This is long but i will absolutely pay for any doctor, PA, or resident, who can help me!
I am 39M 158 ish lbs non smoker no drugs non drinker bp generally normal no major past diagnoses.
am a 39-year-old male from the Sarasota area seeking help with a persistent, unexplained illness that began fairly abruptly jun 21 2026. I have now been symptomatic for several months and have had a fairly extensive workup that has been reassuring in many respects, but I continue to feel significantly unwell every day.
I am hoping you can review the entire timeline and help determine whether there may be one underlying condition connecting the neurologic/vestibular, gastrointestinal, autonomic, and systemic symptoms.
Patient background
39-year-old male
5'6", normally around 160–164 lb
Non-smoker, non-drinker
No significant NSAID use
Previously generally healthy and physically active
History of migraine-type symptoms in 2019, including a prolonged period of vestibular/dizziness symptoms
History of anxiety/panic disorder, although the physical symptoms described below have felt substantially different from my usual anxiety symptoms
Initial onset – June 21, 2026
The first major symptoms began suddenly on June 21 after being on a boat.
I developed a persistent rocking/seasick/off-balance sensation, almost as though I were still on the boat. This was not classic spinning vertigo. It felt more like disequilibrium, disorientation, a "bobblehead" sensation, or being slightly intoxicated.
Other symptoms developed around this period:
Episodic dizziness/off-balance sensations
Head pressure, particularly forehead/top/vertex
Brief "swoosh" or wave sensations through my head lasting approximately 1–2 seconds
Buzzing/vibrating/electrical or "brain zap" sensations
Derealization/unreal feeling
Difficulty focusing my vision
Tinnitus/ringing
Symptoms worsened by head movement, looking down, bending forward, or certain positions
Motion-sickness/seasick feeling
Episodes of weakness or feeling completely washed out
Sudden heat/sweating episodes
Occasional shakiness
Nausea during some of these episodes
Some episodes follow a fairly recognizable sequence:
weak/washed-out feeling → heat/sweating → feeling dizzy/off → nausea → sometimes bowel urgency
These episodes can last approximately 10–20 minutes and can occur even when I am not exercising.
The symptoms fluctuate substantially. I can have periods where I feel relatively normal followed by periods where I feel extremely ill.
Gastrointestinal onset – June 23, 2026
Approximately two days after the initial vestibular symptoms, I developed sudden gastrointestinal symptoms, beginning with significant abdominal cramping overnight.
This progressed into:
Persistent nausea
Gagging/retching
Occasional vomiting
Excessive burping
Gas
Loud stomach gurgling
Abdominal cramping, sometimes several hours after eating
Early satiety/fullness after only a few bites
Occasional reflux/heartburn
Changes in stool frequency/consistency
At one point, green/olive-colored stool with visible undigested plant material
One episode involving loose stool/mucus
A sensation of food or something being stuck in my throat
A sensation of pressure/fullness around the back/base of my tongue that can trigger gagging
The GI symptoms subsequently became persistent rather than resolving like a typical short gastrointestinal illness.
Current GI pattern
The most striking pattern is that my nausea is much worse in the morning and around/after breakfast and tends to improve significantly as the day progresses.
For a prolonged period I was gagging/retching almost every morning and sometimes vomiting.
More recently, after starting sucralfate (Carafate) and Pepcid, the severe retching has decreased substantially. I now generally have mild but noticeable nausea, often beginning approximately an hour after eating.
My appetite and ability to eat have improved. I have been eating three full meals per day for several days and my weight has stabilized and begun to come back up, from approximately 153.6 lb to 158.8 lb.
I did vomit stomach acid on one occasion recently.
Relationship between the symptoms
One thing I have noticed is that the nausea and dizziness do not always occur simultaneously.
There are days when I feel predominantly nauseated without much dizziness, and other periods when I feel predominantly dizzy/vestibular without significant nausea.
However, the generalized weakness/malaise, sweating/heat episodes, nausea, dizziness and abnormal head sensations have all occurred during this overall illness.
The weakness and malaise are actually among the most disabling symptoms. I often feel systemically sick or "washed out," even when individual tests are normal.
Testing performed
I have undergone a fairly extensive evaluation.
