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Suggest treatment for constant fatigue and headaches

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Posted on Mon, 28 Nov 2016
Question: I have been dealing with a chronic health issue over the last 3 years. Symptoms started with constant fatigue and heart palpitations. After initial 3 months, heart palpitations subsided but additional symptoms developed. Constant headache, more prominent when waking from sleep in the morning. Feet tingling during the day as well as muscle twitching all over. Light sensitivity in the eyes with blurring first thing in the morning. Eyes are always burning and feel heavy/fatigued throughout the day. Also developed a constant movement tremor all over. Have had numerous tests over the course of this illness which included MRI of the brain, Cardiac workups, complete blood tests, Thyroid testing, and other various autoimmune disorder testing. Everything that has been done has come back fine with no abnormalities found. General practicioner also had me do a sleep study early on to check on sleep apnea issues. The initial test only showed mild apnea and did not require treatment, so that was ruled out. About a year ago I experience several episodes of waking up choking during the night and was referred to a pulminologist sleep doctor. Another sleep study was performed and came back okay. He did note some desaturation in my oxygen level at night and wanted to do another sleep study to double check. The results of the last sleep study did show more apnea but still mild (only about 6 AHI). He did decide to order me a BIPAP machine with supplemental oxygen at 2 liters per minute. I have been doing really well with the sleep therapy and my daily results show an average AHI of around 1.5. I have been using the BIPAP for the last 10 months and while I feel marginally better, many of my symptoms continue. Significant fatigue, burning eyes, tingling feet, and headaches remain. I never feel that I get refreshing sleep, regardless of how long I sleep or how little I awake during the night. Always feel as tired as when I went to sleep, sometimes worse. For the longest time, I would wake up every morning and would literally feel jittery and shaking when waking. This has subsided some since the sleep therapy but still remains to some degree. Blood sugar testing also show could results and is in acceptable range even in the morning when experiencing these symptoms. I still feel that the symptoms that I experience when waking and during the day are caused by some condition or event(s) that occur while sleeping. Several months ago I purchased a automatic blood pressure machine to monitor my blood pressure reading during the night. I have consistently recorded my blood pressure dropping to levels as low as 85/37 with heart rate remaining around the mid 60s. I am a 41 year-old male weighing approximately 240 lbs and am 6 ft. My blood pressure typically always runs approximately 130/80 when awake. I have been told that is is normal for my blood pressure to drop this low during sleep, but I feel that with my accompanying symptoms, it could be a root cause for the way I feel. I have always been a healthy individual with no issues, over than needing to loose some weight. About 15 lbs of my current weight has been put on during this illness. I am looking for any insight that may help to provide a possible cause to what I have been experiencing. While I am better than I was at my worse my quality of life is still diminished over what it was prior to the start of the illness. Memory issues, brain fog, and concentration has also been very notable during the worst of this illness. Those symptoms still remain as well, although to a lesser degree because of slight improvement over the last year. I feel that my condition has remained unchanged over the last 5-6 months where the sleep therapy and oxygen has a least kept certain symptoms at bay. My sleep doctor tells me that based upon my therapy results, I should be feeling great. I am looking for next steps in trying to evaluate what is going on. Thank you for the review and any help you may can provide.
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Answered by Dr. Geeta Sundar (2 hours later)
Brief Answer:
Hi welcome to HCM, I have read your history in detail

Detailed Answer:
Hi welcome to HCM, I have read your history in detail. Let us simplify things--what you need is to consult a good dietician-- and follow her advise. And lose weight and follow a good exercise routine regularly with no breaks. This is how I would deal with patients like you. Also find a good internist who can enforce this good lifestyle. Sometimes we require less of expensive tests and more of simple lifestyle changes to re-set our disturbed body functions ---regards.

Mention your Height, Weight, and regular food habits so that our dietitians in HCM panel will provide you the proper diet chart.
Above answer was peer-reviewed by : Dr. Nagamani Ng
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Follow up: Dr. Geeta Sundar (1 hour later)
I appreciate the input but I have adjusted diet and incorporated an exercise routine. Not long after the first symptoms started and being cleared by the cardiologist, I incorporated an aerobic regimen where I worked myself up to jogging 3 miles a day. I had to constantly push myself as I never fealt better and actually got worst. I have had environmental and food allergy tests as well as celiac and gluten tests done to see if there were any sensitivities with those elements. I have eliminated all soft drinks and caffine and only drink water. None of these things have helped, even giving significant time to see results. I am not dismissing your advice, but I am pretty confident that diet and exercise is not causing my issue. I have been referred to an endocrinologist to explore other possibilities. Any other considerations or avenues you think I should explore? Thank you
doctor
Answered by Dr. Geeta Sundar (2 hours later)
Brief Answer:
Hi, sorry--you had not mentioned the exercise part in your history and henc

Detailed Answer:
Hi, sorry--you had not mentioned the exercise part in your history and hence my advise. Yes there has to be a cause for all these symptoms. A further work up to find any other mineral or vitamin deficiency, any metabolic cause is indicated. I am sure your doctors will do that. I can suggest an abdominal ultrasound for adrenal cause and MRI brain to rule out a pituitary problem. Incidentally, dipping of Blood pressure at night (nocturnal dipping) is normal. Wishing you the best--regards
Above answer was peer-reviewed by : Dr. REMY KOSHY
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Dr. Geeta Sundar

Internal Medicine Specialist

Practicing since :1975

Answered : 1329 Questions

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Suggest treatment for constant fatigue and headaches

Brief Answer: Hi welcome to HCM, I have read your history in detail Detailed Answer: Hi welcome to HCM, I have read your history in detail. Let us simplify things--what you need is to consult a good dietician-- and follow her advise. And lose weight and follow a good exercise routine regularly with no breaks. This is how I would deal with patients like you. Also find a good internist who can enforce this good lifestyle. Sometimes we require less of expensive tests and more of simple lifestyle changes to re-set our disturbed body functions ---regards. Mention your Height, Weight, and regular food habits so that our dietitians in HCM panel will provide you the proper diet chart.