Brief Answer:
Calmate hija--- tranquila

Detailed Answer:
So the world still goes around according to the traditional laws of physics even though at this time it seems like things are topsy turvy.....right?

I am a bit surprised at the fact that the endocrinologist chose to deflect the diagnosis of reactive hypoglycemia. I am not sure I can immediately understand or appreciate his notion that this is primarily a neurological issue being triggered by a condition of TMJ although if it ends up being something like that it wouldn't totally knock me for a loop either. There are things that occur such as passing out spells (syncope) having to do with overstimulation of the vagus or even trigeminal nerves which could be triggered by chewing movements that could go on to cause drops in blood pressure, heartrate, etc. which could lead to changes in alertness and mental status.

Having said that I still would be very interested in knowing the details of how the endocrinologist came to decide that you don't have a reactive hypoglycemia and instead start thinking along the lines of primarily a neurological issue. Can you get a copy of his consultation report and send it to me by uploading it here or by email in .pdf format? I'd also like to see copies of all lab reports. I would also like to review your logged glycemic episodes during times after you'd eaten vs. how you felt and the times when things started.

Now, there is one thing you mentioned that took me a bit by XXXXXXX ....Did I know you were taking meclizine? Neurologists in general (including THIS ONE) don't really like meclizine to be used for things such as vertigo or BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV). I don't recall knowing that information but why don't you tell me a bit about that problem and then, also what is the timing between how you've been feeling and the use of that medication? Do you do a lot of high impact aerobic type of training? That might be one explanation as to why you could have BPPV. There are ways of combatting the problem without the use of medication. Has any method been tried to correct your "dizziness" or "vertigo" other than using this medication?

If we were to approach this from a purely neurological perspective and assume for a moment that the idea of a reactive hypoglycemia or other endocrine disorder is simply not the right diagnosis then, my approach would be to:

1. PERFORM a detailed NEUROLOGICAL EXAMINATION on you and especially focus on the autonomic system, blood pressure changes to positions of lying, standing, and in between (tilt table testing...or its clinical equivalent....

2. I would get an MRI of the brain (and MRA) in all likelihood and possibly with contrast (gadolinium) just to make sure that something wasn't present intracranially or in the pituitary/hypothalamic axis that could be causing this such as a microadenoma or Schwannoma, etc.

3. I think I would definitely want to send you for at least a tilt table test, a Holter monitor, an echocardiogram, and quite possibly full autonomic function testing.

Of course, all this could be changed, modified, or deleted depending upon examination results and labs.

Sure you don't want to come to XXXXXXX now? LOL!

Gotta go pick up my daughter from piano classes and then, see another patient, get my afternoon workout in for the crossfit competition coming up and then, I'll check to see if you've got any thoughts? Weather is still passable here in the Rock 'n Roll Capital of the World! LOL!

Oh, one favor to ask my dear....could you still go back to the last set of questions and throw a rating on there (did you CLOSE the query as well?.....I'm not sure)....but those ratings and comments are pretty important to us on these sorts of networks....it's a way of puffing out our chests and letting other prospective patients know that you give us the THUMBS UP! HA! Of course, if that's not the case then, please disregard what I just said---- I hope it's to the contrary......talk to you soon.

This query required 41 minutes of physician review, research, and time to envoy patient response.

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Brief Answer:
I would be honored tobe managing your treatment.

Detailed Answer:
although I would be very happy for you to come to XXXXXXX and get this problem taken care of I certainly don't want you to go to a lot of extra trouble and expense if things can still be taking care of down in the lone star state.

I agree that some of the things the endocrinologist seems to be suggesting especially in terms of this being primarily a neurological issue when it seems to really be clearly related to the times that you actually eat to me doesn't make sense.

And especially since you say that things seem to be getting better just with time and some probable modifications on how you are eating things and what you are eating then, the whole notion of this being produced by some kind of nerve irritation upon chewing really doesn't set well with me as a neurologist.

Having said that-the endocrinologist has the advantage in having been able to examine you, order appropriate lab tests, and draw conclusions from those facts. Therefore, I still believe that the best course of action at this time is to get a hold of all The results of lab tests and the doctors notes and put a copy of that on the site for me to review. also, if you already have an appointment set up with a neurologist locally I would suggest going to see them and allowing them to review this information as well.

However, in the meantime I would definitely continue to keep track of your glycemic status especially prior to meals and after meals. I would also keep track specifically of symptoms that you are feeling and how long after you begin eating they come on. I would avoid the carb cycling at this point and simply try to bring things more into balance on a day-to-day basis.

Then, if things continue to improve or even normalize I think you would have a very strong case against there being any neurological components such as what the endocrinologist suggests.

Now here are a couple of things to keep in mind and think about if you decide that you would actually like to consider a road trip to the side of the country (careful you might like it so much that you will want to stay and enjoy XXXXXXX at its best in the fall and winter!). you will need to check with your insurance company to see what sorts of benefits they pay on lab tests, diagnostic studies, and physicians fees if in fact you were to go out of state. I actually think there would be a minimum of testing that would need to be done since you have had at least some testing done by the endocrinologist, you will likely have at least a few more tests done by the neurologist, and when it's all said and done your condition may improve to the point that it will not be necessary to do much more in terms of testing and simply be a matter of putting everything together and tweaking results as well as protocols and parameters of how you should be eating and exercising.

Let's see what happens over the next few days or weeks as you are trying to get records together to upload to the system and in the meantime making your own minor tweaks to what you have been doing in order to feel better.

This particular response required a total of 27 minutes of physician time to read, research, and compile an envoy to the patient.

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