[45M] With episodic overheating and neurological symptoms

Patient Description

A 45-year-old male presents with episodic symptoms including acute tunnel vision, tinnitus described as gradual, temporary hearing loss, overheating, profuse sweating, sudden muscle fatigue in back and shoulder muscles, dizziness described as lightheadedness, and difficulty breathing. These symptoms are alleviated within minutes if the patient lies down with an ice pack on the neck and back. The episodes occur once every few months and are triggered by overheating. The patient has a history of four cervical fusion surgeries and suffered from constant, severe muscle spasms in the neck, back, and shoulders for about 12 years. The patient has narcolepsy without cataplexy, Raynaud's syndrome, hyperlipidemia, fatty liver, high blood pressure, and acid reflux, all diagnosed over 15 years ago. Current medications include Adderall, Omeprazole, Lisinopril, Metformin, Fenofibrate, Escitalopram, Sodium Oxybate, Flexiril (as needed), Crestor (three days per week), Vitamin D, Azelastine HCL nasal spray, and ProAir inhaler (as needed). The patient has allergies to amoxicillin, which triggers narcolepsy, and statins, which cause adverse psychological effects. No family history of heart disease, stroke, autoimmune diseases, diabetes, cancer, or psychiatric illnesses. No substance use reported. The patient uses ibuprofen as needed for neck pain.

Arora's Assessment

What might be happening

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

Heat Intolerance and Autonomic Dysfunction

Heat Intolerance: Your symptoms of overheating, profuse sweating, and relief with cooling suggest that you might be experiencing heat intolerance. This can be associated with various conditions, including autonomic dysfunction.
Autonomic Dysfunction: Given your history of narcolepsy and Raynaud's syndrome, autonomic dysfunction could be a unifying diagnosis. This condition affects the autonomic nervous system, which controls involuntary bodily functions like heart rate, blood pressure, and temperature regulation. Symptoms can include dizziness, lightheadedness, sweating abnormalities, and difficulty breathing.

Cervical Spine Issues

Cervical Spine Issues: Your history of cervical spine surgeries and muscle spasms could be contributing to your symptoms. Compression or irritation of nerves in the cervical spine can lead to symptoms like dizziness, muscle fatigue, and even autonomic symptoms.

Medication Side Effects

Medication Side Effects: Some of your medications, such as Adderall and Escitalopram, can have side effects that include dizziness, sweating, and changes in blood pressure. It's possible that these medications are contributing to your symptoms, especially when combined with heat or physical exertion.

Typical Treatments and Testing

Autonomic Testing: To evaluate for autonomic dysfunction, your doctor might recommend tests such as tilt-table testing, heart rate variability analysis, and sweat tests.
Cervical Spine Imaging: Imaging studies like MRI or CT scans of your cervical spine can help assess any structural issues that might be contributing to your symptoms.
Medication Review: A thorough review of your medications with your healthcare provider can help identify any potential side effects or interactions that might be causing your symptoms.

What you can do

For Dizziness and Lightheadedness

Stay Cool: Since your symptoms are triggered by heat, try to stay in a cool environment. Use fans, air conditioning, and wear light clothing.
Hydrate: Ensure you are well-hydrated, as dehydration can worsen dizziness.
Elevate Your Legs: When you feel dizzy, lie down and elevate your legs to improve blood flow to your brain.

For Overheating and Sweating

Cool Packs: Continue using ice packs on your neck and back during episodes.
Avoid Triggers: Try to avoid activities or environments that cause you to overheat.

For Muscle Fatigue and Spasms

Stretching and Exercise: Gentle stretching and strengthening exercises can help manage muscle fatigue and spasms. Consult a physical therapist for a tailored exercise program.
Pain Relief: Use over-the-counter pain relievers like ibuprofen as needed, but be mindful of the recommended dosage.

For Medication Management

Consult Your Doctor: Discuss your symptoms with your healthcare provider to review your current medications. They may adjust dosages or suggest alternatives to minimize side effects.

For Overall Health

Monitor Symptoms: Use MDandMe to journal your symptoms, track progress, and get insights. This can help you and your healthcare provider identify patterns and triggers.
Regular Check-ups: Schedule regular check-ups with your healthcare provider to monitor your condition and make any necessary adjustments to your treatment plan.

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 Shortness of Breath: If your difficulty breathing becomes severe or does not improve with cooling down, seek immediate medical attention.
Fainting or Loss of Consciousness: If you faint or lose consciousness, this could indicate a serious underlying issue.
Severe Chest Pain: Any severe chest pain should be evaluated by a healthcare provider immediately.
Worsening Symptoms: If your symptoms become more frequent or severe, consult your healthcare provider.

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