Discussions By Condition: I cannot get a diagnosis.

28 w/f dr diagnosed GERD, is there more wrong?

Posted In: I cannot get a diagnosis. 5 Replies
  • Posted By: nolalove
  • June 14, 2009
  • 11:47 PM

Hi. I'm trying to find out what's wrong with me. My problems started in Febuary when I was at an event that required me to walk for several hours, leasurely pace, stop&start. I had eaten Tex-Mex before the event, but about an hour later I started to feel loopy. I felt disconnected from my legs, like fuzzy headed. And when I walked by a sound system w/ heavy base I felt like I was going to pass out from the vibration I was getting in my chest & head. I even went into the restroom & ran cold water over my wrists. While there I looked in the mirror & noticed my eyes where bloodshot. I didn't tell the person I was with b/c I didn't want to make a scene or go to the hospital & a few minutes later I burped & passed gas, I felt like a new person. All of my symptoms disappeared and I continued on for several more hours.
Since then my symptoms have grown & are now an everyday occurance. I have tremors in my hands, an inner vibration in my entire body, lightheadedness & extreme body fatigue where it's hard to get out of the car or press the gas pedal. all this affects what i feel i can do in a day & my appetite. Several times including today, I get the feeling of getting ready to pass out, lightheadeness, disconnected from my body, shaky hands, flushed face. I run cold water over my wrists & sit down & it usually passes. When I told my dr about the 1st instance he said I have gerd & gave me samples of protonix, but b/c my employer doesn't offer insurance, I can't have any indepth testing done or a protonix prescription. I'm so tired of feeling the fatigue, fuzzy-headed, shaking hands & body tremors. It's a daily occurance now & I don't know what the cause is.
I described to my dr & one of the reasons he diagnosed GERD is b/c i get a heavy vibration in the center of my chest. It's like a cat purring. Even though I have noticed an increase in the amount & the deepness of my burping, I'm afraid there may be something wrong with my heart (he says no) and that is the reason for all the symptoms above minus the burping.
My dr did do blood work, but no urine about 2 months ago when i was last there & when i called for the results his nurse said it all came back clear. i was hoping what is wrong would show up in my bloodwork; ie diabeties, thyroid, hypo/hyper glycemic, etc., but nothing. I don't know where to go from here, but I feel like my body is trying to run down on me, and I'm only 28 w/ no real medical history. I would like to know if my GERD could be so severe or if I'm so sensitive to it, that the gerd could cause all other symptoms from above.

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5 Replies:

