Longitudinal Health Symptom, Treatment and Control Summary (2008-2026) A Longitudinal Synthesis of Symptom Burden, Autonomic Linkage, Intervention, Recovery and Present Level of Control

50

46

4

92%

recorded entries

resolved or under control

not under control

resolved or controlled

Autonomic linkage status

Meaning in this table

PROBABLE

Recognised autonomic mechanism with a strong fit to the documented pattern.

POSSIBLE

Biologically plausible relationship, but the symptom is not specific to autonomic dysfunction.

INDIRECT

The condition may amplify symptom burden, reduce cardiovascular or physiological reserve, or complicate autonomic compensation without itself being an autonomic manifestation.

NO ASSOCIATION

No direct autonomic association is identified; the condition is retained as a separate structural, inflammatory, mechanical or other diagnosis. Any indirect reserve effect is described separately where relevant.

Code

Interpretation

Current total

R

Resolved

11 | 22%

UC

Under control

26 | 52%

UCWL

Under control, but retained on watchlist because significant care, specialist review or close monitoring remains necessary

9 | 18%

NUCWL

Not under control and retained on watchlist

4 | 8%

PROBABLE — 18 | 36%

POSSIBLE — 15 | 30%

INDIRECT — 13 | 26%

NO ASSOCIATION — 4 | 8%

Period

Medical condition or symptom complex/how this is related to MSAD

Treatment or management approach

Outcome or level of control achieved

Status

2008

Urinary outlet obstruction

Prostate/urethral problems, later including urethral stricture and obstructed emptying

MSAD linkage (POSSIBLE): structural outlet disease is not autonomic, but bladder filling sensation, detrusor activity and coordinated emptying depend on autonomic pathways. In this history, urethral obstruction and possible autonomic bladder dysfunction can therefore coexist and compound incomplete emptying. Three-hit context: later autonomic bladder impairment may have been superimposed on pre-existing structural outlet disease, especially after Hits

2-3.

Key source: National Institute of Diabetes and Digestive and Kidney Diseases, “Autonomic  Neuropathy.”

Prostate surgery in 2008;

intermittent self-catheterisation; urethroplasty in 2019; another urethral procedure in November 2022

Structural repair and catheterisation provided management; later urinary emptying difficulties persisted.

UC

2008, late

Acute chikungunya—CHIKV: fever, rash, severe joint pain and profound fatigue. The clinical

Hospital

You survived

R

Acute

understanding at the time was that a virus was attacking your heart, with no clear prediction of

admission in April

the acute illness.

CHIKV

which way the outcome would go.

2009 with critical-

Persistent joint

illness

MSAD linkage (POSSIBLE): major viral illness can be followed by persistent autonomic

care monitoring

symptoms, fatigue

disturbance through post-viral inflammatory, immune and neural mechanisms. Within the

and supportive

and subsequent

cumulative-injury/autonomic-reserve framework developed in the MSAD work, CHIKV

management for

cardiovascular

is therefore a biologically plausible early 'hit', although the later dysautonomia cannot

the acute viral

difficulties became

be attributed to it alone. Three-hit context: this is Hit 1, the proposed initiating viral-

illness and cardiac

part of the longer

inflammatory/cardiac stressor in the model.

involvement

health journey.

Key source: National Institute of Neurological Disorders and Stroke, “Postural Tachycardia

Syndrome (POTS).”

2008

Persistent or recurrent joint pain following CHIKV

Ongoing symptom

Persistent joint pain

UC

onwards

MSAD linkage (INDIRECT): persistent post-CHIKV joint pain is not itself an autonomic sign,

monitoring,

remained part of

Persistent

but chronic pain and inflammatory stress can increase sympathetic load, reduce activity and

pacing and

the longer recovery;

joint pain

deconditioning reserve, and consume physiological reserve. It may therefore amplify MSAD

activity

pacing and activity

burden without being caused by MSAD. Three-hit context: persistent post-CHIKV pain added

adjustment during

adjustment

physiological load after Hit 1 and may have reduced later reserve.

recovery from

supported day-

Key source: Blitshteyn, “Dysautonomia: a common comorbidity of systemic disease,” 2025.

