Dr Dimari's Medical Sciences Thread - Read the first post

[Dr Dimari]

Tiej

i am waiting for results back and college acceptance letters . but my first choice was medical science

Good Luck! I know how much of a hell that was, and I was so excited the week of the deadlines come up, I got my place. I was very happy!

[Dr Dimari]

Seaine

Hi, I am wondering if you know of likely underlying conditions for hypersomnia. I don't have anything obvious like multiple schlerosis, and as fas as I can tell I'm not depressed (and no doctor has suggested to me that I am).

I've had the symptoms for it since I was ten or eleven - sleeping at least 9 or 10 hours per night and up to 12 or 13, extremely strong urges to take naps during the day sometimes lasting 2 hours, extremely hard to make myself get up in the morning/after naps, sleep paralysis, feel sleepy all the time despite the amount I sleep. I was diagnosed a couple of months ago with a sleep study that basically just ruled out everything else such as narcolepsy, RLS, or periodic limb movement. They had me sleep for about 7 or 8 hours and then had me take 5 naps throughout the day. I had no trouble falling asleep for any of the naps (after all, 7 hours of sleep is not even close to enough!) and my average time to fall asleep was less than 10min.

I also have chronic migraine syndrome, currently at 1 or 2 migraines per week on three preventatives + migraine rescue triptan. One of my childhood neurologists suggested that chronic fatigue was associated with migraines when my mother complained about my sleeping, although he did fail to diagnose or treat my hypersomnia.

I also have low blood pressure - 90/60 resting. I also have Raynaud's syndrome, started maybe 2 years ago; that is undiagnosed but I am not stupid and I can use the internet. I have also fainted unexpectedly, went to the doctor for that. The internet tells me that these three things can be associated with hypersomnia. When I fainted I was tested for anemia and I did not have it. My thyroid was also tested but they said it was normal. I've heard that people with hypothyroidism usually weigh too much but I weigh 110lbs at 5'2" and I eat whenever I want, so it seems unlikely. However, I've heard some others with hypersomnia say that their thyroid tested within normal range, but thyroid medication still helped them.

One of my neurologists mentioned that a vitamin B-12 deficiency could cause fatigue, but then he did not test me for it. Perhaps he decided I didn't have enough of the symptoms...

What kind of tests should I ask for and what kind of things should I look into, before concluding that my problem is simply genetic and I'll just need to take amphetamines whenever I want to feel awake?

Hi Seaine, sounds like you've been through the mill a little.

Right, so, you've suffered with hypersomnia for a while now, and as you describe its having a problem with your day time.

What three preventatives are you on for your migraines may I ask?

The low BP can be a factor into fatigue during the day, and when taking propanolol its not the best of things; so it could be making you feel worse than what you need. Remember Betablockers act on the receptors to B-adrenaline, and so reduce the fight/flight physiological response your body has: slowing the heart down, dilating blood vessels, resisting dilation of bronchi etc.

Raynauds is quite a an uncommon diagnosis, but with your collection of symptoms, I can see it being a possibility. Please don't take offense, but if you could clarify your own experience to why you think raynaud's I'd be happy to reassure you that you do or don't.

I'm with Munkers here, I think you should definitely look into cortisol production (rather than adrenaline).

testing for this will include:
• A blood test - looking at serum/blood concentrations of cortisol and adrenocorticotropic hormone (ACTH)
• A urine sample - usually a 24-hour sample (http://www.labtestsonline.org.uk/glossary/urine_24.html)

Cortisol is the natural hormone that provides stress to the body, not only that, but alertness, a circadian rhythm of the body that cycles once a day, and helping us wake up in the morning. The cortisol in ones blood varies with the events of the day, but often is quite constant. The biggest peak should be at around 4-5am. This help your sleep pattern realign correctly in to NREM to allow you wake up without deprivation or problems. With people with low cortisol people can often feel tired and sluggish, not wanting to wake up in the morning. This, along with medication, lack of good solid sleep, and other medical problems such as thyroid, could be a problem.

Okay, so things you should ask for:

Full Blood count: recheck for anaemia, pernicious anaemia associated with B12 deficiency
White Cell count: ensure no immunological and possible stem cell pathway issues
U&Es: to see if your kidneys are functioning okay, and see if they are in anyway misbehaving that cause a knock on effect on the blood
TFTs: looking at TSH, T3 and T4 samples again to try and rule out hypothyroidism
Fasting Glucose and HbA1c: rule out any diabetes or similar syndrome
Cortisol testing: as above

Abdo x-ray with contrast or CT with and without contrast to check the adrenal glands and kidneys

[Jonnnn]

I have terrible Blepharitis. I wash my eyes daily but the crud that grows on my eyelashes keeps advancing and it seems like the dryness is getting worse by the day. Is there anything else I can do to make my eyes not feel like the Sahara?

