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Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5555
Experience:  American Board Certified Neurologist, Internal Medicine
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Would like to pay for more service from Dr Subbanna MD,

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Would like to pay for more service from Dr Subbanna MD, Neurologist. Thank you.

Hello, this is Dr. David. I am reviewing your question now and will be with you momentarily.

can I help you? I think I have helped you before?

I don't think the other expert is online

Hi, You are very welcome! Thanks for the question, and I am very glad to help you again with your health concerns. And I am sorry I could not reply earlier since I was away from the computer and just returned.

I am currently preparing & typing my answer and I will post my answer here as soon as it is ready.

Best Regards!

Dr Subbanna MD

I have thoroughly reviewed all the information you have provided at the previous question and please see there is absolutely no evidence for msa in you.

We have discussed this several times before too, I know you are very concerned you are a case of msa, but the truth is you are indeed not having msa

And this is not even an early stage of msa

As mentioned earlier msa (multiple system atrophy), as the name implies is a condition involving the atrophy or degeneration of multiple neurological systems, and the systems involved are the extrapyramidal–motor, pyramidal–motor, cerebellar, and the autonomic nervous system etc – but there is nothing in your history that is indicating you are having damage to any one of the systems mentioned above

While you have been having certain symptoms as you have described but the pattern of your symptoms is not at all pointing towards any serious health conditions.

Please see for the purpose of ruling in or ruling out a diagnosis - it is the pattern of a symptom which is more important than the symptom itself - because it is the pattern of your symptom that provides the doctors very invaluable clues regarding what may be causing the symptoms. The pattern of your symptoms is clearly pointing towards one or other benign issues (those are mentioned earlier), but definitely not pointing towards the possibility of any serious health issues like msa.

You do not have even minor neurological issues, let alone serious conditions like msa etc

Once again I can very categorically reassure you, there is absolutely no evidence for the presence of msa in you, not even early stages of msa too, your symptoms are as mentioned previously too is a combination of poor food intake, fluid intake, less sleep, physical activities out of proportion to the foot and fluid intake, stress, health anxiety/fear of serious illnesses etc, and there is not even iota of doubt on you are not developing msa, absolutely not, so please not to be scared.

Wishing & reassuring you a quick & complete recovery from all your symptoms! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. If you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

Customer: replied 30 days ago.
Thank you. So even the early stage is not possible. This would be mainly because my symptoms lead to a benign concern and that any symptoms are really only sporadic and they would need to be constant to be of concern. I guess it has good news that I did not get lightheaded doing my testing from sitting and from squatting.

You are very welcome! Yes, certainly this is not even early stages of msa, this is not at all msa.

The pattern of the symptoms you are having is not at all suspicious for msa. For example your symptoms are very sporadic & short lived, if these were due to msa then the symptoms are expected to persist constantly or during most of the day. MSA related lightheaded feeling or breathing issues, or other symptoms should persist constantly or near constantly but not the way it has been manifesting in you (just for very short periods, and also occurring intermittently). And the indigestion is due to your body getting accustomed to more food and also changed eating habits like eating throughout the day etc

You are not having msa for sure, and I am 100% convinced in this regard!

Customer: replied 30 days ago.
I would need to be lightheaded and dizzy every time a stand up to be concerned. This would be categorized as constant. I would also have breathing difficulties all the time ans other symptoms would be constant all day.

Yes, you are right, that is how msa may present, but even if you have constant or throughout the day symptoms it will not automatically indicate you are having msa, but such constant symptoms may raise some suspicion for msa, but anyway your symptoms are not showing such pattern, so nothing to be concerned.

This is certainly health anxiety and fear of serious illnesses getting the better of you, and nothing else. You may try to avoid googling for symptoms and analysing them, doing some kind of self-testing etc, the more google search and/or self-testing you do the more you will get scared. The information provided there is not individual specific, the history of every individual is different as each & every patient is different, one patient’s experience cannot be used for another one’s diagnosis. It is not the symptoms rather than the pattern of the symptoms that tells us what kind of illnesses you are having, I had discussed earlier too, the pattern of your symptom is not at all pointing towards any neuro illnesses, let alone serious neuro issues like msa etc

Customer: replied 30 days ago.
any perceived motor concerns, hold a pen, reaching for something just came in this week. I am sure it is anxiety as I am hyper vigilant about my body right now. The nose to finger test with my GP was fine. That tells an accurate story, correct.

