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What Causes Sporadic Shortness Of Breath And Dizziness When Diagnosed With Prostate Cancer?
Question: Male, age 79, after 7 months of tests for over production of red cells, I'm presently classified as idiopathic erythrocytosis. Tests included heart XXXXXXX bone marrow biopsy (normal), echocardiogram, thyroid panel, CT scans from lower abdomen to top of head, cbc's, phlebotomy, BP normal, sleep apnea, HCT and HGN presently in normal range, but will probably rise again ( when this started Hct was 53 and hgn was 18.4). Presently symptoms include fatigue daily that progressively worsens, constant lightheadedness / dizziiness, sporadic shortness of breath, and sporadic low grade headaches. Best time of the day is early morning. No indication of anemia. Had an early stage colon tumor removed in XXXXXXX of 2016; HCT XXXXXXX from 44 to 53
in 8 months after surgery. I have had a pacemaker for 15 years for A-fib, including an ablation. Still have 3 years left on the battery; no problems. I've eliminated most non-essential exertion. I also have neuropathy
for the past 7 years, but I'm not diabetic. Prostate cancer 10 years ago, PSA fine. After all the good test results, it looks like this is no longer a oncology or hematology issue. Neurological maybe? Don't know where to turn....not depressed, active all my life. Thanks.
in 8 months after surgery. I have had a pacemaker for 15 years for A-fib, including an ablation. Still have 3 years left on the battery; no problems. I've eliminated most non-essential exertion. I also have neuropathy
for the past 7 years, but I'm not diabetic. Prostate cancer 10 years ago, PSA fine. After all the good test results, it looks like this is no longer a oncology or hematology issue. Neurological maybe? Don't know where to turn....not depressed, active all my life. Thanks.
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I passed carefully through your question and would explain that your symptoms could be related to different possible disorders:
- the dizziness could be related to orthostatic hypotension or chronic degeneration of the cervical spine
- the fatigue could be caused by neuropathy or heart failure. low blood pressure or orthostatic hypotension can also trigger fatigue.
- the shortness of breath could be related to heart failure, a lung disorder or orthostatic hypotension.
Coming to this point, I would recommend performing some tests to investigate on the above options:
- a cardiac ultrasound and NT pro BNP levels for heart failure
- a chest X Ray study and pulmonary function tests to investigate for a lung disorder
- a Head Up Tilt test for orthostatic hypotension
- thyroid hormone levels
- blood electrolytes
- kidney and liver function tests.
You should discuss with your doctor on the above issues.
Kind regards,
Dr.Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I passed carefully through your question and would explain that your symptoms could be related to different possible disorders:
- the dizziness could be related to orthostatic hypotension or chronic degeneration of the cervical spine
- the fatigue could be caused by neuropathy or heart failure. low blood pressure or orthostatic hypotension can also trigger fatigue.
- the shortness of breath could be related to heart failure, a lung disorder or orthostatic hypotension.
Coming to this point, I would recommend performing some tests to investigate on the above options:
- a cardiac ultrasound and NT pro BNP levels for heart failure
- a chest X Ray study and pulmonary function tests to investigate for a lung disorder
- a Head Up Tilt test for orthostatic hypotension
- thyroid hormone levels
- blood electrolytes
- kidney and liver function tests.
You should discuss with your doctor on the above issues.
Kind regards,
Dr.Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your input. I failed to mention that I had a recent pulmonary fitness test which was normal. The heart XXXXXXX result indicated no narrowing that would be of concern at this time; no blockage or need for a stent. Thyroid panel was normal.
I'm not familiar with orthostatic hypotension, but I will look into it. Same with NT pro BNP levels. I found it interesting that neuropathy can trigger fatigue. I've had this for about 7 years, and it worsens each year; cold increases the pain and discomfort. There is a suspicion that the cause may have been radiation I had at Mayo Clinic 10 years ago following prostate surgery. The other thing that is disappointing is that after the phlebotomy procedure, I don't feel any better. Apparently there is more than one thing going on here. If you have nothing more to add, I'll close out. Thanks again.
I'm not familiar with orthostatic hypotension, but I will look into it. Same with NT pro BNP levels. I found it interesting that neuropathy can trigger fatigue. I've had this for about 7 years, and it worsens each year; cold increases the pain and discomfort. There is a suspicion that the cause may have been radiation I had at Mayo Clinic 10 years ago following prostate surgery. The other thing that is disappointing is that after the phlebotomy procedure, I don't feel any better. Apparently there is more than one thing going on here. If you have nothing more to add, I'll close out. Thanks again.
Brief Answer:
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
I think that your situation is really complex and that there are many factors contributing in your situation.
The radiation can also be a cause of chronic fatigue.
Regarding neuropathy, you should know that this is a chronic progressive disorder, which affects also the autonomic nervous system, causing orthostatic intolerance (including orthostatic hypotension).
As phlebotomy is not helping, it seems that your symptoms are not related to erythrocitosis.
I would also advice checking vitamin D plasma levels and thyroid hormone levels, because chronic fatigue can be related to thyroid dysfunction or vitamin D deficiency.
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
My opinion as follows:
Detailed Answer:
Hello again!
Thank you for the additional information.
I think that your situation is really complex and that there are many factors contributing in your situation.
The radiation can also be a cause of chronic fatigue.
Regarding neuropathy, you should know that this is a chronic progressive disorder, which affects also the autonomic nervous system, causing orthostatic intolerance (including orthostatic hypotension).
As phlebotomy is not helping, it seems that your symptoms are not related to erythrocitosis.
I would also advice checking vitamin D plasma levels and thyroid hormone levels, because chronic fatigue can be related to thyroid dysfunction or vitamin D deficiency.
Hope you will find this answer helpful!
Wishing good health,
Dr. Iliri
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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