CHIKV

to-day function,

with the degree

of resolution

remaining variable.

2009

Myocarditis, diagnosed at North Shore Hospital

Cardiology

Cardiac function

UC

Myocarditis

MSAD linkage (INDIRECT): myocarditis is a cardiac inflammatory injury rather than an

assessment,

stabilised

cardiac

autonomic diagnosis, but it can reduce cardiovascular reserve and increase the work required

cardiac monitoring

sufficiently

injury

of autonomic compensation. In a cumulative-injury model it is a biologically plausible

and continuing

for substantial

contributor to reduced reserve, not proof of autonomic causation. Three-hit context: post-Hit

management

professional

1 myocarditis represents an early documented cardiac injury within the cumulative-reserve

following the

activity to continue,

model.

myocarditis

although the

Key source: Blitshteyn, “Dysautonomia: a common comorbidity of systemic disease,” 2025.

diagnosis

myocarditis-

specific

contribution to later

symptoms cannot

be isolated.

2009

Coronary artery disease requiring coronary stent placement

Cardiac stenting

Coronary stenting

UC

onwards

MSAD linkage (INDIRECT): coronary artery disease is a separate structural vascular

recorded in 2008

treated the

Coronary

disorder, but reduced cardiac/perfusion reserve and vasoactive treatment can materially limit

and March 2022;

identified arterial

artery

the body's ability to compensate for standing and exertion. It can therefore magnify autonomic

another account

disease; symptom-

disease

symptoms without being attributed to MSAD.

mentions 2010

specific benefit is

Key source: Juraschek et al., AHA Scientific Statement on orthostatic hypotension in adults

difficult to separate

with hypertension.

from the broader

cardiac history,

and the procedural

chronology varies

between accounts.

2009

onwards Persistent hypertension

Persistent hypertension, sometimes difficult to control

MSAD linkage (PROBABLE): blood-pressure stability depends heavily on baroreflex-mediated sympathetic and parasympathetic responses. Persistent hypertension alternating with orthostatic pressure falls is physiologically consistent with impaired baroreflex/autonomic

Spironolactone introduced; renal ablation for BP control in

A measure of control achieved, but substantial BP variability

NUCWL

regulation, while medication, renal and vascular factors may modify the pattern. Three-hit

October 2012;

continued. The

context: later worsening after Hits 2-3 is compatible with cumulative baroreflex/autonomic

later reported

contribution of each

vulnerability, without proving a single cause.

medicines

intervention is not

Key source: Juraschek et al., AHA Scientific Statement on orthostatic hypotension in adults

include losartan,

separately recorded.

with hypertension.

spironolactone

and Lasix

2009

Recurrent cutaneous irritation and rash

Identification

Management

UC

onwards

MSAD linkage (INDIRECT): rash is not a recognised core manifestation of dysautonomia.

and avoidance of

centred on avoiding

Recurrent

Inflammatory or medication-related skin disease can, however, increase systemic stress

suspected irritants

suspected triggers

skin rash

and autonomic demand, so it may add to overall MSAD burden while retaining a separate

or medication

and treating

dermatological explanation.

triggers, with

irritation when

Key source: Blitshteyn, “Dysautonomia: a common comorbidity of systemic disease,” 2025.

skin-directed

present; the longer-

symptomatic care

term pattern of

as required

recurrence remains

unclear.

2011

Atrial fibrillation: abnormal heart rhythm

AF catheter

AF brought under

UC

Atrial

MSAD linkage (POSSIBLE): atrial fibrillation is an electrophysiological arrhythmia, but

ablation; Pradaxa

control and ceased

fibrillation

atrial rhythm is influenced by sympathetic-parasympathetic balance and autonomic reflexes.

also appears

to be the dominant

Autonomic dysregulation can therefore modify susceptibility or symptom expression, although

in your later

rhythm problem.