Yes, you are certainly very health-anxious & very hyper-vigilant about your health & body functioning. Also try to avoid self-testing, neurological clinical tests are extremely difficult to self-administer and with underlying health anxiety these tests can always appear abnormal, that your dr has not detected any neuro signs is what matters, you do not have msa. I am writing like this with abundant neurology clinical practice experience - you indeed do not have msa, and for sure.

Customer: replied 30 days ago.
Your explanation of the presentation of symptoms was excellent. It helped me to realize that the internet simply provides a list of symptoms without consideration for pattern of symptoms or context of the symptoms which are most important considerations.

Glad to hear it! Yes, while google research can provide certain information but it can be very confusing too - because the information provided there is not individualized, and it is the responsibility of clinicians like me to analyze the symptoms in the right context with full focus on the pattern of the symptoms too - which is what in the end helps in clinching a diagnosis, and your pattern is not at all pointing towards any neurological illnesses, absolutely not.

Please do not forget to kindly click a positive rating (preferably a 5 star Excellent!), appreciate it! I will be available to answer your questions after the rating too!

Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5555
Experience: American Board Certified Neurologist, Internal Medicine
Dr Subbanna MD and other Neurology Specialists are ready to help you
Customer: replied 30 days ago.
5 star rating. Excellent service. Thank you.
Is there any concern with lightheadedness after eating a meal. Is really even a symptom of msa. Read it earlier in the week.

You are very welcome! I appreciate for the 5 Star Excellent rating! Thanks!

No, the lightheadedness after eating a meal in your case, similar to the other symptoms you have been experiencing has nothing to do with msa.

Please see you do not have msa. There is not even an iota of doubt in this regard. It is not just absence of msa in you, you are not having any types of neurological issues, and certainly no msa in you, and not even early stages of msa.

Customer: replied 30 days ago.
Thank you very much. Just wondering about neck and shoulder pain? I have had both on and off for a week. Is this characteristic of anything to be worried about at all. Thank you sir. Likely feeling every little sensation in my body due to anxiety.

You are very welcome! Yes, health anxiety and fear of serious illnesses is certainly what is causing these constant health concerns you are having. The neck and shoulder issues are either anxiety related, or just some minor musculoskeletal issues that we all get now and then. Home remedies such as Hot or Cold compress, OTC oral pain meds, OTC local pain relieving creams or sprays like Biofreeze or Myoflex etc should help with these symptoms, but there is certainly no suspicion for any other illnesses, most importantly you are not having msa.

Customer: replied 29 days ago.
Thank you, Doctor. As I head into Friday and hoping for a positive weekend with few health concerns and worries I am looking for reassurance regarding a symptom of feeling hot and hot flashes. I have had one hot flash, but seem to have lower tolerance for heat. I seem to get hot and am more sensitive to heat than before. Would this/ could his be a concern in any way. Also, you are sure that the pain in my shoulders is not the beginning of upper body rigidity or weakness, characteristic of msa. Thank you sir.
Customer: replied 29 days ago.
the little gulps of breath that I take involuntarily are not a concern but rather a result of being very concerned about my breathing leading to anxiety. Could any of this really not be the beginning of msa given my pattern of symptoms. Thanks Sir.

You are very welcome! You do not have any manifestations of msa, the above manifestations including feeling hot, increased sensitivity to heat, or hot flashes, pain, breathing issues or any other symptoms that you have mentioned so far have nothing to do with msa, these are the symptoms secondary to one or more of the benign issues that I had mentioned in the previous posts. Your weekend will be totally positive unless you let your health anxiety dominate you. You are 100% not developing msa.

Customer: replied 29 days ago.
Thank you. Can you remind me of the benign issues. Indigestion, anxiety, musculoskeletal pain etc. Anything else?
Customer: replied 29 days ago.
All with sporadic lightheadedness. Still good right.

You are very welcome! The benign/reversible/temporary issues that I had mentioned earlier include indigestion, health anxiety, routine types of musculoskeletal pain, and also importantly the body still getting used to the new routine after the prior habits of poor food and fluid intake, sometimes reduced sleep, physical exertion out of proportion to the food/fluids’ intake etc etc – although you have been rectifying these few issues but the residual effect on your body can remain for some more time. But after having already obtained so much abundant information about your health I am already and totally convinced the main issue in your case is extreme degrees of health anxiety and fear of serious illnesses, and all other benign issues that are mentioned above are only the minor issues now, it is all health anxiety and fear of serious illnesses that is causing your recurrent or new symptoms that you have been experiencing, and nothing else.

