Dysautonomia = can it cause severe anxiety?

[DefectorQC]

Since a while, i'm dealing with extreme anxiety (panic with agoraphobia, OCD, GAD, social phobia), in the past it was easy for me to have the anxiety under control with an antidepressant med like Paxil, but since 2 years I start having weird symptoms mainly cardiovasculars and i'm now med sensitive, so can't take even a tinny dose of an AD to control my anxiety and i'm taking a benzo med call Klonopin at 7.5 mg a day with 10-20 mg of propanolol with no success, i'm now addicted to the Klonopin and the propanolol who was RX for the tachycardia is not working anymore and just lower more my blood pressure.

My Doc think I may have dysautonomia since my blood pressure reading are now very low, around 100/55, in the past my normal was 135/85... the drop of blood pressure occur in the summer of 2011 and happen very fast for no medical reason. He think it can be POTS since my heart rate is too fast for the kind of physical activities i'm doing, he think also it can be an autonomic dysfuntion since i'm having orthostataic hypotension and dizziness.

The main problem is that my Cardio Doc think it's not related to dysautonomia but more to my anxiety!!!

I'm having low blood pressure with tingling and numbness in my left arm and legs as well and chest pain all the time now. I wake up those symptoms and go in my bed with them. My hands are most of the time turning purple with white circles on them, they are clammy, my left hand hurt, my left leg is also often numb and both legs hurt and have a lot of muscles spasms. I have jaw pain on both side and also chronic headache who dont answer to painkiller, so i'm in pain all the time.

The tachycardia is more pronounced in the morning and tend to lower with time but start again just before I go in my bed. I tachycardia is also more present when I do minimal physical activities like taking a shower or just climbing the stairs. I'm often dizzy, most of the time I have orthostatic hypotension from a sit to a standing position, I have no energy even if I sleep well (most of the time I have insomnia) but when I sleep well I feel the same, not better. I have eyes pain, headache who dont stop, the scalp of my head feel numb, I have throbbing pain on both temples of my head and in the back of my head, I start also having IBS with constipation who lead to 2 intestinal obstructions last october with 2 surgeries to repair them.

The chest pain, shoulder pain, left arm pain feel like numbless-tingling. The intensity of the pain will be worse at rest. Also the numbness and tingling on the left side of the body is worse when i'm very anxious and have at the same time low blood pressure. Feel a little bit better when my blood pressure rise.

At first I think the low blood pressure was linked to the hot wheater but this week it's cold and my blood pressure is very low for me, 100/55 when my normal was in the past 135/80-85... I drink a lot of water, take vitamins everyday, I dont exercise and I do smoke, who normally increase the blood pressure but now its doing nothing and just make me more nervous. Also I take once in while some Ibuprofen for my chronic headache and sometimes some Naproxen when the headache transform to a migraine and in the past it was increasing my blood pressure in the high range but now it's lowering it even lower...

I really dont know what happen with me. Is it possible that it's all anxiety related? Anxiety can lower blood pressure?

Is it possible that the problem come from my IBS-C problem? I have chronic constipation, no laxative work, i'm suppose to start biodfeedback for a poor pelvic muscles problem, but dont have the money for it for now, so I strain very hard at least 3 times a day, I can spend 15 to 20 minutes sit on the toilet straining, at some point my face is all red and see strange black circles in my vision and my head hurt like it's burning. I use glycerin suppositories to help me to have bowel movement but I always need to strain more and more cause I feel like my intestine is full and need to do more... I take once in a while a Prevacid pill when my stomach hurt but I dont have GERD problem, so it cant be linked to the chest pain.

Is it possible that the weight I lost in 2001, from 220 pounds to 160 pounds in a 6 months period of time, can be the main problem with my heart symptoms? I loose that weight when I start having IBS with constipation. On the other side, I had a gastric by-pass in 2001 and went from 445 pounds to 190 pounds with no heart problem and no change in my blood pressure for almost 8 years.

I know, I have a lot of issues at the same time and they all trigger severe anxiety and anxiety by itself can do most of the symptoms I have right now, but I just dont feel right.

My Cardio Doc think my heart is fine, I had several EKG and all normal. I wear a events monitor for 2 weeks and everything was fine, I had a stress-test with an echography of my heart who was normal also, I had an echography of my heart who show normal valves and normal heart size. But me I think I may have a coronary problem, probably a blockage or something like that since I can't do physical activities and i'm always tired and all the chest pain, arm and leg pain, that's not anxiety?

All my blood tests are fine, no vitamins or minerals dificiency, no liver problem as well, no inflammation...calcium, magnesium and potassium level are perfect, sodium level is perfect also...