AF itself does not establish MSAD. Three-hit context: AF followed Hit 1; the timing is

medication history

Anticoagulation

compatible with altered cardiac-autonomic vulnerability but is not proof of causation.

served a separate

Key source: NIDDK, “Autonomic Neuropathy.”

protective purpose.

2011 and later Reflux

oesophageal pain

Reflux, oesophageal or chest discomfort, nocturnal throat/oesophageal burning and pain MSAD linkage (POSSIBLE): vagal and enteric pathways coordinate oesophageal peristalsis, sphincter function and upper-GI motility. Reduced autonomic motor reserve can therefore worsen reflux, transit or swallowing symptoms, while EoE and other structural/inflammatory causes remain independently important.

GERD assessment and treatment; gastroscopy, acid monitoring and barium swallow;

Reflux reportedly

resolved after G-POEM; later inflammatory oesophageal

R

Key source: NIDDK, “Autonomic Neuropathy.”

later G-POEM

symptoms required

and EoE-directed

separate treatment.

treatment

2014 and

Severe hip joint disease requiring total hip replacement

Total hip

Both diseased

R

March

MSAD linkage (INDIRECT): hip disease is structurally musculoskeletal, not autonomic. Pain,

replacements

hip joints were

2021

reduced mobility and deconditioning nevertheless reduce the reserve available for upright

surgically replaced,

Severe hip

compensation and can amplify orthostatic intolerance, gait limitation and falls risk within a

providing structural

disease

multifactorial MSAD picture.

treatment and

Key source: Fedorowski et al., “Orthostatic Hypotension: Management of a Complex, But

supporting

Common, Medical Problem.”

mobility; the degree

of pain relief is

not separately

quantified.

2017

Falls, near-falls, gait instability and fall-related injuries, including broken bones

Hospital

The walking

NUCWL

onwards;

MSAD linkage (PROBABLE): documented orthostatic hypotension can directly produce

assessment when

stick, activity

severe

dizziness, visual narrowing, presyncope, instability and falls through reduced cerebral

required; walking

modification

episodes in

perfusion. Musculoskeletal, vestibular and balance factors may coexist, but the autonomic

stick; activity

and postural

2022 and

mechanism is physiologically strong where episodes track upright BP deterioration. Three-

modification and

management

2026

hit context: falls began before 2021, but more severe later episodes are compatible with

management

support safer

Falls gait

amplification after Hits 2-3.

of postural

participation,

instability

Key source: Fedorowski et al., “Orthostatic Hypotension: Management of a Complex, But

symptoms

although gait

Common, Medical Problem.”

instability and falls

risk persist.

2018

Recurrent or severe urinary infections, antibiotic resistance and sepsis reported in earlier

Antibiotic

Antibiotics and

UCWL

and after

history

treatment and

hospital care treated

procedures

MSAD linkage (POSSIBLE): autonomic bladder dysfunction can impair sensation and

hospital care

acute episodes, but

in 2021–

emptying, leaving residual urine that increases infection risk. Urethral obstruction and

recurrent infection,

2022

catheterisation provide additional non-autonomic pathways, so recurrent infection is plausibly

resistance and

Recurrent

the downstream result of interacting autonomic and structural factors.

the earlier sepsis

urinary

Key source: NIDDK, “Autonomic Neuropathy.”

history continued to

infections

complicate urinary

management.

