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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Phillipa on November 26, 2006, at 12:26:18
Quite frankly I'm scared to death. My thyroid yes is the most common type hasimotos thyroiditis autoimmune. But it has gone hyper from 9years of hypo or stable. And then they did a test at the GI docs that said a weak link to autoimmune hepatitis. So could my meds be building up in my liver? I have no symptoms of hepatitis. But when I see the pdoc on Tuesday I don't know what to say. As nothing seems to work after adequate trial. And I don't want to mess up the follow-up thyroid stuff on Dec 21. I've googled all these diseases and I'm scared to death as the treatment for the hep is prednisone which killed my Mother and causes psychosis. What should I do I'm driving myself and everyone else crazy with the worrying? Thanks me again Phillipa
Posted by Racer on November 26, 2006, at 12:51:16
In reply to What Do I Do? Thyroid and Antidepressants and Stuf, posted by Phillipa on November 26, 2006, at 12:26:18
Jan, you really do sound as though you're, as you put it, "What should I do I'm driving myself ... crazy with the worrying?" The best thing you can do is work on the worry itself, and wait to see what the doctors say about the issues with your thyroid, etc.
The doctor mentioned a weak link to autoimmune hepatitis? That's very, very different from saying that he thinks *you* might have hepatitis.
You're afraid that your medications may have damaged your liver? Autoimmune diseases are just that -- autoimmune. They are not caused by medications you take.
You have no symptoms of hepatitis. I'm sure you've had liver function panels done? Have they come back normal? If so, your liver is functioning well, and that's what matters.
The more you can catch the thoughts involved in the worries, the more you can challenge your own thinking before it leads you to panic, the more you can reduce your own anxiety. That's the good part of CBT type exercises. When you start thinking about this, and you can feel yourself getting worked up, take a deep breath and check the reality of the thoughts. Is it possible that something is horrendously wrong with you? Of course it is -- but is it likely? No, it's not likely. If you stop and think about it, you probably know that, right?
As for the pdoc, how about saying something along the lines of, "Doctor, I'm afraid. I have some thyroid stuff going on, and I'm afraid anything that you prescribe might create problems in working that out. Will you communicate with the doctor who's treating that, so that neither one of you get in the other's way?" Often that works best -- the doctors can worry about things like how Drug A will interact with Drug B and what influence it will have on Test X. That's their job. Your job, as a patient, is to work with the doctors, not to do their jobs for them. And frankly, I think it's very possible to scare yourself into bigger problems through the information you can get online. That's a general statement, not you in particular, but I have to say I think it does apply to you, too. (Sorry, I don't mean that in a mean way -- I do it, too, sometimes. I'm pointing it out in hopes that you'll find the feedback helpful.)
What do I think would help you most? You won't be surprised if I say "psychotherapy," since you know I believe it's very helpful for most everybody, right? ;-) I also think that finding an SSRI to help reduce your anxiety more effectively would be the best thing that pdoc can do for you. I know you say you've tried them all, but I think you can try again and maybe if you worry less about side effects, you can find one that works.
Good luck.
Posted by Phillipa on November 26, 2006, at 19:10:41
In reply to Re: What Do I Do? Thyroid and Antidepressants and » Phillipa, posted by Racer on November 26, 2006, at 12:51:16
Racer I have to thank-you. I do agree with you. Now there are a few things maybe you can help me work out. First when I had the diverticulitis enzymes were very elevated since then I was told they have come down. I guess I will have to do the communicating between pdoc and endo as one the pdoc is 5 hours away in another city. And she's not the type to try and call him. I will have to just tell her what's going on and if she feels it's necessary then she can try and make contact with him. Oh I couldn't agree more with you about the theraphy. I've tried three here. They all three said they will only deal with now issues and not go back and examine the biggest call it blockage to taking meds. And that is the fact that the prednisone killed my Mother. I've been terrified of all meds since then as I was l7 when she died. This needs to be worked through. Cause I was told by her that I made her ill and killed her which rationally I know isn't true but my child or whatever don't buy it. The medicare makes it very hard to find a therapist that takes it. The last one didn't . I paid out of pocket with my Disability. And I'm sure you've encountered this before if you take psych meds you're crazy and I always feel guilty about that too. I must say that the endo said to me are those the only meds you're on? So in your opinion seriously and you may babblemail me and I'll gladly give you my e-mail what do you suggest for someone who overeracts to everything? I thought of maybe 5mg of prozac to start with the benzos as years ago the pdoc when I wasn't depressed gave me the standard 20mg pill. First day it worked didn't know it was that but I wallpapered a foyer I'd let sit for three years. Day 2 anxiety, day 3 panic so bad I flushed them down the toilet. And it took three days of incresed xanax at the time to come down so to speak. The pdoc was a friend of mine who I worked with. He begged me to take it every three days I refused. It wasn't till years later and the thyroid went that the depression acted shall I say like depression and not like plain old panic/anxiety. Also I wonder if taking the highest dose of luvox which I tolerate in low doses might work? And of course I still like the idea of EMSAM and my pdoc will prescribe it for me. Thanks Racer I hope you reply. Cause you're a smart cookie and have and are going through a lot yourself. Love Jan
Posted by Racer on November 26, 2006, at 20:41:49
In reply to Re: What Do I Do? Thyroid and Antidepressants and » Racer, posted by Phillipa on November 26, 2006, at 19:10:41
Just one word: PARAGRAPHS!!!
