A bit of a more serious post for me but I'm desperate for answers and looking for any insight, direction, doctor recommendations… so let's start with the facts.
-I had a baby 8 weeks ago.
-He was an emergency c-section because my blood pressure kept dropping.
-Before that I was hospitalized 3 times with the same thing.
-One being life flighted with a blood pressure dropped and lingering at 63/31, blue lips and almost unconscious.
-With these 4 times I got EKG(came back normal), chest x-ray(normal), CT scans(all normal) and all sorts of ultrasounds checking various things(also all normal).
-For the most part they said I would be fine after the baby and these would stop.
-They did until 3 weeks after he was born. Then it was back to violently throwing up anything I ate, dizzy spells, fever & blood pressure drops.
-Of course I went to my PCP upset this is happening again. -For the last 5 weeks I've had 3 bad spells but probably 10 that are note worthy.
-Again, I throw up almost everything I eat. From week 3 to now, week 7, I've lost 15 pounds.
-The ER doctor decided it was my gallbladder and that it was inflamed and that it needed to be removed.
-So I go to a general surgeon who tells me my gallbladder is perfectly healthy and that he isn't going to remove it.
-Now I'm lost again. When I had an answer I was almost happy, because it would be over. Now I am back at square one.

So should I go to my pcp and ask for a full blood workup, referral to an endocrinologist, cardiologist or rheumatologist? I am hoping someone or their SO may have some insight or gone through something similar and an idea of where to start. Location is Burleson County. But willing to travel to Temple, Austin or Houston for the right reasons. Currently I'm overwhelmed and just want to feel better.

This sounds most unpleasant. I'd recommend posting to the Health and Fitness board for suggestions. There are several doctors that post over there. Good luck to you.

Wife had preclampsia with our kid....see cardiologist and make sure to keep obgyn in loop

I'm sorry.

I see Barrow at BSW and am mostly happy with him. I have been thinking about switching (not sure if we talked about my issues before), and people recommended Dr Damian (both of them) or Dr Morgan.

Endocrinologists here are in short supply, and won't see you without an official diagnosis. We'll, one will, but last I checked, his wait list for new patients was over a year.

Dr Sterling has always been fantastic about digging in to find the issue, but he is with DocIsHere now, so unless you subscribe to them, you won't get to see him.

Hope you find answers soon.

Start with bloodwork for sure

trip98 said:

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Wife had preclampsia with our kid....see cardiologist and make sure to keep obgyn in loop

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Pre-eclampsia is high blood pressure induced or exacerbated by pregnancy.

This is low blood pressure. Different issue altogether.

Definitely sounds hormonal but could be a congenital heart defect that went undiagnosed or untreated made worse by the stress of the pregnancy...although this is less likely because those things usually show up with the first pregnancy and this is ur third. Could be some sort of tumor throwing off hormonal regulation.

Because the wait is so long to see the endocrinologist see if u can get in to see a cardiologist first for a work up.

If they rule out the heart, then hopefully the cardiologist can streamline getting you in to see the endocrinologist and get blood work going to get the endocrinologist started or AT LEAST get you some meds to get the blood pressure up.

The blood pressure issue is the most immediate and dangerous.....at least if the cardiologist can get that symptom mitigated even if the main cause of the symptom is not identified, it gives you time to get the underlying root cause figured out.

Not a doctor...but if it was my wife that is where I would start.

Ags4DaWin said:

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trip98 said:

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Wife had preclampsia with our kid....see cardiologist and make sure to keep obgyn in loop

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Pre-eclampsia is high blood pressure induced or exacerbated by pregnancy.

This is low blood pressure. Different issue altogether.

Definitely sounds hormonal but could be a congenital heart defect that went undiagnosed or untreated made worse by the stress of the pregnancy...although this is less likely because those things usually show up with the first pregnancy and this is ur third. Could be some sort of tumor throwing off hormonal regulation.

Because the wait is so long to see the endocrinologist see if u can get in to see a cardiologist first for a work up.

