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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54463
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I have several symptoms and diagnoses that seem to all tie

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I have several symptoms and diagnoses’ that seem to all tie in to each other but I am being treated for them separately. It's a "What came first, the chicken or the egg" kind of thing. I would like to list these symptoms and diagnoses’ chronologically and see what you think. About me, I am a 49 year old woman, per-menopausal, 5'5" 190lbs and smoke about 10 cigarettes a day. First symptoms, Hypoglycemic Reactions and dry skin as a child and still but they are less, tonsils removed. In 2002 classic symptoms of anxiety and panic attacks, heart palpitations, crying spells, a few years later developed insomnia which is now chronic. Without sleeping pills will not sleep at all up to 3 and 4 nights in a row, fatigue (of course). A couple years later, pretty bad acid reflux, digestive problems. After a couple more years discovered high blood pressure (off the charts) I would even get bloody noses. About a year later was diagnosed with Obstructive Sleep Apnea; this is when I start losing jobs, 4 in 5 years. On CPAP about 3 years but it doesn't work. After doing more research on apnea causes I see that I have a very elongated uvula and saggy soft palate. Constant sore throat, clearing throat and coughing, post nasal drip. My airway is abruptly blocked when I blow my nose. Dry and irritated nose, throat and eyes, mucus blocking tear ducts and daily headaches. In the last 6 months or so, fatigue, dizziness, irritable, difficulty focusing, memory loss, confusion and in the last six weeks since losing my last job, isolating, crying spells, avoidance, loss of motivation, interest and appetite. Will this just keep getting worse? I don't know where to begin. Help!!!
Submitted: 8 months ago.
Category: Medical
Expert:  Dr. Phil, MD replied 8 months ago.
Hello. I'm Dr. Phil, licensed and practicing Internal Medicine Physician. Excellent service is my goal.

Thanks for this excellent question

I'm very sorry about all of these problems.

It sounds terrible.

What medications are you on now?
Customer: replied 8 months ago.

I take Adderall only when needed to help me focus. It also seems to help with the anxiety. Since I am not working right now I do not take it often. I have two more doses of Atelolol left and can not get another prescription due to no health insurance, I thought I would try C12 Peptide if it's not too expensive. I take Triazolam to sleep, any where from .125 to .375mg, usually the latter. I tried going without it the last few nights and have not slept at all.

Expert:  Dr. Phil, MD replied 8 months ago.
I'm really sorry Jackie

What information can I provide that would be very helpful to you?
Customer: replied 8 months ago.

Will this just keep getting worse? I don't know where to begin. Help!!!


What do I do now? What do I try next? What is your professional, educated opinion? What other options would you suggest I try? Do you see these symptoms all tying into one another and if so what should my main focus be? What can I do that could produce some immediate relief and what long term things should I focus on, keeping in mind that I need to narrow this down and start SOMEWHERE. As a doctor, what do you see going on here?

Expert:  Dr. Phil, MD replied 8 months ago.
No problem Jackie.

I can help here.

It might take me some time to look at your history and provide a good answer so please be patient with me.

Can you tell me what things you have been tested for and what has been ruled out already?
Customer: replied 8 months ago.

Tested for Diabetes, don't have it. Thyroid is fine. Full heart workup, it's getting old but still pumping. Colonoscopy, fine. Endoscopy, confirmed Acid Reflux. Sleep study, confirmed OSA, prescribed CPAP (set at 14, if that helps).

Customer: replied 8 months ago.
Relist: Other.
I feel a little like I have been getting automated, generic responses to my questions, like I am talking to a computer instead of a person and I have waited a very long time for his next response.
Expert:  Dr. Thomas, MD replied 8 months ago.
Hello from JA
I am a double board certified physician in internal medicine and integrative medicine.

I will give you clinical responses that are top level
First, lets focus.


What do you mean that the cpap does not work?
Customer: replied 8 months ago.

When I first started using it I tried the nasal mask and pillows and if they stayed on all night I did not feel a benefit. I told my sleep doctor that when I exhale through my nose my airway can get blocked but he did really listen to me. I started using the full face mask, faithfully for a few months even though I would wake up in the morning with it wrapped around my neck. Or if I got up in the middle of the night to use the bathroom, when I came back to bed I didn't put it on again because I was doped up on sleeping pills. When I was on Ambien it made me sleep walk so I took the mask off often. But even when using it as regularly as possible, I really can't remember having two good nights in a row. There was a good night once in a while, I could count them all on one hand and it's been about three years.

