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Molly Maloof, MD

Director of Clinical Content
@DoctorBase

My Doctors Are Confused

I come to you after a long 2 months, I've been bedridden with no answers & Cardiologists Are Lost.

"Diagnosed" Symptoms: NSVT, PVCs, SOB, POTS, Tinnitus, Severe Fatigue, chest pain.

Tests completed:

Echo: Normal, Trivial MR

Treadmill: Norm, Stopped at 3 mins b/c of SOB

ECG: SVT, NSVT, PVC

TSH: Norm

HS-CRP, BNP, D-Dimer: Norm

Electrolytes: Norm

Ferritin: Slightly Low

MRI: To Be Done

Anxiety: Ruled Out

I cant walk more than 20 steps without severe SOB. What else can i test/do?
Poster
  • Male | 23 years old
  • Complaint duration: 54 days
  • Medications: None
  • Conditions: None

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Featured Answer

4 UpVoted this answer Gregory Fryer, MD Family Medicine, Clarksville Otumdi Omekara, MD Preventive Medicine Specialist, Portland
I am a cardiologist who is trying to help patients, like you, with the multitude of conditions the Dysautonomia Syndrome a.k.a. 'The Invisible Disease' encompasses, including Autonomic Nervous System Dysfunction, Chronic Fatigue Syndrome, Fibromyalgia, Adrenal Insufficiency, POTS (Postural Orthostatic Tachycardia Syndrome).

These syndromes seem to be connected to Mitral Valve Prolapse Syndrome, Tachycardia, Medication and Substance Sensitivity, Lyme disease, Thyroid & Endocrine Organ Dysfunction, Interstitial cystitis, Irritable Bowel Syndrome, etc.

Over the course of the past twenty-five years, I have come across many patients with some of the above syndromes and conditions, many who have seen multiple specialists, only to finally end up being told that the testing was normal so that they needed to see a psychiatrist.

The lack of research into these syndromes has resulted in lack of knowledge about the best approaches and treatments amongst the medical community, leading physicians to believe that the patient’s symptoms are somehow made up and not real, hence the psychiatry referral.

It behooves the medical community to support a petition by my patient to to gain more funding for research to alleviate our patients’ suffering and allow them to regain their lives and functionality.

Here's the link:

https://www.change.org/p/increase-research-funding-for-me-cfs

Some useful information I provide my patients is given below:

1. Read Dr. Roland Hoffman's MVP-dysautonomia booklet: buy or download fromwww.Amazon.com & seewww.dysautonomiainternational.com,www.dinet.org &www.facebook.com re STOPPOTS- Southern Connection (use Dr. Patel as a reference).

2. Take Cardiamins with food twice daily (may chill or freeze if any after-taste), use discount code CMC to order from 1-888-769-4584 orwww.cardiamin.com . Avoid multi-vitamins and high dose vitamins unless deficiency is present.

3. Take Slow-release Magnesium twice daily.

4. Take Unicity Low Oz 1 to 2 packets daily to hydrate the body more effectively than ‘sports drinks’ (enroll atwww.unicityhealth.com using discount code # 105579801.

5. Use Unicity Calmplex 1 to 2 tablets as needed for anxiety or insomnia (enroll atwww.unicityhealth.com using discount code # 105579801.

6. For weakness or dizziness, use below knee graduated pressure support hose (15-20 mm Hg, adjust pressure to tolerance & use to thighs or waist if needed to keep BP up. Get from medical supply store,www.discountsurgical.com orwww.procompression.com.

7. Use minimal doses of medications and adjust dose gradually when starting, adjusting or stopping treatments.

8. Try preservative free foods (e.g. Kosher foods) and avoiding gluten. Avoid stimulants e.g. caffeine, alcohol, tobacco, chocolate, MSG (mono sodium glutamate in Asian foods).

9. Start a program of gently increasing activity e.g. walking, decrease portion sized and follow the DASH diet – available on the web, to lose weight and feel better. Increase salt & fluid intake if BP low.

10. Download the free HealthTap App for free medical information from the App Store or Google Play or go to http://www.healthtap.com/dr-patel and request Dr. Umesh Patel as one of your team physicians.

Above all, remember you may have a common condition, which is not discussed well in medical school syllabuses, hence leading to patients seeing multiple specialists without getting a satisfying explanation for their seemingly 'unexplainable' symptoms and sensitivities to medications, foods, light, stress, infection, chemical exposure, etc., so do not get discouraged.
3 UpVoted this answer Terrill Theman, MD Cardiothoracic Surgery, Bethlehem Otumdi Omekara, MD Preventive Medicine Specialist, Portland
With a Normal Echo, that should exclude a Cardiomyopathy and your treadmil makes Ischemic heart disease less likely. I would not think the PVC's or NSVT on the treadmill would lead to your symptoms of SOB while exercising. I agree that some lung evaluation is in order now. Get an opinion from a Pulmonologist.
Alvin K. Eng
1 UpVoted this answer
Have a cardiologist and a pulmonologist team up to rule out alcohol induced dilated cardiomyopathy with extensive myocardial fibrosis, which compromises the function of the Heart as a pump, even in the presence of normal test results. The Heart ends to be booth-shaped in this condition.

In the absence of a heart disease, this could be severe chronic obstructive lung disease. More Social and chest hx is needed.
1 UpVoted this answer
Other things to consider are pulmonary, infectious etiology, vitamin deficiency, malignancy, and psychosomatic.
1 UpVoted this answer
Well aarhythmia can cause tachymyopath but this is excluded

(( bedridden)) is not clear if this is because of palpitations or dyspnea or obesity

Have a smart GP take good history and stop reading about arrhythmia as even meny GP or GIM or even general cardiologist understand it

Again lung investigation is worthwhile special PE
Ahmed Damas
1 UpVoted this answer
First, it is concerning to me that you describe your doctors as confused. That must be frustrating. The way to approach your symptoms is to look at the organ systems that could cause the problem as well as a few diseases. I would suggest starting with pulmonary or lung function tests and a CT scan of your chest. Thyroid problems have been ruled out. Next check a thorough physical exam and labs looking for autoimmune disease such as lupus. A cardiac MRI could be helpful here as autoimmune disease such as sarcoidosis and amyloid can cause plaques or lesions on the heart that would cause conduction abnormalities and arrhythmias.
Elizabeth McNeill Byrd, MD
1 UpVoted this answer
I didn't notice a chest xray in your extensive battery of tests. I would start there and am surprised that you haven't had one. It could be primary lung or spontaneous hemidiaphragm paralysis.
John Kuhn
1 UpVoted this answer
Have you had a Pulmonary evaluation (to assess lung function)?

Presume non-smoker -- if not, quit now!
Terrill Theman
1 UpVoted this answer
Sorry to hear of your frustration. You certainly have been run through the Gamet. Appears as though your conditions are both NMS and Visceral in origin. I would recommend a different path of investigation with both a Functional Medicine Physician and a Bio-mechanical Chiropractor.

Learn about FM: http://orangeparkchiropractor.com/functional-medicine/

Find CBP Doc: http://idealspine.com/what-is-chiropractic-biophysics/

Happy to help,

Dr. Otto
1 UpVoted this answer
I would recommend that you see a pulmonologist, specialist in lung disorders. This now sounds suspicious for some type of lung problem.
Gary N. Lesko