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Sinus, Spondylosis, Polyps In Nostrils, Hiatus Hernia, Throat And Chest Tightness, Nausea, Weakness, Taken Steroids, X-ray, Ultrasound, Endoscopy. Normal?
Question: Hi Doc. I am a houswife, 49 yrs old, and weigh 62 with a height of 5'5". I had to undergo FES for my sinus mid-May. But due to polips in my nostril, I was first given antibiotics, steroids and aniti allergics. Soon after, I started getting throat and chest tightness, and nausea. In the 4 months that followed, I have been given 5 more doses of various antibiotics, and an entire course of medication (Metrogil, etc.) for H-Pilori. All through, I have been suffering from nausea every day. And often, I get a pressure around by neck - pushing upwards. there is a creepy-crawly sensation along my spine. Of late, I have been beeling sudden attacks of weakness in both my upper arms, and a pain that eminates from my upper back and goes up to my forehead. My Vitamin D levels had come down to 11, and I have had 2 sachets of Calcerol and 1 megadose of D3 injection (600,000 IU). Last week, the doc found my BP to be a bit high: 150/95 - 160/90. I was given mild BP medicines. Now my BP is fluctuating constantly - and the lower is often at around 55 and upper at around 90. I have got an X-ray done to check for spondiliosis, ultrasound for mt abdomen, endoscopy (which caught the H-pilori and a sliding hiatus hernia). No major problems. The cardio says heart is fine. As the attacks of waekness and nausea are on the rise (and last 2-3 hours), I got a CT of the chest and abdomen done yesterday. Report is awaited. But feeling more nauseaus than ever before. Can by problem be just peri. Gynae says not possible as such weakness is not normal. What do you suggest?
Hi
Thanks for the query.
I have read it thoroughly and understood that you have multitude of problems to be addressed. It is very difficult to attribute all the symptoms towards peri-menopause. It is a greater entity and any symptom (including all the above you have) can be aggravated or presented with. However I acknowledge your concerns and shall try to explain you.
I can say that the nausea, feeling of chest pressure may be attributed to the sliding hiatus hernia associated with possible gastritis and reflux with H.pylori infection. There is a specific therapy to eradicate H.pylori. It comes as a pack now a days and ask your doctor if you completed the course. What is the duration of steroids that you took? Your query does not say exact duration, dose and type.
The back pain which also involves the forehead, creepy-crawly sensation on the back and possibly the arm weakness can be attributed to the extremely low values of Vitamin D (Normal is usually above 32ng/mL) of just 11.
Vitamin D deficiency can cause calcium deficiency which leads to muscle weakness especially of the upper body muscles, cramps, chest pain, tension headaches, irritability, tingling sensation over the body, weakness of limbs, difficulty climbing stairs, difficulty raising arms above head, This cluster of symptoms mostly fit in your condition which can be because of low calcium levels.
You may also need to do rule out various causes of this deficiency like nutritional deficiency, less exposure to sunlight, chronic renal failure (associated with high blood pressure and swelling of body as well), parathyroid gland problem, osteomalacia as well.
You can consult your Doctor to rule out these conditions being the cause of this problem. It is good to hear that Cardiac problems are ruled out by expert.
You need to take your calcium and Vitamin D3 supplements to make sure your blood levels of vitamin D3 and calcium are in normal range. This is of utmost importance. You may get treatment for sliding hernia by either medical or surgical means as recommended by your Doctor.
Also note that taking Nexpro or any other Proton pump inhibitor intended to reduce gastric acidity can also cause calcium deficiency. So do not take the Calcium and Vitamin D supplements along with Nexpro at the same time, rather change the time of the day you take each medicine.
You also need to maintain daily physical activity, lose some weight so that your body strength will improve as well as blood pressure will reduce. Avoid fatty, fried, junk food at all costs. Eat plenty of fresh fruits, nuts and XXXXXXX leafy vegetables which are also good source of calcium. Vit D fortified milk and products are available in the grocery. Drink enough water. Do daily brisk walking exercise for 40 minutes which will also help put back calcium in your bones and muscles.
Ideally the weakness needs to be investigated by Endocrinologist. If you are improving on Vitamin D therapy, then not to worry. Otherwise further tests need to be done to rule out possible hormonal and/or electrolyte imbalance.
