• Dr. Andrew

    January 19, 2024 at 3:30 pm

    12 yom diagnosed with “Dysautonomia” and seeing no progress, no results for approximately 7-8 months.

    CC – onset end of January 2023, sick, nauseous, vomitting, fever, and went to Urgent Care; tested for Strep due to red throat (due to vomiting), test came back positive for Strep G. which is very rare; blood

    PROGRESSION – ended up gonig to several clinics, MDs, urgent cares, Rheumatologists for the same symptoms of nausea, body aches, vomiting

    GASTRO MD – ordered more blood work and upper Endoscopy all WNL

    RHEUMATOID MD – referred to after GASTRO MD workup…diagnosed with DYSAUTONOMIA / POTS

    CARDIOLOGIST MD – worked


    DIET –

    Breakfast – would skip breakfast about 70% of the time;

    First meal – school lunch: pizza, chicken fingers, fries, tater tots

    Snack after school – crackers/cheese, jerky, string cheese, deli meat,

    Dinner – 5:30pm right before hard practices – meat, veggies and starch;


    CHRONIC VOMITING – an early symptom and a chronic symptom, initially would vomit before bed at night, tried GERD medicine, no impact, nochange; dry heaving and complex vomiting for 6 weeks which settled down and pattern changed; after 6 weeks he started vomiting throughout the day but no longer dry heaved; after starting Mirtazapine (alpha 2 adrenergic receptor blocker) his vomiting went away for 6 weeks but now after starting school and getting a mild cold his vomiting came back, dizziness, nausea,

    ANTIBIOTIC EXPOSURE – 5-6 rounds total in his lifetime; a couple of these rounds happened this year trying to treat the Strep G. infections;

    SLEEP: Lights out 9:30, typically takes 20-25min to fall asleep and stays asleep until the morning;

    Wake up 6:45am leave for school 7:15am; picked up at 3:40pm, then home from 4-5:30pm; practice 6-8pm (3x per week plus game);


    Atheletic programing –

    * None on file


    BLOOD LABS – when onset of illness, had low WBC and high inflammatory markers ESR; some iron deficiency symptoms; low Hgb12+, low HCT;


    * MIRTAZAPINE ………………………….. (30MG QD) given this around May, late spring and subsequently improved throughout the summer, increasing salt and water intake;


    PHENOTYPE: chronic severe hypoglycemia and meal skippping driving dysautonomia and catecholamine-related dysfunction; upper GI shut down as a side effect of chronic glucagon exposure and high adrenalin exposure;

    TODAY’S PLAN: Hypoglycemia eating pattern; Shake, adrenal support;


    Dr. Andrew Rostenberg

    – Lumbar Back (QL testing)

    Gallbladder: 4
    Stomach: 6
    Pancreas: 6
    Adrenal cortex, right: 5
    Ileocecal valve, right: 4

    HR – 93
    BP – 110/60 supine L vs. standing L 125/70 L

    • This reply was modified 4 months ago by  Dr. Andrew.