Expert:  Dr. Thomas, MD replied 8 months ago.
This is really where your focus should be.
Many of your problems and symptoms can be from long standing sleep apnea.

What is your height and weight currently?
Customer: replied 8 months ago.

5'5" 190lbs...I had lost weight successfully in my younger years but my attempts to lose weight in the last 5 or so seem like I'm spinning my wheels in the mud.

Expert:  Dr. Thomas, MD replied 8 months ago.
OK
So tell me your most recent TSH value if you have one [part of the thyroid blood test].

Then tell me what you eat, everything you put into your mouth, meal to meal, typical day.
Customer: replied 8 months ago.

I'm afraid I don't know the results of the last thyroid blood test. As I said in my first post, for about the last six weeks I have pretty much completely lost my appetite and have only eaten what is quick and available when the hunger pains nag at me long enough. Today I had a piece of veggie, thin crust pizza and diet coke.

Expert:  Dr. Thomas, MD replied 8 months ago.
OK
Thyroid imbalance can also contribute to the weight problem.

Tell me what you usually eat, typical day, each meal
Customer: replied 8 months ago.

I haven't had the typical three meals a day for quite a while. I drink diet coke every day, unsweetened ice tea and water. Actually it was yesterday I had the piece of pizza, the day before that I had a cup of noodles, The day before that I had a little bit of chicken salad and four crackers and the day before that I had a chicken Ceaser salad. That's pretty much how it goes. I haven't had fast food for months or even eaten in a restaurant.

Expert:  Dr. Thomas, MD replied 8 months ago.
Your diet is terrible, and pro inflammatory, which will continue to stimulate obesity. It is completely lacking in micro nutrients, and as a result inflammation and all sorts of disease, as well as obesity will be promoted.

Your problems are directly related to the sleep apnea, but even that is related to obesity. And the inflammatory state.

I would approach this as follows.

Check the thyroid. Guidelines have changes. If your TSH is over 2.5 you need some replacement of hormone.

Start a nutrient dense anti inflammatory diet immediately.


The diet, in order of preference in quantity, should look like this
leafy greens
green veggies
other veggies
whole fruit, beans and peas
Whole grains no yeasted breads, dry cereals or anything refined
Seeds and nuts, but cut out seeds if you have any diverticulosis.
A little tofu or tempeh daily
A little high quality soy or coconut milk yogurt

The soluble fiber in this strategy will stabilized colon function in about 6 to 8 weeks, then about 2 or three helpings of animal foods a week, preferably fish, can be added back.
See the book Eat to Live by Dr. Joel Fuhrman, for instructions on this type of diet.

Note that inflammation sets up your system for anxiety and panic as well.

In addition
Replace magnesium.

Address the sleep apnea, see a sleep specialist for a mask or device that works.

See an OBS [oral balancing system] dentist to see of your tongue position is contributing. If so, this can be easily corrected.

Exercise, even just a little daily.

Make sure the reflux is controlled, or this will make the apnea worse.

See a functional medicine trained MD in regards XXXXX XXXXX of this.

www.functionalmedicine.org.

These doctors treat underlying disease mediators, and use mostly natural treatments.

OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.


Customer: replied 8 months ago.

I have eaten diets like this before and enjoy them.


What about the insomnia? If I can't fall asleep the apnea doesn't matter and the sleeping pills, I've heard, make apnea worse.


 


What do you think about the pillar implants or surgery to reduce the soft palate?

Expert:  Dr. Thomas, MD replied 8 months ago.
That surgery would be a last resort and does not have a very high success rate...you have not corrected the underlying problems, and the surgery would not work in this case.
The apnea is a direct cause of the insomnia, as is the obesity, so both must be treated.

I would not do pillar implants, as an OBS device is effective and non invasive.

OK. If you have further questions or details, use reply to expert.
Otherwise please choose a positive rating . But, still come back if you need to…think of something later, etc. Bonuses are appreciated.
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54463
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
Dr. Thomas, MD and 2 other Medical Specialists are ready to help you
Customer: replied 8 months ago.

One more thing, I've heard about exercises for the soft palate. Do these work or do any good at all?

Expert:  Dr. Thomas, MD replied 8 months ago.
No data on this at all.

But without correcting the weight, nothing orally is likely to work.
Customer: replied 8 months ago.

OK, well I will give them a try and let you know in a few months... :)

Expert:  Dr. Thomas, MD replied 8 months ago.
Find me any time by request.
Use my name in the title and my request link.
I am here daily.

good luck
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