers of ENS to see if they correlate to my own results.

Any thoughts, advice or assistance that you could offer me in pursuit of this would be greatly appreciated.
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16 Comments Post a Comment
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Avatar_n_tn
I am not a neurologist but I agree to you. I have seen similar symtoms (symptoms) for me. I suffer from throad alergies (allergies), tonsils, nasal congestions etc and it started around 15 years back and form that time onwards I am also suffering from excessive dreams and when i wake up i feel exhausted instead of feeling refreshed. Also over the years I have seen my nervous system weekening. I had medicines for throad and nerve system but unable to find permannet and complete cure. Could you please advise me on remedies.

Regards
Ghanshu
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Avatar_f_tn
Hello,
Just read your post while trying to find out what my husband is suffering from. He has been diagnosed with anxiety/depression disorder and is now on all sorts of meds to treat it.
At the start of this all, he contends that he would get a jolt in the middle of the night that would awake him and his heart was pounding and he couldn't get back to sleep. He always had a chronic nasal condition to begin with as well. To make a long story short, he started getting this jolt every night, fear of sleeping resulted and then he went into a "nervous breakdown".
Does this sound like any of the symptoms that you experienced?
How are you doing?
Any results from your trials?
Thanks for any help you can offer.
Sincerely,
Herm
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Avatar_n_tn
I have very similar symptoms that you have described. I must urge you to continue with your experiments and search for further information regarding your hypothesis. I hypothesize the same as well and actually searched for someone with my same predictions and stumbled upon you on the internet. I have anxiety, especially in social situations, depression, and insomnia which I cannot seem to treat with anything. I feel exactly as if my brain is not producing the necessary chemicals to relax itself while producing more than enough energy, muscle tension, and nervousness. This has caused a very high metabolism in which I cannot gain very much weight. I also have muscle tension, shaking, and sweating in stressful situations. I should also tell you I believe these stressful situations would not be stressful to the average person as they occur many times throughout my day. My heart rate is almost always 90 to 100 beats per minute even while resting. I have always had nasal symptoms but have never thought much of it. I rarely can ever breath through both nostrils at the same time and I have written this off as seasonal allergies. I do not believe my nasal symptoms were as severe as yours and am also unsure of their practical significance to this topic. I would like to hear any advice you have for me based on what I have told you and would like to once again urge you to continue your research because I believe many people have this problem. I have also hypothesized that alternatively many people have an overactive parasympathetic system and many of these people have trouble loosing weight. This disorder could overly relax a person and slow their metabolism leaving them at risk for many other diseases due to weight gain. Your research may in turn help those people as well. Thanks again.
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Avatar_n_tn
"I have also hypothesized that alternatively many people have an overactive parasympathetic system and many of these people have trouble loosing weight."

I recently had an autonomic lab that shows under-responsive sympathetic and excessive parasympathetic response in reaction to standing up.  I think denervation of nerves that control vascular tone would could cause this measurement.  Denervation would lead to failure to clear adrenalin because there are fewer nerve terminals for binding to circulating adrenalin.  There would also be vascular constriction caused by "denervation supersensitivity".  This will cause low blood volume by reducing the available space.  Additionally, this will cause a loss of dynamic range for the sympathetic side because the  variable range for blood storage is reduced consequent to the vasoconstriction.  

With low blood volume due to chronic vascular constriction, the sympathetic side would suffer from a reduced or limited control range.  In other words, there is not enough remaining range for the SNS to properly boost blood pressure in response to postural change.   When the SNS signal to produce adrenalin fail to restore blood pressure back to setpoint, even more adrenalin is secreted.  This additional adrenalin causes the anxiety sensations of dread but there is failure to boost BP because no further vascular constriction is available.

With a portion of the dynamic range of sympathetic control missing, additional sympathetic drive becomes ineffective.  However, the signal to produce more adrenalin continues unabated because BP fails to reach setpoint.   The sympathetic system would drive towards further adrenalin production, limited only by adrenal fatigue. However the additional adrenalin can't produce the required blood pressure boost because the blood vessels are near limit already.  At the same time, the parasympathetic nervous system detects this  adrenalin excess and makes corrections.  On the lab, this shows as parasympathetic excess.  I believe the observed "parasympathetic excess" is a consequence of excess circulating adrenalin.  

A problem with the lab measurement technique is that is measures the effects of sympathetic activity rather than to directly measure the signals or the resulting adrenalin.  It would be valuable to know changes in adrenalin between resting and standing.  I suspect the adrenalin would be found to be quite excessive.  If this is true, then the exaggerated parasympathetic response is appropriate.  In other words the parasympathetic response is a symptom rather than a cause.