2019–2021

Frequent premature ventricular contractions, reaching approximately 15,000 in 24 hours

LVOT PVC

PVC problem

R

Frequent

MSAD linkage (POSSIBLE): PVCs are an electrophysiological rhythm disorder rather than

ablation on 15

treated, but the

PVCs

a diagnostic sign of dysautonomia, but ventricular excitability and symptom perception are

October 2021

procedure caused

influenced by sympathetic-parasympathetic balance. Autonomic instability can therefore

ventricular

interact with the arrhythmia and with BP/HR regulation without being its sole cause. Three-

perforation and

hit context: PVCs preceded Hits 2-3; their ablation precipitated Hit 2, followed immediately

tamponade.

by Hit 3.

Key source: NIDDK, “Autonomic Neuropathy.”

2019

Heat intolerance and difficulty regulating body temperature

Activity and

Temperature

UC

onwards;

MSAD linkage (PROBABLE): sweating, cutaneous vasodilation/vasoconstriction and heat

environmental

regulation became

worse after

dissipation are autonomically regulated. Heat intolerance and impaired temperature control

adaptation; pacing

more dependable

2021

therefore have a direct physiological route from autonomic dysfunction, although medication,

during recovery,

Heat

cardiac status and deconditioning can add to the burden. Three-hit context: pre-2021

although heat

intolerance

heat intolerance worsening after Hits 2-3 supports amplification of an existing autonomic

remains a stressor.

vulnerability.

Key source: NIDDK, “Autonomic Neuropathy.”

2020

onwards; pronounced after 2021 Orthostatic hypotension

Orthostatic hypotension: dizziness, light-headedness, presyncope and occasional syncope on standing

MSAD linkage (PROBABLE): orthostatic hypotension is a cardinal manifestation of impaired autonomic cardiovascular compensation. Inadequate vasoconstriction and/or heart-rate adaptation on standing can reduce venous return and cerebral perfusion, producing the

documented dizziness, presyncope and occasional syncope; medication and volume status may

Fluids and salt as clinically directed; compression garments and abdominal support; positional

Greater practical control and ability to function; postural pressure falls remain a major limitation.

NUCWL

add secondary effects. Three-hit context: orthostatic symptoms pre-dated 2021 but became

adaptation; head-

pronounced after Hits 2-3, strongly supporting a cumulative-reserve interpretation.

of-bed elevation;

Key source: Juraschek et al., AHA Scientific Statement on orthostatic hypotension in adults

pacing and BP

with hypertension.

monitoring

2020–2021;

Gallbladder dysfunction

Gallbladder dysfunction

MSAD linkage (POSSIBLE): gallbladder emptying is influenced by vagal, sympathetic and enteric-neurohormonal control, so autonomic dysfunction can plausibly modify biliary motility. Gallbladder disease, however, has many independent causes and should not be attributed to MSAD without specific evidence.

Key source: Blitshteyn, “Dysautonomia: a common comorbidity of systemic disease,” 2025.

Cholecystectomy reported in an earlier account

The gallbladder disorder was described as settled after cholecystectomy; the operation date differs between the available accounts.*

R

2020-21

Biliary tract dysfunction

Clinical

Biliary symptoms

UC

Biliary

MSAD linkage (POSSIBLE): biliary motility is partly under neural and neurohormonal

monitoring and

remained

tract

control, and broader autonomic GI dysmotility can alter coordinated digestive function. This

evaluation of

under clinical

dysfunction

gives a biologically plausible connection, but biliary tract disease remains nonspecific and

biliary symptoms,

evaluation and

requires its own explanation.

considered

were considered

Key source: NIDDK, “Autonomic Neuropathy.”

separately from

separately from

the gallbladder

the gallbladder

disorder

disorder; a

distinct treatment

response cannot

be established

from the available

account.

2021

Altered or impaired sweating

Temperature

Sweating returned

R

onwards,

MSAD linkage (PROBABLE): sweat-gland output is controlled by autonomic sudomotor

regulation,

and became more

especially

pathways. Altered or impaired sweating is therefore a direct physiological autonomic

hydration, pacing

dependable.

