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Suggest Treatment For Autonomic Dysfunction Leading To Erectile Dysfunction
Question: Hi
My name is XXXXX. I am 31 years old from Hyderabad, A.P. I have been suffering from neurogenic bladder and constipation and erectile dysfunction for last 10 years. My first symptom was ED followed by Incomplete emptying of bladder. Last 3 to 4 years I have been experiencing tremors/involuntary twitches across different parts of my body like thighs/arms/face etc. I have been experiencing jerks while falling asleep which jolts my entire body and wakes me up from my sleep. From last 2 years I have experienced slow heart rate (about 60-65 beats per minute). I have consulted numerous neurologists and urologists and no doctor could not diagnose my condition. Of Late I have been experiencing severe sleep disturbances where the jolts in sleep have increased tremendously and I am not able to sleep entire night. It feels as if I am going to die of short of breath. I gasp for breath as I am awakened by the jolt. I am pretty sure I am having Central Sleep Apnea. I feel sleepy all day long and also feel a continuous pressure on my chest. I got all Heart tests done last week and found no major issues. 2D Echo and TMT were normal. I underwent all blood tests and all were normal. Chest X ray is also normal. I researched a lot on the internet on my symptoms and I have found that I have all symptoms that match Multiple System Atrophy (MSA-C). I have discussed about the same with other neurologists but they have not agreed with me and instead treated me with sleep medications. I don't have any falls yet, but I feel the dizziness when I stand up. But I have tested myself for POTS which is one of the major symptoms of MSA and I found that I have standing heart rate of 120 beats per second, which is almost double of what my heart beat is when I am resting. All these symptoms of mine point to (MSA-C). Most of my symptoms point to autonomic failure. I want to know if there is any diagnosis that can determine my disease and all the suffering that I am going through for all these years. No doctor seems to have an idea about the disease. I have read many blogs which are similar to mine and most those affected have the same story of not able to getting diagnosed until at a later stage with major severity. I would like to know if there are any treatments for this neurological disease or at least medications that can provide relief. I would like to know what is my prognosis and how can I be diagnosed for this condition. Looking forward for your advice on my condition
My name is XXXXX. I am 31 years old from Hyderabad, A.P. I have been suffering from neurogenic bladder and constipation and erectile dysfunction for last 10 years. My first symptom was ED followed by Incomplete emptying of bladder. Last 3 to 4 years I have been experiencing tremors/involuntary twitches across different parts of my body like thighs/arms/face etc. I have been experiencing jerks while falling asleep which jolts my entire body and wakes me up from my sleep. From last 2 years I have experienced slow heart rate (about 60-65 beats per minute). I have consulted numerous neurologists and urologists and no doctor could not diagnose my condition. Of Late I have been experiencing severe sleep disturbances where the jolts in sleep have increased tremendously and I am not able to sleep entire night. It feels as if I am going to die of short of breath. I gasp for breath as I am awakened by the jolt. I am pretty sure I am having Central Sleep Apnea. I feel sleepy all day long and also feel a continuous pressure on my chest. I got all Heart tests done last week and found no major issues. 2D Echo and TMT were normal. I underwent all blood tests and all were normal. Chest X ray is also normal. I researched a lot on the internet on my symptoms and I have found that I have all symptoms that match Multiple System Atrophy (MSA-C). I have discussed about the same with other neurologists but they have not agreed with me and instead treated me with sleep medications. I don't have any falls yet, but I feel the dizziness when I stand up. But I have tested myself for POTS which is one of the major symptoms of MSA and I found that I have standing heart rate of 120 beats per second, which is almost double of what my heart beat is when I am resting. All these symptoms of mine point to (MSA-C). Most of my symptoms point to autonomic failure. I want to know if there is any diagnosis that can determine my disease and all the suffering that I am going through for all these years. No doctor seems to have an idea about the disease. I have read many blogs which are similar to mine and most those affected have the same story of not able to getting diagnosed until at a later stage with major severity. I would like to know if there are any treatments for this neurological disease or at least medications that can provide relief. I would like to know what is my prognosis and how can I be diagnosed for this condition. Looking forward for your advice on my condition
Brief Answer:
My reply is below.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your detailed symptoms and I must admit it was very helpful.
It is unfortunate that no proper diagnosis has been made in your case, despite consulting several doctors.
