Posted by Adam on August 12, 2001, at 18:29:47
In reply to Re: I may need help.... » Adam, posted by Elizabeth on August 10, 2001, at 15:19:12
Hi, Elizabeth. Thanks for writing.
> As you've seen, the medical profession seems to have this belief that psychiatric patients don't get "real" illnesses --
Yes. Part of my fear: My maternal grandmother, who, by all accounts had been keen on leaving this world for as long as anyone could remember, was misdiagnosed as hypochondriacal (which she had in fact been at times), later to be diagnosed with a rare form of melanoma, which had metastesized so much that it was already too late. She died six months later. She got her wish, but how she got it...unacceptable.
> I think the best way to deal with this type of prejudice is not to act like a stereotypical "mental patient"Yeah, I'm sure you're right. The problem is, the symptoms really were quite distressing, and after getting the blow-off from the ER doc, I did start to become very afraid. It was difficult not to appear "mental" at times, I'm guessing, and that didn't help at all. It is, probably not coincidentally, around the time that my symptoms were persistant enough that my level of anxiety had naturally dissipated through sheer familiarity, that the doctors seemed more responsive.
>...false positives, negatives, etc.
>
There are actually more false positives than negatives, e.g. sometimes a past infection with Rocky Mountain spotted fever can cause a false potitive. The usual course is to do the ELISA first, the Western blot second after getting a positive (the latter being more accurate because you can see clearly, by molecular weight, if the band that "lights up" is the right one). After two negatives, my doctor said "you don't have Lyme." Well, I didn't test positive for Lyme, and so having Lyme is unlikely. Let's be specific.All of this confidence in the accuracy of the tests rests on the assumption that bacteria do not evolve and change over time. Kind of like the confidence doctors had that we had eradicated TB. The very drugs used to treat Lyme accelerate divergence and speciation. This is well known among skeptics, and some Lyme clinics are starting to adopt multi-strain screening assays. There is an alarming amount of diversity out there, and even with a pool of serum antibodies (polyclonal), the most commonly used tests are several steps behind evolution. How large the threat is is anyone's guess. It could be big, it could be tiny. No one really knows because the research hasn't been done. End of story.
> Antibiotics shouldn't be used unless there's a fair certainty that they're necessary.
>
Yes, in retrospect, I agree.
>
> Taking it into your own hands, I guess. Not terribly reassuring -- sorry. I do think you should be able to find a doctor who will treat you like a human being; you're in a location that's swarming with doctors, and there's a lot of medical research being done there.
>
I guess I've gotten used to being my only advocate. I think my GP is on my side, though, having gotten to know me a little better. I hope, anyway. Time will tell. If all this just resolves on its own, and no one knows what happened, what will he think? How will it affect my future treatment? I wish I could say.>
> Re sleep problems: I assume you've probably tried some medications for this. Which ones, and did they help at all?
>
I haven't tried many sleep meds. Neurontin is probably the first thing I've tried for that specific problem. Mirtazapine did wonders for sleep, but didn't quite measure up as an antidepressant. Lorazepam...now that was great, though I sometimes woke up early. I ran out of that a long time ago, and never asked for more. We know how that goes. Diphenhydramine is what I've used occasionally to self-medicate. Obviously, persistant use might be problematic. So now there's neurontin. 100mg wasn't supposed to do much, but it knocked me on my ass. I woke up in a stupor. I could barely put together a complete sentance until the early afternoon. I hope I get used to it.> Re hypertension: (1) Is it possible that you're getting "white-coat hypertension?" (2) How long before getting it checked had you taken your last dose of selegiline? (3) Have you had your BP monitored over a long period of time (i.e., not just once, but every 15 or 30 minutes for a few hours)? (4) How old are you?
>
I actually suggested to the doctor anxiety was to blame the first time he read me at 150/90. The weekend passed, and I monitored. I would seem to fluctuate, getting worse as the day progressed, and being pretty normal the next morning. I'm 31, so this is high for my age group, and high for me. I guessed at the selegiline (l-meth and l-amphetamine) + diphenhydramine interaction because b.p. seemed to follow what I would expect my peak plasma levels of selegiline and/or it's metabolites might be. I regarded this conclusion as practically a post-dictum, having a fair amount of time to discern the pattern, and something that an expert pharmacologist would have anticipated. My doctors, however, were unimpressed. Hence, I am tapering, and getting tested for pheochromocytoma.
>
> Re pheochromocytoma: this is rather far-fetched. It can cause hypertensive crises, particularly in people taking MAOIs (it's an absolute contraindication for MAOI therapy). Sometimes the paroxysmal hypertension associated with pheochromocytoma manifests as panic attacks. I think that a urinary catecholamine level test would be indicated, but you would need to be off selegiline for that to be meaningful. Pseudopheochromocytoma is one description that I've seen for hypertensive episodes due to other causes (including MAOI interactions).
>
Yep. I'm getting off selegiline, and getting tested, per doctor's orders. Get this: I think it's unnecessary. Some hypochondriac I am. We'll see what happens.> Re l-amphetamine and l-methamphetamine: I think this might be the most reasonable explanation of the ones that have been mentioned so far. I'm not terribly up on the metabolism of selegiline, but l-amphetamines are nasty and I do believe that the CYP2D family is involved there. Stopping the Benadryl and seeing if Neurontin works seems like it would be worthwhile.
>
Well, thank you very much. The praise of the praiseworthy is quite heartening. As it turns out, having been off Benadryl cold-turkey for five days now, yesterday was my first normal b.p. day for the 24-hour stretch. The first night I was off the Benadryl, my b.p. got up to almost 160/95 and I thought my head was going to pop open. Plus, I couldn't sleep for a damn. But I didn't want complicate the "experiment" so, no neurontin. Things improved the next night, and the night after that. Oh, but I'm _sure_ I just dreampt it all up.
>
> Sadly, it's no shock to me. Doctors can be just as bigoted as the rest of the population.
>
> I really hope you succeed in getting an accurate diagnosis and treatment. I also hope that you don't have too hard a time tapering off the selegiline. Please keep posting to let us know you're all right.
>
> best wishes,
> -elizabethYou know, I do too. But at this point, I'd be happy just to feel better. I'm afraid. I'm trying to get to the bottom of it, but to do that, I'm risking a relapse of my depression. I'd be happy enough if it just went away. Today, and the past couple days, I felt pretty good. Maybe that will continue. Maybe it won't. That's been the troubling thing: It comes and goes, and I don't know why. Maybe I am just sleep-deprived, and, after a good two years of 5-hours-a-night-if-I'm-lucky, maybe I've hit a breaking point. Maybe I misdiagnosed myself in my anxiety, and mistook a kind of exhaustion for other things. Weird stuff can happen when you don't sleep enough, or so I'm told. Anyway, perhaps I can use the selegiline washout, neurontin, and a simultaneous attempt to develop a rigorous, low-impact exercise schedule, to normalize my sleep as much as possible. I hope that's all it is.
poster:Adam
thread:69963
URL: http://www.dr-bob.org/babble/20010809/msgs/74820.html