Impaired

manifestation; later return of sweating is also consistent with selective recovery, compensation

and observation

sweating

or recalibration of autonomic function. Three-hit context: the post-Hits 2-3 timing strengthens

during autonomic

the fit with a broader multisystem autonomic deterioration.

recovery

Key source: NIDDK, “Autonomic Neuropathy.”

2021

Delayed pupil response, light sensitivity and difficulty adapting between bright and dim

Softer, predictable

Provides practical

UC

onwards;

conditions

lighting and

accommodation;

described

MSAD linkage (PROBABLE): pupil size and light-dark adaptation depend on coordinated

environmental

complete resolution

in 2026

sympathetic and parasympathetic control. Delayed pupil response and impaired adaptation

adaptation

not reported.

Delayed

therefore have a direct autonomic pathway, although ocular or neurological causes should

pupillary

still be excluded. Three-hit context: this post-Hits 2-3 symptom fits the broader emergence of

response

autonomic signs after the 2021 insults.

Key source: NIDDK, “Autonomic Neuropathy.”

2021

Cognitive fatigue, slower processing, difficulty finding words or making decisions under load

Pacing cognitive

Sustained

UC

onwards;

MSAD linkage (PROBABLE): cognitive slowing and fatigue can arise when orthostatic/

work, rest

thinking, writing

continuing

autonomic failure reduces cerebral perfusion and increases the metabolic effort needed

and assistive

and professional

in 2026

to maintain homeostasis. The close association with upright intolerance makes this

communication,

work regained;

Cognitive

physiologically plausible, while sleep, medication and other neurological factors remain

including LLM-

processing speed

fatigue

possible contributors. Three-hit context: prominence after Hits 2-3 is consistent with reduced

supported writing

and fatigue remain

cerebral-perfusion/autonomic reserve in the post-2021 phase.

limiting at times.

Key source: NINDS, “Postural Tachycardia Syndrome (POTS).”

2021–2026,

Trauma-related distress, fear, frustration, grief, emotional exhaustion and the burden of

Self-directed

Research, writing

UC

recurring

repeated setbacks

trauma processing

and musical

Trauma

MSAD linkage (INDIRECT): emotional stress activates sympathetic, cardiovascular and

through research,

expression provided

emotional

endocrine stress pathways and can temporarily consume autonomic reserve. It can therefore

explanatory

a framework

exhaustion

amplify an established dysautonomia; this is a bidirectional physiological interaction and

writing and

for processing

does not imply that the autonomic disorder is psychological in origin. Three-hit context: Hits

musical

repeated setbacks,

2-3 were themselves major physiological trauma; later emotional arousal can further tax

expression,

while pacing and

autonomic reserve.

together with

reduced demands

Key source: Goldstein, “Linking the Extended Autonomic System with the Homeostat Theory,”

pacing and

supported ongoing

2024.

adjustment of

adjustment.

daily demands

15 October

2021

Cardiac tamponade

Cardiac tamponade and haemodynamic collapse following ventricular perforation MSAD linkage (POSSIBLE): haemodynamic collapse, emergency sternotomy and cardiopulmonary bypass constitute major cardiovascular, inflammatory and neural stress.

Within the cumulative-injury/autonomic-reserve model, this event is a plausible major 'hit' capable of reducing autonomic reserve and preceding multisystem dysregulation, although causation cannot be proved from one case. Three-hit context: tamponade/haemodynamic collapse is Hit 2; the emergency sternotomy, CPB and ventricular repair constitute Hit 3. Key source: NINDS, “Postural Tachycardia Syndrome (POTS).”

Emergency sternotomy, cardiopulmonary bypass and ventricular repair

Life saved and immediate cardiac injury

repaired. Recovery was followed

by extensive multisystem difficulties.