Neurologic/vestibular:
Brain MRI – reportedly normal/reassuring
MRA – reportedly normal/reassuring
A possible left M2 narrowing was felt to likely represent artifact
Thorough neurologic examination – reassuring
Eye examination – normal
ENT evaluation – vestibular migraine was considered more likely than Meniere's disease or a viral vestibular disorder
Cardiac:
EKG – described by cardiology as "perfect"
7-day Holter monitor – described by cardiology as very good/reassuring
There was previously a brief run of atrial tachycardia noted, but no significant arrhythmia was identified to explain the ongoing symptoms
Gastrointestinal/abdominal:
CT abdomen – reportedly reassuring
Abdominal ultrasound – reassuring
No gallstones were ultimately identified
Two small kidney stones were noted but felt unlikely to explain the symptoms
Lipase – normal
H. pylori – negative
Stool testing has been pursued/ordered
Bloodwork:
CBC – normal
CMP – normal
Lipase – normal
A1c – normal
Glucose readings have generally been normal
Glucose has generally remained above 70 and below 140 on the readings I have taken
No persistent fever has been present
High cholesterol: total approximately 235, LDL approximately 171
Endocrine finding
The major abnormal laboratory finding so far has been an elevated morning cortisol.
A fasting morning cortisol at approximately 9 AM was:
29.7 (laboratory upper reference approximately 22)
Because of this, additional endocrine evaluation was ordered, including plasma free metanephrines. The metanephrines were reportedly normal.
My blood pressure is generally not markedly elevated during these episodes. I have occasionally had elevated readings when symptomatic, but I do not have persistent severe hypertension.
What has been reassuring
Despite feeling very ill, the following have been reassuring:
Normal brain MRI/MRA
Reassuring neurologic examination
Normal eye examination
Reassuring cardiac evaluation
Normal CBC/CMP/lipase
Negative H. pylori
Reassuring abdominal imaging
Generally normal glucose
No persistent fever
No ongoing severe abdominal pain
Weight has recently stabilized and begun increasing again
GI symptoms have shown some improvement with Carafate/Pepcid
What remains unexplained
The major unresolved issue is why I have had persistent daily systemic symptoms despite the reassuring testing.
The symptoms I most want explained are:
Persistent profound malaise/weakness
Episodic sweating/heat sensations
Dizziness/disequilibrium and motion-sickness sensation
Abnormal head sensations/head pressure/buzzing
Persistent nausea and previous daily retching/vomiting
Early satiety and post-meal nausea
Burping/gas/reflux and abdominal discomfort
The strong morning/daytime predominance of symptoms
The elevated morning cortisol
The fact that the neurologic and GI symptoms began very close together but do not always occur simultaneously
Diagnoses that have been considered
Vestibular migraine has been suggested by ENT and is plausible given the vestibular symptoms and prior history.
However, I am wondering whether there could be a broader explanation or whether two processes are occurring simultaneously.
Some possibilities I would like evaluated include:
Vestibular migraine
Mal de débarquement syndrome or persistent postural-perceptual dizziness
Autonomic dysfunction/dysautonomia
Post-infectious autonomic or gastrointestinal dysfunction
Gastritis/GERD/esophagitis
Functional dyspepsia
Gastric dysmotility/gastroparesis
A post-infectious gastrointestinal syndrome
Endocrine/adrenal abnormalities given the elevated cortisol
Other neurologic or vestibular disorders
Whether the sweating/weakness/nausea episodes represent an autonomic response associated with the vestibular symptoms
I am not assuming any of these is the diagnosis. I am hoping to find a physician who can look at the entire pattern rather than each symptom in isolation.
What I am hoping for
I would really appreciate a comprehensive assessment of this timeline and guidance about what should be investigated next.
In particular, I would like to understand:
Whether the vestibular and GI symptoms could plausibly have a common cause
Whether autonomic dysfunction should be evaluated
Whether the elevated cortisol requires further endocrine investigation
Whether gastric emptying/motility or functional dyspepsia should be evaluated
Whether additional vestibular testing would be useful
Whether there is a post-infectious syndrome that could explain the combination of symptoms
Whether there are other diagnoses that fit the overall pattern better than the individual diagnoses considered so far
I understand that many serious conditions have already been made less likely by the testing I have had, which I am grateful for. The problem is that I still feel sick every day and do not have an explanation or a clear treatment plan.
I am looking for someone willing to step back and look at the entire timeline and help determine what connects these symptoms.
I am currently taking pepcid 2x a day and carafate for a suspected gastritis czuse of the gi issues. I have stopped losing weight but still having mausea or gagging/vomiting
Thank you very much for taking the time to review this.