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Suggest remedy for severe facial flushing in a person with acute anxiety

Answered by
Dr. Swarnava Dattagupta

General & Family Physician

Practicing since :2013

Answered : 906 Questions

Posted on Tue, 3 Nov 2015 in Bones, Muscles and Joints
Question: Hi, I am a 35 year old Caucasian woman, who has suffered from Bulimia (recovered 3 years). I do suffer from anxiety and depression. I currently take the following daily meds: 20 mg Prozac, 50 mg topamax (for bulimia), 15 mg of proprananol for facial blushing and .05 mg of ativan as need (usually two a day).
In my early 20’s I was diagnosed with degenerative disk disease, scoliosis, stenosis and two herniated and bulging disks in my lower back. I have not taken medication for these problems but over the past two years I have noticed that the pain has increased. The internist gave me 10mg of flexeril and vicodin which I take on occasion.
Over the past month I have had sudden fatigue and joint pain. Especially in my hands/wrists and feet/ankles. I was sent to the Orthopedist who explained to me this was part of aging.
I called my Internist back because I know there is something wrong with my body. She ordered test s and I received them back but she is on vacation for 2 weeks. Can you give me some insight on my results below?
One additional piece of info, about 4 months I suddenly started getting severe facial flushing. I saw a dermatologist who said it could be rosacea and prescribed Mirvaso cream, which helped a little. To help further my internist gave me a beta blocker to help. Before being prescribed the beta blocker my bp was around 110/70 and is now 99/69 but my flushing is much better.
I am very frustrated and nervous about my health, I would be extremely grateful for any help!!

I apologize, my test results were not included.

Test D Test Result H/L Range Note
Laboratory test finding -C-Reactive Protein Not Yet Available
Laboratory test finding- Vitamin D 25-Hydroxy,Total,Immunoassay Not Yet Available
Laboratory test finding -Rheumatoid Factor Not Yet Available
Ana Choice (TM) SCR W/RFX To Titer Ifa- Not Yet Available

Comprehensive Metabolic
Sodium 136 mmol/L 134-149
Potassium 3.7 mmol/L 3.6-5.5
Chloride 102 mEq/L 94-112
Carbon Dioxide 24 mEq/L 21-32
Glucose 111 mg/dL 70-118
BUN 9 mg/dL Low 10-26
Creatinine 0.7 mg/dL 0.6-1.4
BUN/Creat Ratio 12.9 CALC
Calcium 8.9 mg/dL 8.5-10.5
Total Protein 6.4 g/dL 6.3-8.1
Albumin 4.5 g/dL 3.8-5.5
Globulin 1.9 g/dL
A/G Ratio 2.4 CALC
Alk. Phosphatase 66 U/L 42-128
Alt (SGPT) 101 U/L High 10-40 2
Ast (Sgot) 75 U/L High 9-44 3
Total Bilirubin 0.9 mg/dL 0.2-1.3
GFR Non-African XXXXXXX >60 ml/min/1.73m^ >=60
GFR XXXXXXX XXXXXXX >60 ml/min/1.73m^ >=60
Lipid Profile 10/16/2015 Cholesterol 179 mg/dL 140-200
Triglycerides 121 mg/dL 30-150
HDL Cholesterol 56 mg/dL 35-85
LDL (Calculated) 99 CALC
HDL Risk Factor 3.2 CALC

Complete Blood Count
WBC 8.8 x10^3/UL 4.1-10.9
RBC 4.29 x10^6/UL 4.20-6.30
HGB 14.6 g/dL 12.0-18.0
HCT 43.4 % 37.0-51.0
MCV 101.0 fL High 80.0-97.0
MCH 34.1 pg 26.0-36.0
MCHC 33.8 g/dL 32.0-37.0
RDW 13.3 % 11.5-14.5
PLT 234 x10^3/UL 130-400
MPV 9.3 FL 7.0-11.0
Gran # 6.2 x10^3/UL 2.0-7.8
Lymph# 2.1 x10^3/UL 0.0-6.0
Mono# 0.5 x10^3/UL 0.1-0.6
Gran % 70.1 % 40.0-80.0
Lymph % 24.4 % 13.0-47.0
Mono% 5.5 % 0.0-10.0
Laboratory test finding 10/16/2015 Esr 9 mm/hr 0-20
TSH 0.770 mIU/mL 0.250-5.000

Answered by Dr. Swarnava Dattagupta 1 hour later
Brief Answer:
Blood reports are more or less normal

Detailed Answer:
Thank you for posting your query in
This is Dr. Swarnava dattagupta answering your query.

I understand your concern.
I have gone through the history and reports thoroughly and there are only a few values which are not within normal limits- SGPT, SGOT and MCV. SGOT and SGPT are not excessively high but might denote minor liver damage. However, not much to worry.
Also, the MCV or mean corpuscular volume is high that is the RBC or red blood cells are slightly bigger. It is also of not any concern because the hemoglobin value is normal. However, there might be some vit b12 and folic acid deficiency. No drug therapy is needed for that now, maybe a multivitamin syrup for 2 months can be taken and it would be helpful.
For the joint pain and fatigue, it is a chronic problem and I would suggest blood uric acid and blood vit d3 level to get tested. According to reports, drugs can be suggested later. Also, you have few reports pending, which you can followup later.
Lastly, active elbow, wrist, finger, ankle and toe movements are advised. It will lead to decrease in the intensity of pain.

Hope i have answered your question.
If you have any further questions i will be happy to help.
Above answer was peer-reviewed by : Dr. Raju A.T

The User accepted the expert's answer

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