R

October 2021

onwards Post-exertional fatigue

Severe fatigue, weakness, reduced endurance and slow recovery after exertion

MSAD linkage (PROBABLE): exertion requires rapid autonomic adjustment of heart rate, vascular tone and cerebral perfusion. Blunted or delayed compensation can produce weakness, breathlessness, fatigue and prolonged recovery; cardiac recovery and deconditioning may add to, but do not exclude, this autonomic mechanism. Three-hit context: onset immediately after Hits 2-3 gives this fatigue/endurance syndrome a particularly strong temporal relationship.

Key source: NINDS, “Postural Tachycardia Syndrome (POTS).”

Pacing, rest, protected exercise, recumbent cycling and treatment of individual cardiac, digestive and urinary problems

Meaningful recovery of activity and professional participation; fatigue and delayed recovery continue to fluctuate.

UC

2022–2026,

especially BP

regulation instability

Supine or resting hypertension alternating with low upright BP

MSAD linkage (PROBABLE): the combination of supine or resting hypertension with low upright BP is a recognised pattern of impaired autonomic/baroreflex control. Failure to buffer pressure appropriately in opposite postures provides a strong physiological link, while cardiovascular disease and medication can further shape the observed values. Three-hit

context: this post-Hits 2-3 BP pattern is a central expression of impaired baroreflex/autonomic reserve.

Key source: Juraschek et al., AHA Scientific Statement on orthostatic hypotension in adults with hypertension.

Specialist-directed medication management, home BP readings, head-of-bed elevation and adjustment of daily activity

Partial control; the coexistence of high and low pressures remains difficult to manage.

NUCWL

2022–2023,

Inadequate heart-rate response to standing or exertion, with breathlessness and exercise

Cardiology

Gradual

UC

especially

intolerance

review, heart-rate

improvement:

Blunted

MSAD linkage (PROBABLE): heart-rate adaptation to standing and exercise is partly

and symptom

exercise HR

heart-rate

autonomically mediated. A blunted chronotropic response with breathlessness and exercise

monitoring,

reportedly rose

response

intolerance therefore fits impaired autonomic cardiac regulation within the broader MSAD

graded activity

from rarely

pattern. Three-hit context: post-Hits 2-3 chronotropic limitation is compatible with worsened

within tolerance,

exceeding about 70

autonomic cardiac responsiveness.

and pacing to

bpm to around 100

Key source: NIDDK, “Autonomic Neuropathy.”

limit exertional

during walking and

breathlessness

approximately 120

with greater effort

by late 2025.

2022–2024;

Autonomic storms: abrupt widespread physiological disturbance and exhaustion

Blood-pressure

Storms ceased

UC

later

MSAD linkage (POSSIBLE): abrupt multisystem episodes involving cardiovascular,

management,

or markedly

intermittent

thermoregulatory, gastrointestinal or exhaustion symptoms are physiologically compatible

pacing, trigger

diminished during

episodes

with unstable autonomic signalling and an exaggerated homeostatic stress response.

reduction, self-

2024–2026.

Autonomic

'Autonomic storm' remains a descriptive term rather than a separate diagnosis. Three-hit

monitoring and

Improvement

storms

context: emergence after Hits 2-3 fits a temporarily unstable, low-reserve autonomic system.

recovery during

cannot be attributed

Key source: Goldstein, “Linking the Extended Autonomic System with the Homeostat Theory,”

episodes

to one intervention

2024.

alone.

2022–2024,

Delayed gastric emptying/gastroparesis: early fullness, nausea, bloating and difficulty moving

Gastrointestinal

Improved gastric

UC

especially

food through the stomach

investigations;

emptying and

Delayed

MSAD linkage (PROBABLE): gastric emptying depends substantially on vagal, enteric

smaller meals;

digestive function;

gastric

and pyloric coordination. Autonomic neuropathy can slow gastric transit and produce

G-POEM in 2024

meaningful

emptying

gastroparesis, making the documented delayed emptying a recognised GI-autonomic

to address pyloric

improvement in

manifestation, while medication and local gastric factors may coexist. Three-hit context:

resistance

quality of life.

clinically important gastroparesis emerged after Hits 2-3, matching the broader post-2021

GI-autonomic deterioration.

