question-icon

What causes dizziness and tremors in the hands and feet?

default
Posted on Sat, 17 Sep 2016
Question: might be a lot for on line review , went to ER 6/2016, with severe dizzy, shaking trembling hands feet (cold nervous), felt close to passing out, (did not,) sea legs, equilibrium, not spins, felt the floor uneven, no head ache, this was after about 6 weeks of near pass out and near dizzy, 2016 july, started to feel dizzy and as I become more nervous my hands shake and stomach starts to hurt more XXXXXXX 16 er doc did , cat with contrast and nuclear stress test, blood tests, ultrasound, results were brain and heart fine. in hospital 3 days
seems as zanex helps the shake and the stomach pain the dizzy the panic etc.
very low dose .250 in 4 quarters or .0625 3 times a day
symptoms were worse in shopping malls, grocery stores, had similar symptoms on and off for 3 years , but much less severe since aug 2013. on and off
2013 i stopped niacin, and the dizziness went away. after all medical tests were completed all good. we thought it was the niacin. XXXXXXX 2014 after exercise felt a bit dizzy, sea legs, no appetite, woke up next day heat prickle feeling on face like going to pass out, dizzy, sweaty and I hit the floor and passed out, went to ambulance, ER said I was dehydrated, 2 liters IV fluids, and I felt great.
typically for years i work out every day light weights, with long walks, several miles every day. 60 degrees to 110 degrees in Vegas never a problem. always hydrated
working out august 2014 lifted weights over head, and major pain lower left abdomen.
stomach was vibrating major pain, went to doc,
went for colonoscopy and everything came out fine. after test, and prep for test the pain went away. stopped aspirin for 6 days and vitamins and pain went away after prep..
stomach pain came back 2015 when I work out, feels like I did 1000 sit ups.
stomach hurt severely july 2016, loss of appetite, hands shaky after work out, I stopped the work outs in july 2016, the stomach pain started to go away in lower left and hands started to shake less. still no work outs, aug 25 2016 and feeling better but still notice slight pain,

going to new cardiologist and neurologist next week
could be stomach issue? (lower left) and a panic issue? claustrophobia? had light tremors for 30 years,

new triggers
1. seems heat causes me to be dizzy, near pass out feeling, this is new august 2016 when out side at car wash waiting for car, I noticed I felt like almost pass out sitting outside. yes 110 shade, went in A/C 6 mins heart rate went normal, the feeling of passing out passed. no zanex was taken. just water and was almost back to normal.
2. exercise work out or walking caused me to feel like sea legs, almost dizzy, no work out since july 2016
3. stomach when nervous loss of appetite, lost 6 pounds and gained it back after start of zanex july 2016
4. XXXXXXX and july could not walk into mall or store with out full blown panic much better now with zanex. I can shop but by the time I get to cash register I must get out fast
5. bp at rest at home 110/65 60 beats white coat at dr sometimes
let me know what you think.
appreciate your review




doctor
Answered by Dr. Olsi Taka (6 hours later)
Brief Answer:
Read below.

Detailed Answer:
I read your question carefully and I understand your concern.

Judging from your history of several symptoms involving different anatomic systems, with normal tests, as well as the fact that Xanax (an antianxiety medication) helps with alleviating your symptoms I would say that the most likely cause would be an anxiety disorder with episodes of panic attacks.

The fact that it causes gastrointestinal symptoms is not surprising, many common stomach and intestine issues like gastritis or irritable bowel syndrome are related to anxiety. The episodes of near syncope which are reported are also more common in anxious individuals.