If they rule out the heart, then hopefully the cardiologist can streamline getting you in to see the endocrinologist and get blood work going to get the endocrinologist started or AT LEAST get you some meds to get the blood pressure up.

The blood pressure issue is the most immediate and dangerous.....at least if the cardiologist can get that symptom mitigated even if the main cause of the symptom is not identified, it gives you time to get the underlying root cause figured out.

Not a doctor...but if it was my wife that is where I would start.

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Very good points here. Rule out the "big stuff" first, especially cardiac (with the low blood pressure and presumably low blood oxygenation), then if it persists and remains a mystery you can keep pressing onwards. Migraines can also present in really odd ways - dizziness, vomiting, etc., and they are way under diagnosed - especially in females of reproductive age - but throwing fever and low blood pressure into the mix doesn't make sense with that diagnosis. Hope you figure it out or the episodes go away on their own.

Which is why I was thinking maybe a cyanotic heart defect. EKG would have ruled out most arrhythmias and CHF right?

Would it be possible to have an undiagnosed one that due to pregnancy stress became worse or a tear that developed?

Low blood oxygenation and low BP leads to increased heart rate further stressing heart. Increased acid levels due to low blood oxygenation causes body to react to low o2 levels similar to elevation sickness which increases BP to head and causes heavy and extreme low BP to high BP fluctuations in the brain. High BP in the brain causes rest of the body to react by dropping BP. Dizziness and nausea a result of the fluctuations.

Fever result of poor blood flow through lungs as a secondary effect of fluid build up and low grade resp infection.

Once again, I am not a doctor.....so this is not "medical advice" but I did watch all the seasons of House MD twice.

You can get an IV to hydrate and replace the missing calories in the short term.....there is nothing u can do with a malfunctioning cardiac system.

And enough of the symptoms can be explained or secondarily explained by a cardiac issue.....would be worth looking at that first especially if you can't get in to see an endocrinologist for a long time.

Especially if they already ruled out all other common issues.

I think the drops are the kicker. Before extracting #3 the doctor sat and observed these drops and he even noted you could see them coming as I would start to lose color and my lips would get pale then everything would start dropping and going crazy for 2-5 minutes then I'd come right back up. It's been a strange 6 months.

I hope you find the answer soon and get to feeling better.

Thank you.

Sorry to hear this update, Lex. I'm not a 'real' doctor so i won't offer more than my hopes for an accurate diagnosis and speedy recovery. Hope you get well soon!

Thank you for all this. I appreciate you explaining your reasoning too.

Thanks love! I hope for answers soon.

I can't say I've ever had a migraine. But that could be it without obvious signs, I'll definitely bring it up with my pcp and see what she thinks.

Autonomic eval,
You're becoming orthostatic

Per ChatGPT: "Postpartum Complications Evaluation

Model: GPT-4

User
You are a consultant physician who specializes in difficult diagnosis. A 30 year old female presents with the following complaint: "-I had a baby 8 weeks ago.
-He was an emergency c-section because my blood pressure kept dropping.
-Before that I was hospitalized 3 times with the same thing.
-One being life flighted with a blood pressure dropped and lingering at 63/31, blue lips and almost unconscious.
-With these 4 times I got EKG(came back normal), chest x-ray(normal), CT scans(all normal) and all sorts of ultrasounds checking various things(also all normal).
-For the most part they said I would be fine after the baby and these would stop.
-They did until 3 weeks after he was born. Then it was back to violently throwing up anything I ate, dizzy spells, fever & blood pressure drops.
-Of course I went to my PCP upset this is happening again. -For the last 5 weeks I've had 3 bad spells but probably 10 that are note worthy.
-Again, I throw up almost everything I eat. From week 3 to now, week 7, I've lost 15 pounds.
-The ER doctor decided it was my gallbladder and that it was inflamed and that it needed to be removed.
-So I go to a general surgeon who tells me my gallbladder is perfectly healthy and that he isn't going to remove it."