If there is vascular constriction from sympathetic excess or denervation, there is likely to be a complaint of "cold hand  and cold feet".  Other patients I know with this syndrome suffer from chronic thirst.  The consumed liquids are promptly excreted because with chronic vasoconstriction, there is no space to store it.  If you ever attend a Chronic Fatigue Syndrome, Fibromyalgia, or Complex Regional Pain support meeting, you will notice nearly everyone carries water with them.

I







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Avatar_f_tn
Both in response to your original post and to Larry's response, I think that you are in the ballpark.

I have an autonomic dysfunction diagnosed as POTS (postural tachycardia syndrome); and experienced similar responses as Larry's autonomic tests.  With POTS, there is clear evidence & it is frequently cited that the response includes "inappropriate levels of norepinephrine" and ephenephrine (which is adrenalin).  

Recently I have been researching autogenic training exercises to balance the autonomic nervous system.  Here's a good online guide to a 3 month training regimen that I'm about to start: http://www.guidetopsychology.com/autogen.htm

Yogic breathing details the balance of the nostrils (and the constant fluctuations between the nostrils and thus the para and sympathetic nervous systems; it's interesting reading and I look forward to finding the medical information that correlates.

In additional to pharmacological treatments and physical therapy, I am pursuing a whole foods supplement and amino acid supplement program focusing on the neurotransmitters and rebalancing my ANS. ...specifically my parasympathetic is overactive and sympathetic is deficient.

Good luck to you/us all.  And I look forward to the continued discussion.

P.S.  Sinus rinse/Netti Pots are a very good thing!!!!!!
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Avatar_n_tn
Thank you all so much! I have been experiencing these same symptoms and several doctors have told me that there is nothing they can do for me because they can't figure out a proper treatment. I experience what I call internal vibrations a few times a week. I have to be practically constantly drinking something or I feel as if I'm dying of thirst within a few minutes. In the past I had frequent weakness and unexplained trembling of my extremeties. I had pins and needles sensations daily in my extremities which my doctor termed parasthesia. I've had three MRIs of my brain showing increased signal abnormalities, FLAIR signals, whatever they are called. It was explained to me that they are white spots on my brain. I also went through a cervical spine MRI, EEG, EMG, complete evoked battery, extensive bloodwork, a visual neurological exam to test optic nerves, and several doctor consultations with a variety of specialists. Every one of them told me that they couldn't understand my symptoms and that therefore there was nothing that they could do. My neurologist actually told me that he had treated one other patient with the same symptoms in his career but was never able to determine an appropriate cause for that patient either. He told me "well she's still alive" and that I shouldn't be concerned because it was unlikely that these problems would kill me! I ended up leaving every doctor appointment and crying in my car for a while afterwards. I believe the most depressing words a doctor can say are "there's nothing I can do for you". I have had horrible nasal problems since a very young age. At this point I can't breathe through my nose and receive enough air to sustain me. If I don't breathe through my mouth, I don't get any oxygen. I've taken a daily allergy medication as far back as I can remember. I've been diagnosed with everything from maxillary antral disease to deviated septum to panic disorder to seizure disorder, to allergic asthma, to farsightedness, nearsightedness, bilateral stigmatisms and a lazy eye to life long untreatable post nasal drip to migraines to agoraphobia to unexplained insomnia to unexplained rapid heartbeat to unexplained chest pains. AND THEY TOLD ME THERE WAS NOTHING ANYONE COULD DO!! It's sooo frustrating to be fighting your own body for your health. I thought I was the only one in the world experiencing these symptoms. I was convinced that there was something wrong with my genetic composition. My doctor told me that I just had to wait until medicine caught up to me. He said that there isn't enough known about the brain to figure out a treatment plan for me yet. At one point I was thought to have MS but there wasn't enough demyelination. Does anyone have suggestions for ways to balance the sympathetic and autonomic nervous systems, medical or not, and any doctors that have seen these symptoms before? Has anyone been able to determine a proper treatment for this? Thank you in advance for any suggestions and also for helping me to realize that I am not alone in this.
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Avatar_f_tn
Was shocked to find so many people with my same issues and also having to earn a medical degree while trying to find the cause.  I finally got somewhere when I googled "high levels of norepinephrine" since the one useful test I've had showed this result.  So I have a few questions: Has anyone here been tested for pheocromocytoma (adrenal gland related tumors) or tumors of the pituitary or something related?  This has been my angle so far because of the neurotransmitter levels, but this forum is the first time I've heard mention of the sinus connection.  I  have a knack for finding the least educated doctors anywhere I go, so I just get shrugs with each additional symptom.  Endocrinologist says I must just be depressed, but that would not explain the tingling feet, cold intolerance, pre-diabetes (doesn't run in my family, I'm not overweight, have cut out sugar), etc. etc.  High levels of norepinephrine explain depression and anxiety symptoms, as well as tingling feet etc.  I wonder if everyone diagnosed with depression or fibromyalgia should get their neurotransmitter levels, specifically norepinephrine, checked, in case there is an underlying medical condition behind it?
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Avatar_n_tn
I would suggest anyone who can not find an answer find a doctor or chiropractor in their area that uses the NutraSpec system. I am being treated for a Parasympathetic imbalance and am feeling better, not quite there but I know these things take time. If in the central Pa area, I go to the man that started this system and he shares with other chiropractors across the US.  you can probably find one in your area. Hope this helps.
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Avatar_m_tn
Thanks pa7k, but I find snake-oil gives me indigestion.
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Avatar_n_tn
Well its not snake oil, he uses supplements and some diet to get your body back on track. I am starting to notice a big change, my post nasal drip is gone and my vision is much better as well as my digestion and anxiety and pain that I was told was fibromyalgia are gone.  Good luck to you, sounds like your on the right track...
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Avatar_m_tn
Sorry, pa7k, but correlation is not causation.
Just because you got better at around the same time as taking these supplements doesn't mean that they are the cause of your improvement.
Also, NutraSpec is classic snake oil. Not that vitamins and minerals aren't good for you, but their claims are completely unfounded and unsupported by evidence.

