[35F] With lifelong dizziness, hypermobility, and slow wound healing

Patient Description

A 35-year-old female has been experiencing dizziness when standing her entire life, sometimes seeing stars or blacking out. This occurs almost every time she stands and is accompanied by an elevated heart rate, always above 90 bpm, and low blood pressure. She also reports slow wound healing, with injuries taking months to heal, though patches with medicine provide some relief. Additionally, she experiences lifelong tingling numbness, hypermobility in her elbows and knees, and has had two surgeries on her right knee without resolution of discomfort. She has been diagnosed with ADHD, high anxiety, depression, OCD, and eczema. She also experiences forgetfulness and head fog, exacerbated by lack of sleep, and has a habit of picking at her skin until it bleeds. Her past medical history includes low iron, low potassium, and low sodium. Current medications are Vyvanse 60mg chewable, Gabapentin 1200mg in the morning, Pantoprazole 20mg, Sertraline 100mg, Iron 325mg every other day, and Vitamin D 5000mg daily. Family history includes autoimmune diseases, cancer, and diabetes.

Arora's Assessment

What might be happening

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

Postural Orthostatic Tachycardia Syndrome (POTS)

Symptoms: Dizziness when standing, elevated heart rate upon standing, low blood pressure.
Rationale: POTS is a condition that affects circulation (blood flow). It involves the nervous system and is characterized by an excessive increase in heart rate when standing up. This can lead to dizziness, lightheadedness, and even fainting.
Typical Treatments/Testing: Diagnosis often involves a tilt table test, blood pressure monitoring, and heart rate monitoring. Treatment may include increasing fluid and salt intake, wearing compression stockings, and medications to regulate blood pressure and heart rate.

Ehlers-Danlos Syndrome (EDS)

Symptoms: Hypermobile joints, slow wound healing, skin picking, and possibly the tingling sensation.
Rationale: EDS is a group of disorders that affect connective tissues, primarily the skin, joints, and blood vessel walls. Hypermobile joints and slow wound healing are common symptoms.
Typical Treatments/Testing: Diagnosis is usually clinical but may involve genetic testing. Treatment focuses on managing symptoms, including physical therapy for joint stability and wound care for skin issues.

Iron Deficiency Anemia

Symptoms: Chronic low iron levels, fatigue, dizziness.
Rationale: Iron deficiency anemia can cause fatigue and dizziness due to a lack of red blood cells to carry oxygen throughout the body.
Typical Treatments/Testing: Blood tests to check iron levels, and treatment usually involves iron supplements and dietary changes.

Anxiety and ADHD

Symptoms: Forgetfulness, head fog, skin picking, high anxiety.
Rationale: Anxiety and ADHD can contribute to cognitive symptoms like forgetfulness and head fog. Skin picking can be a manifestation of anxiety or a related condition like dermatillomania.
Typical Treatments/Testing: Psychological evaluation and treatment, which may include medications like those you are already taking (Vyvanse, Sertraline), and behavioral therapy.

What you can do

Dizziness and Elevated Heart Rate

Immediate Steps: Increase your fluid and salt intake, wear compression stockings, and avoid prolonged standing.
Long-term Steps: Consult a healthcare provider for a tilt table test and other evaluations to confirm POTS. They may prescribe medications to help manage your symptoms.

Slow Wound Healing and Skin Picking

Immediate Steps: Continue using medicated patches for wound care. Try to keep your skin moisturized to manage eczema.
Long-term Steps: Consult a dermatologist for specialized wound care and eczema management. Behavioral therapy may help with skin picking.

Forgetfulness and Head Fog

Immediate Steps: Ensure you are getting enough sleep and manage your anxiety with relaxation techniques.
Long-term Steps: Continue your current medications and consult a healthcare provider for a comprehensive evaluation of your cognitive symptoms. They may recommend cognitive behavioral therapy (CBT) or other interventions.

Hypermobile Joints

Immediate Steps: Avoid activities that strain your joints and consider using supportive braces.
Long-term Steps: Consult a rheumatologist or geneticist for an evaluation of EDS. Physical therapy can help strengthen the muscles around your joints to provide better support.

General Health

Immediate Steps: Maintain a balanced diet rich in iron, potassium, and sodium. Keep track of your symptoms and any triggers.
Long-term Steps: Use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.

What you should look out for

Given the complexity of your symptoms, it's important to seek medical care for a comprehensive evaluation. Reasons to seek care more urgently include:

Fainting or severe dizziness
Uncontrolled bleeding from skin picking
Severe joint pain or instability
Significant changes in your cognitive function or mental health

Remember, while I can provide information and suggestions, it's crucial to consult with real healthcare professionals for a formal diagnosis and treatment plan.