Should I see a neurologist?

Should I see a neurologist?  After several years of dealing with feeling rotten, and visits to about ten different doctors, I still don't know why I feel this way.  What should I do?  Please help!  
From the symptoms and information below, could it relate to autoimmune autonomic neuropathy or some dysfunction of the autonomous nervous system?

Here's my fact sheet.


male 52 years old

Symptoms: (in order of severity and frequency)

1. extreme fatigue at times
   (mornings are usually better than afternoons and evenings)

2. occasional dizziness & “light-headedness”
   …also dizzy when I stand up from a low position (even slowly)
   (I have low blood-pressure) but also even when I don't.

3. lots of headaches  seem to be sinus-related   (2 to 7 per week)

4. periods of “hot-headeness” (my glasses actually “fog-up”) Sweating seems to be normal.


diagnosed “pre-diabetic”
not overweight
non-smoker

no shortness of breath, wheezing only when I do the peak flow meter
not a problem when I exercise . . . I’m in fairly good shape

I have a “mild asthma condition” according to my physician.
peak flow meter Tuesday, July 8 (during a period of extreme fatigue) reads 490   (normal is 570-600)

I take singulair once per day
discontinued advair about 8 months ago
have albuterol inhaler but doesn’t seem to help
(my allergy physician says I should begin shot treatment, but I’m not convinced it works, is safe, or is the solution)


Supplements:
  take vitamin B complex, and multivitamin
  take after meals (for blood sugar control):    
      fenugreek, cinnamon, or prickly pear


How do I get to feeling better?  Thanks!

[Esteban Cheng-Ching, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to review your medical history and examine you, I can not tell you what is causing your symptoms, but I will do my best to provide you with information regarding your symptoms in general.

You seem to have a very complex group of symptoms that by themselves are non-specific, and I am not sure if they are neurologic in origin.

Autonomic neuropathy or autonomic dysfunction can have multiple causes including diabetes, or belong to a specific syndrome which are usually rare. Symptoms manifested with autonomic neuropathy include changes of blood pressure and heart rate with changes in position, changes in the normal sweating pattern, changes in bowel movement pattern or the sensation of early satiety, urinary or bladder dysfunction, changes in vision with dark or bright environment, and multiple other symptoms. If there is question of autonomic dysfunction, the history usually suggest it and physical examination gives a clue. Some maneuvers include blood pressure and heart rate measurement with changes in position, heart rate variability with different activities including with inspiration and expiration, and changes with exertion.
Regarding the symptoms you describe, dizziness and lightheadedness with changes in position may suggest some autonomic problem, however this by itself cannot make make a diagnosis, and specific BP and HR measurements should be done to meet the criteria. Even then, this by itself is only suggestive and more extensive testing needs to be done, such as something called “tilt table test” for example.
What you mean “hot headedness” and sweating could also suggest an abnormality with sweating, but this is also nonspecific.
The other symptoms, such as headaches and generalized fatigue, may or may not be related.
Headaches are caused by multiple problems and entities, and is by itself something that usually can be evaluated separatedly.
Other conditions to be considered include other endocrinologic problems, such as thyroid problems. An you will need specific blood work for confirmation.
Because of your multiple symptoms, I suggest that you should be seen initially by an internal medicine physician, and if there is more specific question about autonomic disorders, a neurologist with some knowledge in this field should be consulted.

Based on what you describe I cannot make a diagnosis, and cannot tell you what your problem is. However a formal evaluation with a physician and further work up can help with making a diagnosis.

Thanks for using the forum. I hope this helps.