I'm happy that you're doing well, but you should be looking deeper for the reasons.
I did, and was completely surprised by the results... and realised that I had created false correlations along the way.
Good luck!
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Avatar_m_tn
It is some time since you posted your article so things may have moved on for you since then both in terms of your research and health issues. However, in case you are still looking for information here is some for you to look into that may help you on your way. i like your theory but feel it may fall down due to the following: The parasympathetics act primarily in the efferent (motor) part of the nerve system - that is the part that sends messages from the brain to the body - and not in the sensory system (messsages picked up from the body to go back to the brain). Sensory stimulation in the nose comes primarily from the sensory aspect of cranial nerves (the one with the parasympathetics to the nose is different from the one which carries the sensory info) which in turn lead to stimulation of the paraspympathetic (motor) aspect of the nose involved in mucus secretions and nasal blood flow alterations. Consequently, incoming messages from the nose to the brain via sensory pathways would potentially (if significcant) lead to a parasympathtic response of the parasympathetic nerves specific to the nose and not likely to the parasympathetic system in general. In order to connect your mental state to your nose and the GERD you report to have, my suggestion would be to look more into a more general involvement of your autonomic nerve system which will rely on factors leading to a more general effect. For example an over activation of the parasympathetics of the gut could lead to histamine release in the gut which will increase stomach acid - a possible cause of the reflux. This same over activity of the parasympathetic system in your body as a whole could lead to increased mucosal discharge in the nose and also even a reactive over stimulation of the sympathetics to try and counteract these parasympathetic events which would give bursts of anxiety (fight/flight of sympathetic activity). Repeated sympathetic outbursts raise cortisol output and it is postulated could lead to some form of adrenal fatigue type scenario/chronic fatigue.
The relation of autonomic imbalances and mental and or physiological stress (including hormonal/metabolic imbalances/distrubances) is somewhat a chicken and egg scenario - i believe the jury is still out on that one. Assuming general medical health checks are in order, tilt table testing or the seemingly newer 'heart rate variability' testing may show up generalised autonomic imbalances associated with many and varied autonomic manifestations such as those you have mentioned. This may be of interest/use to mIss nervy. However, be warned that medical knowlege of dysautonomias (autonomic disorders) although acknowleged that it exists, is very limited amongst general medical practitioners nor is it a straighforward business in respect of the availbility of (or lack of) evidence in general to support any one type of best practice management - which may explain the reluctance of some to test for them in the first place.  
Lastly, there is some information from a company called 'airactive' which may be able to relate the nose and autonomics as you suggest  in repect of the HRV mentioned earlier. I think they use somesort of breathing apparatus to affect HRV (which is postulated to be a measure of autonomic balance). This is more to do with the effect of breathing on Heart rate than stimulation of the nerve endings in the nose but Perhaps they can answer your question as to whether nasal stimulus affects autonimic function in general in the body?
Anyway, hope you have both found this of interest. Good Luck.
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Avatar_m_tn
I read the post. I would like to educate everyone with my problem. I had an orbital floor fracture last year and had a soft tissue entrapment. A month later had oculo cardiac reflex where my pulse went down to 62 from 72. The result was increased blood pressure. Also I had chest pain. No doctor could identify it. Now it has started effecting my heart. I also had an injury on my nose and believe that parasympathatic system got stimulated via vagus nerve.

Result low heart rate/high blood pressure, fatigue, tremors while sleeping.

