Brief Answer:
We need to start a stepwise series of tests.

Detailed Answer:
Hey XXXXXXX Thanks for coming to HealthCareMagic.com

I've gone through your query and a few possibilities jump out immediately. What I'd like to do is summarize what you've told me, so you can make sure I understand it all. Then ask YOU a few questions to help clarify issues. Lastly, i'll tell you what I'm thinking and leave you with some actionable advice.

So firstly. Let me recap your situation. Set me straight is I miss anything or get something wrong.

You're an 81 year old male. Currently you are taking ASA and Bendryl.
Occasionally, when you're trying to fall asleep and you are lying down, you get a flutter or a feeling of nervousness before you fall asleep. Sometimes the sensation is so intense that you can't actually get to sleep. Getting out of bed and walking around seems to relieve the sensation. The sensation seems to happen after you have sugary foods.

Overall you have good vitals and bloodsugars and you have had no other medical issues of note.

Let me ask you a few questions so I can get a clearer picture of things.

1) Does this sensation ever happen when you're just sitting down or walking around?
2) Have you ever had this sensation when you haven't had a high sugar meal?
3) Have you ever had this sensation when NOT taking Benadryl?
4) Do you drink alcohol? If no can you give me an idea of how much and how often?
5) On average how much sleep do you get? Do you wake up feeling refreshed in the mornings?
6) Do you have any other medical issues? Why do you take the ASA?
7) Are you taking Benadryl as Sleep Aid? Or is it for something else?
8) How much exercise do you get on a day to day basis?
9) Have you had a physical done recently? Any recent bloodwork? If you've had anything done in the last year, it would be nice if you could upload it. That way I could go over it and it would help me gain a clearer picture of your overall health.
10) Aside from this current issue. How would you say your overall stress and anxiety state is? Are you stressed by anything going on in your life? Is there something beyond this issue that is adding to your anxiety?

So, what jumps out at me overall is 2 things. Your Sugar metabolism and the use of Benadryl. Also, we might need to look a bit more closely at your heart.

Sugar Metabolism. The thing about sugar is that it affects us in ways that are really tough to imagine. When you get a massive influx of sugar into your blood stream.. your body can do some funny things. I'm sure you know all about insulin and the like.. but did you know sugar has a pretty interesting effect on a part of the Nervous System called the Autonomic Nervous System(ANS)? When you have high blood sugar levels. Your ANS, specifically the Sympathetic component of the ANS can go into overdrive.. making you sweat, get flushed and want to urinate as well. It also boosts your feelings of thirstiness. Also short term highs in blood sugar can leave us feeling kind of jittery (think of a 5 year old who has had too many jelly beans). In an adult, these effects can translate to a feeling of flushing or nervousness.

You might be wondering why high sugar meals haven't done this to you before. My only explanation for that is that you might be showing the beginning signs of Impaired Glucose Tolerance. That's a situation where the body is generally able to keep your sugars in check under normal situations, but a really high and rapid bolus of sugar into the blood stream can cause transient issues. The way to test for this is to keep track of your sugars after a meal (like checking your blood sugars every day exactly 2 hours after lunch), or by doing a lab test called an Oral Glucose Tolerance Test (where they load you with sugars and do the basic same thing in the lab).

I'm not saying that this IS what is happening. But your symptoms remind me of this phenomenon and it is much more common that you think. If you've had any recent bloodwork revolving around your sugar metabolism, I might be able to go through it and ether rule this theory out or rule it in.

The second issue is the use of Benadryl. Its sometimes used as a short term sleep aid and I'm not a big fan. When it is used for a long time, it does funny things to the releae of histamine in your body. Histamine is a chemical which causes your blood vessels to dilate. That dilation can cause a flushing sensation, it can also drop your blood pressure! When your BP drops, your heart has to make up for it by beating faster (needs to keep the same amount of blood flowing through your vessels right). So overuse of Benadryl could sort of explain your symptoms. If you are having sleep issues.. there are better meds out there. The only way to really test this theory is to stop using the Benadryl. Let me know what you think about that.

Lastly, undetected Heart Arrhythmias can cause these kinds of sensations.. They can even trigger panic attacks. So I'd like you to send me all the testing that has been done with regard to your heart. If you've had a recent ECG / EKG, I'd like to see it to look for evidence of an Arrhythmia.

I'll cut off for now. I don't want to overload you with information at the outset. See if you can answer those 10 questions I asked you and see if you have anything you can upload. I'll go over it and try and form a plan for you. If you have trouble with the uploading you can email the documents to YYYY@YYYY and ask the CRM team to upload the files to QueryID 215625.

Hope this helps. I look forward to your reply.

Vinay Bhardwaj, MD

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