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    Second Opinions
    Tom_S posted:
    Good afternoon:

    I've visited my family physician several times within the past six months for a number of issues, and have also had a few tests. Specifically, I frequently experience bouts of nausea, dizziness, foggy headedness (e.g., difficult concentrating, mind feels blank), difficulty focusing my eyes, feelings of adrenaline in my stomach (butterflies), tinnitus and trembling. I should point out that I'm able to sleep, and when I wake up in the morning, these symptoms seem to start within about 15-20 minutes of waking up. I also get these weird feelings, usually after eating, where I feel like my muscles want to tighten up. During this time, I feel as though my speech is impacted, and I can't speak clearly.

    I've had the following tests:
    - Blood work (Everything OK)
    - EKG (Everything normal)
    - Blood pressure (107/68)
    - Gastroscopy/Colonoscopy (Nothing abnormal)

    After these tests, my doctor has decided that my problem is anxiety, and has referred me to a psychiatrist (I have an appointment scheduled, but it's not for another month). I asked if it could be neurological, and he said the symptoms are not consistent with a neurological condition. Should I trust my doctor's opinion, or should I seek a second opinion? Does anybody have experience with similar symptoms?

    lifes responded:
    Hi Tom,

    Isn't the body just so mind-boggling---it makes weird symptoms we can't always understand. Worse, because we want to understand so go to drs, who say in so many words 'It's all in your head'. Exasperating! So let's go over some things first.

    Docs look for symptom patterns in physical illness. If it doesn't fit... it must be the mind. Second, some physical symptoms are non-specific-- it could fit a 100 problems. If it doesn't fall into a symptom must be the mind. In their defense, docs only have so many tools, so it often comes down to patients figuring things out themselves.

    I don't know your age, situation, personal habits, what you like to eat, your job, your worries, your stresses, etc. Some of the things I'd suggest to ask yourself are:

    1. What is happening in those 15-20 minutes after waking up? Do you feel rushed? bombarded? pressured? worried? Do you have a wife/gf, or kids who make morning 'demands'? If you could change one thing about your morning routines, what would it be?
    2. Does it happen every day, no matter the time you wake up? Is it always "15-20 minutes after"? If you woke up 15 minutes earlier, do you think you'd have just 5 mins before symptoms... or 35 mins before symptoms? e.g. just what is it about those 15-20 minutes that start the symptoms?
    3. You said eating triggers it. You don't say What you eat. Do you have breakfast before the symptoms? Do the symptoms come if, say, you skip a meal? eat 3 hours later? eat less? eat more? Just what is this connection to food/eating?
    4. You also don't say bowel habits---food/eating triggers peristalsis in every person...peristalsis triggers bowel to move downward...most people have a BM within an hour or two after eating. The vagal nerve registers pressure from stool in the rectum and reacts to straining, especially in constipation. The vagal nerve can produce symptoms like heart beat changes (to heart attack), sweating, nausea, etc.
    5. For these 'foggy' symptoms and can't concentrate... When you first wake up, does your mind feel clear? Does foggy come when you begin thinking of the day? What's happening in the 30 minutes before you get foggy? Would it help to write several notes before bed, so "foggy" doesn't interfere in the morning? If it begins after waking but only after you begin thinking about "what I need to do today", what do you think "foggy" is telling you? Most times, "foggy" would "say", "Gee, I 'can't think straight'--can ya slow it down there buddy? Give me a break already?" Men and women can experience "fogs"---often, it's a matter of figuring out what your brain needs, including "extra time".
    6. Adrenaline is a wonderful but powerful aspect to our bodies. As the "fight-flight" hormone, it saved our ancestors from big bad animals. It heightens senses, from eyesight, to hearing, to muscular readiness---Ancestors could run faster, hear and see better, strike harder--- but we don't live those threats today. Adrenaline mis-reads what we need. What causes your adrenaline to spike so badly? All I needed at 7am was hearing my daughter say, "Mom I need money for..." for my adrenaline to spike. But 'money worries' could also come from me just thinking about money. What-or who-is triggering your flight-fight response??

    Lastly, how do you relax? How do you get out frustration? If you could work out, walk, run, get more exercise, it would use up some of that adrenaline. Likewise, true relaxing can help calm. Before I wasted money on a psychiatrist and on the drugs---because that is all psychiatrists DO---I'd see if I could change things I do, what I eat, how I relax, how I deal with stress, how I cope with kids/spouse, etc. I'd keep some lists to track my symptoms--what improves it? what starts it? what makes it worse?

    If my life changes did not help in 6 weeks, then I'd go to another doctor. But personally... I'd skip the psychiatrist. Your own doc can prescribe anti-anxiety or anti-depressant.


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