Good luck in finding solutions.
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Avatar_m_tn
I'm a 27 year old dancer and I've recently retired due to chronic injuries, health problems, muscular imbalances. Long story short, I've shared a lot of the symptoms on in my lifetime and it has all led up to the diagnosis in my having a "parasympathetic nervous dysfunction." I always thought my ear infections, chronic sinus infections/terribly deviated septum, TMJ were related. Then, as I aged, I had problems with my neck and shoulder, pain in my sternum, terrible GERD, asthma symptoms, increased allergies (food and environmental). Then came pain with urination and BMs and pain with sex. I had steadily worsening and frequent panic attacks and soon, depression became a factor as well.
However, I have been making a lot of improvement. After doing a lot of searching and trial and error with different doctors, therapists, chiropractors, etc, I have been working with Caroline Feig and Patricia Ladis from KIMA physical therapy in NYC and have made a lot of improvement. Most of my treatment is a combination of physical therapy manipulations, Feldenkrais Method and cranialsacral work. The feldenkrais seems to be the most beneficial. There is already a huge change in my bath room habits, movement  and breathing patterns. Also, my anxiety levels have improved immensely. It takes a lot of focus and it's necessary to acquire a keen physical self awareness, but it's worth it.
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Avatar_m_tn
I have to admit that I finally found a Dr. for this sort of problem. I can recommend Dr. Ramesh Aduraju in lower Bucks county, Pa as an expert for CNS dysautonomia. He is cardilogist, specialist in CNS disorder and internist.

In last 2-3 yrs. I started having chest pains (3x checked in ER), my reflux- like symptoms worsened, and have a lot of dyspnea (sob) not until upon climbing stairs, but also on sudden loads and even slightly inclined plane walking in my neighborhood. On top of that, all hrt.- work came as negative, no hrt. hypertrophy or cardiomyopathy.

He did test called "ANS check" where 4 ecg leads to chest plus BP cuff. For 5 ' I sat quietly and then started doing Valsalva manuevers (coughin!) as urged to for 10- 15". After those 5' was asked to stand up for ab. another 5'. Two days following test was given results. My HR was almost contant @ 66- 67 (might be due to Bystolic 5 mg qd, at leats I thought..! :-), when he said normal variability should be w/in 20 bpm. Parasymp. was found to be hyperactive, at one pt. even max. of 3.66 (relative paras. tone). Sympatethic would not activate appropriately, when I stand up instead of rising up to 2 (that would he expect for my age..!), it stayed about .6 - .7.

Disposition: ANS DYsautonomia, Tx: Advised to take Amitriptyline 10 mg 3 h before bad time. I took it for last 2 nights and was able to sleep like a newborn baby, quietly and w/out sudden adrenal arousals (night terrors) that I had every now and then in last 2 yrs. Explained difference btw. SSRIs who actually even caused and worsened thos terrors last yr. and tricyclic antidep. like Elavil
In last 2 yrs., I had a ton of episodes of unpleasant nocturnal erections (not priapism), almost every 2nd night on avg,, which promoted me to believe that paras. is out of wack..! Proven to be like that and that even can cause HTn and even tachycardia. Put even min. amt. of Ca rich foods, milk in my mouth- immediate palpitation and frequently before using beta- blocker, even- tachycardia. System- EXTREMELY sensiitive...! so much that most Dr's sound it UNbelievable.

Advised to come back after 3 mo.s to retest ANS. Will inform you on new developments and expected changes in lowering PSNS influence.
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Avatar_m_tn
Whatever oth. Docs thought I have anxiety, and advised to take SSRIs- it was proven in my case that they even - worsen the para-S activation...!

On top of that about 6-7 yrs. ago came out of nowhere ED. If ED is testos. related low T) I asked myself, why would I have extremely strong nocturnal erections awakening me..?! NO sense at all!

It's just and ONLY SNS to be precise: ANS. So many hlth. complaints and bldwork (+ oth. tests) always- regular i.e normal. Though one cardiologist once found thiny, loose POTS, but no oth. direct signs of dysautonomia.

Dr. Adiraju also told me that dysutonomia us. improves w/ time smtm.s even w/out treatment. I do NOT expect to use Amitriptyline foreva. Cause of mine was possibly (not provable easily!) either chest and/or head trauma.

He explained clearly to me that what other Docs call "anxiety" is here basically internal anxiety, that as in my case even min. amt.s of certain foods such as cheese or milk, anytg. Ca rich- causes "internal anxiety" It's simply that system is TOO SENSITIVE for anything to deal w/, and deals in a very non- adjusted, hyper- or over- active manner.

Again, look for those ANS specialists- and have in mind that prognosis is excellent w/ or w/out treatment. Of course, high BP is the only thing that might not be easily correctable and needs a long- term treatment.

Everything else here- panic attacks, anxiety, urinary symptoms (frequency and urgency), constipation or IBS, chest pain, dyspnea, all your and mine symptoms- are REVERSIBLE.


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