Discussions By Condition: I cannot get a diagnosis.

Dizziness, upper abdominal pain, nausea

Posted In: I cannot get a diagnosis. 29 Replies
  • Posted By: bryan11
  • December 24, 2008
  • 02:08 PM

My wife is a 40 year old female in excellent physical shape. Her only medical history is hypothyroidism two years ago, which was corrected with diet changes and verified with blood tests.

Past three months:
- two episodes each for 3 days solid where stomach felt like it was boiling acid
- constant dizziness when standing/moving
- mild, constant pain in upper abdomen;
- constant nausea
- occasional headache
- pulse is normally at 64, but a few times a day moves up to 100 for no reason
- Saw a doctor twice. Blood work looked perfect. Initial diagnosis was ulcer. Took prescription antacid for 3 weeks. It helped constant nausea somewhat, but nothing else.

Changes in last 5 days:
- pain in upper abdomen moved higher toward heart
- strong nausea; can't eat anything but a few crackers
- extreme fatigue; Spent 3 days in bed, then doc admitted to hospital for monitoring

GI specialist ordered CAT scan and said it's definitely not an ulcer or a GI problem.

After three days in the hospital, we're really hoping for some diagnosis and solution.

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29 Replies:

  • Day four in hospital. Two adrenal tests came back normal. Physician said he's not sure what to test next. She's spending another day in the hospital to see the on call physician tomorrow morning and hopefully obtain a plan for the next steps.My wife says even drinking water makes the nausea and stomach pains worse. I'm having a hard time believing this isn't a GI issue. Then again, she says she's light-headed all the time, sort of like when you are starting to wake up in the morning. No idea what the next steps might be.
    bryan11 8 Replies
    • December 25, 2008
    • 03:12 AM
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  • Has her gallbladder been checked?Also,has she been tried on a proton pump inhibitor such as Prilosec or Nexium?:)
    richard wayne2b 1232 Replies
    • December 25, 2008
    • 01:06 PM
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  • Has her gallbladder been checked?Also,has she been tried on a proton pump inhibitor such as Prilosec or Nexium?:)Also, you can't diagnose an ulcer with a CT scan,and it sounds as if she's having gastresophageal reflux withpain getting near her heart.Only an upper gi or an endoscopy can rule out an ulcer.Has her thyroid been checked because hypothyroidism is not treated with dietary change?
    richard wayne2b 1232 Replies
    • December 25, 2008
    • 01:16 PM
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  • try researching POTS syndrome.P
    pamelasmc 82 Replies
    • December 25, 2008
    • 08:37 PM
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  • Thanks for the ideas. I'll ask about gallbladder and use of proton pump inhibiter drugs tomorrow. Today went well. My wife was given Zofram, and for the first time in three months her nausea subsided enough for her to eat normally. One nurse really helped us out today by reviewing all the tests and doctor notes and finding where the last doctor forgot to write down orders for the next tests and referrals. Her phone calls got things moving again in the correct direction. Another GI specialist stopped by and ordered a full set of abdomen x-rays with a barium drink. He says that will let him view the entire GI system and see where an issue might be. They also noticed her hemoglobins were low, 10.9 instead of 12 to 16. They said that might be the cause of her feeling light-headed and 'fuzzy' all the time. A test tomorrow for 'iron levels' was ordered.Tests showed normal thyroid levels, so they're fine now. Her diet changes worked in a couple months. It's not a normal approach in the US, but it let her avoid taking drugs to fix the issue.
    bryan11 8 Replies
    • December 26, 2008
    • 05:15 AM
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  • Day six. A full abdominal x-ray series shows some GERD, i.e. acid reflex. My wife never noticed this, but the GI says this could cause everything except the light-headed and dizzy feelings. Next up tomorrow: More discussion on this with the GI and then ultrasounds of the gallbladder and heart. One note about all this. I'm learning that one really needs a person at the hospital reviewing the doctor's notes and asking lots of questions. Three doctors failed to write orders for things they commented on being needed. One was interrupted and stopped writing, two changed their position 180 degrees on their diagnosis after I questioned things and asked about various tests, and one doctor played 'pass the buck', refusing to listen or say anything other than to talk to the on-call doctor the next day. We're noting each step, test, recommendation, and medicine on a notepad.
    bryan11 8 Replies
    • December 27, 2008
    • 05:17 AM
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  • How is her heart?Arrythmias can cause light-headedness and fatigue.Also,there are reports of heart irregularities in some patients with ge reflux.I've personally seen two cases of it.:)
    richard wayne2b 1232 Replies
    • December 27, 2008
    • 00:56 PM
