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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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My symptoms are as follows: dizziness which worsens with

Customer Question

My symptoms are as follows: dizziness which worsens with movement (this is particularly problematic going up stairs), occasional speckling of vision as if I were about to pass out (but never actually did), blurred vision during the dizziness episodes with difficulty focusing, heart palpitations and SOB during these dizziness episodes, feeling weak (but quick strength testing does not show any gross muscle weakness), muscle pain (can be all day in severe cases or just after even the slightest exertion like going up the stairs), motion sickness, intermittent menstrual irregularities, brain fog and forgetfulness (which I call baby brain since did not have any of these problems until after my son was born), intolerance to cold or heat, fatigue (with more difficulty getting going in the morning). When I try to exercise, I have a long recovery period (as noted in my cardiac stress test and from personal experience where I may feel "crappy" for a day or 2 after a short run), sudden drops in blood sugar (shaking and starving), tinnitus, migraines about 6 days per week which follow a very regular pattern (no symptoms upon wakening at 5am, starting with slight intermittent lightheadedness by between 11a-1p, progressively worsening until I go to bed). Some of these symptoms may be linked to the migraines (ie. tinnitus), but without being sure, I am offering them all to you. I was dx with asthma at 14yo, and depression at 18yo. I am now 31. I had none of these symptoms before I got pregnant with my son, who is now 2.5 yo. In my first trimester, I had some lightheadedness, which cleared by 2nd trimester. Then it came back after he was born, but the GYN said it was anemia (I lost a lot of blood in delivery, there was a brief discussion of blood transfusion, but we ultimately decided that pumping me up with fluids and taking iron supplements would be sufficient. My symptoms definitely get worse with emotional stress (major family problems at the Jan 2015 which are more or less resolved by 6/2015). These problems existed before the stress however. I have had a transvaginal ultrasound for the irregular menstrual periods which was normal. I had a cardiac stress test, EKG, and echo and were "normal" (expect for the part where the staff had a hard time getting my heart rate below 100 so they could conclude the test). I has my ears checked for fluid, MRI of brain including inner ear canals normal. My thyroid has been checked every which way (my mother and both siblings have hypothyroid or nodules) and has been assessed as normal by PCP and endochrine. Endochrinologist noted that despite my FSH, LH, and Estradiol being within normal range, that I have mild ovarian suppression (my son nurses 1x/day) and he recommends retesting after weaning fully. Historically, I threw high sedimentation rates and cholesterol in and around 2008, I have high BUN/Creatinine ratios off and on, lymes negative, a bunch of autoimmunes negative (have a family history), old EBV shown in blood work. My AM cortisol level is 11 (flagged normal), PM is 2.0 (flagged as low). Other wise, CBCs and CMPs normal.
my first question is my endochrinologist said that anything less than 4 is normal for an afternoon cortisol, but couldn't there be such a thing as having a too low cortisol in the afternoon? It may explain why my symptoms get worse in the afternoon? My 2nd question is if you have any general insights into my condition, and if there is anything else we should be looking into?
Submitted: 11 months ago.
Category: Neurology
Expert:  Dr. Frank replied 11 months ago.

Hello. Welcome to JA. I will review your statement and issue a reply shortly. Please read this preliminary answer and respond, we can discuss this until you are satisfied. Dr Frank

Expert:  Dr. Frank replied 11 months ago.

Hi. From a distance here online, without the ability to examine you, I would say that you exhibit many of the signs I see in difficult migraine patients, we term them complicated or variant migraine. Frequent "classical" migraine (migraine with aura, that being the visual phenomena) and then variant symptoms that include dizziness, palpitations and symptoms of panic attack (some neurologists think it is a platelet inhibitor factor called p25 seen in migraneurs that causes that problem). You also have depression, muscle pain and I bet problems turning in sleep infrequently (have you had a sleep study) which follows the "fibromyalgia" category, or an autoimmune hypothesis for all your symptoms. You have chased that and come up empty with your blood work, but I do not think that excludes you from the category, especially if you have a family history. RA negative rheumatoid arthritis can give you isolated CNS vasculitis.... But you tell me your MRI is clean. So in the end here, I really do not know what medical problem you have, maybe it is all stress related, and you should find ways of mitigating that problem, like stress reduction, biofeedback, etc. Get back to me to discuss this if I can help. Have you ever tried meds like Lyrica (pregabalin) for the muscle pain? Dr Frank

Expert:  Dr. Frank replied 11 months ago.

Hello. I have not heard back from you. Did you read my posting? Please get back to me if I can help. Dr Frank

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