[Seaine]

Munkers

No, beta blockers don't affect your adrenals like that. In your case, the beta blocker is acting on your blood vessels to help prevent the constriction that occurs in some migraine sufferers.

But yes, looking into your adrenal function would involve blood tests.

My only other possible thought is that maybe this is somehow autoimmune, but again, you'd be dancing in territory that not all physician agree about in terms of treatment or whether or not it's even a legitimate condition.

Really? It blocks epinephrine, so what is the difference between that and the adrenal gland producing less?

Munkers

My only other possible thought is that maybe this is somehow autoimmune, but again, you'd be dancing in territory that not all physician agree about in terms of treatment or whether or not it's even a legitimate condition.

I have heard that narcolepsy is an autoimmune disorder... but that was ruled out in the sleep study because I only went into REM during one nap, and not two or more. Also I don't have cataplexy or random falling asleep while standing and whatnot.

[Seaine]

Dr Dimari

What three preventatives are you on for your migraines may I ask?

Continous birth control - my migraines were more frequent and less responsive to the rescue medicine on the placebo week. Switching to constant hormone reduced the number of migraines I get by about 5 per month.
Migravent - a non prescription herbal supplement with anti-inflammatories in it such as magnesium (far more than I would ever get in my diet), feverfew, and butterbur. Recommended to me by a neurologist, reduced the frequency of my migraines by about 20%.
Propranolol - reduced frequency by about 75%, on top of the Migravent's reduction.

Dr Dimari

The low BP can be a factor into fatigue during the day, and when taking propanolol its not the best of things; so it could be making you feel worse than what you need. Remember Betablockers act on the receptors to B-adrenaline, and so reduce the fight/flight physiological response your body has: slowing the heart down, dilating blood vessels, resisting dilation of bronchi etc.

Yep, my blood pressure used to be around 110/70 before the Propranolol. However, I did not notice any significant worsening of my symptoms before compared to after I started taking it. In addition, it reduces my migraines from 4 per week to 1 per week, and I've probably tried around 20 other preventatives that did absolutely nothing for my migraines. Sure hypersomnia sucks, but migraines suck worse so they win in this case.

Dr Dimari

Raynauds is quite a an uncommon diagnosis, but with your collection of symptoms, I can see it being a possibility. Please don't take offense, but if you could clarify your own experience to why you think raynaud's I'd be happy to reassure you that you do or don't.

Sure - about two years ago, I was at college in a significantly colder climate than I normally live in (about 20F colder in the winter). It was the first winter that I had been there. One night while driving I noticed that the last two fingers of my right hand were numb, and when I got inside I noticed they were also stark white while the rest of my hand was normally colored. There was a clearly defined line between white and normal color. After about 20 minutes it went away. A couple of months later, I was started on Propranolol and this started happening much more frequently, always to my hands or feet and always in the cold. Raynaud's is a known side effect of Propranolol. Since I had this occur before I actually started taking Propranolol, I suppose I have it very mildly and the Propranolol + colder climate made it worse. Pictures of Raynaud's on the internet look just like my hands/feet when it happens - a good example: http://www.drmueller-healthpsychology.com/i//Raynaud_s_Syndrome_hands.jpg

I figured there was no point in going to the doctor about it unless it got worse. The info I find on it basically just says it could be a beginning symptom to a slew of other disorders and there's no point unless I start getting other symptoms.

Dr Dimari

I'm with Munkers here, I think you should definitely look into cortisol production (rather than adrenaline).

testing for this will include:
• A blood test - looking at serum/blood concentrations of cortisol and adrenocorticotropic hormone (ACTH)
• A urine sample - usually a 24-hour sample (http://www.labtestsonline.org.uk/glossary/urine_24.html)

Cortisol is the natural hormone that provides stress to the body, not only that, but alertness, a circadian rhythm of the body that cycles once a day, and helping us wake up in the morning. The cortisol in ones blood varies with the events of the day, but often is quite constant. The biggest peak should be at around 4-5am. This help your sleep pattern realign correctly in to NREM to allow you wake up without deprivation or problems. With people with low cortisol people can often feel tired and sluggish, not wanting to wake up in the morning. This, along with medication, lack of good solid sleep, and other medical problems such as thyroid, could be a problem.