  • There's nothing among your symptoms to suggest anything more serious than somatoform associated with anxiety disorder. Realize that physical symptoms in the absence of physical disease are extremely real and the reason that patients misconstrue the associated physiological responses as symptoms is that they are unfamiliar. I would not necessarily agree that you have actual GERD unless you are demonstrating symptoms of reflux into the esophagus. Belching in of itself does not qualify unless chyme is regularly forced into the esophagus and sometimes further into the oral cavity. Most patients with GERD have nighttime and early morning symptoms as well. Let's talk about your original incident. Realize that when the body is experiencing certain types of anxiety, it produces a general excitation of the central nervous system to the extent that normal sensory feedback becomes dysregulated. Consequently, things like pounding bass sounds that cause physical sensation can produce odd feedback to the brain and the same holds true for certain light intensity or color. When sensory feedback becomes dysregulated, it typically produces a warning to the brain that something in the environment may constitute a threat. Realize that this kind of response is extremely archaic and is innate in all humans. It is sometimes referred to as the "fight or flight" response, during which the body produces certain physiological preparatory actions to either escape from harm or physical fend off the threat. Heart rate, respiration and blood pressure are increased, epinephrine is released from the adrenal glands and most sympathetic nervous activity is increased, including vigilence. Parasympathetic activity is diminished greatly, including parastalsis and bowel function. Environmental stimuli, together with the body's feedback response, can produce a rather unrealistic sensation to the affected person; They may feel intermittent numbness in the lips or face, the hands and feet may tingle, tremulousness and unsteadiness may occur, and the limbs may feel heavy or unresponsive to some extent. Some people even experience heart palpitations of various intensity, sweating, racing thoughts or a feeling of impending doom that cannot be identified. Gas may become trapped in the upper abdomen and cause pressure against the diaphragm, resulting in shallow breathing and the sensation that one cannot get enough air or take a deep, inspirational breath. It is a common complaint for persons with anxiety disorder to complain of buzzing sensations in the chest that most often occurs from stimulation by the vagus nerve, which incidentally is also responsible for the palpitations which may sometimes occur as well. Sharp changes in vagal tone can also produce a sensation of pressure in the head or ears, with a sensation of lightheadedness, sometimes even tunnel vision and syncope (fainting). The original incident typically produces a sense of uncertainty in the individual and if not held in check, can produce health anxiety because certain aspects of the symptoms continue to appear, or there is apprehension that they will manifest. All tests typically produce negative results because algorithms of diagnostic tests are based on actual parameters of disease. Since no disease actually exists or is responsible for the symptoms, the tests demonstrate negative results. Also realize that sensations of derealization or depersonalization occur most often because of subtle changes in blood gases that occur due to shallow breathing and stress. Many patients describe the feeling as being in a bubble or being in a dream-like state to the extent that their senses of the outside world are somehow blunted. This is because the sensory process is dysregulated by stress or anxiety, causing an attenuation of what the affected person would feel as more normal. Many patients with this disorder become particularly concerned about their heart due to palpitations or proximal muscle spasm that feels like a little motor running inside their chest. There is nothing among your symptoms to suggest any type of cardiopathology, so from that perspective you need to take a breath and relax. Your story is quite common and the mounting frustration is well-recognized. It's important for you to refrain from making a direct relationship between your symptoms and the prospect of underlying disease being responsible. Somatoform is the term we use to describe physical symptoms that occur in the absence of physical disease and as such, it needs to be treated from the standpoint of reducing the anxiety and stress which is actually responsible. Also realize that your "symptoms" are actually just physiological responses that are occurring in the absence of an actual need. In other words, by example, let's take the instance where someone is suddenly frightened. You will often hear them describe the immediate aftermath as "My heart skipped a beat" or "It ran shivers up my spine" or "I nearly passed out" or "I almost wet myself" or "I couldn't get my breath." These are all examples of the body responding to the fight or flight mechanism but in instances where fear immediately preceded the events, there is no contemplation of heart disease because the heart skipped a beat, nor worries about disease because they nearly passed out or felt tingling sensations running throughout their body. Only in cases where the fight or flight mechanism is engaged due to anxiety or stress does a person find no correlation. In fact, many patients experiencing such sensations nearly always state "but I don't feel anxious. I know what anxiety is and I don't have that." Well, the problem in making such a subjective statement is that situational anxiety is very common and everyone recognizes the sensations of such apprehension, but this is far and away different from the level of anxiety that can produce somatoform in a person and is absolutely of a different character altogether from situational anxiety. It's the next step in anxiety so to speak. Also realize that many, many people mistake the signs of an epinephrine spike from the adrenal glands for hypoglycemia. They feel nauseated and weak, their hands or legs may tremble and they may feel lightheaded. It is reinforcing that once a person eats or drinks, the symptoms begin to subside, but in no way is this due to eating food but rather eating causes parasympathetic activity to increase which lowers sympathetic tone and consequently, the production of epinephrine by the adrenals. Hypoglycemia is actually extremely rare, but many people claim to experience it regularly. What they are actually experiencing are the effects of adrenaline (epinephrine). Additionally, realize that running cold water over your wrists produces something known as the "dive reflex" and actually lowers sympathetic tone. The heart beats slower, blood pressure is lowered along with respiration and other functions excited by sympathetic nervous activity. It is similar to pressing gently on the eyes, which produces a similar response. Your GI symptoms are certainly derived from the anxiety issues and once you're able to lower the threshold of the anxiety, you'll be surpised to see that your GI symptoms and other irregularities will diminish as well. It's important, however, to understand more specifically how anxiety and stress can cause physical "symptoms" to manifest in the absence of underlying disease. You'll be fine. It would be beneficial to speak with your doctor about approaching your symptoms from an anxiety standpoint and whether short-term therapy would demonstrate a reduction in your overall symptoms. If you feel comfortable doing so, you might also consider speaking with a professional with experience in dealing with somatoform and anxiety. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Ok, this doesn't make sense. For instance, I'm sitting here at work, basically doing nothing and yet I can feel the vibration in my chest. Last night I ate a hamburger for dinner w/ onion (which are a no-no on the GERD list) and as soon as I got up today I felt the vibrations in my chest. I can tell when I eat or drink something that I'm not suppose to that a short while later I get a noted vibration in my chest cavity and as soon as I burp it's relieved. I will say that on only 2 occasions has food been regurgitated and I never have the burning associated with heart burn. Beyond the usual stresses of the day, work, paying bills, maintaining a house, I have nothing to be anxious about. I have no children, am not in a relationship and can do whatever I want. Also I'm basically my own boss, because I may see my boss 3 times a day, at most. If I can never recognize an obvious reason for anxiety, then how is my body maintaining (from what your saying) a constant, daily high level of anxiety? And why would it suddenly develop at an event that I wanted to go to and had no reason to be stressed by? If this is a sudden chemical imbalance my body's producing I can understand that; but then by that then something IS physically wrong with me. This isn't something I'm imagining, nor can I go around chasing phantom causes for this "anxiety". I would have to deconstruct my entire life, alienate my family, quit my job, basically alter every aspect of my life, to MAYBE find out I'm truly suffering from anxiety caused by some mystic form. I can't fight or solve an issue that has no real cause or reason for being. One day I felt ok, now I'm not. My "anxiety" symptoms happen everyday, no matter what setting I'm in. Somedays are better, some are worse; but even when I'm doing something I use to enjoy (shopping) I feel the symptoms I described in my 1st post.
    nolalove 2 Replies Flag this Response
  • Well, I've been a physician for more than 40 years and your symptoms do not suggest pathology associated with underlying physical disease. If, like so many, you feel that it's impossible for the cause to be anxiety related, then by all means pursue whatever course and diagnostic testing that you feel warranted. There is, however, no universal direct relationship between physical symptoms and underlying physical disease. Purely as a matter of inquiry, I'd be curious to know why you'd continually elect to consume food products known to be problematic as stated in your response several times if you're so concerned about the subsequent symptoms that arise, ie "vibrations" in your chest? In my years as a doctor, I've certainly encountered patients who don't know what they have, but with unswerving confidence know what it is not. I wish you the best in determining the cause of your ailment. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Seeing that you've been "a practicing physican for 40 years", I get the impression that you prescribe to the belief that if a diagnosis can't be made with x-rays or through blood work then all symptoms are imaginary. Your statement that there is no direct link between how a person feels (fatigue, pains in body, etc) and an ailment or disease, makes absolutely no sense. Have you ever heard of the basic laws of physics; action to reaction, cause and effect? I've never heard of a cancer patient or diabetic or any other person that suffers from something as mild as a headache to as severe as flesh eating bacteria not having pains or symptoms that help their doctors discover what is wrong. That is what the word symptom was created for. Not everything is imaginary and for a doctor to not believe there is anything wrong because nothing is visable or apparent is a violation of the Hippocratic oath. I would have more belief if a doctor told me that maybe it is a physical reaction to stress (which would explain nothing more than the fatigue). Anxiety is part of fight or flight, and a by-product of stress, but unless there is a chemical imbalance, it is impossible to maintain a constant high state of anxiety. By now I would have already gone crazy; suicidal or died. I'm by no means a doctor and my common sense tells me anxiety is impossible to cause daily fatigue, hand shakes, etc. UNLESS it is a chemical imbalance, in which there is a physical problem and my body is reacting to this imbalance. The reason I quoted in the 1st post about hyper/hypo glycemia is b/c of this website. When typing in the symptoms I have, it repeatedly listed them as a possible cause. Also there are so many items on the list of foods that trigger GERD, it is impossible to eat anything fast food or with any spice or caffeine. I had a burger last night at 11pm b/c I worked til 10pm and by the time I got home it was so late all I could do was stop and get fast food. It seems to me that anxiety and stress are the modern answers for the Victorian custom of using the terms "fit" or "decline", when doctors couldn't then & can't now find the cause for a patients illness and giving a verdict of a generalized problem with no real solution works easiest for the doctor. It easiest to give a random prescription, wait several weeks or months and if the patient still complains about the same ills or worse; then the doctor moves on to another pill until the patient does get cured or dies.
    nolalove 2 Replies Flag this Response
  • Did you ever figure out what it is or manage to feel better? I was diagnosed with gerd recently and experience the same exact symptoms. I get those vibrations when driving and hit a bumpy road (like I feel it in my chest and my breathing "catches" for a minute as though the bump echoes through my insides). The chest gurgling and breathing and shaky hands are scariest. I've realized eating a dense food that will go down the esophagus and can sit in the stomach as its digested helps, eating light food like soup is the worst because it causes more esophagus irritation.
    Anonymous 1 Replies
    • October 31, 2015
    • 05:00 PM
    • 0
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