I was told by my Cardio Doc to drink more salty drink like Gatorade but it's doing nothing, it's like the NSAID's, it tend to lower my blood pressure more. The only thing who increase my blood pressure is anxiety and when I have to get out of my house...

I have also heat intolerance, can't stay under the sun or outside when it's hot cause I start feeling dizzy and the cardiovasculars symptoms get worse. I can't sweat like in the past, seem like the only places where I sweat is from my feet and my hands.

Being always tired and not able to do physical activity like in the past is for me not normal. It's not normal to have a very fast heart rate of 140 when I only walk from the living room to the kitchen... same when I take my shower who the heart rate can go as fast as 160.

Also never had low blood pressure or chest pain or tingling/numbness on my left side, even when I had a panic disorder problem only...had the usual fast heart beat from the panic but nothing else...

So what can be the problem? Should I call my Cardio Doc again, I think he his tired of me and think it's all in my head and anxiety related since he do nothing to help me more.

Thanks for any kind of answer I can have ;-) And hope I will at least have one comment or some support!!!

[pritchag]

I am suffering with much the same. I think it's possible that our previous antidepressant usage has caused a kind of chemical dysautonomia in us?

[pritchag]

I am suffering with much the same. I think it's possible that our previous antidepressant usage has caused a kind of chemical dysautonomia in us?

[LivingInHope]

Now this is interesting- your adrenaline was low and your nor adrenaline was low normal.  Low adrenaline (epinephrine) is not something one would expect in someone with a lot of anxiety!  Nor is it what one would expect with someone with P.O.T.S..  

The body typically puts out more cortisol, not less, in response to stress, which can cause more abdominal fat.

I really think you should ask for a referral to a competent endocrinologist and  look into adrenal insufficiency.  (See private message about adrenal insufficiency and the Addison's disease I mentioned.)  There are tests for these things.

It does not sound like the propanolol is helping anything to me.  You are still having anxiety and you notice no help for your other symptoms.  Your adrenaline is low, not high.  I'd recommend getting another doctor's opinion on that.

Have they ruled out musculoskeletal issues for your chest pain (such as constochondritis)?  I know one can get tingling hands with a panic attack.  Also, if you lean on your elbow a lot, you can make your pinky finger tingly.

[DefectorQC]

Hi,
    Yes, my Family Doc RX an adrenal glands test, 24 h urinary test, and a supression test as well. My cortisol level was normal but more to the low side, the adrenaline was very low and the noradrenaline level was low-normal, dopamine level was normal. The supression test show normal reaction for the cortisol as well. My Doc said it was normal to have a lower cortisol when you are under extreme anxiety for a while. Also had recently everything test in my blood, iron and ferritine are normal-high so no anemia, TSH, T3, T4 and free T3 are ok. Nothing in my blood can explain why I feel so exhausted and have so many cardiovascular symptoms.

For the Propanolol, of course I stop it for 2 weeks this summer and see no difference, my blood pressure was a little bit higher but only in the 100/70 range, so the diastolic was higher only. The pulse rate was a little bit faster but nothing to be scare. The headache was the same as well as the cardiovascular symptoms. I ask my Doc for trying another med but he say to stay on the propanolol since he think it can prevent me from having panic attacks.

The main problem is that where I live (Quebec city in Canada), we dont have an hospital where they have a tilt table to test if someone have POTS. Of course my Doc was thinking about that test, but he said in Quebec city they dont have it, will have to go in another city and well i'm agoraphobic so that's a no no for now. He said that POST and dysautonomia are diagnosticed here with the list of symptoms and examinal tests done by the Doc, he took my blood pressure when I was lying down, then take it when I was sit, take it when I stand and the results wasnt normal, decrease systolic blood pressure of 20 and more when I stand and increase diastolic blood pressure. Pulse rate jump from 68 to 135 only from a sitting to standing position. He make me do some light exercises in his office like jumping in the air for 1 minute and took my pulse rate again and it was at 170... he look at me and said that's not normal... so he do a RX paper to have more tests done from my Cardio Doc. I go see him last winter and he look at the RX paper and said that POTS or dysautonomia are rare disease and that since I had almost all the tests done for my heart, with the exception of a nuclear test or angiography, he said that my heart is fine and that's it's only anxiety related. He ask me to sit with my legs up in the air at night to help my blood circulation, he also ask me to drink more sport drink with salt in it, he said it will pass with time and when my anxiety will improve.

