Discussions By Condition: I cannot get a diagnosis.

Starting to think I'm crazy

Posted In: I cannot get a diagnosis. 6 Replies
  • Posted By: hdoiel
  • April 17, 2009
  • 00:41 AM

I have had the shakes if I don't eat for quite a few years now and just assumed that it was normal until recently. I went in for blood work to determine if I am hypoglycemic or diabetic and my tests came back normal. I now have new symptoms. Extreme nausea and then projectile vomiting. Cold sweats that will soak my clothes. Extreme fatigue after my "shaking" episodes. Diarreah with what I could only describe as blood clots. These have landed me in the emergency room twice in the past 4 days with the doctors just scratching their heads. Please if anyone can help, my husband, son and I would greatly appreciate it!

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  • Okay, realize that adrenal stimulation due to stress can cause weakness, tremulousness, nausea, sweating and other symptoms often mistaken by patients to be associated with hypoglycemia, a disorder that is actually far more rare than believed to be the case. In rare instances, when these symptoms are accompanied by labile blood pressure and other clinical markers, a tumor known as a pheochromocytoma is responsible and grows upon the tissues of the adrenal gland, stimulating it. I doubt it's the case in your instance, but a cortisol test can generally rule it out. How long have you been experiencing the vomiting and diarrhea, specifically in terms of days? When you say blood clots in your stool, tell me whether they are bright red, very dark or black in color and is there blood on the tissue, if so is it bright red? It would be rare for actual blood clots to appear in the stool because blood is digested when in the intestines and takes on a very dark to black appearance if sufficient in quantity, and if small in amount typically cannot be detected without an occult blood test. Also, when you vomit, does the chyme appear like coffee grounds or dark rust in color? Does the vomit appear to be largely composed of undigested food? Several considerations come to mind. If the vomiting and diarrhea have only been taking place for the past several days, then it's possible that you have acute gastritis secondary to viral infection that can last from 10 to 14 days. The symptoms could also be due to gastroparesis, wherein delayed emptying of the stomach arises from damage or dysregulation of the vagus nerve, called the pneumogastric nerve at the level of the stomach. If there is indeed blood detected in the stool, then it's possible that you may be experiencing ischemic colitis, confirmed by colonoscopy. Also, what appears to be clots may in fact be mucous, in which case would suggest Irritable Bowel Syndrome. I doubt it's the case here, but is a diagnosis of exclusion. Also, any medications being taken would be important. For instance, if you're taking beta blocker drugs for hypertension, they can mask actual hypoglycemic conditions in people with diabetes, so it would be important to know all medications being taken. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Also, any medications being taken would be important. For instance, if you're taking beta blocker drugs for hypertension, they can mask actual hypoglycemic conditions in people with diabetes, so it would be important to know all medications being taken. Best regards, J Cottle, MD I am taking Propranolol for anxiety related issues...trying to keep my heart from racing when I am very anxious.I have been on the Propranolol for about 2 months now and it seems to be helping alot! My heart doesnt race anymore and the chest pain that I was experiencing is now almost non-existent.I have always feared that I was hypoglycemic b/c I feel extreme hunger a few times a day. It comes on sudden and if I can't eat something quickly I feel nauseous and faint. I have always thought, well I am small (5'7", 115lbs, 25 yrs old) that I felt this way b/c I have little reserves in terms of my body? I began the Propranolol after a visit to the ER for what I thought was a heart attack, but it was just anxiety. There was a ton of blood work done and everything came back normal. My question is...Will hypoglycemia and/or diabetes show up in a normal blood test or do you specifically have to be tested for it?Both times when I was pregnant I was borderline with Gestational Diabetes...dont know if that has anything to do with how I currently feel? I have felt this extreme hunger for several years now, so before I was on medication. I feel this hunger, along with, constant fatigue and muscle aches.I just wanted to get your opinion, you seem to know ALOT about everything!Thanks!
    LT8605 20 Replies Flag this Response
  • Well, I'm a physician. At 84 years old, I would hope that I know at least something of my profession. Your problem is not hypoglycemia, but rather adrenal stimulation secondary to anxiety disorder. As I stated, patients very often confuse the symptoms associated with hypoglycemia with those from adrenal stimulation. Realize that under normal circumstances when epinephrine (adrenaline) is increased, it is susbsequent to a demand placed on the body such as exertion or being placed in a fearful or dangerous situation. The body responds in these cases by upregulating epinephrine to compensate for the increased physiological demands. It is altogether differernt, however, when this same increase in epinephrine occurs at rest and is due to anxiety that causes the adrenals to be stimulated. The result is abdominal pain or discomfort, nausea, sweating, tremulousness, light-headedness. The hunger is related to a sympathetic nervous response, not the need for glucose. The response is almost always thought to be associated with hypoglycemia because eating causes the problem to dissipate, not to an increase in glucose, but rather reduction in adrenal stimulation resulting from a parasympathetic nervous response. As symptoms subside, people are reinforced that they must have indeed been hypoglycemic, a disorder that is actually very rare. Gestational diabetes or borderline conditions are quite common, but this would not necessarily subject you to developing type II diabetes. The chest pain and sensations similar to a heart attack that led you to the ER visit, was in actuality something known as DaCosta's syndrome and is often encountered in patients with anxiety or panic disorder. It has nothing to do with the heart muscle, but rather the muscles of the chest wall and diaphragm. The propanalol will work well because this class of drug also produces an anxiolytic effect, thereby reducing the physical symptoms of anxiety. You might find benefit from seeking a professional who can help with the anxiety, which would result in a corresponding decrease in the physical symptoms you are experiencing. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Well, I'm a physician. At 84 years old, I would hope that I know at least something of my profession. Your problem is not hypoglycemia, but rather adrenal stimulation secondary to anxiety disorder. As I stated, patients very often confuse the symptoms associated with hypoglycemia with those from adrenal stimulation. Realize that under normal circumstances when epinephrine (adrenaline) is increased, it is susbsequent to a demand placed on the body such as exertion or being placed in a fearful or dangerous situation. The body responds in these cases by upregulating epinephrine to compensate for the increased physiological demands. It is altogether differernt, however, when this same increase in epinephrine occurs at rest and is due to anxiety that causes the adrenals to be stimulated. The result is abdominal pain or discomfort, nausea, sweating, tremulousness, light-headedness. The hunger is related to a sympathetic nervous response, not the need for glucose. The response is almost always thought to be associated with hypoglycemia because eating causes the problem to dissipate, not to an increase in glucose, but rather reduction in adrenal stimulation resulting from a parasympathetic nervous response. As symptoms subside, people are reinforced that they must have indeed been hypoglycemic, a disorder that is actually very rare. Gestational diabetes or borderline conditions are quite common, but this would not necessarily subject you to developing type II diabetes. The chest pain and sensations similar to a heart attack that led you to the ER visit, was in actuality something known as DaCosta's syndrome and is often encountered in patients with anxiety or panic disorder. It has nothing to do with the heart muscle, but rather the muscles of the chest wall and diaphragm. The propanalol will work well because this class of drug also produces an anxiolytic effect, thereby reducing the physical symptoms of anxiety. You might find benefit from seeking a professional who can help with the anxiety, which would result in a corresponding decrease in the physical symptoms you are experiencing. Best regards, J Cottle, MD Thank you very much for your response, Dr. I really appreciate your knowledge and willingness to help.I will definitely do my research on DaCosta's syndrome and learn as much as I can.I did see a Psychiatrist, who put me on Lexapro. The very first pill I took caused me to feel so ill. About 2 hours after I took it I was extrememly nauseous and I kept having these very cold tingling sensations through out my body, although I was sweating. I laid down after I started feeling that way and ended up taking a 2 hour nap (something I never do). I felt "hung over" when I woke up and for the rest of that day. My response to the medication scared me and I didnt take anymore of it. The week following, I continued to feel nauseous, but eventually is subsided and I felt like me again.I feel that the Propranolol is helping. I still feel nervous and fearful of many things, but I have tried to just "deal" with those feelings. When I feel that I am having a panic attack I check my vitals and it is always to my surprise, but my heart is beating normal at 70bpm.Thank you again for your help!LT
    LT8605 20 Replies Flag this Response
  • Okay, realize that adrenal stimulation due to stress can cause weakness, tremulousness, nausea, sweating and other symptoms often mistaken by patients to be associated with hypoglycemia, a disorder that is actually far more rare than believed to be the case. In rare instances, when these symptoms are accompanied by labile blood pressure and other clinical markers, a tumor known as a pheochromocytoma is responsible and grows upon the tissues of the adrenal gland, stimulating it. I doubt it's the case in your instance, but a cortisol test can generally rule it out. How long have you been experiencing the vomiting and diarrhea, specifically in terms of days? When you say blood clots in your stool, tell me whether they are bright red, very dark or black in color and is there blood on the tissue, if so is it bright red? It would be rare for actual blood clots to appear in the stool because blood is digested when in the intestines and takes on a very dark to black appearance if sufficient in quantity, and if small in amount typically cannot be detected without an occult blood test. Also, when you vomit, does the chyme appear like coffee grounds or dark rust in color? Does the vomit appear to be largely composed of undigested food? Several considerations come to mind. If the vomiting and diarrhea have only been taking place for the past several days, then it's possible that you have acute gastritis secondary to viral infection that can last from 10 to 14 days. The symptoms could also be due to gastroparesis, wherein delayed emptying of the stomach arises from damage or dysregulation of the vagus nerve, called the pneumogastric nerve at the level of the stomach. If there is indeed blood detected in the stool, then it's possible that you may be experiencing ischemic colitis, confirmed by colonoscopy. Also, what appears to be clots may in fact be mucous, in which case would suggest Irritable Bowel Syndrome. I doubt it's the case here, but is a diagnosis of exclusion. Also, any medications being taken would be important. For instance, if you're taking beta blocker drugs for hypertension, they can mask actual hypoglycemic conditions in people with diabetes, so it would be important to know all medications being taken. Best regards, J Cottle, MD Thank you for your helpful response! My vomiting has finally subsided but my diarrhea is getting worse. The blood in my stool was a dark red with a mucus look. The blood in the toilet was also a very dark red. I have gone from a liquid version of diarrhea to a pencil thin version. This has been going on for 4 days now.I am on several different medications daily. Multi-vitaminCalcium and Vitamin D (us Alaskans need that one!)Birth Control (Yasmin)NeurotinNaproxenGlucosamineChondritinProzacand Iron (I'm anemic)I still have the cold sweats and the extreme fatigue. I went from being fully active with going to the gym everyday at lunch and playing with my 18 month old and pets to all I want to do is sleep. I really appreciate all of your help and ideas!
    hdoiel 1 Replies Flag this Response
  • Okay, the suspect among your medications would be the Naproxen. In the presence of GI symptoms, particularly where questions arise concerning the possibility of intestinal bleeding, Naproxen should be discontinued to determine if symptoms improve. The longer you've been taking this drug, the greater the risk. Unless the cause of your anemia has been identified, this would provide further support to immediately withdraw from the Naproxen. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
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