A Horrible Mystery, Please Help!

Question

Hi Dr. Frascino! You are so awesome with the folks that write in that I was wondering...Can you please help me figure out what in the heck went wrong with my body last Winter? Last year I was a store manager in San Franciso and had just moved up from Orange County. I was working many long, stressful hours during the holiday season. I ate like crap, lots of fast food and sugar, and never really slept well during that time. It seemed like I was always stressed out as well. I had moved three times in 4 months trying to find convenient and affordable housing, (In S.F., yeah right). Eventually, I became extremely run down, nervous, and miserably bitchy. My moods were always whacked out because I was always so tired. I also felt exhausted and very uncomfortable inside, kinda like I was having internal tremors deep in my chest and it was hard to catch my breath. Then it all came down on the morning of New Year's Eve. I've come to call this day, "The Episode". I woke up and was so exhausted I could barely drag myself out of bed. I called in sick to work, drank a few big gulps of orange juice and decided to take a shower. About 5 minutes later in the shower I began shaking, my heart racing and I truly felt I was going to drop to the floor and black out or go into convulsions. I jumped out trembling, ran into the street (barely clothed) and took a cab to the nearest emergency room. When I got there I was sweating, still shaking, and was so hypersensitive to light and sound that all I could do was just put my head in my knees hoping to God that I wasn't going to die. I was so exhausted that even when I stood up to walk my heart started racing. The doctor did a CBC and everything came back normal and he said that these symptoms were probably due to stress/overwork. I've been treated for anxiety before but this was completely different!! If he only knew how I felt he would have checked for other things! I staggered out of there half coherent, scared, weak, and unsatisfied and just crashed in my bed when I got home. Strangely though, as trembly and weak as I was I had a fair amount of physical strength, I was just ultra exhausted. The next several weeks the living nightmare just continued. Many mornings as I was waking up I would be disorientated and would take me several minutes to figure out where I was. I also had a lot of sexual cravings/fantasies during those waking minutes which I thought was weird. My tachycardia was so bad that even a trip to the toilet would make my heart feel like it was going to pop out of my chest. I would also suffer eratic crying spells. I remember my best friend that I was staying with would come home to check on me during his lunch hour and when he would leave I would just burst into tears. At night as I was falling asleep I would have major muscle spasms, racing, bizarre thoughts, and would get all clammy in my chest. It took about two weeks for the worst of these symptoms to pass but I still felt tired and had tachycardia for the next month. I was referred to a cardioligist by my regular doctor who gave me Zoloft of all things. They did another CBC, Echo Gram, a Thyroid test, chest X-Rays, and made me wear a Holter Monitor for two days. Everything came back normal. GEEZ! I finally decided to get an HIV test since it had been 9 years since my last negative one and unfortunately it came back positive. Took me about another month to get the nerve to see a specialist and my first set of labs weren't as gruesome as I thought they would be. My VL was 500 copies and my CD4's were about 540. In July my second set of labs were a VL of 550 and a CD4 of 734. So far, no meds, and hopefully not for a long time either. I saw 2 different specialists and both of them said that my "Episode" was most likely not HIV related and wasn't typical of an HIV infected person epecially one with my numbers. IF it wasn't HIV, then what the hell was it? I have never, ever dealt with anything like this in my life, (I'm 29), and I'm so terrified that I may relapse back into this state again. It took me about 3 months to completely recover. I had to take a leave of absence from work and ended up demoting myself because I really thought I would never get better. I was also experiencing chronic back and leg pain that lasted for another three weeks! Thankfully, I feel like my old self again and very healthy. Based on what I told you, what other things do you think may have caused an otherwise energetic guy to become virtually bedridden despite normal lab tests? Blood sugar problems maybe? Or, does this sound like a case of extreme fatigue like the doctor said? Please help me figure out this mystery. I never, ever want to go through anything like this again. Thank you so much for listening! :)

Answer

Hello!

HIV-wise, it does seem like you are doing well with a very low viral load and high CD4 cell count. So what could the episode be? Seroconversion episodes may involve fatigue but really wouldn't explain the other symptoms. Your symptoms - fatigue, internal tremors deep in the chest, difficulty catching your breath, rapid heartbeat, sweating, shaking, hypersensitivity to light and sound, erratic crying spells, muscle spasms, racing bizarre thoughts, feeling clammy, feeling like you were going to have convulsions or black out, etc - occurring while you know that your lab work, including CBC, Echocardiogram, thyroid tests, chest x-ray, and holter monitor, are normal strongly indicates you are having some type of panic or anxiety attack. In fact, it sounds like a textbook description! Add to this the fact you had been treated for anxiety problems in the past, and that your current episode was preceded by "long, stressful" days, bad diet, inadequate sleep, generalized stress sensations, and difficulty finding affordable housing, and you have a definite setup for a major anxiety event. Being "extremely run down, nervous, and miserably bitchy" with "whacked out" moods and chronic exhaustion just pushed you over the edge. The psyche, just like any other part of our body, can get wounded or hurt, and that's what happened to you. Do you watch the hit T.V. show, "The Sopranos?" Tony Soprano, the big mafia boss, has exactly the same condition you do, except he actually does pass out from time to time. My recommendation to you is to see a qualified and compassionate psychiatrist. (It's working well for Tony Soprano.) These episodes are uncomfortable, very disconcerting, and in most cases, preventable with the proper care. Was it your HIV? No, I strongly doubt it. But, living with HIV is one more stress in your life. See a psychiatrist. They will advise you whether medication or counseling or both would be the best course of action for you. Finally, if you haven't been watching The Sopranos, start watching. It's a great show! (Although maybe not quite as good as Sex and the City and Six Feet Under). Good luck.

Dr. Bob