Customer: replied 29 days ago.
in summary. 100% not msa and I should completely enjoy my weekend and my life. Does this sum things up accurately. Thank you for everything.
Customer: replied 29 days ago.
Need to fully embrace that I am a healthy man and try to forget about this illness. You have been a great help, sir.

You are very welcome! Yes you can certainly & fully enjoy your weekend & full future life, you are 100% not having msa.

Customer: replied 29 days ago.
Do you think that I require more testing at all. Tilt table to test blood pressure etc.

No. No neurological tests of any kind are needed in your case. I don’t want you to lose money unnecessarily. If I had even the slightest doubt of a neurological possibility in you including msa etc I would have mentioned it to you immediately and recommended you to see a neurologist in the clinic/further neuro tests etc, but you certainly have no neurological diseases of any kind including msa, so no neuro testings are necessary in your case, including tilt table testing or any other neuro tests.

Customer: replied 29 days ago.
I do need to stop checking for symptoms. As you know my biggest concern and initial concern was the faint and lightheadedness. I have tested myself s couple times today from squat and sitting in a chair. Though not significant I have felt a slight "fuzz" when I stand up. Not dizzy just a little fuzzy. Get myself scared when this happens. I have got out of my a chair a number of times during the course of the day and have not noticed anything ...likely because I am not thinking about it. Thoughts on this.

To stop checking for symptoms - if you are still not convinced that you do not have any illnesses including msa etc - then what you need is treatment for the health anxiety and fear of serious illnesses. I will try to provide you below with a list of various treatments that can help you in diluting this type of extreme levels of health anxiety and fear of serious illnesses that are unfounded.

The following is a list of various treatments that can help you in resolving this kind of severe health anxiety, fear of serious illnesses, stress etc;

CBT (Cognitive Behavioral therapy)

ACT (Acceptance & Commitment Therapy)

Mindfulness meditation

Other types of meditations





Deep breathing/Deep relaxation techniques

One or more of the over the counter Herbal or Supplement preparations like – Theanine (L Theanine), Rhodiola rosea, Valerian root extract, Ashwagandha, Ginseng-preparation (preferably American Ginseng), Chamomile, Inositol, Kava, L Tryptophan or 5 HTP (5 Hydroxy Tryptophan), Skullcap, Magnesium preparation, St Jones Wort, SAMe (S adenosyl methionine), Omega 3 Fatty acids (DHA & EPA) etc

One of the over the counter combination preparations – that contain a combination of certain herbal supplements + vitamins + minerals like magnesium etc - and examples for such combination pills include - Himazol Fast Acting “Extra Strong” Anxiety & Stress Relief Herbal Supplement, Stress Relief & Natural Anti Anxiety supplement, CALM NOW Anxiety & stress Relief Supplement, , herbal Blend, Genexa Stress & Anxiety Relief, CALM-ER Anxiety Relief Supplement, SERENITY RX- Anxiety & Stress Relief Formula, Alprazium combination pill (all Natural Stress Relief & Anti-Anxiety Supplement) etc

One of the benzodiazepine agents like Alprazolam or Clonazepam (not recommended for long term use, also preferably used in small doses)

One of the GABA structural analogues like Gabapentin or Pregabalin

One of the SSRI agents like Fluoxetine or Sertraline

Azapirone agent Buspirone

One of the beta blockers like Propranolol or Atenolol

Amitriptyline + Chlordiazepoxide (Limbitrol or Limbitrol DS - not recommended for long term use, also preferably used in small doses)



Using a medical devices such as CES (Cranial Electrotherapy Stimulation) etc

The above list contains names of allopathic medications, non-allopathic herbal medications, as well as non-medication treatment options so that the treatment plan may be chosen depending upon the individual preferences. I am not telling all these above treatments are required in your case, but providing you with a list of varieties of treatment options that are available for your condition. If you see any of the above treatments you have already tried please disregard them and consider exploring the ones you have not already tried yet.

In addition to the above special treatments general measures like adequate daily exercises, especially aerobic exercises and healthy & balanced diet is recommended too since they also contribute the dilution of the anxiety, stress & fear feelings.

You may try one or more of the above therapeutic interventions and these can help you in getting rid of this pathological degree of health anxiety & fear of serious illnesses that do not exist at all in your case.

