Daily Midday Fatigue, GI Distress, and Neurological Issues: Is It Enteric Neuropathy?
Since my bout with COVID, I have been grappling with persistent fatigue, gastrointestinal troubles, and neurological symptoms that seem to escalate every day between noon and 2 PM, regardless of my dietary choices or activities. **Key Symptoms:** - A notable collapse in energy around midday accompanied by intense fatigue, mental fog, and an overwhelming “toxic” sensation. This fatigue can sometimes rise again in the evening. - Gastrointestinal complaints include sensations of nausea, a feeling of food lingering in my stomach, and bloating without vomiting. I experience a cyclical pattern of constipation lasting 4-6 days followed by diarrhea. - There’s a history of experiencing ocular aura migraines and nocturnal choking incidents, both of which have significantly improved with metformin treatment. - I also have a history of Optical Neuropathy, having lost sight in my left eye early in life due to a severe illness caused by ticks. - Significant gastrointestinal challenges persist, such as problems with swallowing. - The antihistamine Benadryl seems to offer considerable relief, suggesting potential involvement of mast cells. - Metformin (500mg twice daily) initially provided substantial improvements for roughly two weeks, alleviating hunger issues, migraines, and choking sensations, although the appetite problems have resurfaced while neurological symptoms remain more stable. **Medical History and Investigations:** - Small fiber neuropathy was diagnosed through a skin biopsy taken from my thigh and leg. - Throat motility problems were confirmed via manometry and a barium swallow test. - Numerous GI specialists performed EGDs and colonoscopies with results consistently revealing: - Gastritis - Blunted villi in the small intestine - A normal appearing large intestine - No signs of celiac disease - I have repeatedly used PPIs for extended periods, but the first course resulted in a C-Diff infection. - Successful triple therapy eradicated H. Pylori. - Tryptase levels are low, yet there are pronounced clinical indicators of mast cell activation. - I have consistently low alpha-1 antitrypsin levels. - Blood work has shown low white blood cell counts alongside elevated red blood cell counts for several years. - My A1c has reliably ranged from 4.9% to 5.2%, and continuous glucose monitoring has been normal. - While my ANA results were negative, the ongoing fatigue, neuropathy, and GI symptoms raise concerns about dysautonomia or an inflammatory process. - I experience Raynaud's symptoms during these episodes. **Questions Moving Forward:** Could the pattern of my symptoms be indicative of small bowel dysmotility or neuropathy related to SFN or involvement of the enteric nervous system, potentially exacerbated by mast cell activation? Would procedures such as capsule endoscopy be beneficial for further exploration, or would a SmartPill or more comprehensive motility testing be a more appropriate next step? My personal trainer suspended my gym sessions due to feelings of dizziness and shaking that arose shortly after I began exercising. I’m cautiously attempting to reintroduce physical activity into my routine. These health challenges have significantly impacted my quality of life, and I am open to suggestions. I am seeking guidance, especially from gastroenterologists, neurologists, or anyone who has experienced similar situations. Any help would be greatly appreciated.
Answers (1)
3/27/2025, 2:10:55 AM
OpenHealth AI
Thank you for sharing your detailed health concerns. It sounds like you're experiencing a challenging combination of fatigue, gastrointestinal issues, and neurological symptoms that are significantly affecting your quality of life. Let's break down your situation and explore actionable next steps.
Main Points:
- Symptom Overview: Your symptoms, including midday fatigue, gastrointestinal distress, and neurological issues, may suggest dysfunction in the enteric nervous system, potentially exacerbated by small fiber neuropathy (SFN) or mast cell activation.
- Next Steps: Exploring further gastrointestinal motility testing and reassessing your treatment plan may help clarify your condition and guide management options.
Explanation:
The symptoms you're experiencing could indeed be related to disturbances in the enteric nervous system and small bowel motility. Conditions like SFN may lead to gastrointestinal dysmotility, which aligns with your reported symptoms of nausea, bloating, and irregular bowel habits. Additionally, the significant variability in your fatigue and neurological symptoms throughout the day could suggest that these issues are interlinked, possibly influenced by mast cell activation and dysautonomia.
Given the complexities in your medical history and current symptoms:
- Capsule Endoscopy: This procedure allows for a non-invasive examination of the small intestine, which might reveal issues not captured in EGD or colonoscopy.
- SmartPill: This is a motility capsule that can provide information about gastric emptying, small intestinal transit time, and colon transit, which could be particularly useful given your GI symptoms.
- Comprehensive Motility Testing: Engaging in more extensive motility assessment can help determine if there's an underlying problem with the muscles or nerves that control your bowel movement.
Actionable Next Steps:
-
Consider Comprehensive Testing:
- Discuss the possibility of capsule endoscopy with your healthcare provider to visualize the small intestine.
- Inquire about the SmartPill to assess motility issues if capsule endoscopy is not indicated.
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Review Treatment for GI Symptoms:
- Since Benadryl seems to help, discuss continuing or adjusting your treatment plan to further manage your mast cell-related symptoms with your healthcare provider.
- Reassess the use of PPIs and consider alternatives based on your past experience with C. diff infection.
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Dietary Adjustments:
- Implement a food diary to track what you eat and correlate it with symptoms to identify potential triggers.
- Consult with a dietitian experienced in GI motility disorders to tailor your diet for optimal management of symptoms.
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Gradual Re-introduction of Physical Activity:
- As you cautiously reintroduce exercise, prioritize low-intensity activities and short durations, gradually increasing as tolerated. Monitor how your body responds.
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Symptom Management Strategies:
- Practice stress-reduction techniques to help manage fatigue and overall well-being, as stress can exacerbate both neurological and GI symptoms.
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Regular Follow-ups:
- Keep in close communication with your gastroenterologist and neurologist about your symptoms and any changes, especially with your neurological symptoms or if any alarming new symptoms arise.
Your symptoms are certainly complex, and it’s understandable to feel overwhelmed. However, taking systematic steps can lead to better clarity and symptom relief. Please keep me updated on how things progress or if you need additional guidance along the way.
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