Key source: NIDDK, “Autonomic Neuropathy.”

2022

diagnosis;

Pancreatic exocrine insufficiency, impairing digestion

MSAD linkage (INDIRECT): the exocrine pancreas is densely regulated by parasympathetic and sympathetic pathways, so autonomic dysfunction can plausibly alter digestive secretion and gut-pancreatic coordination. Established pancreatic exocrine insuficiency nevertheless requires its own pancreatic explanation; within MSAD it may further reduce nutritional and physiological reserve.

Key source: Blitshteyn, “Dysautonomia: a common comorbidity of systemic disease,” 2025.

Creon with meals

Digestion improved and pancreatic insufficiency brought under practical control with ongoing enzyme support.

UC

treatment

from 2023

Pancreatic

insuficiency

2022

onwards Constipation evacuation difficulty

Constipation and difficult evacuation

MSAD linkage (PROBABLE): autonomic and enteric pathways regulate colonic propulsion, rectal sensation and internal-sphincter behaviour. Dysfunction can therefore contribute to constipation and dificult evacuation; pelvic-floor, medication and structural mechanisms may coexist, especially where outlet relaxation is impaired. Three-hit context: post-Hits 2-3 onset fits the wider post-2021 pattern of enteric/autonomic dysmotility.

Key source: NIDDK, “Autonomic Neuropathy.”

Hydration, soluble fibre in earlier accounts, and Microlax when required

A measure of bowel control achieved; continued bowel management remained necessary.

UC

2022

onwards Dry eyes

Acute dry eyes

MSAD linkage (POSSIBLE): lacrimal secretion and ocular-surface homeostasis are influenced by autonomic parasympathetic and sympathetic pathways. Dry eyes can therefore form part of autonomic dysfunction, although local ocular-surface disease, medication and environmental factors are common alternative or additional causes. Three-hit context: post-Hits 2-3 timing is compatible with multisystem autonomic involvement but remains nonspecific.

Key source: NIDDK, “Autonomic Neuropathy.”

Prescribed eye drops following University

of Auckland Optometry Clinic assessment

Prescription eye drops provided a defined treatment pathway following optometry assessment;

the extent and durability of symptom relief are not quantified.

UC

2022

Muscle tightening and dystonic episodes occurring with autonomic disturbance

Pacing, postural

Pacing, gentle

UC

Muscle

MSAD linkage (POSSIBLE): dystonia or muscle tightening is not a core autonomic sign,

and autonomic

mobility and

dystonic

but sympathetic surges, pain, altered perfusion and heightened physiological arousal can

symptom

autonomic

episodes

trigger or intensify abnormal muscle contraction. A primary neurological or musculoskeletal

management,

management

explanation must remain in consideration. Three-hit context: post-Hits 2-3 timing makes

gentle mobility,

provided a practical

autonomic surges or altered perfusion plausible amplifiers, not proven causes.

and monitoring of

framework for

Key source: Goldstein, “Linking the Extended Autonomic System with the Homeostat Theory,”

muscle-tightening

episodes; their

2024.

episodes

frequency, severity

and response

remain under

observation.

2023

Colonic polyps

Four colonic polyps identified during colonoscopic investigation

MSAD linkage (NO ASSOCIATION): colonic polyps are structural mucosal lesions and are not explained by autonomic dysfunction. Their importance is gastrointestinal surveillance rather than evidence for MSAD.

Key source: NIDDK, “Autonomic Neuropathy.”

Colonoscopy and removal of four polyps

Polyps removed; a separate effect on bowel symptoms is not recorded.

R

2024, during oesophageal treatment Oesophageal medication irritation

Oesophageal irritation associated in your observations with taking Pradaxa

MSAD linkage (INDIRECT): medication-associated mucosal irritation is not autonomic, but impaired oesophageal motility or clearance could prolong local exposure and magnify symptoms. The observed relationship to Pradaxa remains clinical observation rather than

proof of an autonomic cause. Three-hit context: post-Hits 2-3 dysmotility could plausibly have reduced oesophageal clearance and amplified a medication-related injury.