Customer: replied 29 days ago.
Thank you. I will certainly act on the health anxiety suggestions. That being said, if I do feel a little fuzzy getting up, I am still ok. Is this not orthostatic hypotension. I know it is the pattern and not the symptom that is most important but just wanted to ask about this. Thank you for your care.

You are very welcome! No, you do not suffer from orthostatic hypotension.

Customer: replied 29 days ago.
Please elaborate if you can. How do you know? Then I will leave you to your other patients. Thank so much.

You are very welcome! it has already been explained by me many times earlier, please go through my previous answers. If you are still not convinced then please try to take other opinions here at the site or try to see a neurologist in the clinic, or try to undergo a tilt table test etc - but I have explained all these things in great details and have also repeated them several times already - on why you are not a case of orthostatic hypotension or msa etc.

Customer: replied 29 days ago.
Thank you for your time. I will be taking your advice and counsel. I do not need a second opinion at all. Your are excellent and would not ask for a second opinion. Reassurance was all I required about the hypotension if you are willing to give it one more time. I will work to distract myself from symptoms and I will not check myself or test myself. I have learned a great deal from you and I am grateful for your care. Thank you, Sir.

You are very welcome! Yes try to distract your mind as much as possible to prevent these intrusive negative health thoughts constantly bothering you. You definitely do not have any neurological illnesses including orthostatic hypotension, or msa etc. Not at all.

Customer: replied 29 days ago.
What would be indicative of Othostatic hypotension. What would this look and feel like. Constant and throughout the day, right. This will be the very last question. Thank you so very much.

You are very welcome! Yes orthostatic hypotension should present with symptoms throughout the day or constantly.

Customer: replied 29 days ago.
Hi Doctor. Since I paid another stipend last night I hope I have a couple more questions remaining. First of all I was ashamed to tell you that I had this much health anxiety and I am taking sertraline Zoloft. Thought my anxiety would be better not worse. Did not think it was a factor. I have been taking it for 6 days as I was so scared by my faint. Today I realize that this could be the reason for my nausea, hot flashes, sweating, dizziness and peceived jitteriness and lack of coordination and body aches. These are all side effects of sertraline Zoloft. I did faint and I do feel dizzy upon rising at times, but the other things I am feeling could very well be caused by the medication that I hope will take my anxiety away. Please comment sir and again I am sorry for not sharing my full medical picture. I just had no idea that the meds could cause such side effects. Thank you so much.
Customer: replied 29 days ago.
I see that it can cause low blood pressure too. This might be causing my lightheadedness upon rising these days as well.

Hi, you are very welcome! First of all there are many people who have severe health anxiety and there is nothing to be ashamed of having it, also it was a good decision from you to try medication for treating this condition. It seems it has not helped you. On sertraline (zoloft) one may go up to about 200 mg per day, not sure what dose you are on now, if you are on smaller dose then one option is to slowly up the dose up to 200 mg as necessary and as tolerated. If you do not like sertraline then you may try to choose one of the other treatment options that are mentioned in the list I had provided earlier. However I cannot tell whether the medication is causing these side effects or is this all health anxiety related, because if medication is causing the side effects then the side effects are expected to be constant or continuous or nearly continuous, but your symptoms appear intermittent, so this still appears anxiety related, rather than medication related. But if you do not like this medication then you may try one of the other treatment options that I had mentioned in the list I had provided previously.

Customer: replied 29 days ago.
still 100% no msa in your view ...correct. Your perspective on my good health combined with sertraline over time will help me feel better and beat the anxiety.

Yes, 100% no msa in you.

Customer: replied 28 days ago.
Good morning, Sir. Would you be concerned if I was to get a slight head rush most times returning to standing from a squatted position. Would this be an issue if it happened regularly. Thank you very much. Just trying to tie up all loose ends and questions early in the weekend. Thank you

Good morning, you are very welcome! No, this is not at all concerning.

Customer: replied 28 days ago.
It is not orthostatic hypotension?

No, not at all, orthostatic hypotension should present with clear cut dizziness/lightheadedness, fainting, or feeling of fainting etc

I have answered several questions in this thread already; shall I send a premium offer like last time?

Customer: replied 28 days ago.
please. Thank you

You are very welcome! I will send the offer soon. Please accept the offer if you are fine with it. Thanks!

Thanks, ***** *****! I am available here to answer more questions for you. Please let me know!

Customer: replied 28 days ago.
Tell me more about orthostatic hypotension. Is not coming up from a squat and feeling a head rush not characteristic. Again. I go through most of my day without dizziness. When I test the deep squat I can feel it. I should stop testing myself.

