24 Yr Old Male Debilitating and Needs Diagnosis

[chemlabrat]

I'm 24 years old, male, athletic one year ago, debilitated now.

Symptoms (vary from time to time, but listed in order of prevalence of what I'm feeling at the moment).
-Dizzyness (light-headednes) Feels like I'm going to faint, but the room doesn't spin and I don't feel off-balance.
-Head pressure/tingling sensation in scalp. Tingling is usually brief, while pressure can last hours or a day or two.  Pressure builds on standing most times, and sometimes it doesn't.  Usually the pressure is just above my ears and on the back of my head.  Similiar to two fingers keeping pressure on my head just above the ears from the inside out.  The head tingling can be brought on by straining hard, such as to lift or push something.
-Post-nasal drip.  Worse in the mornings, seems to increase with symptoms.
-Heart arrthymia.  Sinus Tachyardia picked up in EKGs and holter.
-Palpitations.  PACs.  Not very prominent at the moment, but I can get 50 or more in an afternoon when they get started.
-Brief waves of nausea that come and go within 10 seconds.
-High blood pressure (going on 4 years now).  During times when I'm most dizzy, and while on Benicar 20mg, it can hit 165/95 or so.  At rest, it's around 130/80.
-Tired/Fatigued


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[Kevin Pho, MD]

Not sure I can add anything in light of the comprehensive workup you have had, including multiple specialist referrals.  

Many of the common disorders would have been ruled out with the tests that you had.  

I would go further with the cardiology testing.  Further evaluation of the heart can be done with a stress echocardiogram as well as tilt-table testing.  The latter test can help determine if autonomic dysfunction is a possibility.

With the response of the symptoms to steroids, looking for autoimmune disease is reasonable.  Initial tests for the ANA level and rheumatoid factor can be done.

You can discuss these tests with your personal physician, or obtain another opinion, preferably at a major academic medical center.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[chemlabrat]

When I wake up in the morning, I seem to feel fine aside from having sinus drainage.  Around 10am I get much much worse almost like clockwork, and get very lightheaded.  The rule doesn't always apply, and sometimes the bad feeling can start as soon as I wake up and last all day.  Sinus drainage increases.  Pressure in the back of my nasal cavity increases.  Drinking a coke or something with a lot of sugar seems to help.

Tests I've had:
-Numerous blood tests (vitamin check, cbc, eppstein barr, complete metabolic panel, flu, etc)
-Balance test given by an ENT
-MRI without contrast
-Holter monitor that recorded 50 or so palpitations
-EKGs with two different cardiologist
-ECG a year ago and recently
-Chest x-ray
-Urine sample

And FINALLY, I got some relief.  I went to my ENT again asking about anything that could possibly be causing it.  He said that he was positive it wasn't inner ear due to the tests we had done.  He wanted to treat for allergies to see if that helped.  So i started taking Nasonex, Lodrane 24, and prednisone.  The Prednisone was a 7 day pack, and on the 2nd day, ALL MY SYMPTOMS had almost completely gone away.  I was having side effects of higher than normal blood pressure and also feeling wired and jittery and was waking up with a pulse of 120 to 130bpm for about an hour ever day.  But I didn't care, because the symptoms I'd lived with for months and months were gone.

The prednisone pack tapered off, and the symptoms have now come back.  So what does this mean?  I went back to my general practicioner, and they are testing me for autoimmune disorders with blood tests that I should get the results of tomorrow.  I don't much believe that it's autoimmune since my symptoms don't sound similiar to what people with autoimmune diseases have.  I did some google'ing and asked my doctor if I could be treated for Candida, even though it was a long shot.  So starting yesterday I was put on a once a week anti-fungal pill to see if it is a yeast problem.

The only diagnosis I've been given was by a cardiologist that suggested a mild form of dysautonomia and an internist that agreed.  I went to another cardiologist and internist, and both argued that I didn't have dysautonomia, because when I go from sitting to standing abruptly, my blood pressure shoots up, heart rate increases, and then I stabilize back to normal.  They said normally with dysautonomia I would see blood pressure dropping causing the dizzyness, but instead it was higher than normal.  I was also diagnosed with anxiety by my general practicioner and given Paxil, which I did not respond well to after only taking one pill on two separate occasions.  I haven't pursued the anxiety anymore since finding out that the prednisone caused the symptoms to go away.  I do have a history of occasional panic attacks and anxiety, and have had palpitations stemming from anxiety, such as during a final exam week I would have palpitations all week long that would go away when the finals were over.  I don't feel like I have any major stressors in my life, and I feel happy.  I get light-headed and feel terrible whether I'm at home, work, resting, or active.  It seems to be worse at work, but probably just because I'm unable to lay down and relieve the symptoms.

Not sure where to go next or what to do.  I had to stay home from work again today and I'm going to lose my job unless something changes soon.  No one can give me a diagnosis.  Please help.

[chemlabrat]

It is also noteworthy that I have had increased allergy problems in recent years.  It never bothered me much in the past, but in the past couple of years my allergies in the spring time have been absolutely horrible.  I'm not sure if or how that would tie in, but it's a little more info.

I called today and requested my doctor do a 24 hr urine test for adrenal function as well.  

Also called a local psychiatrist to see about appointments.  I don't feel like I have anxiety, but if all the other tests turn up negative and I don't know what else to do, maybe I'll have to convince myself I'm anxious and don't know it?

[Larkenn]

I would be interested to know the results of your 24 Hr urine test for adrenal function.  I have similar symptoms to yours including the blood pressure and heartrate going up when I stand up instead of down.  This confuses my doctors too.

[jk01]

Wow, I have almost the same thing.  The tingling in the scalp thing worries me.  I also have neck and back pain, plus my ear click and pop every time I swallow.  I also have numbness and tingling in my legs and feet.  Keep us posted on your tests.  I have a rheumatoid factor of 160 (it was 68 about 3 weeks ago), but other than that my blood tests came back fine.  I feel "spaced out" most of the time. Good luck and God bless.

[chemlabrat]

I will keep everyone posted.  The tingling/numbness in my head seems to have stopped and has been gone for the past couple of weeks.  I also get the tingling in the back of my legs from time to time, but in my legs it feels more like blood "bubbling" through the veins.  I'm still having trouble with most of the other symptoms though.  

Only updates I have so far is that I went to see a psychiatrist on Friday about the possibility of it being anxiety related.  They told me their diagnosis would be chronic fatigue syndrome.  The original onset happened back in February after what felt like the flu or mono or some other type of virus I had.  I was tested for flu and mono but they came back negative.  The psychiatrist didn't reccomend I take any anti-anxiety medications, and just try to "be more healthy" with meditation, relaxation, exercise, and diet.  To be frank, I didn't trust the guy.  He didn't seem to know what he was talking about, and I paid for an hour and got to see him 30 minutes before he cut it off.  I'm going Friday to see a psychologist who I think will be more trustworthy.

In the mean time, I'm seeing my cardiologist again tomorrow to talk about getting a tilt table test to rule out dysautonomia.  I'm also going to return the urine specimen to my GP to be sent off for adrenal testing.  I'll keep posting.