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    What causes dizziness, fatigue and stomach discomfort?

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Posted on Wed, 25 May 2016 in Brain and Spine
Question: To whom it may concern,

I had an odd bout 2 weeks ago. I was out doing some work and hadn't eaten much that day. While driving home I started getting extremely dizzy and fatigued...almost out of it. I was getting over a fairly aggressive infection that day after being sick the previous week. While at the doctor's office I felt weak, incoherent, and like I was going to almost pass out. Almost vomited twice but ended up feeling a little bit better. For 3 days after that, I had this full stomach feeling which mostly subsided. The only I have had since then is this lingering fatigue that will not go away. I had a CBC done (no issues except slightly raised rbc count and platelets) and urine test which also showed nothing.

I was doing family history stuff and found out that my mom side ( she passed away from Sarcoidosis 2 years ago at 57) had 2 people (my second cousins) who separately suffered from Inclusion Body Myocytosis. They went paralyzed and passed away in their late 50's.

I'm scared that this lingering fatigue could be that illness. I was fine one day and hit me. Been feeling tired ever since. Any advice?
doctor
Answered by Dr. Shuba Hariprasad 4 hours later
Brief Answer:
Anemia, Thyroid problems, correctable causes first

Detailed Answer:
Hello
Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.

I've read through your query & understand the concern & anxiety behind it.

Being aware of the possibility of sarcoidosis or inclusion body myositis (IBM) is a good sign.

Fatigue, as you may already know, is a symptom associated with many illness (mild & serious). Having just recovered from an aggressive infection, some amount of fatigue is expected for a upto 10 days (approximately) after infection resolves till your key heals from within.
Other correctable causes for fatigue , which show up after or during an illness, like anemia, Hypothyroidism, sleep disturbances, medications, to name a few, should be evaluated for, if the fatigue persists.

If it has been more than month since your infection, I would do a thorough physical exam (Including a detailed neurological exam-given the family history of IBM) blood tests (thyroid function, electrolyte levels, complete blood count, peripheral smear, liver & kidney function tests, infection markers if necessary), a chest x-ray, ultrasound of the abdomen, electrocardiogram, echocardiogram.

Based on the clinical findings, result on the above tests I would make a treatment plan or get more information from specific investigations.

Fatigue alone is not diagnostic of either sarcoidosis or IBM.

Sarcoidosis commonly affects the lungs. & lymph glands (although it can affect any part of the body). It involve formation of (non infectious cause) of granulomatous in the affected parts causing damage/inflammation to the tissue and loss of function.

IBM involves damage to certain muscles (usually asymmetrical - one side of the body more than the other) and is characterized by muscle weakness. Sensory function remains intact. Dysphagia (difficulty swallowing) which is progressive may be present. Specific symptoms depend on the muscles affected.

A positive family history would caution me to keep a watchful eye on any suspicious symptom. A chest x-ray or a. CT of the chest can help to check for sarcoidosis of the lung, which if in early stages is confirmed by a biopsy of the affected tissue to check for granulomatous and/or infection. Any lymph node enlargement not associated with an infection or that is persistent need be biopsied

A neurological exam can help detect the type weakness and associated signs - positive signs (for instance, proximal more than distal weakness for the lower limbs/vice versa for upper limbs) and negative sign - absence of these favours diagnosis of IBM (no neural involvement- unless concurrent polyneuropathy exist like diabetes).
Electromyograph may be done to confirm clinical findings.

Although there is no cure for these diseases, there are measures that can taken to improve quality of life.
The important step is to know. I strongly recommend you see your doctor with these on erst if the fatigue lasts more than a couple of weeks after your infection is through. Correctable causes should be ruled out first.
At home : stay well hydrated, eat nutritious food, get proper sleep. Exercise in fresh air (once cleared by your doctor to do so), practice deep breathing exercises and yoga/meditation (helps to maintain homeostasis of the body & mind, relieving stress). Do not delay seeking medical attention, if this persists

I hope this helps. Please let me know if there is anything more I can do for you.
If not, please close this discussion & rate my answer.
Wish you good health
Regards,
Dr. Shuba Hariprasad

Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Shuba Hariprasad 1 hour later
Thank you for the replay ma'am.

Do you think anemia coukd be an issue if my rbc was on the high side?

Also...family history...

Dad's side
-skin cancer survivor never wore sunscreen in honduras. Got it removed early. No issues since.
- suffers from arthritis since 1985 and ankylosing spondylitis. Major issue but manageable with mess like celebrex.
Grandpa died of lung cancer after smoking for 17 years.

Mom's side...
-Sarcoidosis in 1994. Stopped working in 2006. Went diabetic after years of methotrexate. Passed in 2013. May she rest in peace.
-Grandpa died of myocardial infarction at 58. Smoked drank bad lifestyle.
- 1 brother died from liposarcoma at 22.
- 1 brother suffered guillon barre. Immobilised for a year. Was on iron lung. Recovered.
- two second cousins with IBM. One of their kids had cancer not sure which or what.