Do keep me update with your Results including Chest and Abdomen CT scans. I will try my best to help you figure the problem.
Also information about menstrual cycles is good to assess the hormonal status.
I hope I have answered your query. I will be available to answer your follow up queries.
Regards,
Thanks for the query.
I have read it thoroughly and understood that you have multitude of problems to be addressed. It is very difficult to attribute all the symptoms towards peri-menopause. It is a greater entity and any symptom (including all the above you have) can be aggravated or presented with. However I acknowledge your concerns and shall try to explain you.
I can say that the nausea, feeling of chest pressure may be attributed to the sliding hiatus hernia associated with possible gastritis and reflux with H.pylori infection. There is a specific therapy to eradicate H.pylori. It comes as a pack now a days and ask your doctor if you completed the course. What is the duration of steroids that you took? Your query does not say exact duration, dose and type.
The back pain which also involves the forehead, creepy-crawly sensation on the back and possibly the arm weakness can be attributed to the extremely low values of Vitamin D (Normal is usually above 32ng/mL) of just 11.
Vitamin D deficiency can cause calcium deficiency which leads to muscle weakness especially of the upper body muscles, cramps, chest pain, tension headaches, irritability, tingling sensation over the body, weakness of limbs, difficulty climbing stairs, difficulty raising arms above head, This cluster of symptoms mostly fit in your condition which can be because of low calcium levels.
You may also need to do rule out various causes of this deficiency like nutritional deficiency, less exposure to sunlight, chronic renal failure (associated with high blood pressure and swelling of body as well), parathyroid gland problem, osteomalacia as well.
You can consult your Doctor to rule out these conditions being the cause of this problem. It is good to hear that Cardiac problems are ruled out by expert.
You need to take your calcium and Vitamin D3 supplements to make sure your blood levels of vitamin D3 and calcium are in normal range. This is of utmost importance. You may get treatment for sliding hernia by either medical or surgical means as recommended by your Doctor.
Also note that taking Nexpro or any other Proton pump inhibitor intended to reduce gastric acidity can also cause calcium deficiency. So do not take the Calcium and Vitamin D supplements along with Nexpro at the same time, rather change the time of the day you take each medicine.
You also need to maintain daily physical activity, lose some weight so that your body strength will improve as well as blood pressure will reduce. Avoid fatty, fried, junk food at all costs. Eat plenty of fresh fruits, nuts and XXXXXXX leafy vegetables which are also good source of calcium. Vit D fortified milk and products are available in the grocery. Drink enough water. Do daily brisk walking exercise for 40 minutes which will also help put back calcium in your bones and muscles.
Ideally the weakness needs to be investigated by Endocrinologist. If you are improving on Vitamin D therapy, then not to worry. Otherwise further tests need to be done to rule out possible hormonal and/or electrolyte imbalance.
Do keep me update with your Results including Chest and Abdomen CT scans. I will try my best to help you figure the problem.
Also information about menstrual cycles is good to assess the hormonal status.
I hope I have answered your query. I will be available to answer your follow up queries.
Regards,
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
QUESTION 1: Can blood pressure checked back-to-back 3 times fluctuate rapidly to four levels within a span of 2-3 minutes: 94/51 (Pulse 46); 100/70 (Pulse 57); 106/61 (Pulse 53)
About 20 minutes later, reading was 120/79 (Heart 60).
All the above readings were late night while lying down.
However, an ambulatory blood pressure check 2 days earlier showed showed a 24-hour systolic minimum of 86, maximul of 154, and an average of 109. The diastolic minimum was 44, maximum was 98, average was 61. The heart rate mimum was 41 (4.35 am), maximum was 80, average was 59.
Her ECG is fine.
When Moushumi was well, her pulse rate usually used to be around 70.
QUESTION 2: Can the pulse rate dropping to 41 be dangerous? What should be done when this happens? 1/4 teaspoon of salt got the pressure up from 54 to 63 in 30 minutes.
Two weeks ago, her pulse was checked during a visit to the doctor. The pressure was 160/90. So, she was given given Nebivolol - 5 mg x 7 days. From tomorrow, it will be reduced to half.