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  • We already know that her pulse goes up to a 100 for no apparent reason(I just reread your original post.)It might be going higher and with irregularity.:)
    richard wayne2b 1232 Replies
    • December 27, 2008
    • 01:00 PM
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  • By the way, what treatment did they prescribe for the reflux?
    richard wayne2b 1232 Replies
    • December 27, 2008
    • 05:22 PM
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  • Your comment on "heart irregularities in some patients with ge reflux" interests me, since so far all both GI specialists have said they have nothing to do with each other. Here's where we're at on day 7. The second GI is still waiting on gallbladder results, but says it still looks like classic acid reflux. He gave her Carafate Oral and said to keep taking that for 7 weeks. It should have some effect in 2 or 3 days. We're a bit concerned the Zofram might mask any beneficial result of the Carafate.A cardiac specialist did an EKG, then ordered a heart ultrasound to investigate more. Since the light-headed / dizziness is the only symptom not supposedly explained by the acid reflux, I questioned my wife more about the light-headed / dizziness spells. She said that for the past 3 months she's always light-headed, as if when you just start waking up. When she stands up, about 25% of the time her vision dims in a few seconds to complete blackness, her ears start ringing loud enough to block everything else, and the room 'wobbles'. At this point, she must sit down or pass out and fall down. In addition, every time she stands up she feels her heart pounding, her pulse increases from 64 to 100, her blood pressure drops, and she feels exhausted in a few seconds.All this makes me worry about heart issues. Are these two independent issues that happened to show up at exactly the same time, or could one be causing the other? What are the approaches for fixing all this?
    bryan11 8 Replies
    • December 28, 2008
    • 04:50 AM
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  • IT's possible that two things are at work at the same time.It sounds as if her blood pressure drops when she gets up.A tilt table test will confirm this or not.Just tell her doctors what you just told me.She might even have POTS.:)
    richard wayne2b 1232 Replies
    • December 28, 2008
    • 01:24 PM
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  • Changes in autonomic function are not uncommon in gastroesophageal reflux conditions and irritation to the mucosal linings can actually stimulate the vagus nerve, subsequently producing palpitations. Realize that this is not an arrythmia, but merely the superimposition of a signal upon the normal sinus rhythm of the heart that depending upon precisely when it intervenes during the cardiac cycle, can produce sensations of a hard thump, a stumble or flutter and even what patients sense as an absence of a heart beat. During ventricular depolarization, the ventricle action is extremely forceful and the vagal stimulation which causes the palpitation event can sometimes be felt up in the throat. During atrial depolarization, the smaller chambers of the atria produce a milder fluttering or buzzing type of response that patients often define as "stumbling" of the heart muscle. Lastly, if the superimposed signal arrives precisely during ventricular repolarization, or the momentary quiet phase of the cardiac cycle, it can produce what is sensed as a prolonged absence of a heart beat. Your wife is experiencing the dizziness on rising due to the effects of reduced vagal tone. Realize that when you stand from a seated or lying position, certain physiological change must occur at the level of the vascular system to challenge the effects by gravity. The most important task by the body is to maintain perfusion to the brain. Even slight changes in perfusion can cause tunnel vision, light-headness and even mild confusion or disorientation in some persons. As an example to illustrate this type of physiology, fighter pilots struggle constant to overcome a reduction in perfusion to the brain because of extremely high G forces being experienced. Pressure "G" harnesses remedy the problem to a great extent, but in the days prior to this advent pilots had to perform something called a valsalva maneuver, which impedes return of venous blood to the heart and consequently maintains sufficient perfusion over the effects of gravity. If your wife were to peform this maneuver, you'd see that the effects she is experiencing would diminish, but realize that this is not the answer to her difficulty but rather merely illustration of what is actually taking place from a physiological standpoint. The reason that her heart pounds is because the drop in blood pressure and perfusion sensed by baroreceptors in the ascending aorta which send signals to the cardiac center in the brain to increase cardiac force. One of the quickest methods by the body to restore pressure is to increase cardiac force, sensed by the patient as a hard, pounding of the heart muscle. In fact, we use medications called beta-blockers to reduce cardiac force and consequently, blood pressure in some hypertensive patients. If she is experiencing difficulty with hypotension, it is because the increase in cardiac force is sometimes insufficient to overcome reduced vagal tone. Although it may not be the case here, persons with diabetes often suffer from poor vagal tone and gastroesophageal reflux, but I'm presuming that this has been evaluated by your wife's healthcare team. As I said, I doubt it's the case here, but illustrated simply to demonstrate that her symptoms are associated with a sort of battle going on between autonomic responses, some of which do not necessarily represent pathology of any type, but merely coincidental to the underlying condition. I would also ask whether your wife is under any inordinate amount of stress from events like a recent death in the family or other significant trauma that was proximal to the onset of symptomsin general? Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • December 28, 2008
    • 02:28 PM
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  • The Zophram won't mask any of the other effects.:)
    richard wayne2b 1232 Replies
    • December 28, 2008
    • 03:33 PM
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  • Dr.Cottle might be right,but I'd get the tilt table test anyway just to be safe.
    richard wayne2b 1232 Replies
    • December 28, 2008
    • 03:36 PM
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  • Hi Bryan,I've posted before and I'll try again....please research POTS syndrome. Your wife has many of the symptoms. It is an uncommon syndrome that does affect the heart, although it is not a heart disease. I have had all of the tests you've mentioned plus many more, until the tilt table test proved the answer. Luckily I have a milder form of POTS, and it is an unpleasant diagnosis, as it is hard to treat and can't be cured. It is manageable however, and it's a relief to know what is wrong. potsplace.com is a good place to start.Good LuckPamela
    pamelasmc 82 Replies
    • December 28, 2008
    • 06:58 PM
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  • have they checked her for a parasitic infection? Several of her symptoms are similar to those of having a parasite.
    rianngio 7 Replies
    • December 28, 2008
    • 10:33 PM
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  • Thanks to everyone for their help with this! We're planning to disuss several items mentioned here with a new doctor tomorrow morning.Dr. Cottle: My wife read what you wrote and said that was more useful than 13 doctors in the last 7 days. Richard and Pamela: My wife read about POTS from www.potsplace.com and considered it a good possibility we should discuss more tomorrow with the doctor. Much of the information there was very useful.Today, the cardiac specialist read the heart ultrasound results and said her heart is in excellent condition. The GI and heart specialists said today to look into Menieres disease, so an ENT visited, found nothing, and said this doesn't look like Menieres at all. Basically, they've ruled out ENT, heart, and neuro. The on-call doctor coordinating all this has asked a psychologist to talk to her tomorrow. We don't feel stress or any events are part of this, but it's worth talking to them to get another opinion. Some iron supplements (3 pills a day) have brought her hemoglobin level from 10.9 to 12.0. They've been doing a test where she lays down flat for 15 minutes, they measure her pulse and BP, then sit, measure again, wait 5 minutes, measure again, stand, measure, wait 5 minutes, measure, etc. Standing, she would feel her heart rate pounding, have shortness of breath, and sway back and forth without noticing it. The nurse told me tonight her max drop was 7 and they generally don't worry unless it's closer to 20. She wasn't familar with POTS at all.Tomorrow, a new doctor will be taking over all this, so maybe they'll connect all the dots here and create a plan to treat all this. The current doctor says he's "at the end of his knowledge" and if the other doctor doesn't figure out anything different we'll need to go to Mayo Clinic or a research/university hospital in Iowa City.
    bryan11 8 Replies
    • December 28, 2008
    • 11:52 PM
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  • Carafate might help,but it's not the drug of choice for reflux.She should be on a proton pump inhibitor such as Nexium or Prilosec.
    richard wayne2b 1232 Replies
    • December 29, 2008
    • 01:22 AM
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  • Also,she should elevate the head of her bed 6-8'' and not eat 2-3 hours before bedtime.Usually it's smart to take antacids(Maalox or Mylanta)1&3 hours after eating with a bedtime dose as well.I'm shocked that he didn;t prescribe something else & that he didn't give you these very basic instructions.
    richard wayne2b 1232 Replies
    • December 29, 2008
    • 01:29 AM
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  • I caught sight of something in this thread and need to step forward and make amends. To Richard_Wayne2b: I must apologize in that I did not mean for my response to represent any type of countermand of your recommendations for the tilt test. I would wholeheartedly agree that it should be performed. Best regards, J Cottle, MD
    JCottleMD 580 Replies
    • December 29, 2008
    • 01:54 AM
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