Rapidly worsening dysautonomia

SpinachHands

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TLDR at the end!

My partner who I care for is fully bedbound with severe long COVID/ME and dysautonomia. Their LC/ME has actually been improving recently, especially after a month on Ketotifen, but the dysautonomia has been worsening.
The past few weeks especially have included some new symptoms out of nowhere, alongside exacerbation of existing symptoms. Particularly:

- what used to be some muscle twitches/spasms when their dysautonomia flares up, now is full body convulsions that look like a seizure (referral to neuro has been made just in case) their HR and BP stay pretty normal during this and they remain conscious

- they have fairly low blood pressure usually (97/70ish) but would get sudden drops every couple of days, and usually 20/30mins with their legs elevated and me massaging/squeezing their legs would improve things. This now happens about 3-4 times a day and is often followed by them falling asleep. Often it doesn't read that their BP has changed much but they'll get faint, cold body parts, slowed breathing, difficulty moving/speaking, extreme pain through their body, etc. Elevating/compressing their legs isn't doing anything, neither is increased salt, fluids, electrolytes, etc.

- they would get some dizziness and nearly always had a mild headache that could sometimes get worse, but now they have very severe bouts of dizziness through the day, and intense migraine type headaches for several hours a day. Their GP doesn't want to prescribe any migraine meds until neuro clears them (which could be a months long wait), they can only take codiene sparingly, and paracetamol/ibuprofen/aspirin each flare up other symptoms of theirs

- what's new is episodes of wooziness that my partner describes as feeling high. They will talk like they're half asleep and often get kind of giggly- they still make sense and say they don't feel tired during it. This usually comes on with the dizziness and/or headaches, and feeling faint/lightheaded

- another new symptoms is weird temperatures, they usually run hot and have problems with overheating, but recently they've been feeling temperature incorrectly. They'll have chills and say they feel cold when they're quite warm to the touch, or say they feel burning hot when they're cool to the touch

Before things escalated, a month or two ago their specialist prescribed fludrocortisone as it really seems from all symptoms that this is a blood pressure/circulation/blood volume/fluids issue. But it caused my partner the most intense pain they've ever felt. We recently retried it at 1/8 of a tablet but the pain was still too much.

Aside from this subset of symptoms, they also get stomach churning/pain when eating, intense adrenaline dumps and sympathetic overload, full body pain, especially joints plus their hands and ankles, just basically a while host of dysautonomia that no doctor has been able to explain or treat yet. They have been bedbound and unable to even sit up, unable to chew solid food, use their phone, or do any kind of activity for seven months now.

I have an urgent appointment with their specialist on Tuesday and she should hopefully be sending recommendations for blood tests to their GP next week. Happy to list all the supplements, vitamins and meds they take too if this gives any indications, but they're on all the usual vits/supps pretty much.

Nothing in their environment/diet/meds/routine has changed recently so I don't know why it's suddenly getting so much worse the past two weeks, even today and yesterday seem much worse.

TLDR: my bedbound partner's dysautonomia is worsening, specifically episodes of migraines, pain, dizziness, seizure-like convulsions, BP drops, and a "high" woozy out-of-it feeling. The past two weeks they have been getting worse daily, but nothing has changed as far as we are aware. Has anyone else had symptoms like this together? What helped? Could something else be wrong? Any reasons it's worsening despite no external changes?
 

andyguitar

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South east England
Their LC/ME has actually been improving recently, especially after a month on Ketotifen,
That sounds encouraging.
Before things escalated, a month or two ago their specialist prescribed fludrocortisone as it really seems from all symptoms that this is a blood pressure/circulation/blood volume/fluids issue. But it caused my partner the most intense pain they've ever felt. We recently retried it at 1/8 of a tablet but the pain was still too much.
The symptoms you list match fairly well with the known side effects of Fludrocortisone, so if nothing else has changed recently I would suspect an adverse reaction to that drug possibly in combination to the effect of stopping/reducing the dose is causing the problem.
 

