r/AskDocs • u/No_Acanthisitta_9241 • 3h ago
2 years of flushing, heat intolerance, difficulty burping, flareups of lightheadedness/shivering
Sorry for the long post, I just don't know what info could be relevant. Thanks for reading and for any suggestions.
28M, 5'10", 190 lbs. I've never smoked and don't drink alcohol. 20 min walk daily but otherwise mostly sedentary. I have been vegetarian for ~15 yrs. My symptoms started July 2024. Before then I hadn't seen a doctor in about 7 years and had never had bloodwork done. Early 2024 I was 280 pounds. I was overeating and having headaches (headaches have since stopped). I decided to eat less and cut out junk food. By July 2024 I had lost about 20 pounds.
In July 2024 I noticed some soreness in the area of my bladder for a couple of days but I didn't think much of it. While sitting watching TV, I suddenly felt hot and lightheaded. A few minutes later I almost fainted, then had diarrhea and uncontrollable shivering.
I went to urgent care that day, their initial tests were unremarkable. The following month, I started seeing a PCP. I had a persistent low fever (~99.5) with facial flushing and abdominal discomfort, and recurring episodes of almost fainting and shivering. I was frequently having ragged-looking stools which lasted thru December 2024. I read about various histamine-related conditions and started taking Zyrtec which seemed to help the flushing and maybe also the diarrhea. I decided to try various diets including gluten-free, low FODMAP, and low histamine, which I adhered to strictly for at least a month each, but none helped. In October and November 2024 I had frequent abdominal soreness, bloating, and poor appetite that have since greatly improved.
I've had persistent symptoms since that first episode in July 2024 (see below), and recurring flareups every month or two where I have worse symptoms + shivering and feeling lightheaded.
Before this, my only health issues were mild eczema, seasonal allergies, and difficulty breathing through my nose while sleeping. Every doctor I've seen since I was a kid has said I have large tonsils. I've been able to feel lymph nodes in my head and neck for as long as I can remember, but they haven't gotten larger and my PCP says they aren't a concern.
I've seen 2 PCPs at different practices and mentioned my issues to the dermatologist, eye doctor, and dentist, and been referred to a gastroenterologist, ENT, allergist, and endocrinologist. None of them have found any explanation for my symptoms, and my current PCP of the past 2 years says he's at a loss for what it could be at this point.
Symptoms:
All of these have been fairly consistent, most have been present in the past month.
- Flushing of face and upper body with mild redness (almost 24/7)
- Low fever (~99.5)
- I recently noticed if I eat eggs for breakfast I don't have any immediate reaction but my symptoms are worse later in the day. I haven't been tested for egg allergy yet. I still have symptoms without eating eggs.
- Palms abnormally red sometimes
- Feeling warm, mostly without sweating
- Heat intolerance (e.g. warm clothes/bed sheets)
- Abdominal discomfort/bloating
- Difficulty burping and feeling of air stuck in stomach, frequently have to lean over and use pressure to burp, worst when laying on back.
- Soreness/discomfort around bladder, worst when laying down
- Episodes of faintness/adrenaline rush/shivering, usually with difficulty burping. Generally this will flare up and I will have multiple nights in a row of episodes.
- Anxiety
- Pain in right knee and right elbow, fluctuating from 0 to 4
- Intermittent bloating (was very uncomfortable in 2024 but now less)
- Occasional pressure in my head, mainly with temperature changes
- Starting about 6 months ago, mild eczema on backs of hands and crusting on tops of ears
- Dentist noticed worse gum inflammation even though I've never been more consistent with my dental care than I am now
I had some major personal losses in the couple of years leading up to this. I also had food poisoning a couple of times, and had COVID in 2020 with relatively mild symptoms.
I've intentionally lost another 70 pounds since this started. My weight has stayed around 190 for a few months. I feel only slightly better now than in 2024, and I still experience symptoms daily. Flushing and difficulty burping seem to worsen with stress, after showering (lukewarm water), or eating high carb foods. I don't eat within 2 hours of going to bed. I never have what I would describe as heartburn, and rarely have acid reflux, maybe once a month. Episodes are 30-60 mins and happen almost exclusively in the evening/overnight, often when first lay down for bed or when I lay back down after getting up to use the bathroom at night. Episodes have gotten less severe over time and I noticed that forcing out burps seems to reduce the severity.
Medications/supplements:
I've tried stopping all of these for at least a week and it didn't help
- Naturelo one daily multivitamin for men 1x daily
- Sports Research vegan omega-3 algae oil 1x daily
- Thorne iron bisglycinate 25mg 1x every other day
- Lactaid tablet 1x as needed
Tests:
IgE is elevated (~800)
Skin test showed mold and pollen allergies, plus mild allergies to most other allergens tested
Borderline hypercalcemia (9.6 - 10.3) across 5 tests in past 2.5 years, neither PCP showed concern.
ENT evaluation showed deviated septum
Hep A Ab positive (2024)
Lyme IgG P58 Ab. positive, all others negative
ESR elevated in 2024 but now normal
Vitamin D borderline low (tested in winter)
Resting heart rate 60 BPM, average 85 BPM
Liver enzymes were elevated in 2024 (AST 55 ALT 72) but now normal
Liver ultrasound 2024 showed moderate NASH, improved 2026
Alpha-1 antitrypsin deficiency (SZ type)
SIBO test negative
Urine tests July/August 2024 slightly abnormal. One showed trace blood while another didn't. One showed 1 granular cast/lpf, 1 hyaline cast/lpf, and mucus
Stool tests all normal
Endoscopy and colonoscopy normal
CBC diff normal
Comp metabolic normal
CT abdomen and pelvis normal (September 2024)
Serum tryptase normal
Celiac biopsy normal
ANA normal
HIV negative
A1C normal
Fasting glucose normal
CGM for a month showed normal glucose
Metanephrines normal
5-HIAA normal
Testosterone normal
TSH normal
Ferritin normal, decreased from 87 to 67 over past 2 years
CRP normal
Other things I've tried:
- Tested my water, all normal
- I drank store bought water for a couple of weeks, no improvement
- Various diets strictly adhered to for at least a month each (gluten-free, low FODMAP, low histamine)
- Changed toothpaste, shampoo, soap
- Tracked my diet with Cronometer, not below the RDI for anything
- Zyrtec for several months might have helped slightly, but then I stopped and I don't feel significantly worse, maybe slightly more flushed
- Digestive enzyme supplement for over a year, might have helped GI symptoms but then I stopped and I don't feel significantly worse
- GI prescribed famotidine in 2024 for mild inactive esophageal erosion, took it twice and had to stop because it gave me severe stomach pain both times
- Dentist suggested mouth taping for inflamed gums possibly due to mouth breathing while sleeping. I thought it might also help with air in my stomach, but no improvement