Sure I will explain, see first of all I can fully understand you are seriously suspecting serious neurological condition like msa to explain the various symptoms you have been experiencing. But so far none of your symptoms resemble symptoms that are associated with conditions like msa. For example you mentioned head rush feeling but the autonomic nervous system dysfunction presenting as orthostatic hypotension should present with frank dizziness or light-headedness, or fainting or fainting like feeling etc, but so far you never have experienced these, rather your symptoms are just psychological type. Even if you experience symptoms like head rush constantly or every time when you stand up it cannot be considered as real dizziness. Head rush is commonly associated with anxiety and this is not how autonomic orthostatic hypotension manifests. What you have is just symptoms of anxiety and yes, you should definitely stop administering all these various self-testings, this could cause enormous psychological trauma to you, because you feel you are already having msa whereas in reality you are not having even minor neuro illnesses, so there is absolutely no question of you having msa etc. Stop self-testing, rather try to distract yourself with other activities, try exercises, healthy and sufficient diet, adequate fluids, proportional amount of exercises only, not more than that, may continue on Zoloft for now, if it is not helping then may consider trying one or other treatment options mentioned in the list I had provided earlier.

100% no msa in you.

Customer: replied 28 days ago.
I have fainted once but it stands to reason that my original faint was from dehydration and under nourishment and very little sleep...not neurological at all. After a day of eating one meal after a 30 hour fast. Little water and 2 hour workout.
Customer: replied 28 days ago.
After weeks and months of eating one meal a day and excessive overtraining.

No, that single episode of fainting cannot be given any significance neurologically since it was clearly related to a combination of poor eating, drinking fluids, sleep deprivation, and excessive physical over-training etc, and that episode has nothing to do with any neurological illnesses.

Customer: replied 28 days ago.
overall. There is no sign whatsoever of msa. Health anxiety has taken over my thoughts and has created and exasperated symptoms. I am totally physically healthy. Need to work on my emotional state. Walked outside today and felt unsteady. Read that this unsteadiness and jittery feeling can be a side effect of early Zoloft and most likely anxiety. Any chance of this unsteadiness being motor issues related to neuro issues. Or my mind working overtime.

It is not just unsteadiness or jittery feeling, any symptom – if occurs on intermittent basis then it is unlikely from msa because msa being a progressive neurodegenerative disorder is expected to present constant and progressively worsening symptoms. Even medication side effect too is expected to manifest more constantly rather than intermittently. The symptoms you have been having appear secondary to severe health anxiety and fear of serious illnesses rather than secondary to any actual pathological conditions including msa etc.

Customer: replied 28 days ago.
Thank you sir. Tell me one last time ( I promise) that I am 100% healthy and free of msa. Gratefully. Thank you for everyone.

You are very welcome! You are certainly 100% healthy and free of msa, if there is even tiniest doubt of msa then I would have immediately asked you to get further investigated, but you are 100% not having msa.

Customer: replied 28 days ago.
Thank you sir. Take good care. With appreciation and gratitude. 5 stars of course.

You are very welcome sir!

Customer: replied 27 days ago.
Good morning. I was moving things around in my crawl space basement today at home. Bent over/ squat for a few minutes. When I stood up I got lightheaded. Tried it a few times since. Same thing. Is this not orthostatic hypotension. Just checking. No other symptoms at all. Thank you sir.
Customer: replied 27 days ago.
If I get up and start walking I am fine. If I stand still I feel it.

Good morning, if this is orthostatic hypotension then the dizziness should happen each and every time when you stand up from sitting or lying down position, and also the dizzy feeling should present even when you start walking too - so the dizziness you have described above is not at all consistent with orthostatic hypotension dizziness.

Customer: replied 27 days ago.
beginning to walk is not a factor then. I thought that it kept blood pressure a bit higher due to movement. Thank you sir. Yes. If I get up and move, I do not feel it.

You are very welcome! No, nothing like that, beginning to walk etc cannot raise the blood pressure to an extent it can actually counter the drop in blood pressure due to orthostatic hypotension.

Customer: replied 27 days ago.
Still nothing that would urge you to get me to see a neurologist ?

Whether to see a neurologist in the clinic or not is totally your decision, but if you ask my opinion - I do not see any need for it because you 100% have no msa.

Customer: replied 27 days ago.
if it is just a fuzzy feeling getting up, no problem, right. I do actually sit on the side if the bed before getting up from bed. Not directly from lying down.