It is good that your are seeing a cardiologist and a neurologist. I believe it should be discussed with the cardiologist the necessity or not of doing a prolonged monitoring of heart rhythm, a 24-48 hour Holter EKG to make sure there are no arrhythmias at the root of the fainting (if that has not already been done that is).
With the neurologist it should be discussed the possibility of initiating a more long term treatment (as Xanax shouldn't be used for long term, causes dependence and tolerance), such as a SSRI antidepressant to control the anxiety.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Olsi Taka (26 minutes later)
Hi Dr.
I just attached the results from hospital visit from XXXXXXX 2016 ER
it did not attach first time.
my doctor wanted me to start Zoloft, but when I had horrible panic attack in grocery store around first week in july 2016, I thought Zoloft works immediate like zanex,and it does not so I went from bad to very very bad, that's when stomach started to hurt severly again, hands shake etc, felt nauseous could not eat lost 6 pounds in week etc, was horrible until the zanex leveled me out. and I stopped working out, then started to feel better.
I take a 5mg zanex and break it into 8 doses, not to get hooked on it. and so I can gradually weed myself off it. I take 3 or 4-- 1/8ths per day, or 1/2 pill a day.
cardiologist thought exercise could trigger the sea legs, feeling unbalanced, but those tests were negative, yes agree on the Holter monitor and try to cause the trigger, thanks again XXXXXXX

doctor
Answered by Dr. Olsi Taka (8 hours later)
Brief Answer:
Read below.

Detailed Answer:
Hello again and sorry for answering a little late.

I read your additional file and it only reinforces my first opinion.

The thing with Zoloft or other SSRIs is that their action needs some time, may take a month to come into full effect. Actually in the first days of treatment they may paradoxically increase the anxiety level. Personally when I initiate a SSRI in my patients I accompany it with Xanax (or similar drugs) for the first two weeks interrupting it afterwards and continuing only with the SSRI, in order to counter that initial anxiety.

So I do not think that you have had an adequate trial of Zoloft. I remain of the opinion that an SSRI should be used for a month.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Olsi Taka (38 hours later)
Hi Doctor,
today I noticed I had a short 15 min drive to the food store, this might have been A trigger, as when I got into store I started to have a mild panic attack, by the time I got to the register I felt I needed to get out of store asap.
I do not take a full dose of the zanex as I don't want to get hooked. seems I need to take more zanex every day. but I am still under 1/2 of a pill per day, over 4 doses a day. in July 2/8ths of a 5mg was working, now 4/8ths
my last two episodes were caused by standing out side at car wash last sat, for 20 mins in 110 heat in shade, and immediate relief when sat down in a/c, and the drive to the food store today. I notice while at stop light I can not look at the cars as they pass right to left, kind of make me nauseous.
from what I wrote,do these symptoms correlate to any know major medical problem, from what you see?
Thank you Doctor
XXXX


doctor
Answered by Dr. Olsi Taka (2 hours later)
Brief Answer:
Read below

Detailed Answer:
Hello again!

Fortunately your account doesn't point to serious medical condition, I mean not threatening ones, that's why I'm saying fortunately.

It only reinforces my previous opinion about an anxiety disorder with panic attacks being the origin. As I said before Xanax is not used long term cause it creates dependence and tolerance. Tolerance is precisely what you describe, previous dose not achieving the same effect and having to increase dosage to achieve it. That is why ssri or other antidepressants are advised to avoid that, they don't create tolerance.

Apart from the medication psychotherapy is also strongly recommended. It would help you identify pattern of thinking leading to anxiety and relaxation techniques.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3674 Questions

premium_optimized

The User accepted the expert's answer

Share on
What causes dizziness and tremors in the hands and feet?

Brief Answer: Read below. Detailed Answer: I read your question carefully and I understand your concern. Judging from your history of several symptoms involving different anatomic systems, with normal tests, as well as the fact that Xanax (an antianxiety medication) helps with alleviating your symptoms I would say that the most likely cause would be an anxiety disorder with episodes of panic attacks. The fact that it causes gastrointestinal symptoms is not surprising, many common stomach and intestine issues like gastritis or irritable bowel syndrome are related to anxiety. The episodes of near syncope which are reported are also more common in anxious individuals. It is good that your are seeing a cardiologist and a neurologist. I believe it should be discussed with the cardiologist the necessity or not of doing a prolonged monitoring of heart rhythm, a 24-48 hour Holter EKG to make sure there are no arrhythmias at the root of the fainting (if that has not already been done that is). With the neurologist it should be discussed the possibility of initiating a more long term treatment (as Xanax shouldn't be used for long term, causes dependence and tolerance), such as a SSRI antidepressant to control the anxiety. I remain at your disposal for other questions.