SpinachHands

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United Kingdom
An update: just now alongside feeling faint/woozy they experienced numbness then pain in one hand, then the other, and then their feet. They said it was like pins and needles but it didn't hurt to move, like clenching their fist, but really hurt when I lightly touched them. It went away after about 20mins. From some quick searches I'm looking into peripheral or autonomic neuropathy. Seems the nerve damage can happen from long COVID, but still no idea why it's getting so rapidly worse.
 

JES

Senior Member
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1,372
Clutching at straws, but I suppose taking Ketotifen does count as a "change", so maybe the worsening is due to it even though it improved ME/CFS? I think your approach is correct in trying to figure out anything that has changed when there is such a quick development of new symptoms.
 

SpinachHands

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United Kingdom
Clutching at straws, but I suppose taking Ketotifen does count as a "change", so maybe the worsening is due to it even though it improved ME/CFS? I think your approach is correct in trying to figure out anything that has changed when there is such a quick development of new symptoms.
We have been wondering that, if it's improving their ME but worsening dysautonomia. It would be a shame to stop as this is the only medicine they've had that actually seems to be helping..
 

SpinachHands

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That sounds encouraging.

The symptoms you list match fairly well with the known side effects of Fludrocortisone, so if nothing else has changed recently I would suspect an adverse reaction to that drug possibly in combination to the effect of stopping/reducing the dose is causing the problem.
They were only on it for about three days a couple of months ago, then two days about three weeks ago at 1/8 of a dose. I wouldnt think that could be enough to still be affecting them, especially where their condition is worsening each day.
 

Violeta

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3,151
I've seen mentions of things being anticholinergic but don't really understand what it means, will look into choline tho if it could help!

So great of you to be trying to take care of someone with this awful syndrome. It's so difficult to deal with, and it's hard to find doctors who understand it.

My brain is fuzzy, it's evening and I'm tired, so I hope I am thinking about this the correct way.

Here's a simple to understand post by Suzy Cohen about POTS and choline.

https://suzycohen.com/articles/choline_bloodpressure_pots/

POTS/dysautonomia are related to the H-P-A axis and at least some of the symptoms sound like something wrong with the hypothalamus.

"The hypothalamus harbors high levels of cholinergic neurons and axon terminals. Nicotinic acetylcholine receptors, which play an important role in cholinergic neurotransmission, are expressed abundantly in the hypothalamus."

Choline can help. This is what the B5 is good for.

"Vitamin B5 is required for the manufacture of red blood cells, and the stress hormones and sex hormones produced in your adrenal glands. As a nootropic, Vitamin B5 is crucial for converting the choline in your nootropic stack into acetylcholine (ACh)"

B5 is also good for the adrenals, the "A" in the H-P-A axis.
 

SpinachHands

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United Kingdom
"Vitamin B5 is required for the manufacture of red blood cells, and the stress hormones and sex hormones produced in your adrenal glands. As a nootropic, Vitamin B5 is crucial for converting the choline in your nootropic stack into acetylcholine (ACh)"
Thank you for this info! Is there a chance taking choline could then increase adrenaline though and increase sympathetic activation? That's something we also have to be very careful of as my partner already struggles with sympathetic activation and excess adrenaline.
 

Wayne

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Ashland, Oregon
what used to be some muscle twitches/spasms when their dysautonomia flares up, now is full body convulsions that look like a seizure... Has anyone else had symptoms like this together? What helped? Could something else be wrong? Any reasons it's worsening despite no external changes?

Hi @SpinachHands -- I've recently (past month) had a very similar experience(s). Vertigo, dysautonomia, dizziness, all worsening. Inner feeling like I'm about to fall, or am falling. Noises of various kinds, whether loud or not, cause it to flare, leading to intense inner trembling, and on occasion, full body convulsions.

