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Suggest treatment for anemia, fatigue and double vision

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Posted on Mon, 18 Jul 2016
Question: I am currently being sent to many different physicians and have the following diagnosed symptoms: orthostatic hypotension, blood pressure that is extremely low (90/58, 85/53 while taking fludricortisone and drinking tons of fluid w/salt), except when I get excited then it quickly goes up to 120/80 which is great, but I can't be excited all of the time. mild anemia, extreme fatigue, temperature intolerance to heat, dizziness, double vision, recently hospitalized for rhabdo, Lymes disease (was treated with antibiotics for 7 weeks) and anxiety.They believe that I'm having autonomic nervous system dysfunction. as far as my blood pressure, any ideas why the only thing that seems to bring my pressure up is getting excited? Could this be important information for my doctors? I am out on medical leave and can't get back to work until we can get at least some degree of control over my blood pressure.
doctor
Answered by Dr. Ilir Sharka (57 minutes later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

I carefully passed through your question and would explain that it is quite normal to have higher blood pressure values during emotional or physical stress.

This is caused by the activation of sympathetic nervous system, leading to a load of catecholamines ( adrenaline and noradrenaline) in your blood. These hormones cause increased heart rate, blood pressure, frequency of respiration, which is also called "fight or flight response".

This is a normal physiological reaction, which happens in all healthy individuals.

It is not a sign of any disorders.

From the other hand, your symptoms could be related to Lyme disease.

You should know that this is a specific infection, which can cause several symptoms in your body ( including your symptoms).

A prolonged treatment with antibiotics may be necessary.

I would also recommend checking your cortisol and aldosterone plasma levels for possible adrenal gland dysfunction.

You should discuss with your doctor on the above issues.

Hope to have been helpful!

Feel free to ask any other questions whenever you need!

Kind regards,

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka (1 hour later)
thank you. Thus far, they have ruled out adrenal and cardiac issues. Is it possible to be deficient in noradrenaline? I know that there is a considerable amount of controversy regarding the treatment for Lymes. I sought out the opinions of two different Infectious Disease specialists. The first doctor, believes that Lymes can linger and it's possible that the Lymes infection is related to the autonomic dysfunction. The other physician believes that the Lymes is likely gone after the 7 weeks of antibiotics, but it's possible that the Lymes triggered an immune system response which triggered autonomic nervous system dysfunction? I'm not sure which physician to follow. I stopped the doxycycline as it questioned whether it contributed to the rhabdo. I was retested with a western blot test and I'm scheduled to have a lumbar puncture so I'm hoping that will provide some additional information to determine if this is still a current infection? I'm doing my best to be educated as much as possible, but it's tough when there is controversy in the medical field regarding treatment.
doctor
Answered by Dr. Ilir Sharka (11 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I agree with you that there are not determined guidelines to treat Lyme disease.

There are many controversies in the treatment of this disorder, because as you can see, different specialist of this field believe in different therapies. This happens in the specialists of this field world wide.

Anyway, it is true that this specific infection can mimic a lot of endocrinological disorders.

I do not believe that there is not enough noradrenaline being produced by your body. But your symptoms seem to be related to orthostatic intolerance.

Do you have any other symptoms like dry skin or mouth, difficulty sweating, abdominal pain, constipation or diarrhea? These symptoms would indicate a generalized autonomic dysfunction.

In such case, I would recommend performing Ganglionic AChR antibodies to check, which are elevated in this disorder.

It is true that Lyme infection, as well as other infections can lead to autonomic dysfunction. This is an autoimmune reaction of the body to an infectious agent, which can be a virus, bacteria, etc..

I recommend also peforming some tests:

- PCR and sedimentation rate for inflammation
- vitamin D levels (Lyme disease has been associated to vitamin deficiency)
- vitamin B12 levels

A lumbar puncture, and some immunological tests for Lyme disease and other infectious agents would be helpful to investigate for the possible cause and evaluate a possible affection of central nervous system.

I recommend discussing with your doctor on the above issues.

Meanwhile, I would recommend continuing your actual therapy, take plenty of water to remain well hydrated and avoid straining physical activity and prolonged standing up position.

Increasing salt and caffeine intake would be helpful too.

Hope to have clarified some of your uncertainties.

Best wishes,

Dr. Iliri


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ilir Sharka (2 hours later)
Thank you Dr. Your explanation was very helpful. I am actually vitamin D deficient and my doctor just ran the B12 test last week. I was having problems with dry mouth, but the issues have seemed to have clear up. This all started months ago after someone said that I drink like a fish and they suspected that I was diabetic.

I don't have any problems with constipation or diarrhea, but I do have difficulty with sweating/regulating temperature. Oddly, I've had this issue for years. I just avoided being outside in really hot/humid days or would place a wet towel on my neck.

The infectious disease specialist just ran some tests looking for some type of proteins, he mentioned amyloidosis?

I am getting a second opinion from a rheumatology tomorrow, so I will bring up some of these tests. I guess it definitely appears that I am having autonomic nervous system dysfunction, but it's unclear why at this point.

Sincerely,
XXXX
doctor
Answered by Dr. Ilir Sharka (6 hours later)
Brief Answer:
My answer as follows:

Detailed Answer:
Hello again!

Thank you for the additional information.

I would confirm that Lyme disease can lead to these hormonal changes to your body.

And from the other hand it seems that your symptoms are compatible with autonomic dysfunction.

So, I would recommend discussing with your doctor on the above mentioned tests.

From the other hand amyloidosis could cause some of these symptoms in the advanced stage. You are too young for such disorder.

Nevertheless, further lab tests are needed to investigate for the cause.

I would be happy to review your tests as soon as you can upload them.

You can ask me directly at any time on the link below:

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=69765

Greetings!

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ilir Sharka

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Practicing since :2001

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Suggest treatment for anemia, fatigue and double vision

Brief Answer: I would explain as follows: Detailed Answer: Hello! Welcome and thank you for asking on HCM! I carefully passed through your question and would explain that it is quite normal to have higher blood pressure values during emotional or physical stress. This is caused by the activation of sympathetic nervous system, leading to a load of catecholamines ( adrenaline and noradrenaline) in your blood. These hormones cause increased heart rate, blood pressure, frequency of respiration, which is also called "fight or flight response". This is a normal physiological reaction, which happens in all healthy individuals. It is not a sign of any disorders. From the other hand, your symptoms could be related to Lyme disease. You should know that this is a specific infection, which can cause several symptoms in your body ( including your symptoms). A prolonged treatment with antibiotics may be necessary. I would also recommend checking your cortisol and aldosterone plasma levels for possible adrenal gland dysfunction. You should discuss with your doctor on the above issues. Hope to have been helpful! Feel free to ask any other questions whenever you need! Kind regards, Dr. Iliri