Okay, so things you should ask for:

Full Blood count: recheck for anaemia, pernicious anaemia associated with B12 deficiency
White Cell count: ensure no immunological and possible stem cell pathway issues
U&Es: to see if your kidneys are functioning okay, and see if they are in anyway misbehaving that cause a knock on effect on the blood
TFTs: looking at TSH, T3 and T4 samples again to try and rule out hypothyroidism
Fasting Glucose and HbA1c: rule out any diabetes or similar syndrome
Cortisol testing: as above

Abdo x-ray with contrast or CT with and without contrast to check the adrenal glands and kidneys

Alright, although I am not sure the doctor would be willing to order all of that without some additional symptoms such as for diabetes. He'll probably go for the TFT and anemia stuff at least. I had never heard of cortisol being a possible problem.

P.S. I guess I forgot to mention that I have problems when standing up. I always assumed this was associated with the migraines but I guess it could be related to hypersomnia. I mean the thing where you stand up and your blood pressure does not adjust fast enough so your vision goes black and you have to wait before starting to walk.

[Seirya]

I'm worried I might have... something. Like a blood clot.

I've had my blood pressure taken before, and apparently it's normal. The doctor didn't tell me exactly what she read.

I'm 5 feet tall, chinese, and weigh 45kg. This hasn't changed since I was 16, and I'm now 21.

I borrowed my grandpa's (who has diabetes) blood glucose monitor to measure my own once, last week, 12 hours after my last meal, and got a reading of 2.5. I did it again two nights later, 4 hours after my last meal, and got a 5.5. Haven't actually been able to check again, since my family's attitude is something like "Oh, you shouldn't worry. It's not like you'd get anything serious at your age."

I woke up 3 nights ago at 3am because I felt a sharp pain just under my left bottom-most rib. Actually, it only hurt when I expanded my chest to a certain degree while inhaling. After a few minutes of wondering, since it didn't go away, I also realised I needed to go to the bathroom, and when I got there realised the pain had gone.

12 hours later, I felt a sort of soreness extending from my armpit to mid-forearm, along the bottom-anterior side. I'd say it was the same sort of soreness you get when you've overworked a muscle, except it didn't feel like it was in the muscle. Or was in a small muscle. I wasn't doing anything at the time, except sitting down at a lab bench.

Also, I've been getting occasional stabbing migranes that last only a second, generally at the anterior border of the temple near my eyebrow, and this morning had another sharp pain in my chest, again on the left side but in a place a little more lateral to the last one.

I've had this happen before, usually about once every 9 months, but it never really worried me because it usually went away. And I suppose the entire timeframe may not be consistant with anything, but I don't know.

I think I may be mildly water deficient, since I generally drink only about 300-600mls of water a day. But if I drink any more, it just seems to all... flush out within 3 hours. Not to say I don't have regular bathroom breaks, but I don't expect a flood every time I go. Or to go 3 times in an hour.

[Golden Dysprosium]

Well, the blood glucose seems alright; obviously it's higher after meals. I doubt it would be a blood clot, though.
It might be just the usual aches and pains; I have a weird diet, which can lead to gas pains. Those usually just pass (painfully). The pain seems to be pretty spaced out, so it might just be soreness.
But that's my guess.

[Dr Dimari]

Jonnnn

I have terrible Blepharitis. I wash my eyes daily but the crud that grows on my eyelashes keeps advancing and it seems like the dryness is getting worse by the day. Is there anything else I can do to make my eyes not feel like the Sahara?

Blepharitis is inflammation of the upper eyelids. This can be due to 3 main reasons: bacterial, a skin reaction or a gland dysfunction.

I think yours is one of the first two, most probably the second one - a seborrhoeic dermatitis based Blepharitis: based on a reaction to a yeast germ that lives in the oils of your skin .

The best thing to do, is see your doctor and hopefully they will be able to decipher which one it is.

It can be quite hard to treat:

• better eye hygiene. Follow the guide on this website (patient.co.uk)
• antibiotic ointment can be used: chloramphenicol
• hypromellose eye drops (eg. Tears Naturale®) can keep the eye lubricated; 4 times a day when needed.

Remember try not to rub you eyelids as it will make them worse, and ensure that they are cleaned and moisturized. Depending on the type of Blepharitis you have, alters the treatment. It can take a while to treat, and sometimes it can reoccur.

[Dr Dimari]

Seaine

It does sound like Rynaud's is quite a possibility for you. *nod*
As for the PS: You have something called postural hypotension, and it is quite common in young people, and teens to get. Often it will go away on its own, and its nothing to worry about. If its affecting you quite bad, see your GP. They may take you off the propanolol as thats whats most likely causing it, and change you to another preventative.

[Dr Dimari]

Seirya

I'm worried I might have... something. Like a blood clot.

I've had my blood pressure taken before, and apparently it's normal. The doctor didn't tell me exactly what she read.

I'm 5 feet tall, chinese, and weigh 45kg. This hasn't changed since I was 16, and I'm now 21.