QUESTION 3: Her blood pressure is now mostly on thw lower side. Will continuing Nebivolol be a problem? Or will it steady her blood pressure?
She has bouts of acute weakness (especially in her upper arm) and a pain from ths top of her spine extends up to the back of her head, These bouts last around 2 hours, and then her weakness reduces by 50-60%. This seems to be more connected to sharp fluctuations, rather than pressure lows - but not too sure.
QUESTION 4: Will simply assuming that these are symptoms of peri be a wise diagnosis - considering her other symptoms?
Her bouts of weakness started 3 days after a long walk in the sun which made her collapse, 2 days after a day's low fever and bad throat (which lasted 6 days) and 1 day after a superdose of Vitamin D3 (600,00 IU) injection. Could any of this have led to a rare imbalance in her body symptom/s that most doctors are not aware of?
About 20 minutes later, reading was 120/79 (Heart 60).
All the above readings were late night while lying down.
However, an ambulatory blood pressure check 2 days earlier showed showed a 24-hour systolic minimum of 86, maximul of 154, and an average of 109. The diastolic minimum was 44, maximum was 98, average was 61. The heart rate mimum was 41 (4.35 am), maximum was 80, average was 59.
Her ECG is fine.
When Moushumi was well, her pulse rate usually used to be around 70.
QUESTION 2: Can the pulse rate dropping to 41 be dangerous? What should be done when this happens? 1/4 teaspoon of salt got the pressure up from 54 to 63 in 30 minutes.
Two weeks ago, her pulse was checked during a visit to the doctor. The pressure was 160/90. So, she was given given Nebivolol - 5 mg x 7 days. From tomorrow, it will be reduced to half.
QUESTION 3: Her blood pressure is now mostly on thw lower side. Will continuing Nebivolol be a problem? Or will it steady her blood pressure?
She has bouts of acute weakness (especially in her upper arm) and a pain from ths top of her spine extends up to the back of her head, These bouts last around 2 hours, and then her weakness reduces by 50-60%. This seems to be more connected to sharp fluctuations, rather than pressure lows - but not too sure.
QUESTION 4: Will simply assuming that these are symptoms of peri be a wise diagnosis - considering her other symptoms?
Her bouts of weakness started 3 days after a long walk in the sun which made her collapse, 2 days after a day's low fever and bad throat (which lasted 6 days) and 1 day after a superdose of Vitamin D3 (600,00 IU) injection. Could any of this have led to a rare imbalance in her body symptom/s that most doctors are not aware of?
Hi
Does she get bouts of sweating and hand tremors
Has she been tested for thyroid problems
She is having a problem called Labile hypertension. Labile hypertension can be caused by thyroid problem, migraine, adrenal gland problem, carcinoid syndrome and other causes.
Regarding her fluctuating blood pressure and pulse rate suggests either problem in the nervous system and hormones or problem in the heart.
Since there is rapid change in blood pressure and heart rate, one can consider problem with adrenal gland, especially if she gets profuse sweating occasionally. There is usually sudden rise and fall in blood pressure and heart rate because of fluctuation in hormones.
Do let me know the results of her CT Scan to rule out possible Phaeochromocytoma and Carcinoid syndrome.
There are many causes of autonominc dysfunction, which is what she has. It can be hormone disorder, certain infections or genetic problems.
According to her reports she has a mild yeast infection in her bowel which can be because of lot of antibiotics which kill off the good bacteria. But in time it will normalise. She can have plenty of curds and yoghurt to improve her condition.
Has she been tested for Diabetes because this can also cause autonomic dysfunction.
The low Vitamin D is possibly because of dietary deficiency, which can be cured with Vitamin D and calcium therapy. Also she needs to drink milk and eat plenty of fresh fruits and XXXXXXX leafy vegetables to bring back normal calcium.
Salt is not a good idea as it tends to increase blood pressure very high and this can cause organ damage. In such cases, low salt diet is necessary. Also weight loss s very important with proper diet and regular exercise.
Vitamin D is not directly related to her changes in blood pressure and heart rate but low levels can cause headache, neck pain, chest pain as well.