Things seem to be very slowly improving, which I attribute to narrowing my activity envelope. Interestingly, what helps sometimes is for me to walk, and that can often somewhat help "right my ship". It sounds like that's out of the question for your partner however, who seems to be bedbound.

My symptoms all seem to have gotten worse with a series of "startles", from our kitty with a loud and piercing meow catching me off guard, to a number of other lesser and greater startles (like sudden firecrackers in the neighborhood, motorcycles coming out of nowhere, etc.). Too many in too short of a window of time it would seem.

Before all this recent worsening started, I often (daily) felt discombobulated, especially when starting out my day. I got into the habit of doing a number of energy and polarity balancing exercises to bring me back to a semblance of normalcy, which consistently worked almost miraculously for me. With the advent of my new symptoms this past month however, I discovered to my dismay that these energy balancing exercises (for a while) actually made my symptoms worse.

It's only been in the past few days that they've started to (slowly) be effective again. So in my case, I think a series of "startles" or "auditory traumas" likely kicked off a new cycle of energetic disruption in my system, and I'm now beginning the long process of bringing things back into harmony.

If you have any interest in energy balancing, I'd suggest looking into biocircuits, which were invented by a British soldier trying to recover his health from his injuries in WWI. Biocircuits is a powerful tool to bring our energies back into balance, and this soldier was able to fully recover from his serious injuries.

In the literature on biocircuits, it says that approx. 2% of the population actually have their energies flowing in reverse, and that biocircuits can bring them back into harmony. It would make sense that various traumas could cause our energies to go into reverse. I've long suspected that many pw/ME/CFS have some significant energetic disruption underpinning their physical situation.

Another thing I've considered for myself with all this recent worsening is whether or not I may have something called Proprioception Dysfunction, and am exploring that a bit:

Proprioception dysfunction, also known as proprioceptive dysfunction, refers to a disorder affecting the body's ability to sense its position, movement, and action. This condition can lead to difficulties in coordinating movements, maintaining balance...​

All the best to you and your partner. I feel I can relate, even though it sounds like what you're dealing with is an even more challenging situation than my own. Take care!
 
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Violeta

Senior Member
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3,151
Thank you for this info! Is there a chance taking choline could then increase adrenaline though and increase sympathetic activation? That's something we also have to be very careful of as my partner already struggles with sympathetic activation and excess adrenaline.
Yes, there is a chance that choline could increase adrenaline. It's good your realized that. I am sorry for giving you bad advice.

I didn't know there was a type of dysautonomia caused by adrenaline. I looked at Dr Lam's website about adrenal fatigue and found an article on it.
 

SpinachHands

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Location
United Kingdom
It's only been in the past few days that they've started to (slowly) be effective again. So in my case, I think a series of "startles" or "auditory traumas" likely kicked off a new cycle of energetic disruption in my system, and I'm now beginning the long process of bringing things back into harmony.
Thanks for your reply! Sorry to hear you're going through something similar, but good to know it's not entirely unusual. I remember reading about how Galen Warden's son had a seizure after hearing their dog barking which could also be similar.

It seems like their nervous system issues just have their nerves on a hair trigger, so maybe whatever is stressing their body out is making everything go into overdrive. I've actually been wondering if it could all be being triggered by their pain, and instead of pain being one of the symptoms that come on together it's actually the trigger, so if we can get that managed, it may reduce their body's response with everything else. Their GP agreed with me that their headaches sound like migraines, so is going to try my partner on sumatriptan, and if it helps may try a long term daily preventative. It could be that a lot of their symptoms are part of it or because of the pain
 

Wayne

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Location
Ashland, Oregon
intense migraine type headaches for several hours a day.
Hi @SpinachHands -- I just ran across a reference to using castor oil for migraines. Below is a link, which starts at about a 1-minute segment on migraines. Ya never know when one little thing might end up helping a lot. -- I hope you can find something that helps with the migraines.

Use Castor Oil Before Bed – See Results by Morning!

BTW, I suffered from migraines for years, and finally got consistent relief from coffee enemas.
 
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