I borrowed my grandpa's (who has diabetes) blood glucose monitor to measure my own once, last week, 12 hours after my last meal, and got a reading of 2.5. I did it again two nights later, 4 hours after my last meal, and got a 5.5. Haven't actually been able to check again, since my family's attitude is something like "Oh, you shouldn't worry. It's not like you'd get anything serious at your age."

I woke up 3 nights ago at 3am because I felt a sharp pain just under my left bottom-most rib. Actually, it only hurt when I expanded my chest to a certain degree while inhaling. After a few minutes of wondering, since it didn't go away, I also realised I needed to go to the bathroom, and when I got there realised the pain had gone.

12 hours later, I felt a sort of soreness extending from my armpit to mid-forearm, along the bottom-anterior side. I'd say it was the same sort of soreness you get when you've overworked a muscle, except it didn't feel like it was in the muscle. Or was in a small muscle. I wasn't doing anything at the time, except sitting down at a lab bench.

Also, I've been getting occasional stabbing migranes that last only a second, generally at the anterior border of the temple near my eyebrow, and this morning had another sharp pain in my chest, again on the left side but in a place a little more lateral to the last one.

I've had this happen before, usually about once every 9 months, but it never really worried me because it usually went away. And I suppose the entire timeframe may not be consistant with anything, but I don't know.

I think I may be mildly water deficient, since I generally drink only about 300-600mls of water a day. But if I drink any more, it just seems to all... flush out within 3 hours. Not to say I don't have regular bathroom breaks, but I don't expect a flood every time I go. Or to go 3 times in an hour.

Hiya there. Well, if I'm being honest I think Golden Dysprosium is on the right lines.

The pains under your ribs are most likely abdominal pains from the large intestine, most probably trapped wind. As when you walk around they seem to go.

The ache in the arm, is probably nothing to worry about either, we all get cramps and soreness from time to time, its part of being human and having a somtimes stupid body.

The headache you are having, aren't migraines (migraines have a pre, during and post phase. They have a one-sided headache usually, and last more than 2 hours to 2-3 days). They are fronto-temperal tension type headaches and are very unlikely to be related to the chest type pains you describe. If they become more frequent, get worse or trouble/worry you, seek medical attention from your GP.

Your BMI is 19, which is normal, and your sugar levels are nothing to worry about, they are normal too. I don't think you have a blood clot, and its not diabetic related. As for the fluid issue, you should try and drink more water. The recommended is a minimum of 1.5 litres a day. If you don't drink so much you can be more liable to cramp pains, and problems with the blood and kidneys. Yes, water is meant to go through you quickly, and thats a good thing.

[Seirya]

Whew. Thanks for the information Golden Dysprosium and Dr Dimari. It's always nice to be reassured that you're normal, even if I may end up sounding a bit paranoid.

[Golden Dysprosium]

Yay! I'm right about something! I feel special now. xd
I find water to be good for gas relief (maybe it's just me).
A sign that you're drinking the right amount of water is if your urine rinses clean (it's see-through), but still has a yellow tinge to it. Too much of anything is bad.
I should also mention that BMI isn't as thorough as it sounds; it measures your weight against your height. The number produced is your BMI. The problem is that you can have either, say, 40 lbs of fat or 40 lbs of muscle, and the reading would still be the same. The general assumption is that you're balanced between the two.

[Seaine]

Dr Dimari

Seaine

It does sound like Rynaud's is quite a possibility for you. *nod*
As for the PS: You have something called postural hypotension, and it is quite common in young people, and teens to get. Often it will go away on its own, and its nothing to worry about. If its affecting you quite bad, see your GP. They may take you off the propanolol as thats whats most likely causing it, and change you to another preventative.

Nah, I get it when I'm not on Propranolol too. It is often much worse right before, during, or after a severe migraine. It can also occur with no migraine associated. It can be pretty severe, but all I really need to do is lean over so my head is lower and it goes away quickly. (Also, I have given up on finding another preventative. I've tried every type as far as I know. I'd tolerate a lot of side effects for Propranolol.)

Seirya

I woke up 3 nights ago at 3am because I felt a sharp pain just under my left bottom-most rib. Actually, it only hurt when I expanded my chest to a certain degree while inhaling.

Hey, Dr. Dimari already went over this, but I just wanted to let you know that this happens to me all the time. It can be quite painful but it's nothing to worry about. My boyfriend gets it too. I am more likely to get it when I have a cold and it's really painful to inhale; sometimes if I inhale sharply enough I get a popping sensation and the pain is gone.

[Golden Dysprosium]

Despite being a strong advocate of pain relief, I don't think the "popping sensation" is a good thing. sweatdrop

[La Veuve Zin]

Golden Dysprosium

Despite being a strong advocate of pain relief, I don't think the "popping sensation" is a good thing. sweatdrop

Could be a popping gas bubble.