What are the possible causes? What tests or diagnostics should be performed with this patient? What are the top working diagnoses?

ChatGPT
This is a complex case with symptoms that could indicate a variety of different conditions. The symptoms presented include hypotension (low blood pressure), vomiting, weight loss, dizziness, and fever.

Given the context, it's important to look at conditions that could be related to recent childbirth. Two that come to mind are Sheehan's Syndrome (pituitary gland failure due to blood loss during childbirth) and Postpartum Thyroiditis (inflammation of the thyroid post childbirth). However, these usually don't cause the hypotension described.

Another condition to consider is Addison's Disease, an adrenal insufficiency that could explain many of the symptoms including hypotension, nausea/vomiting, weight loss, and fatigue.

Lastly, the possibility of an autoimmune condition should also be considered, like systemic lupus erythematosus (SLE), which can cause a wide range of symptoms, including those described.

It's also crucial to rule out more common postpartum issues like infections (endometritis, mastitis, or urinary tract infections), venous thromboembolism, and postpartum depression/anxiety which can sometimes present with physical symptoms.

Here are some recommended tests/diagnostics:

Hormonal: Check ACTH stimulation test to assess for Addison's Disease, TSH, T3, T4 for thyroid function, and possibly pituitary hormones (FSH, LH, prolactin, growth hormone, ACTH) to assess for Sheehan's Syndrome.

Autoimmune: ANA, dsDNA, and complement levels to assess for SLE.

Imaging: Consider an MRI of the brain to evaluate the pituitary gland, particularly if hormonal tests suggest a pituitary issue.

Infection: Complete blood count, urine culture, and possibly blood cultures to rule out infection.

Others: Monitor orthostatic vitals, review current medications and consider discontinuing any that may lower blood pressure, check electrolytes, renal function, and liver function.

In summary, top working diagnoses could be:

Addison's Disease
Postpartum Thyroiditis or Sheehan's Syndrome
Systemic Lupus Erythematosus (SLE)
Postpartum infection
Other less common causes like pheochromocytoma, mast cell activation syndrome, or a paraneoplastic syndrome.
The management will depend on the final diagnosis after the recommended evaluations. Always remember to approach such cases in a multidisciplinary manner, involving the patient's obstetrician, primary care physician, and possibly a endocrinologist or rheumatologist."

Okay, this is pretty cool and gives me very clear ideas of what we should test for and be looking at. Thank you.

I wouldn't totally rule out your gallbladder especially if episodes follow eating certain foods (donuts, ice cream, etc...)

A gallstone in your cystic duct is more of an acute pain in the upper right quadrant sometimes radiating to your back. Those would last anywhere from 10 minutes to about 3 hours.

A gallstone in your common bile duct feels more like food poisoning causing vomiting and fever. These episodes were very unpleasant with the last one resulting in acute pancreatitis. It would sometimes take more than a day to clear.

When the gallstones do clear, you feel absolutely fine and it's possible that nothing even shows up on a scan.

Gallstones & Bile Duct Stones

Anyway, I hope you get a proper diagnosis and not have to suffer through those episodes.

Would that cause the drop in BP?

Sounds like POTS. Stick with cardiology.

https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

KidDoc said:

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Sounds like POTS. Stick with cardiology.

https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

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This man likes Iron Maiden and Rush.

Listen to him.

maroon barchetta said:

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Would that cause the drop in BP?

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It's sometimes associated with Acute Pancreatitis

Quote:

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Who does POTS affect?

The majority of people with POTS are women and people assigned female at birth aged 15 to 50 years. But men and people assigned male at birth can also have POTS.

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The enabling of mental illness by the medical community over the last few years has done a great disservice to their credibility.

Would be helpful to have a set of fasting labs prior to doctor visits. A PCP would be able to facilitate this so you can use insurance benefits. Insurance also covers an annual physical.

A cardiologist visit would also be helpful by performing an EKG and ultrasound of the heart.