If the CT scan come normal, then this problem could be treated mainly with anti-anxiety drugs which will give relief. Stress relief is also very necessary, which can be helped by doing Yoga.
Wishing you good health.
Does she get bouts of sweating and hand tremors
Has she been tested for thyroid problems
She is having a problem called Labile hypertension. Labile hypertension can be caused by thyroid problem, migraine, adrenal gland problem, carcinoid syndrome and other causes.
Regarding her fluctuating blood pressure and pulse rate suggests either problem in the nervous system and hormones or problem in the heart.
Since there is rapid change in blood pressure and heart rate, one can consider problem with adrenal gland, especially if she gets profuse sweating occasionally. There is usually sudden rise and fall in blood pressure and heart rate because of fluctuation in hormones.
Do let me know the results of her CT Scan to rule out possible Phaeochromocytoma and Carcinoid syndrome.
There are many causes of autonominc dysfunction, which is what she has. It can be hormone disorder, certain infections or genetic problems.
According to her reports she has a mild yeast infection in her bowel which can be because of lot of antibiotics which kill off the good bacteria. But in time it will normalise. She can have plenty of curds and yoghurt to improve her condition.
Has she been tested for Diabetes because this can also cause autonomic dysfunction.
The low Vitamin D is possibly because of dietary deficiency, which can be cured with Vitamin D and calcium therapy. Also she needs to drink milk and eat plenty of fresh fruits and XXXXXXX leafy vegetables to bring back normal calcium.
Salt is not a good idea as it tends to increase blood pressure very high and this can cause organ damage. In such cases, low salt diet is necessary. Also weight loss s very important with proper diet and regular exercise.
Vitamin D is not directly related to her changes in blood pressure and heart rate but low levels can cause headache, neck pain, chest pain as well.
If the CT scan come normal, then this problem could be treated mainly with anti-anxiety drugs which will give relief. Stress relief is also very necessary, which can be helped by doing Yoga.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
As we discussed this a while ago, I am writing the main points again: My wife was given 5 days of oral steroids, nasal steroids (around a month) and anti-allergic medicines to reduce her nasal polyps before a sinus surgery. She immediately started feeling nauseous. This was 5 months ago. Through these 5 months, she has had 7 dozes of various antibiotics (for H-pilori, post-nasal-surgery, others), and a megadose of Vitamin D injection + 3 sachets of Calcerol (Her Vitamin D level had fallen to 11, now OK) and also 3 shots of Vitamin B Complex injections.
We have got a CT Scan (Abdomen + Chest), Ultrasound (Abdomen), Endoscopy, Colonoscopy, X-ray complete spine, CT Brain (before sinus surgery) done. All clear. She lost 4 kgs, but then steadied out. She is 49, but not reached menopause yet.
Her nausea has progressively increased. Does not throw up. Appetite healthy, but VERY nauseous 24x7. Weight steady. Hb level steady at 11.5. Thyroid levels fine. Ferratin low. Surge of 'nerve weakness' in upper arms. Sensation along spine travelling up to nape of neck. CD/Colonoscopy detected non-specific thickening of colon walls near cicum and sigmoid.
QUERY:
Can her pancreas be malfunctioning. The net says that not all patients experience pain. But without CT and ultrasound detecting any inflammation, can there be a problem with the pancreas that is causing:
1. Acute nausea 24x7
2. Increase in nausea 1 hour after eating and while lying on the right side
3. Feeling of weakness - especially in arms
4. Fluctuating blood pressure and pulse rate
5. Hb level having come down from her regular 13-14 to 11.5?
6. Ferratin level had fallen to 7.4. Now little better at 10.4?
7. Has become extremely reactive to all drugs - including a simple para
If yes, will a blood test help figure this out? What tests? Does she need to give the blood sample on an empty stomach?
Can we include some other blood tests to figure out some other reasons that could possibly be causing her nausea? Hormones?
We have got a CT Scan (Abdomen + Chest), Ultrasound (Abdomen), Endoscopy, Colonoscopy, X-ray complete spine, CT Brain (before sinus surgery) done. All clear. She lost 4 kgs, but then steadied out. She is 49, but not reached menopause yet.
