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Have POTS syndrome. Endoscopy showed small bowel with no h.pylori. Report positive SPEP showing Polycolonal Gammapathies. Remedy?

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General & Family Physician
Practicing since : 1973
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Hello- I have POTS syndrome (unable to digest food well) here are my tests results
Endoscopy- Showed Gastritis- biopsies done in the stomach and small bowel with no h.pylori
Colonoscopy- negative- I did have a sessile polyp removed. & XXXXXXX hemmroids.
HIDA scan, RUQ ultrasounds, CT of my abdomen and Pelvis, Gastric Emptying test, Small bowel series All negative- though they told me my small bowel had "Rapid Transit time"

I have been negative for so many kinds of stool infections- tested for C-diff and a whole bunch of others.

I have more CONSTIPATION rather than diarrhea though I get diarrhea hat times.

With the POTS syndrome I get SO MUCH different symptoms - numbness and tingling, muscles spasms anywhere ANYWHERE in the body), I use to get random rashes (but those have gone away) . I sometimes get shooting pains ANYWhere, also along with all of that I have High heart rate upon standing but no change in blood pressure (thank God)
Halter monitor showing many places of tachycardia - with few PVC's , no arrythmias
I was seen by a neuromuscular doctor- who did an extensive exam on me - he told me I was fine though I had a skin biopsy that was negative for peripheral neuropathy
I have had a spinal tap to look for WBC - Negative. I have had a MRI/MRA of my brain... negative. I had a thyroid nodule at one point so had a thyroid biopsy - benign.
tested for celiec through blood AND biopsy- negative
tsh , t3, t4 all normal
antibodies to pancreas, thyroid both negative
CBC, CMP, CRP, Triponin, SED rate, CRP all negative (though 3 months ago my SED rate was positive)
I have had multiple chest Xrays- all negative
I have had a CT of my Chest- negative
Echocardiograms and Echo stress test all Have been negative.
THey did a thermoregulatory sweat test- negative
Qsart- Negative
they looked at a whole bunch of vitamins and minterals - all within normal limits with the exception of my Vitamin D being low
Amylace, Lipase, calcium normal
they even did paraneoplastic autoantibodies which were negative.
Normal PT/INRs , Normal CK, Normal Urinalysis and Urine Cultures.
Xray of my back Normal - though I get really tight and tender upper back sometimes.

as you can see I am a chemistry test I feel :-(

here are the abnormals - I had Gastritis found in my EGD & I do have acid reflux it was negative for H. Pylori
Low Vitamin D
Most concerning- I had a positive SPEP showing Polycolonal Gammapathies. with a High IgG (just right out of normal range) . I was tested for Mono and EBV - negative
I have a fungal infection on my right foot - which has been there since college (8 years ago)
I had a papilloma taken off my Uvula (low grade HPV)
My small intestines show rapid transit time (and I have HAD major bowel issues and maintaining weight since I got Postural orthostatic tachycardia syndrome)
I had a positive tilt table test - which diagnosed the POTS

What is WRONG With me ? why do I have POTS, and why do I have polycolonal gammapathy?
I was normal and healthy till after a very premature birth- I lost my baby at 23 weeks gestation- and 2 weeks later I was sick in the hospital with POTS (never had it before) - and belly issues and nothing has been found .......

very frustrated patient .
Posted Mon, 15 Jul 2013 in Heart Rate and Rhythm Disorders
 
 
Answered by Dr. S. Jegadeesan 5 hours later
Hello,
Thanks for your inquiry,
You are suffering from POTS. Any investigations will not confirm POTS. Only a tilt table test is vital to diagnose POTS - which is positive for you. All the other investigations which are almost normal are done to rule out the numerous possible etiology of your symptoms of POTS. The possible causative mechanisms in POTS remain unclear and are likely heterogeneous. The exact cause is yet to be found out. The only possibility in theory forms are available. The symptoms are due to fall of both systolic and diastolic Blood flow to the Brain, during change of position.
Pain, dizziness and increased heart rate (palpitation) may be the major symptoms.
Positive SPEP showing Polycolonal Gammapathies occur in a wide variety of infectious, inflammatory, and immune-mediated diseases.
The Gastritis and acid reflux are not connected with this.
You have expressed that you had major bowel issues - which may be the reason for Your Rapid distal small bowel transit - which may occur in so many conditions including IBS and affected sympathetic nerve supply- for that also so many investigations are done.
Finally what I assume is
You have POTS - the etiology is not known - only theories are available
You Rapid distal small bowel transit - which may due to your past intestinal problems
You may have increased production of several different immunoglobulins - for this investigations may be repeated.
If you think in a relaxed mood -your symptoms are minimized - investigations are maximized - leading to lots of confusion.
Take only negative aspect of investigation and consult with the Dr for proper treatment. You will be alright
Best wishes for a speedy recovery
Dr. S. Jegadeesan


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