[41F] Experiencing severe confusion upon waking and multiple chronic conditions
Patient Description
A 41-year-old female presents with severe confusion upon waking, occurring 2-4 times a week for the past year and a half. These episodes last 30 minutes to an hour and resolve after eating or drinking. Symptoms include shaking, heart palpitations, and occasional sweating. The patient has chronic fatigue syndrome, mast cell activation, and unique symptoms such as a purple mottled pattern on her arms and legs when not cold. Her hands are swollen, red, and painful, responding well to Benadryl cream. She also experiences frequent infections (UTIs, sinus infections, eye infections) which exacerbate her confusion. Blurred vision occurs intermittently in both eyes, worse with contacts than glasses, and improves when glasses are removed. The patient has a history of PCOS (diagnosed in 2005), celiac disease, mast cell disorder (both diagnosed in April 2024), endometriosis (diagnosed in January 2022), and POTS (diagnosed in March 2022). She also has extreme environmental allergies, chronic sinusitis, and a history of inflammation and swelling, especially after IVs and surgeries. Current medications include a multivitamin, Zyrtec, methylated folate, extra vitamin D, and fiber. Family history includes autoimmune diseases and genetic conditions, with an upcoming genetic appointment at the University of Buffalo. The patient has experienced significant weight fluctuations, chronic inflammation, and has a history of broken bones in childhood. She also reports lifelong issues with inflammation and swelling, particularly after surgeries and IVs.
Show More
Arora's Assessment
What might be happening
It sounds like you have a complex medical history with multiple overlapping conditions. Here are some possible explanations for your symptoms:
Waking up confused, shaking, and with heart palpitations
- Hypoglycemia: Even though your blood sugar readings are within the normal range, your symptoms suggest that your body might be reacting to low blood sugar levels. This could be related to your body's response to infections or other stressors.
- Adrenal Insufficiency: Given your history of hormonal imbalances and the fact that your cortisol levels have been low, adrenal insufficiency could be a contributing factor. This condition can cause symptoms like confusion, shaking, and heart palpitations, especially during times of stress or illness.
Swollen, red, and painful hands
- Mast Cell Activation Syndrome (MCAS): Your symptoms of swelling, redness, and pain that respond to Benadryl cream are consistent with MCAS. This condition can cause a variety of symptoms due to the release of histamine and other chemicals from mast cells.
- Autoimmune or Inflammatory Conditions: Given your family history and your own history of autoimmune conditions, it's possible that an underlying autoimmune or inflammatory condition is contributing to your symptoms.
Frequent infections
- Immune System Dysfunction: Your frequent infections could be a sign of an underlying issue with your immune system. This could be related to your existing conditions or a separate issue that needs to be investigated further.
Blurred vision
- Dysautonomia/POTS: Blurred vision can be a symptom of dysautonomia or POTS, especially if it occurs intermittently and is worse with certain activities or stressors.
- Autoimmune or Inflammatory Conditions: Blurred vision can also be a symptom of autoimmune or inflammatory conditions, which you have a family history of.
What you can do
Waking up confused, shaking, and with heart palpitations
- Consult your doctor: It's important to discuss these symptoms with your healthcare provider. They may want to perform additional tests, such as a glucose tolerance test or cortisol level test during an episode.
- Keep a symptom journal: Use MDandMe to track your symptoms, including what you eat and drink, and any potential triggers. This can help your doctor identify patterns and make a more accurate diagnosis.
- Ensure regular meals: Try to eat small, frequent meals throughout the day to help maintain stable blood sugar levels.
Swollen, red, and painful hands
- Consult your doctor: Discuss these symptoms with your healthcare provider, especially given your history of MCAS and autoimmune conditions. They may want to perform additional tests or adjust your treatment plan.
- Use Benadryl cream: Continue using Benadryl cream as needed to manage the redness and swelling.
- Avoid triggers: Try to identify and avoid any potential triggers that may be causing your symptoms to flare up.
Frequent infections
- Consult your doctor: Discuss your frequent infections with your healthcare provider. They may want to perform additional tests to evaluate your immune system function.
- Practice good hygiene: Make sure to practice good hygiene, such as washing your hands regularly and avoiding close contact with people who are sick.
Blurred vision
- Consult your doctor: Discuss your blurred vision with your healthcare provider. They may want to perform additional tests to evaluate your vision and rule out any underlying conditions.
- Use glasses: Since your vision is better with glasses than with contacts, consider using glasses more frequently.
What you should look out for
Given the complexity of your symptoms and medical history, it's important to seek medical care as soon as possible. Reasons to seek care even more urgently include:
- Severe confusion or disorientation: If you experience severe confusion or disorientation that does not improve with eating or drinking, seek medical attention immediately.
- Severe swelling or pain: If you experience severe swelling or pain that does not respond to treatment, seek medical attention.
- New or worsening symptoms: If you develop new or worsening symptoms, such as difficulty breathing, chest pain, or severe headaches, seek medical attention immediately.
Remember, while I can provide information and suggestions, it's important to consult with your healthcare provider for a formal diagnosis and treatment plan.
Show More
1
Hugs
0
Comments
Save
3 mo ago