Dear Forum members,

I am writing as I am looking for guidance and medical advice on my condition related to flights, which seems rather unknown to most doctors around here, and accordingly no treatment was yet identified.

Here is a description of my symptoms:
Recently, I started experiencing a worrying condition on flights. Relatively quickly (20-40mins or so into a flight) after reaching cruising altitude (e.g., 38000feet), I am feeling the following:

- constant blinking of the eyes and having to refocus for clear vision.
- difficulty/unease to eat/swallow (drinking is fine)
- difficulty/unease to talk (I can, but I quickly feel I might loose control/conscience)
- difficulty to think (it quickly triggers the same feeling of loss of control/conscience especially if it's complex or emotions are involved)
- Looking head down leads to some vertigo/dizziness, so I try to look straight only.
- Overall impression that I will loose conscience/loose control at specific moments within the flight.
- After the flight, there is still a light "strange/tired" feeling in the head for a few hours at least.

Additional background/contextual information:

- I am not sick (no cold, etc) and don't have any medical condition, at least to my knowledge (e.g., low/high blood pressure etc.)
- I have no fear of flying (frequent flyer, at least historically).
- As I am not sure what the condition is, I tried using the following techniques: turn on the direct ventilation during the whole flight, drinking a lot of water during the flight (this seems to help somewhat), eating salty food prior to the flight (not sure about this one).
- This happens on short-haul flights, I have not yet taken a long-haul flight since these symptoms appeared (i.e. not experienced what happens 5-6 hours into a flight)
- The symptoms above are more or less present, depending on the flight. - Some flights are "perfectly" fine, while others are "tough". I have the impression that 30000feet flights are the ones without issues, while 33-38Kfeet are tough (I always ask the captain AFTER the flight about altitude, i.e. I have no info on the altitude WHILE I am flying). I have not tried a dreamliner flight yet, which apparently keeps the cabin pressure at an "altitude" of about 1600m.
- I visited an "altitude/mountain doctor", as I thought it's related to the low air pressure, but he mention the symptoms related to high altitude only appear above 2500m-3000m, after ~5 hours at that altitude, and acute symptoms I am describing appear only at the very high altitudes (e.g.>4000-5000, Himalaya, etc.). Flights are pressurized at about <2400m.
- I did spent 7 hours at 3000m in the mountains to test my ability to deal altitude. I did have some strange feelings in my head up there, but not necessarily feelings of "loosing control". However, the most striking symptom was a 8-hour long terrible(!) headache after my descent. It vanished after 8 hours. However, I felt quite weak mentally for 10 days or so after this event.

Now, it's important to note that I did have an acute medical emergency on a flight last year, before any of these symptoms appeared, but arguably triggered these in on follow-on flights. Here is the full story: I took flights to India with a heavy cold and got issues with my ear drum. I delayed my return flight accordingly to prevent my eardrum to burst. On that return flight, 4am (I was tired), about 2 hours into the flight, while watching a TV series, I suddenly wasn't able to swallow (mechanically impossible). Scary moment. If I drank water I could swallow, but with saliva alone, I wasn't able to swallow. I stood up to inform the steward and then I collapsed (while still keeping conscience). I wasn't able to speak entire sentences, and suddenly I starting panicking (I guess), was lying on the floor and breathing fast to the point that I felt my heart was "exploding" out of my chest... I felt I was going to die. Breathing through a plastic bag helped reduce my breathing pace. Suddenly, I felt numb on the left side of my forehead (between eyes and ears), very scary feeling. This numbness came back on and off every 30mins, for the next 6 hours (!). I vomited 10 times over 6 hours. When I landed symptoms were mostly gone. Was taken to emergency, they didn't find anything wrong with my medical condition. About 8 hours later at home similar symptoms started again (head numb, etc.), but I got them under control after 30mins or so. The next day all was fine. No real impact, but intellectual work was more difficult. I was not able to work more than 4 hours, so I decided to take 10 days off. After that break, I was fine again, could work long hours and since then I am back at 90% of my intellectual capabilities I would say. However, every time I fly since that incident, the symptoms I described at the beginning of this post are felt. It's important to note that these are different symptoms from the ones I felt during the incident, but are probably related.

I am seeking guidance. I am trying to understand what my condition is, and find someone who experienced this as well and especially solved the issue. I am not looking for advice saying I should visit a psychologist/psychiatrist to address a panic attack. Done that already without success. I am rather convinced it's a physical condition.

This issue has potentially some very severe implications for me, so thank you very much for your help.

Kind regards,

James
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