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Vakul Aren
Vakul Aren, Doctor
Category: Health
Satisfied Customers: 3380
Experience:  MBBS,DTM&H( Univ of Liverpool),30yrs experience in practice
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i am so tired after getting a baby 10 months ago it started

Customer Question

i am so tired after getting a baby 10 months ago it started by feeling very tired , then started to almost faint and light headiness whenever i stand , i feel as if blood is not reaching my brain, with a strong feeling of my heart beats as if it is trying to pumb blood and not feeling comfortable in my chest,

i had normal holter, normal ECHO, Normal CT Brain,

Tilt table test, resulted in almost fainiting with rapid heart rate reached 140 per min and bloo pressure 80/ 40

CT abdomin Had mild enlarged liver ( but doct said its nothing)

blood Tests, ,
normal CBC, normal Urine analysis, normal TSH , T3 and T4 , ANA and D- ANA are normal , thyroid antibodies are normal

ESR is slighly high 31 normal range below 12 ( Doc said its normal too)

Cortisol sitimualtion test before was 7 and after 60 mins 18.2 ( doc said its normal)

Creatinine and SGPT are normal
magnesium , calcium, soduim , potassium are normal

i need to know whts wrong with me, i am on inderal 10 twice daily, Fludrocortison twice , midodrine twice daily and tregtol once daily and nothing seems to work enough

my medical history is before getting pregnant i had removed and ovarian cyst and took clomid for 3 months till i got pregnant
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Sohaib replied 1 year ago.

Hello.

Welcome to Just Answer and thank you for the question.

I am Dr. Sohaib, a Medical Internist (who deals with diseases of all the organ systems of body) and i will do my best to find an answer for you.

It appears from the mentioned extensive laboratory work that you are suffering from postural hypotension and already on treatment for that.

I have searched a beautifully written easy to understand article for you regarding this condition which will help you understand your problem in great detail. Please click this link:

http://www.mayoclinic.com/health/orthostatic-hypotension/DS00997

Please specifically read life style and home remedies mentioned in this article.

If the drugs you have taken did not help you significantly, there are other options which can also be employed.

Sometimes a specific cause for this can not be identified, in which case it is called Idiopathic Postural Hypotension, but we continue with all the management strategies to provide you a symptomatic relief.

There are few things about which you should ask your doctor.

Inderal can cause fall in blood pressure and may potentiate this problem, so why not it should be stopped?

Anxiety can also contribute to your symptoms and may make it worse, therefore, discuss with your doctor regarding evaluation and possible treatment for anxiety.

I would have been worried too if i were at your place but let me reassure you that this is a treatable condition and carry a good prognosis with appropriate management.

Stay relaxed.

Wish you good luck.

Kindest Regards.

It was a pleasure assisting you and i hope my answer was helpful. I will

appreciate 4/5 Star Rating (Good/Excellent Service) & a Bonus as this is the

only way i get credit for my time & expertise. Do not hesitate to ask any follow up

questions or clarifications any time.

Customer: replied 1 year ago.


i am on inderal bec despite of having low blood pressure and light headiness most of the time but all of that started when suddenly i had an attack of a very strong and rapid heart beat as if am scared and lasted for 2 or 3 mins


my endo suspected something called pheochocytoma i ordered another tests like CPK and some others , whts is that and is it treatable


 


and if i had wht u said why specially aroused after delivery and when could i get bck to normal

Expert:  Dr. Sohaib replied 1 year ago.

Thank you.

Inderal should not be used as this can worsen the fall in blood pressure; you need to discuss this with your doctor.

Pheochromocytoma, is a tumor of adrenal gland and this can cause episodes of anxiety, flushing, tachycardia, high blood pressure, followed by postural hypotension for some duration.

Yes this is very much a treatable condition and can be diagnosed with the help of some blood tests and scans.

An exact time frame can not be given as still the absolute diagnosis is in doubt, and further work up is planned by your doctor, but all these conditions when get diagnosed with certainty can be treated adequately with a good prognosis.

Wish you good luck.

Kindest Regards.

It was a pleasure assisting you and i hope my answer was helpful. I will

appreciate 4/5 Star Rating (Good/Excellent Service) & a Bonus as this is the

only way i get credit for my time & expertise. Do not hesitate to ask any follow up

questions or clarifications any time.

Customer: replied 1 year ago.

unfortunetly u were not that helpful u were like just a friend making me calm, the article has alot of causes how would i know i am suffering any of them , plus if i should work on with my doc why then u r giving medical advices, u didnt even mention wht other blood tests required itodiagnose my case reading on the net is easy i already read that article but i neeed an expert to help indiagnosing my sickness

Expert:  Vakul Aren replied 1 year ago.
Postural Orthostatic Tachycardia Syndrome(POTS)is one of the disorders associated with Orthostatic Intolerance(OI),in these there is a wide range of symptoms all of which need not be there in all patients.The symptoms include fatigue,dizziness,abdominal discomfort,severe palpitations,weakness,nausea,syncope and fainting attacks,blurry vision,there may be symptoms of hyperadrenergic state due to paroxysmal overactivity of the sympathetic nervous system.The disease is usually seen in females between 15-50 years of age and has been found more active just before menstruation.The disease state has been initiated following acute periods of stress like a pregnancy,post viral period,after surgery and trauma.Fludrocortisone,milderone and beta blocker agents have been used to try and treat the syndrome.Gradual increase in physical activity and exercise has been found beneficial.Other aches and pains lke migraine may accompany this.Hormonal states like Cortisol disorders and phaeochromocytoma may mimic POTS.Increased intake of salt and fluids to correct any hypovolumia/dehydration,plenty of coffee/caffeine,drugs like Pyridostigmine,Non Steroidal Anti-inflammatory Drugs (NSAIDs) and Epoetin/Procrit have been used along with lifestyle changes in managing this disorder.use of compression stockings to prevent pooling of blood,ruling out CNS diseases like Parkinsons disease ,peripheral neuropathy,Shy -Drager syndrome may help pinpoint the diagnosis .Going slow while getting out of bed,avoid bending below the waist,leg exercises when symptoms appear may help avoid attacks of dizziness.
Customer: replied 1 year ago.

well this was helpful, so just correct me if am wrong first i neeed to exclude pheochromocytoma and cortisol disorders, regarding that i made an abdominal ct and found no tumors on the adrenal gland could this exclude the pheochromocytoma


and made acth stim test, my basal cortisol was 7 and jumped to 18 after


, could this rule out anycortisol disorders


and made tilt table test and i fainted during the test is it enough to


rule out brain disorders noting that my brain MRI WAS CLEAR r


so wht do u recommend to take as a nxt steps

Expert:  Vakul Aren replied 1 year ago.
A 24 hour urine for catecholamines and Vanllylmandelic acid(VMA) and a plasma metanephine level will help establish the diagnosis of Pheochromocytoma.
For adrenal disorders the cortisol levels should at least double upon the ACTH stimulation test.Measurement of 17-Hydroxyprogestrone levels will help reveal any adrenal insufficiency.
Increased fluid and salt intake will help,regular exercise would be achieved gradually,avoiding sudden getting up from a sitting position to avoid syncope.Ruling out Meniere's Disease and Benign Positional postural Vertigo(BPPV) and other inner ear causes of syncope will help.A ENT specialist will help in ruling out ear disease.A consultation with a neurologist and Endocrinologist may be needed if no cause is pinpointed by tests and investigations.
Vakul Aren, Doctor
Category: Health
Satisfied Customers: 3380
Experience: MBBS,DTM&H( Univ of Liverpool),30yrs experience in practice
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