Key source: NIDDK, “Autonomic Neuropathy.”

Taking the medicine with food, as you reported

Irritation reportedly settled. The proposed inflammatory

mechanism remains an interpretation.

R

2024

Altered taste

Altered taste

MSAD linkage (INDIRECT): taste is not a defining autonomic function, but autonomic control

Observation of taste changes,

Taste changes were managed through

UC

of salivary secretion and oral perfusion can influence the environment needed for normal taste

review of possible

observation,

perception. Medication, oral and gastrointestinal causes remain more direct alternatives, so

medication or

review of possible

the MSAD connection is biologically plausible but weak.

gastrointestinal

contributors and

Key source: Blitshteyn, “Dysautonomia: a common comorbidity of systemic disease,” 2025.

contributors, and

dietary adaptation;

dietary adaptation

the subsequent

as needed

course remains

uncertain.

2025

recurrences;

Eosinophilic oesophagitis: swallowing difficulty, oesophageal discomfort and recurrent attacks MSAD linkage (INDIRECT): EoE is an inflammatory oesophageal disease, but autonomic/ enteric dysmotility can reduce oesophageal motor reserve while EoE reduces structural-mechanical reserve. The combined loss of reserve can plausibly lower the threshold for dysphagia or food-impaction symptoms without making MSAD the cause of EoE. Three-

hit context: EoE remains independent, but post-Hits 2-3 dysmotility may have reduced oesophageal functional reserve.

Key source: NIDDK, “Autonomic Neuropathy.”

Jorveza/ budesonide, followed at times by swallowed Flixotide/ fluticasone

Symptoms brought under control.

Approximately eight weeks without treatment or flare were reported

in 2026; later recurrence again required Jorveza.

UCWL

clinically

active after

G-POEM

Eosinophilic

oesophagitis

2025/26

During

Attacks associated in your observations with dog exposure

MSAD linkage (INDIRECT): an environmental or allergic trigger is not an autonomic phenomenon, but inflammatory activation can increase sympathetic and homeostatic load and transiently reduce available physiological reserve. The dog-exposure association remains observational and does not establish either allergy or autonomic causation.

Key source: Goldstein, “Linking the Extended Autonomic System with the Homeostat Theory,” 2024.

Grooming and bathing the dog; modifying close interaction

You reported elimination of that apparent trigger. This records your experience without establishing an allergy mechanism.

R

recurrent

EoE

symptoms

Suspected

allergic

trigger

2026

Post-meal exhaustion or “crash”, particularly about two hours after dinner

Smaller, more

Used to reduce

UC

Post-meal

MSAD linkage (PROBABLE): after a meal, blood is redistributed to the splanchnic

frequent meals;

the burden of

exhaustion

circulation and healthy compensation requires increased vascular resistance and appropriate

pacing around

eating; the evening

cardiac responses. When autonomic compensation is limited, this can produce postprandial

meals

crash remains a

hypotension, cerebral hypoperfusion and a delayed energy 'crash'; meal size and GI disease

vulnerability. Its

may intensify the effect. Three-hit context: this late post-Hits 2-3 symptom has a strong

separate treatment

physiological route through impaired splanchnic vascular compensation.

response is not

Key source: NINDS, “Postural Tachycardia Syndrome (POTS).”

quantified.

2026

Fluctuating focus or blurred vision; visual fatigue during reading, screens and conversation

Screen breaks,

Helps organise

UC

Blurred

MSAD linkage (PROBABLE): blurred or narrowed vision can result from reduced cerebral

pacing visual

visual demands;

vision

and ocular perfusion during inadequate autonomic BP compensation. Refractive, ocular-

work and

symptoms remain