For the constipation, I had a gastric by-pass to loose weight 11 years ago so my intestine is not the same as someone else. My stomach is not the same also. I dont digest most of the foods I eat cause I have a short intestine now, only 1.50 meters long insistead of 6 to 7 meters so I have a fast transit... Foods dont stay inside me for a long time. The constipation start after a surgery to remove internal hemmrhoids. The constipation is worse since I had 2 intestinal obstructions last october for unknow reason. I was on a malnutrition state so they had to instal an jejunostomy tube connected directly into my small intestine and had enteral feeding for 4 months. Of course I had A LOT of tests done, Ct-Scan with dye contrast for my intestine, I saw a Gastro Doc and had a long colonoscopy who show nothing wrong, I had a gastrocscopy and my stomach seem normal The Gastro Doc think I may have dumping syndrome, mean that foods dont stay in my stomach and go directly into the intestine so i'm prone to have hypoglycemia. For the constipation, we try everything, double the dose, take even 4 doses of everything we try from Lax a day to milk of magnesia, nothing can help me to have normal bowel movement. The Gastro Doc said I have a poor pelvic muscles function, that my muscles are tense and that I will need to have biofeedback to help me to learn how to relax my muscles and have normal bowel movement without straining.

Well I really have orthostatic hypotension and tachycardia and for me it's increasing my anxiety and I worry a lot about it who probably made it worse. I also have an obsession with my blood pressure and take it at home often and take my pulse all the time. And of course the chest pain and left side symptoms on my body make me feel A LOT more anxious.

For the TMJ, I think about it last year and ask my Dentist, he done some X-ray, said everything is ok, no TMJ, I also dont clench or grind my teeth when I sleep and not at daytime also. I avoid chewing gum, BUT I tend to have very tense muscles on my face and play with my tongue inside my mouth, who can produce a certain level of pain and be linked to the headache.

Well, thanks for your answer ;-) Very informative. Of course I would love to have a tilt table test done but here dysautonomia is not really a disease for most of the Cardiologists...they see it as only minor symptoms, not dangerous, told you to drink more salt and if it's too bad they RX meds to increase the blood pressure but nothing else... too bad cause i'm pretty sure it's one of the main problem for my cardiovascular symptoms...and anxiety as well...

[LivingInHope]

I know at times my rapid heart rate has made me feel wired.  But people with orthostatic intolerance don't tend to have anxiety more than any one else, though symptoms can disturb a person and potentially lead to anxiety.

[LivingInHope]

Has your primary care physician considered ruling out Addison's Disease, testing cortisol and aldosterone levels since you've had this change in blood pressure readings?

Since the propanolol is no longer helping the tachycardia and is lowering your blood pressure more, ask your doctor if you can just go off of it.  I'd do that first, before I asked about getting tested for Addison's- see if it solves the blood pressure problem!  I know I've been on blood pressure medication that has knocked my blood pressure too low and given me a migraine headache.

Ask your primary care doctor if you could get a referral for a tilt table test since he suspects dysautonomia.  I had an electrophysiologist conduct mine.  It was a comfort to me when a cousin of mine, who has P.O.T.S. as I do, told me that chest pain is a normal symptom of it.  I was anxious about my having chest pain in the past.  She also told me when her heart is extra fast, she spends time in her recliner with her feet up.

It takes a lot of energy for someone with orthostatic intolerance to stand.  And you might want to make sure your ferritin and iron are at okay levels, because iron deficiency can make you tired, give you headaches, cause palpitations (or make them worse if you already have them), etc..

The lack of sweating sounds like what some with dysautonomia suffer from and there is a test that can be run on that, but I think the places that do it might would be limited to some with a dysautonomia specialty.  (You might check with Heiferly- send a private message asking where you can get that test.)

Have they checked your thyroid function with TSH, free T 3 and free T 4 tests?  If you have an overactive thyroid, weight loss and palpitations can be symptoms of it, and so can nervousness, so if you haven't gotten that checked, please ask your doctor if he'd do that for you.

You might consider going to a Chinese herbalist about your constipation.  I took some prescribed herbs called Coptis Purgefire myself (they might want you to take something else)- first by Health Concerns, then I took the Chinese form, which were little pellets.  They actually gave me diarrhea, so a licensed Chinese herbalist might just help with your constipaton.

Furthermore, if it is first determined it is not medication you are taking causing the amount of constipation you're having (for example, Klonopin has constipation as a common side effect), you might see a GI doctor at the dysautonomia clinic also because your motility of your intestine should not normally be this slow.  And chronic constipation is not good for your bowels, besides putting a strain on you!

With the throbbing pain in your temples- do you clench or grind your teeth?  This can cause TMJ symptoms which can include a headache in your temples.  You might consider saving up for a night guard or splint from an oral and maxillofacial specialist who does them or a TMJ dentist who does them.  I know the last night I did not wear my flat planed TMJ splint, I got a horrible migraine.