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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34685
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Ive been suffering with various non-specific symptoms for

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I've been suffering with various non-specific symptoms for over a year now (I have had some* of them for many years but in a much less noticeable form) but only now beginning to see a pattern.
The first and longest symptom is dizziness* and occasional feeling faint, followed soon by anxiety, panic attacks, and feeling tired/fatigued* (despite improving sleep and rest habits), generally feeling unwell* or "wrong", sometimes overwhelmingly so, also palpitations and most recently - and possibly nothing to do with the other symptoms - muscle twitches/tremors (from several times a day to several times an hour at the worst times - these started when I started taking antidepressants - see below - and assumed these were side effects but have continued months after stopping the meds). Over the time I've been to doctors who would say it's tiredness, stress, "maternal exhaustion" (I have 3 children aged 1.5, 3 and 6) to most recent - and mostly self-diagnosed - anxiety and panic attacks. As I was getting nowhere with the doctors and feeling worse, so I paid to see a psychiatrist who confirmed anxiety disorder (and mild depression at that time too) and tried me on various meds but I get side effects from all of them so completely off everything now. I have started hypnotherapy for the anxiety.
I have noticed though that when I came off the pill (BC) a few months back I noticed a huge improvement in my mood and wellbeing (unfortunately not quite "back to normal" but significant enough for everyone to notice); I have since had the Mirena coil fitted (approx 3 month ago) and since my bleeding is very irregular and almost constant, I notice big jumps (downhill) in my mood and how I feel: i.e. 1 week no bleeding - minimal anxiety and feeling fairly ok; 1 week of heavy spotting - beginning to feeling down, no energy, grumpy and moody; heavy bleeding starts - feel dizzy, faint, unable to get out of bed (which is impossible with 3 kids!), low, teary, very high anxiety, nervous, "snappy", low BP, palpitations (more than normally), generally overwhelmingly unwell, also low tolerance threshold (visual, audio, sensory - flashing lights on tv, bright light in shops, bright light at home, noise - especially if coming from multiple directions, even fairly quiet; over-sensitive to touch - skin feels painful; taste and smell over-exaggerated, etc.).
I am now starting to believe it's not the anxiety that makes me feel so unwell (which is what everyone has been trying to make me believe - and I did for a while), but that somehow it may be a physical problem that is causing/adding to the anxiety - could it be hormones (I already take vit B6 as suggested by a GP)?
Also, what could be causing the muscle twitches/tremors - no pain though (they are worrying, uncomfortable, they often wake me up, and add to my anxiety) - I have no theory and no-one will comment on this.
I had blood tests done for thyroid, calcium, magnesium, cortisol, blood glucose, also had extensive heart investigations (ecg, 7 day tape, ultrasound) - all OK. My BP is low. I do not drink coffee or cola or other carbonated drinks, only weak tea, no alcohol, cigarettes or other drugs). I take vit B6 and sometimes other vitamin/mineral supplements, eat healthily, I'm slim, I do not exercise (looking after the kids is exhausting enough plus I have agoraphobia due to anxiety so do not get out much). Generally speaking I "look" perfectly healthy. Only I feel awful...
Where do I go from here? Please help. I am running out of options and ideas, and this is affecting my life and the life of my children and husband very much, it is debilitating and I cannot let it go on - just don't know where to turn! Hoping you can give me some ideas please.

You have been fairly investigated. Your symptoms do suggest thyroid abnormalities. But you mentioned that it came out to be normal. Most of the physicians get only TSH for the thyroid evaluation. I would suggest a full work up for thyroid, which includes; T3, T4, free T3, Free T4 with TSH (if not yet done). The other work up recommended would be parathyroid hormone assay for your symptoms of dizziness, muscle twitching and anxiety. An ANA panel also would be advised with the anemia work up. Anemia alone can cause all of your symptoms. The most common causes of anemia are;


1) iron deficiency (with or without blood loss),

2) chronic disease/inflammation

3) chronic kidney disease

4) deficiencies of folate or vitamin B-12,

5) diseases of the bone marrow

6) hypothyroidism, hypersplenism, and hemolytic anemia


So investigations entail;


1) Complete blood count (CBC)

2) Peripheral blood film

3) Vitamin B-12

4) Folate

5) Reticulocyte count

6) LDH

7) Thyroid-stimulating hormone

8) Serum creatinine and estimated glomerular filtration rate

9) Serum ferritin

10) Serum iron

11) Total iron-binding capacity.


These work up should be able to point to the diagnosis and accordingly treatment can instituted. Meanwhile Anxiety can be treated by the following measures by yourself;

1) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT); done by a psychologist.

2) Relaxation training and biofeedback.

3) Hypnosis

4) Acupuncture and acupressure

5) Yoga

6) Meditation

7) Group sporting activities

8) St. John's wort

9) Melatonin
10) Valerian root


Muscle fasciculation or muscle twitching is caused by minor muscle contractions in one particular area, or the persistent and uncontrolled twitching of a muscle group in a distribution of a single nerve fiber or filament. Usually they are benign and resolve on their own, but persistent flutter may need following investigations;


1) electromyography (EMG)

2) nerve conduction velocity (NCV)

3) blood electrolytes like calcium, magnesium, potassium, sodium, etc

4) thyroid and parathyroid function tests

5) blood chemistry and complete metabolic profile


The common causes can be;


1) Idiopathic; no cause is ascertained and majority falls in this group.


2) Increased caffeine intake


3) Increased alcohol intake


4) Medications


5) Deficiency in diet and nutrients / minerals


6) Some neurological diseases; uncommon


As we discussed; twitching usually is benign and do not point to any serious issue. Anxiety itself can be responsible for the muscle twitching.

Please feel free for your follow up questions.


I would be happy to assist you further, if you need any more information.


Dr. Arun
Customer: replied 5 years ago.
Thank you, XXXXX XXXXX is very informative. I have had most of these tests done including anemia and kidney function (which I did not mention earlier) but will double-check with my GP.
As for anxiety I have already tried CBT, relaxation and am cyrrently trying hypnosis. I have read of St Johns Wort and Melatonin - will try these.
Just my final question: do you think there may be any fault of the hormones at all - either my own or in the Mirena? (Since symptoms are worst around the bleeding - or is that a fairly common occurence?) Should I consider having the Mirena out? Or any hormone tests done? Thank you!
You are very welcome.

Since your almost all hormonal tests are done; this may not be an hormonal issue. It is not uncommon for symptoms to aggravate during the period.

It is privilege assisting you.

Dr. Arun
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