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The world doesn’t feel real and I can’t calm down, what’s going on? Dr Zoe Williams answers your questions

IT’S easy to worry about potential symptoms, or to be concerned about the health of yourself and loved ones.

However, if you’re worrying so much that it’s affecting your day-to-day life, or you’re feeling anxious in scenarios that wouldn’t ordinarily make you feel stressed or uncomfortable, it may have become a problem.

Dr Zoe Williams answers some common questions sent in by readers

Check out nhs.uk/every-mind-matters for lots of tips and strategies for managing anxiety and easing stress.

If things are getting too much, speak to your GP who will be able to offer further support.

Here’s what readers asked me this week . . . 

Q) I recently turned 60 and have not had a period for ten months (nearly there, hopefully).

I’m really struggling with too much adrenaline, have derealisation and am feeling out of control, with a racing heart and no appetite.

I just can’t seem to calm down and feel totally worn out.

I did have a major episode of anxiety 30 years ago after an accident and losing my career.

I had derealisation then and my GP put me on trazodone.

I only took it for a week as it allowed me to rest (calming my overactive brain) and I felt fine after this, what do you advise now?

A) Firstly, the symptoms you’re describing need to be assessed by a doctor.

Some of the symptoms you describe could be caused by medical conditions such as an abnormally working thyroid gland, or even abnormal activity of the heart.

It’s important to have your blood pressure checked too.

This is because the mention of adrenaline does make me, as a doctor, also consider rare things such as phaeochromocytoma, a rare tumour of the adrenal glands, which sit above the kidneys and secrete adrenaline.

I do not want to frighten you, and the final example is certainly less likely as it’s rare, but I do want to highlight the importance of having symptoms properly assessed by a doctor, even if you’ve had similar in the past.

The derealisation you mention does give a clue towards your mental health being the more likely primary cause of your symptoms.

Derealisation is the sensation that the world itself is unreal. It may leave you feeling panicked, or foggy or anything in between. It’s one way in which some people’s minds cope with too much stress.

I do wonder, is there anything going on just now?

It could be menopause-related, as you seem to imply you are going through it, not having had a period for ten months.

The decline in hormones through the menopausal years can affect most aspects of our health, both physical and mental.

You mention you’ve experienced these symptoms before and took trazodone which is a type of antidepressant.

This medicine may help with symptoms again, but it is really important to also figure out the underlying cause.

If you haven’t spoken to your GP about it, make an appointment to see them — and in the meantime, I’d advise starting a diary of your symptoms, to help identify any patterns or triggers.

Q) I WAS diagnosed with COPD and fibromyalgia. The fibromyalgia is really bad with a lot of stiffness.

I’m wondering if it could be multiple sclerosis instead as it’s got worse.

I also have other symptoms including poor vision in my left eye, balance issues and I feel lightheaded and dizzy.

I have pain in my back and running down my legs and sometimes I’m so stiff I can’t get up and can’t move my arms and legs.

It feels like I’m temporarily paralysed.

A) It sounds like you’re having a very hard time at the moment and if you haven’t called your GP to make an appointment, please do so straight away.

I’m not surprised by your worry that it could be MS instead of, or in addition to, fibromyalgia.

You’re right in your research that the symptoms for both can be similar.

MS is an autoimmune disease and occurs when your immune system mistakenly attacks your own cells and tissues.

Fibromyalgia is thought to be caused by your nervous system not being able to control or process pain signals properly.

People with fibromyalgia are more likely to experience irritable bowel syndrome, depression and widespread, persistent pain.

People with multiple sclerosis are more likely to experience weakness, vision problems, muscle spasms, and bowel or bladder issues.

While it sounds like you’ve been officially diagnosed with fibromyalgia, there’s no single test that confirms either condition, and diagnosis of both often involves ruling out other conditions first of all.

If your GP suspects MS, they should refer you to a neurologist, who will thoroughly assess you and probably do an MRI — which can detect scars caused by MS.

It’s vital you continue to pursue the right diagnosis so you can access the right treatment.

If you’re struggling with exhaustion and fatigue, it’s worth taking a list of symptoms with you so you don’t miss anything, and you’re entitled to take a friend or family member along to share their account too.

I fear bloat is ovarian cancer

Q) I AM worried I have ovarian cancer as my stomach is always bloated.

A) Yes, persistent bloating can be a sign of ovarian cancer and I’m so glad that you have raised this because March is Ovarian Cancer Awareness Month.

Other symptoms include persistent tummy pain, needing to wee more frequently, difficulty eating and feeling full quickly, or feeling nauseous.

Sometimes ovarian cancer does not cause any symptoms until it is quite advanced, so it’s important that people know what to look out for, so thanks again for your question.

Having said that, there are many other more common causes of bloating, such as irritable bowel syndrome, food intolerance or even coeliac disease, so I’m wondering what else might be going on to make you concerned about ovarian cancer? Your age? Family history? Or other associated symptoms?

Ovarian cancer is most common in postmenopausal women, with two thirds of cases diagnosed in women over 55, but it can affect anyone with ovaries at any age.

Your GP can find out the whole history from you, examine you and then do a CA125 blood test, which is a tumour marker for ovarian cancer.

If that comes back normal and the GP doesn’t have any other suspicions, that’s very reassuring.

If the tumour marker is raised or there are other concerns, your GP may organise a trans vaginal ultrasound test to assess the ovaries.

A reader’s response: ‘I suffered for many years too’

IN last week’s Sun Health, we had a question from someone struggling with debilitating burning mouth syndrome.

One reader, Jackie, emailed in with her experience and wanted to share it with readers, in the hope of helping others . . . 

Hi Dr Zoe, In regard to your patient with burning mouth syndrome, I was also diagnosed with this issue at around 50, at roughly the same time as the menopause started.

I suffered for several years. I am healthy, eat a good diet and go to the gym most days. I also had joint pain and fatigue.

The first specialist I saw told me it was all in my head and said “it will be something deep and dark and buried” and that I should see a psychologist.

I even saw one when completely at the end of my tether, even though I didn’t feel it was personally relevant.

A specialist dentist had me complete a food and stress diary and eventually did surgery on the roof of my mouth to take a sample.

The rheumatologist diagnosed fibromyalgia and chronic fatigue syndrome.

The amitriptyline (antidepressants) eased my symptoms but I didn’t want to stay on it long term.

As time went by and I started on HRT Oestrogel, my symptoms eventually eased and I put all of my symptoms down to the menopause.

Until, just before last Christmas when my GP said I needed to take medication for high blood pressure.

I used to take tablets for my blood pressure in the past, but weaned myself off them with diet and exercise.

Within a few days of taking the same tablets I had been on previously all of my symptoms returned: excruciating mouth pain and gum ulcers, joint pain and fatigue.

I stopped taking the tablets, the symptoms almost immediately subsided and my GP prescribed a different medication.

In retrospect the original symptoms coincided with the commencement of these tablets.

It may not be relevant, but feel free to pass this on to your patient!

Dr Zoe Said: That’s really interesting.

It’s always a good idea to consider new medication side effects if developing any new symptoms.

This is not a known common side-effect of this medicine, Telmisartan, but rare side-effects are dry mouth and altered taste.

  • If you live with a condition raised in Dr Zoe’s column and would like to share your advice with readers, please do follow Jackie’s lead and email us.

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