When I was at the docs office 2 weeks ago. Chest xray only revealed a gas bubble in stomach. Some leftover mucous in lungs but mostly clear.

Idk what else this could be. My wife says the chances of me catching IBM are extremely small since we don't think my dad was a carrier. But I do feel most of my muscle weakness in my forearms and right shin/gastronemius area. It's not bad. Just feels like walking on jello at times. Very onset.

What about me eating and feeling a little bit better at times? Today I felt out of it but after eating I felt better too. Do you think pancreatic cancer is possible? God I hope not..
doctor
Answered by Dr. Shuba Hariprasad 7 hours later
Brief Answer:
Recuperative phase after a severe infection

Detailed Answer:
Hello,
Thank you for the follow up.

You have a strong family history of auto immune disorders - AID(ankylosing spondylitis, sarcoidosis) & of cancer (which seems to be due to poor lifestyle choices).

Maintaining a healthy lifestyle will help to keep disease at bay. Although AID are present in the family, it doesn't necessarily mean that you will get it, it just means that the risk of acquiring it is higher than those with out a family history of AID.

If eating makes you feel better, please do so at frequent intervals.(every couple of hours) The body's metabolism during the recuperation phase, after an illness, is high and needs proper nutrition & Hydration.

A gas bubble in the stomach is normal in a chest x-ray (which includes the upper part of the stomach). Some residual mucus is also normal.

Carrier status of disease is assessed by making a pedigree (a family tree chart with at least 2-3 generations of family included with their disease status) & by genetic testing.
I understand how this may affect your peace of mind, but the chances of you getting the disease if your was a carrier is minute unless your mom had it too and IBM transmission is not properly under stood yet.

Pancreatic cancer, in fact, any cancer have a very small chance of occurrence as most seem to have been acquired by poor lifestyle choices in your family.

Are you able to flex & extend your fingers, wrist, arms, knees & hips normally, on both sides of the body.
Are you able to carry on your usual routine?
If yes, then you are fine.
if you feel an obvious weakness on performing these movements, especially on one side of the body, you should see a doctor to rule out muscle weakness.
I suggest that you focus on recovering from your infection.
I won't ask you to forget about the possibility of disease,instead push it to the back of your mind and focus on today. If something suspicious develops you can always get help right away.

Many times diseases & the morbidity /mortality associated with it is due to lack of awareness & fear of the unknown.
You are perfectly aware and are willing to seek help. This makes a world of difference. Worrying about it will not make it go away. Instead you sought advice & help.
Be aware of your body, listen to your instincts, have a healthy lifestyle. Any red flags you sense should be monitored.

Hope this helps.
Please let me know if I can be of more help.
If not, please close this discussion & rate my answer.
Wish you the best of health.
Regards,
Dr. Shuba Hariprasad


Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Shuba Hariprasad 1 hour later
Ok thank you.

My last statement...

I'm not sure if it's weakness I feel or muscular fatigue. When I type at work it feel like my forearms are going through one of my old weight workouts. Going up and down stairs is fine but I feel more muscle burn than usual. Even typing this from my XXXXXXX phone is making my forearms and lower bicep area a bit like I just got done lifting. I guess what u nerves me is that simple tasks feel like working out and I was already a pretty fit guy.

Thank you
doctor
Answered by Dr. Shuba Hariprasad 4 hours later
Brief Answer:
GBS (Guillain Barre Syndrome)

Detailed Answer:
Hello,
Thank you for the follow up.

You have described fatigue on your limbs. Some amount of fatigue is usual. It is difficult to quantify, however, proper rest, balanced diet & Hydration should show improvement if the fatigue is due to the after effects of the infection (more so if you took a strong dose of antibiotics & steroid therapy)

Your description of the symptoms point more toward fatigue than muscle weakness and unlikely to be IBM as you experience it bilaterally (on both sides of your body).

However the extent of your fatigue does concern me (typing causing fatigue). Also makes sense why you are worried about it.
I would like to rule out GBS (Guillain Barre syndrome) which results after a severe infection in the body.
I would do a neurological exam to check for the weakness typical of GBS. This, if present, requires hospitalization, and intravenous immunoglobulin therapy for 5 days.
It is basically an immunological response, to an infection, that affects the nerves.
If your fatigue gets worse or doesn't improve with the above measures, I suggest you see your doctor right away to rule out GBS, in addition to the correctable causes mentioned in my previous replies

This is treatable and has a good prognosis if caught on time.

Hope this helps.
Please let me know if there is anything else I can help you with.
If not, please close this discussion & rate my answer.
Wishing you good health.

Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Deepak
doctor
Answered by
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Dr. Shuba Hariprasad

General & Family Physician

Practicing since :2002

Answered : 1087 Questions

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