[23M] With chronic spacey feeling, hand tightness, chest pain, and increased sweating

Patient Description

A 23-year-old male has been experiencing a constant 'spacey' feeling during the day for the past two years, which improves at night. This feeling has gradually become constant over time and affects his daily activities and ability to work. Being in the sun for long periods, standing for too long, and walking in stores exacerbate this feeling. He has tried anxiety medications and steroids without improvement. Additionally, he experiences hand tightness, chest pain, and facial redness. He has headaches in the center of his head a couple of times a week and occasional vertigo. He does not experience dizziness, changes in vision, or shortness of breath. He has palpitations and a racing heart at random times, but his EKG and stress test results are normal. He feels tightness in his hands when closing them or holding something, but no numbness or tingling. Over the last six months, he has experienced increased sweating when outside or doing strenuous activities inside, with sweating significant enough to wet his clothes and drip off his forehead. His medical history includes anxiety, depression, acid reflux, sleep apnea, and fatty liver, all diagnosed a year ago. He is currently taking Cymbalta 60 mg once daily, Pantoprazole 40 mg once daily (for the past 6 months), and Vitamin D3 2000 IU once daily. He has no allergies or adverse reactions to medications and does not take any other over-the-counter medications, supplements, or herbal products. He has not been exposed to any chemicals, toxins, or other environmental factors, and has not traveled recently. His family history includes his mother having lupus, thyroid problems, diabetes, and a past of breast cancer, as well as a family history of fatty liver and carpal tunnel. His father has bipolar disorder. His last thyroid test showed a TSH level of 3.5, free T3 of 4.3, free T4 of 1.20, and thyroxine-T4 of 7.5. In the last three years, his weight has increased from 160 lbs to 250 lbs.

Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Thyroid Dysfunction

Rationale: Your symptoms of fatigue, weight gain, and feeling "spacey" could be related to thyroid dysfunction. Although your thyroid test results are within the normal range, they are on the higher end of normal, which might suggest subclinical hypothyroidism.
Typical Treatments/Testing: Further evaluation by an endocrinologist might be necessary. They may recommend additional thyroid function tests or a trial of thyroid hormone replacement therapy.

2. Chronic Fatigue Syndrome (CFS)

Rationale: The constant "spacey" feeling, fatigue, and inability to work could be indicative of CFS, especially since these symptoms have persisted for two years.
Typical Treatments/Testing: Diagnosis is often clinical, based on symptom criteria. Treatment focuses on symptom management, including medications, cognitive behavioral therapy, and graded exercise therapy.

3. Autonomic Dysfunction

Rationale: Symptoms like feeling worse when standing for long periods, palpitations, and increased sweating could be related to autonomic dysfunction, such as Postural Orthostatic Tachycardia Syndrome (POTS).
Typical Treatments/Testing: A tilt table test can help diagnose POTS. Treatment may include increased fluid and salt intake, compression stockings, and medications to manage symptoms.

4. Anxiety and Depression

Rationale: Anxiety and depression can manifest with physical symptoms like chest pain, palpitations, and a "spacey" feeling. Your history of anxiety and depression could be contributing to these symptoms.
Typical Treatments/Testing: Ongoing management with a mental health professional, including medication adjustments and therapy, can be beneficial.

5. Sleep Apnea

Rationale: Sleep apnea can cause daytime fatigue and a "spacey" feeling due to poor sleep quality. Your diagnosis of sleep apnea might be contributing to your symptoms.
Typical Treatments/Testing: Ensuring optimal use of CPAP therapy and follow-up with a sleep specialist can help manage this condition.

What you can do

Thyroid Dysfunction

Action: Consult an endocrinologist for further evaluation and possible treatment.
At Home: Maintain a balanced diet and monitor your symptoms.

Chronic Fatigue Syndrome

Action: Seek a referral to a specialist who can diagnose and manage CFS.
At Home: Pace yourself with activities, prioritize rest, and consider gentle exercise.

Autonomic Dysfunction

Action: Consult a cardiologist or neurologist for further evaluation.
At Home: Increase fluid and salt intake, wear compression stockings, and avoid prolonged standing.

Anxiety and Depression

Action: Continue working with your mental health provider to optimize your treatment plan.
At Home: Practice stress-reducing activities like mindfulness, meditation, and regular exercise.

Sleep Apnea

Action: Follow up with your sleep specialist to ensure your CPAP therapy is effective.
At Home: Maintain a regular sleep schedule and avoid alcohol and sedatives before bedtime.

General Tips

Action: Keep a symptom journal using MDandMe to track your symptoms, triggers, and any changes over time. This can provide valuable information to your healthcare providers.
At Home: Stay hydrated, eat a balanced diet, and engage in regular physical activity as tolerated.

What you should look out for

Given the complexity of your symptoms, it's important to seek medical care if you experience any of the following:

Severe chest pain or shortness of breath
Fainting or severe dizziness
Unexplained weight loss or gain
New or worsening symptoms that significantly impact your daily life

Remember, while I can provide information and suggestions, it's crucial to consult with real healthcare professionals to receive a formal diagnosis and appropriate treatment. If you have more questions or need further assistance, feel free to continue the conversation.