No such precautions are necessary since you are really not having orthostatic hypotension, but since you still truly believe you are having orthostatic hypotension so it is fine to take such precautions.

Customer: replied 27 days ago.
despite this situation of feeling fuzzy, I am healthy and can forget this the best I can.
Customer: replied 27 days ago.
Still 100% no msa

Yes, 100% no msa in you.

Customer: replied 27 days ago.
Hi doctor. Is this a good sign? I drove for 2 hours. Sitting in my SUV. Got out. Stood up. Felt great. No dizziness. Would this count as standing from a sitting position getting out of my car?

Hi, yes, this indeed count as standing from a sitting position, so no dizziness during this process implies you are definitely not having orthostatic hypotension.

Customer: replied 27 days ago.
Even though I am a bit elevated to begin with. That I have to step out and down a bit.

Yes, this is still consistent with standing up from a sitting position.

Customer: replied 27 days ago.
What if standing from sitting I can feel my heart rate increase and hear a slight pounding/thumping in my head. Normal? Heart speeds up as one moves from sitting to standing. No stars or fuzzy feeling though.

This is certainly normal. Nothing pathological here.

Customer: replied 26 days ago.
Hi Doctor. I had a great day feeling well. No dizziness. Usually am walking upon standing and getting out of my chair. Just to verify, walking is not enough to increase blood pressure to offset orthostatic hypotension on rising. Correct? Did not feel it once today but got up and walked most of the time. Thank you sir.

Hi, you are very welcome! Yes, that is correct, for the blood pressure to rise secondary to physical activities then there need to be significant physical activities such as exercises or long distance walking or running or jogging etc, just walking short distances within or around the house etc is not going to raise the blood pressure, so if you are not having the dizziness then it is not due to the minor degree of walking you have mentioned above, so this again implies you never had your blood pressure dropped, so there is indeed no orthostatic hypotension in you.

Customer: replied 26 days ago.
Thank you so much. I know you aren't a gastro doctor, but I can't figure out my indigestion after I eat during the day. I guess, as discussed, this is likely my body getting accustomed to more food and eating during the day. I have not eaten breakfast or lunch for a decade so this is likely a big change. Any other ideas? Though digestion issues can accompany msa, it does not come on like this in isolation correct. Thank you again.

You are very welcome! Yes this is the effect of change in your eating habits, eating more food in the day time now. This cannot be secondary to msa, since you do not have msa, also it should not be occurring as an isolated finding, if it were due to msa. This should resolve by itself as your body adjusts to this new development of eating more in the day time.

Customer: replied 26 days ago.
Yesterday I asked the question about sometimes hearing my heartbeat in my ears and feeling my heart pounding a little heavier on moving to a standing position. Not dizzy, lightheaded, or faint but can feel my heart speed up a bit. You said not pathological. Can you explain please. I assume normal and nothing to do with orthostatic hypotension. Thank you sir. Take good care.

You are very welcome, the symptoms you have mentioned above do not appear secondary to orthostatic hypotension, because this condition is expected to cause clear cut dizziness/fainting etc. While you are having certain symptoms as mentioned above but the pattern of these are not suspicious for any illnesses. If this is due to illnesses then it is expected to occur every time or almost every time when you move or stand up etc, also additional symptoms like dizziness/fainting, nausea or vomiting, passing out etc too are expected to occur – in the absence of all these this has to be some benign issue, and nothing more than that. I really do not see the possibility of any neuro illnesses in you including msa etc, and I have explained why this cannot be msa many many times before too, and I will repeat again - 100% no msa in you.

And I have already answered several questions for you since the last offer you had accepted, and if you have more questions could you open a new question?

Customer: replied 25 days ago.
Thank you. I will be opening a new question. Please watch for it. Take care.
Customer: replied 25 days ago.
Just paid for and started a new question. Requested you.
Customer: replied 25 days ago.
No dizziness today at all. Feel a little "off" I think from the sertraline side effects. My knee buckled a couple times Over the last few days. Does this indicate weakness or have any neuro significance. Pain in my neck and shoulders a bit as well. Back to the knee bucking. It is very slight but it worries me that it might be weakness in my muscles. Let me know your thoughts. Stood up quickly a few times today. No dizziness. This was after sitting for about 3-5minutes. Sometimes longer. Thank you for your care, doctor.

Welcome sir, I am answering at the new question, I am typing now, I will post my answer asap.