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As to my previous question: I have been under severe stress…

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As a follow up to...
As a follow up to my previous question:
I have been under severe stress for about 6 months. A couple months ago it began to affect me physically. I have had a lot of blood tests done and everything is normal. I thought for sure it was my cortisol levels, but apparently not. I have no answers and not sure where to go from here. Or...is this all just the stress manifesting itself in physical symptoms, where there might not be anything physical happening?I had already gotten a reply from a neurologist on this site, with the same question and I was extremely disappointed in his reply. As you'll see on the attached labs, yes my cholesterol was off and has now been addressed. I am more concerned with the sypmtoms I have that I was positive were due to cortisol levels after what's happened to me for the last 6 months. But I guess not.
Submitted: 1 month ago.Category: Medical
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3/19/2018
Doctor: Dr. D. Love, Doctor replied 1 month ago
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,433
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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What time was the cortisol level drawn?

It gives a date and time above the result, but is this the date and time when the blood was drawn or the date and time that the result was done?

There is a different time for the next test, which makes me think that the time is for the result.

What symptoms are you having?

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Customer reply replied 1 month ago
I see what you're saying. That is the time the results were sent to me. I was the first one at the lab that day and it was right at 7:30am.My feet are absolutely freezing ALL the time. Sometimes they feel like frozen blocks of ice. My hands are also freezing, but not nearly as bad as my feet. My hips and back have been aching. The hips are BAD. And I've never had hip pain before. I tend to end up getting a bad cough every time I get a cold because I smoke, but it does go away after I get over the cold. But now, I've been coughing terribly and I haven't had a cold since January. Out of nowhere a month ago approximately my right arm pit began sweating uncontrollably. I tried every antiperspirant out there and nothing worked. PCP wrote me a script for a stronger one I guess and it is better, but not completely fixed. Out of nowhere my gag reflex is so terribly sensitive. Something makes me gag and I can't stop until I throw up. I am trying to think of it all...Oh! In December just before Christmas I woke up with a bad headache. By mid afternoon I was totally debilitated by it. My husband (his abuse is the reason for all of this stress) refused to come home to watch our kids so I could go to the urgent care because I couldn't get into my PCP until the next day. And I couldn't handle taking them with it was so bad. He finally came home at midnight. By that time my vision was going crazy, I was puking, my left arm was going numb from the top down. I should have called an ambulance in retrospect, but I barely made it to the ER driving. They said it was a migraine, they did a head CT (I have that result too if you want) and the scan was normal. I got a few different IV meds and it did feel much better and I was discharged. However, it has NEVER gone away since then. Clearly it's not at that level anymore, but I have had a constant headache every single day since.Sorry for the length. I just hope I have covered all of it. I'm sure there's other stuff that I have forgotten to include. I feel like I am falling apart there are so many things.
Customer reply replied 1 month ago
Also, obviously I take lithium and other medication. I also slipped into a very deep depression, despite being fairly level for quite some time. It was because of the things happening to me at home. My psychiatrist upped my lithium and lamictal quite a bit over two different times and after the second increase it did help within about 3 or 4 days. But even though I got out of that terrible low, I am still exhausted all the time and depressed. But again, what's happening at home is a living nightmare so anyone would be crying and depressed. I just don't know if all of this insanity I am still living in could cause those physical symptoms? Maybe there's nothing wrong and it's all just the stress?
Doctor: Dr. D. Love, Doctor replied 1 month ago

From your description, it certainly sounds like these symptoms could be due to stress. However, there are several comments that are pertinent regarding cortisol testing.

Diagnosing elevated cortisol levels (also called Cushing syndrome) is frequently difficult. In more severe cases, the cortisol will be elevated whenever it is checked, but someone with a less severe manifestation can be more difficult to diagnose. If a blood cortisol level is performed as an initial test, the most sensitive test is to perform the test when the cortisol levels should be lower. As you can see by the normal range that is supplied, the cortisol varies throughout the day and is highest first thing in the morning. The ideal time to check a cortisol level is when it should be at its lowest, which is actually around midnight. Midnight testing is difficult, so late afternoon testing is done by many doctors. An alternative screening test would be checking the free cortisol level in the urine over an entire 24 hours.

So, a normal morning cortisol is not sufficient to say that there is no issue with Cushing syndrome.

With the symptoms that you are having, it would be appropriate to consider whether there are issues with blood flow to the extremities or peripheral nerve disorders. The first screening for these disorders would be done on physical examination, and your doctor may not be concerned about these condition after performing the physical examination.

If I can provide any additional information, please let me know.

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Doctor: Dr. D. Love, Doctor replied 1 month ago

Is there any further clarification that would be helpful?

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