Weird Sensations/Further Testing

Medical Q&A [Moderated]
1

Hello Doctors,

I will basically go through my short history, and I would appreciate your considerations.

On July 1st I went to a gym in Palm Desert CA, in the AM after only having some coffee and 2 pop tarts. I went through my work out, but experienced some fogginess, and blurred vision in my left eye while benching. I figured it was just something orthostatic, finished the workout and went home. This was probably my 4th lifting session since of a new LP, and I hadn’t touched a barbell since gyms in CA shut down. Upon, taking a BM, and getting into the shower I felt weird on my left side, and went so far as to ask my wife if I had a facial droop or any strength deficits. She did not see any difference, but I continued to feel off to the point where I felt like my legs were heavy, and I generally felt malaise.

I am a Physical Therapist, and at the time we were working a travel contract that basically saw patients in their homes under Medicare Part B. I was supposed to see my first patient that morning, but felt so off that I went to the ER. Labs and ECG came back normal, and I was given a bag of fluids because my sodium “was low”, and as the temps were regularly 110+ this is probably standard procedure. I discussed getting a CT with the attending ER physician, and as there was no deficits we decided it wasn’t worth it.

I returned to work that afternoon, and I was alright, but I regularly worried about why I felt off, and I often felt perceived heaviness in my left leg, and tingling in my left arm. After work on Friday I was very anxious, and still felt weird “left sided” symptoms after my wife (who is also a PT talked to her sister who is a Nurse) we were all worked up that I should have gotten the head CT. After an 8 hour ER visit that night I came home with a normal head CT, and continued malaise. I basically slept for 2 days, had a Covid test come back negative, and after I convinced myself nothing was wrong I went back to work on Tuesday and had no real issues. We chalked it up to anxiety, “dehydration”, and the stress of working with pretty stressed out and attention deprived patients in homes and ALFs.

Flash forward to Mid August, and I start to feel more weird bodily symptoms, I don’t have strength, proprioception, or tactile deficits, but I just feel weird “heavy legs” and am worrying something is seriously wrong with me. I see a commercial regarding MS and I go into a panic thinking that I could have some neurological condition, and this is the start of it. On the weekend of August 22nd I have what I can only describe as a panic attack where I couldn’t really control my worry, and I was catastrophizing. I also felt emotionally drained, and couldn’t even cry when my wife expressed her emotions, and began crying (I typically cry when she does). The night of Sunday the 23rd I went into a tailspin, and was so anxious that I couldn’t sleep all night, and had a lot of difficult controlling my thoughts. I also started to notice a weird aura through my head that typically goes away when I have a hat on or am truly distracted. It really weirds me out. After a visit with urgent care I was given a prescription for Ativan, and told to go home (back to the midwest for some down time)

I returned home and saw my PCP on Friday the 28th and we discussed my options. I still struggled to sleep, but the Ativan really did not help me, and I moved from taking Benadryl and melatonin to basically nothing over a weeks time. A month later my sleep is improving, but is not where it was prior to my anxiety attack on the 23rd. I typically got 7.5-8 hours before with minimal interruptions, now I get probably 5-6 and I regularly wake up, and have to find ways to relax myself back to sleep. I have restarted a LP and it has progressed over the past 3 weeks with no major problems, and I have started to talk to a counselor.

There will be times when I feel totally normal, and other times where I can’t stop from ruminating on the possibility that something is wrong, and that tends to make things worse. I know that life has been more stressful than normal over the past 4 months or so, and I was often contemplating how tough life can be after treating a lot of my patients who have lived into their 70s and 80s only to be confined to their home and cut off from loved ones and friends. I know that I regularly contemplated their grief as I drove from patient to patient.

All things considered I have no physical deficits, my LP has progressed fine for someone who had to take 3+ months off, and I can play tennis, and do recreational things without anyone noticing my deficits. I just feel really fricken weird some times. I realize that I know just enough about the body to get myself into trouble, and I am trying to “make sense” of the way I feel. My wife and I are doing one more travel contract before settling down somewhere, and while I am excited about it, this last month has worried me.

Should I consider seeing a neurologist or getting further tests. I hate the idea of “checking things out for peace of mind”, but I am struggling to retrain myself to not worry about things. Especially, because of how weird the sensations of my legs and my head are. I will say that after a meeting with a counselor and discussing active approaches to treatment I basically went the rest of the evening with no sensations, but then I start rescanning myself the next day, and it gets hard to get myself out of the loop.

Any thoughts or considerations are appreciated. I appreciate the work you guys do, and I will say that I taught many people how to deadlift with broomsticks and detergent bottles amongst other things this summer, and that was pretty cool.

Thanks.

2

Sorry to hear about this. This is a common scenario people can find themselves in.

Unfortunately I am not in a position to provide strong recommendations for or against further evaluation for you via this forum, although I would say that the history you provide of recent progress without significant or progressive deficits is fairly reassuring.

I do certainly agree with your approach to work with a therapist, and think that is an excellent idea. Hopefully over time they can help you develop skills and strategies to self-manage and redirect unhelpful thoughts and fears about the meaning of these sensations you experience.

3

Thanks for the input. It is the classic case of uncertainty and then subsequent rumination/catastrophizing that is tough. If it were in pain I feel like i would handle it better. But maybe I have wound myself up in a similar way as someone who is experiencing pain.

I tend to notice that the more I sit and stew on the meaning of the sensations the more anxious I tend to be and that doesn’t help anything. Still, it is hard to break the cycle because things don’t completely subside.

Thanks again.

4

It’s been a bit over a month since I posted my initial post. In that time I have had quite a bit of difficulty, and in hindsight I can report that I really got myself into a hypersensitive state. Basically, I attribute my “physical sensations” to hypersensitization to normal “body noise”. I have finally accepted that I don’t have some weird disease, or the start of something like Chronic Fatigue syndrome. My thoughts/fears were continuously ramping up my checking into how I feel, and that cycle is really difficult to break.

Basically, I would perceive X body part as feeling heavy, and then I would worry about why it felt that way, and the check into how it was feeling. Repeat that over and over a bunch of times in a day and you have some pretty vicious patterns. Then insert a new body part and start doing that over and over again. I even went so far as to question if I was tired and then began to worry about Chronic Fatigue Syndrome which in my own opinion(especially now is anxiety mediated).

I have learned a tremendous amount in this process. I always knew the power of the brain/mind and our ability to nocebo ourselves, but this has shown me how difficult it can be for people to break these cycles. My medical training probably was both a curse and a blessing. Also my general thoughts on health, life, and my goals contributed to my fears/worries. I am still working on breaking cycles and there are good and bad moments, but I am getting better at just working through those moments.

Meditation, moment to moment strategies to move away from my cycles, and general optimism have been really useful in this period. Learning to perform body scans and accepting what I feel and letting it pass has been useful as well. Further, I am thankful for a support system that has both listened, and reassured me. People who go through unfortunate mental health situations without that support can easily get caught into some pretty bad situations. I am afraid to think of where I could be without a strong support system, and some wise words from people who have dealt with health anxiety in the past.

I am still working through this. As I type this I note that I am “checking in” to see how my head feels. I hope this helps someone who may be going through something similar.