Her nausea has progressively increased. Does not throw up. Appetite healthy, but VERY nauseous 24x7. Weight steady. Hb level steady at 11.5. Thyroid levels fine. Ferratin low. Surge of 'nerve weakness' in upper arms. Sensation along spine travelling up to nape of neck. CD/Colonoscopy detected non-specific thickening of colon walls near cicum and sigmoid.
QUERY:
Can her pancreas be malfunctioning. The net says that not all patients experience pain. But without CT and ultrasound detecting any inflammation, can there be a problem with the pancreas that is causing:
1. Acute nausea 24x7
2. Increase in nausea 1 hour after eating and while lying on the right side
3. Feeling of weakness - especially in arms
4. Fluctuating blood pressure and pulse rate
5. Hb level having come down from her regular 13-14 to 11.5?
6. Ferratin level had fallen to 7.4. Now little better at 10.4?
7. Has become extremely reactive to all drugs - including a simple para
If yes, will a blood test help figure this out? What tests? Does she need to give the blood sample on an empty stomach?
Can we include some other blood tests to figure out some other reasons that could possibly be causing her nausea? Hormones?
Hi,
As I have mentioned before she seems to be having labile Hypertension where the blood pressure fluctuates drastically. It can be a result of adrenal gland problem which will need further testing like CT scan abdomen.
Her haemoglobin and ferritin levels going low indicated that she is possibly having Iron deficiency anaemia. This is a classical finding in those who have this kind of anaemia. There will be weakness, body pain and lethargy for those who have this anaemia. She will need to take iron tablets as recommended by her Doctor and also eat food XXXXXXX in iron like plenty of fresh fruits and XXXXXXX leafy vegetables.
The increase in nausea after eating could be due to the sliding hernia which puts the upper part of stomach at risk for ulcer or gastritis and also need investigation for gall bladder problem which can be tested by endoscopy and ultrasound respectively.
Pancreatitis will cause severe abdominal pain in the upper part of abdomen which would radiate towards the back associated with vomiting. Also she will be passing abnormal stools or may also be constipated. CT has shown no findings indicating less chance of Pancreatitis.
What I would suggest is that she get a thorough evaluation for the above mentioned problems. Make sure she eats small frequent meals and not heavy meals. This can help reduce the nausea. Also she should avoid eating oily, fatty and spicy food. She can have more curds, yoghurt, bland non-oily food. She can lie down after food only after 2 hours. Till then she can recline till 45 degrees with head end up. The only cure will be surgery if medical treatment does not work with specific anti-acid therapy to treat the sliding hernia.
Certain tests like VMA test in urine to look for possibility of adrenal gland problem, kidney function tests.
Wishing you good health.
As I have mentioned before she seems to be having labile Hypertension where the blood pressure fluctuates drastically. It can be a result of adrenal gland problem which will need further testing like CT scan abdomen.
Her haemoglobin and ferritin levels going low indicated that she is possibly having Iron deficiency anaemia. This is a classical finding in those who have this kind of anaemia. There will be weakness, body pain and lethargy for those who have this anaemia. She will need to take iron tablets as recommended by her Doctor and also eat food XXXXXXX in iron like plenty of fresh fruits and XXXXXXX leafy vegetables.
The increase in nausea after eating could be due to the sliding hernia which puts the upper part of stomach at risk for ulcer or gastritis and also need investigation for gall bladder problem which can be tested by endoscopy and ultrasound respectively.
Pancreatitis will cause severe abdominal pain in the upper part of abdomen which would radiate towards the back associated with vomiting. Also she will be passing abnormal stools or may also be constipated. CT has shown no findings indicating less chance of Pancreatitis.
What I would suggest is that she get a thorough evaluation for the above mentioned problems. Make sure she eats small frequent meals and not heavy meals. This can help reduce the nausea. Also she should avoid eating oily, fatty and spicy food. She can have more curds, yoghurt, bland non-oily food. She can lie down after food only after 2 hours. Till then she can recline till 45 degrees with head end up. The only cure will be surgery if medical treatment does not work with specific anti-acid therapy to treat the sliding hernia.
Certain tests like VMA test in urine to look for possibility of adrenal gland problem, kidney function tests.
Wishing you good health.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Answered by
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