I agree with you that you have features of autonomic failure, as evidenced by erectile dysfunction, bladder and bowel symptoms, changes in heart rate, etc.
Autonomic dysfunction can be confirmed by several tests, which can be done bedside and without any risk to the patient. These include:
1. Valsalva maneuver
2. Isometric hand grip,
3. Cold pressor test,
4. Deep breathing test,
5. Mental arithmetic test,
6. Active standing test.
In a specialised set up, head up tilt test (HUTT) can be done.
All these are available in Hyderabad.
Tests such as sympathetic skin response and measurement of nordadrenaline can be done in specialised centres.
Regarding the diagnosis of MSA-C, it is mostly clinical (detailed neurological examination). We need to look for features of cerebellar disease, such as inch-ordination, imbalance, etc. Some features of extrapyramidal disease such as tremors, slowness, falls, etc may also be present. Memory should be normal in cases of MSA.
High Tesla MRI of brain and PET scan of brain are also helpful in the diagnosis of MSA-C.
Regarding the treatment, unfortunately there is no cure. However, there are several medications to improve the symptoms. For example, fluodrocortisone tablets help in improving several of the autonomic symptoms.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
My reply is below.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your detailed symptoms and I must admit it was very helpful.
It is unfortunate that no proper diagnosis has been made in your case, despite consulting several doctors.
I agree with you that you have features of autonomic failure, as evidenced by erectile dysfunction, bladder and bowel symptoms, changes in heart rate, etc.
Autonomic dysfunction can be confirmed by several tests, which can be done bedside and without any risk to the patient. These include:
1. Valsalva maneuver
2. Isometric hand grip,
3. Cold pressor test,
4. Deep breathing test,
5. Mental arithmetic test,
6. Active standing test.
In a specialised set up, head up tilt test (HUTT) can be done.
All these are available in Hyderabad.
Tests such as sympathetic skin response and measurement of nordadrenaline can be done in specialised centres.
Regarding the diagnosis of MSA-C, it is mostly clinical (detailed neurological examination). We need to look for features of cerebellar disease, such as inch-ordination, imbalance, etc. Some features of extrapyramidal disease such as tremors, slowness, falls, etc may also be present. Memory should be normal in cases of MSA.
High Tesla MRI of brain and PET scan of brain are also helpful in the diagnosis of MSA-C.
Regarding the treatment, unfortunately there is no cure. However, there are several medications to improve the symptoms. For example, fluodrocortisone tablets help in improving several of the autonomic symptoms.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor for the detailed answer.
I would like to know whom should I consult for treatment for Sleep Apnea. Is there any specific treatment available for sleep problems in Hyderabad. I am unable to sleep and feel irritated and sleepy all day. I would be happy if you can refer me a doctor whom I can consult for treating my sleep disorders.
Also I would like to undergo these tests to evaluate my condition for MSA. Can you kindly let me know how much would it cost me to undergo the above tests specified and whom to consult.
Also can medicines like neurobion forte help in overall Neurological improvement. Kindly let me know.
Thanks
XXXXX
I would like to know whom should I consult for treatment for Sleep Apnea. Is there any specific treatment available for sleep problems in Hyderabad. I am unable to sleep and feel irritated and sleepy all day. I would be happy if you can refer me a doctor whom I can consult for treating my sleep disorders.
Also I would like to undergo these tests to evaluate my condition for MSA. Can you kindly let me know how much would it cost me to undergo the above tests specified and whom to consult.
Also can medicines like neurobion forte help in overall Neurological improvement. Kindly let me know.
Thanks
XXXXX
Brief Answer:
Thank you for getting back.
Detailed Answer:
For sleep problem, we can do sleep study (polysomnography). You can consult me for that.
For autonomic function tests, we can do that too.
The cost would depend on what all tests are needed. I can confirm once I have examined you.
I would request you to consult me once at Apollo Hospitals, Jubilee Hills branch.
Neurobion forte may help if there is vitamin B12 deficiency.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Thank you for getting back.
Detailed Answer:
For sleep problem, we can do sleep study (polysomnography). You can consult me for that.
For autonomic function tests, we can do that too.
The cost would depend on what all tests are needed. I can confirm once I have examined you.
I would request you to consult me once at Apollo Hospitals, Jubilee Hills branch.
Neurobion forte may help if there is vitamin B12 deficiency.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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