Sorry, can't help myself: easier to read, eh? ;-)
> Now there are a few things maybe you can help me work out.
I can try...
>I guess I will have to do the communicating between pdoc and endo as one the pdoc is 5 hours away in another city. And she's not the type to try and call him.
They can telephone from that distance... Seriously, it may be that your endo is the one who'd have to make the calls.
But they may not need to call at all. My pdoc sends his reports to my GP, my T, our marriage counselor, and the repro-endo. As soon as he's written his report, after my appointment, it goes into the mail to all of those. If there's some issue that any of them need help working out, then they can communicate about that issue -- whether via telephone, or fax, or mail. I know you're having trouble finding decent treatment where you are, but if your pdoc isn't willing to send a report to the endo, I'd ask her why not?
Aside from getting your pdoc to send on the reports to your GP and endo, I would also bring up your concerns with the endo. "Gee, Doc, I see you, I see pdoc -- I want to know that the two of you are on the same page. Will you send your information to my pdoc, and call her if you see a potential problem?"
> I've tried three here. They all three said they will only deal with now issues and not go back and examine the biggest call it blockage to taking meds. And that is the fact that the prednisone killed my Mother.
I can understand that being traumatic for you. And I can certainly understand how it became the problem it is now for you.
Here's a point, though: you're not afraid of all meds -- you take benzos, and have for years. You take thyroid medication, too, don't you? Do you think you can identify what it is about certain drugs that trigger your fear? Maybe a rational response to counter the fear would help.
> And I'm sure you've encountered this before if you take psych meds you're crazy and I always feel guilty about that too.
No, not anymore. At least out here, most doctors aren't phased by it. Yes, back in the bad old days it was a problem to show up and say you took psych meds. Now, though? Half the people on the street these days are taking an SSRI, or even an anti-psychotic for sleep. It's not nearly as stigmatizing as it once was.
And even if they do think you're crazy, SO WHAT??? As long as they do their job, who cares what they think? I know, it's not that easy, and I go through it, too. But seriously: the doctor's job is to treat your disease or symptoms. If he/she's doing that, who cares if he/she thinks, "Hm... That Jan probably thinks she's living with a six foot pink bunny rabbit..."
> what do you suggest for someone who overeracts to everything? I thought of maybe 5mg of prozac to start with the benzos as years ago the pdoc when I wasn't depressed gave me the standard 20mg pill. First day it worked ... Day 2 anxiety, day 3 panic so bad I flushed them down the toilet.
What do I suggest? I suggest a complex approach:
1. You sit yourself down and have a little talk. Tell yourself that you're going to be trying a new medication and it may feel pretty crappy for a while, but that if you can stick it out, it will help. That's the first step: prepare yourself for feeling pretty crappy for a while, because it's likely to happen with any new drug.
2. After step 1, have a cup of tea and move on to step 2 -- make a list of the side effects you can tolerate, ways to make them more tolerable, ways you can cope with them, and which side effects you absolutely positively cannot live with. (For me, for example, the three things I cannot live with are: weight gain, constipation, and fogginess/lethargy/feeling half asleep. Anything else, I can learn to live with.)
3. Talk to your pdoc about strategies to help minimize your adjustment phase anxiety. Personally, I'd ask about a low dose of propranalol, which will stop the physical symptoms of anxiety. The psychological aspects you'll have to deal with, but the racing heart, etc, won't be there.
4. Write a contract with yourself, where you agree to try the medication you're prescribed for a minimum length of time, and at the dose prescribed. This is important, I think, because I don't think you do yourself any favors by trying to start with tiny fractions of doses. That seems like a good way to prolong your agony, if you know what I mean?
5. My recommendation is to try Lexapro. Start with a low dose, generally I think they start people on 5mg, which is half a tablet. I'd plan on working up to 10mg to see how you do. The first couple of weeks, be prepared to go through some discomfort -- all SSRIs are going to take some adjustment.
If Lexapro is a no for some reason, then Zoloft. It's sort of a mid-range drug, in my experience: not as sedating/anxiolytic as Lexapro, but not nearly as agitating as Prozac. I do have a problem with fidgeting and foot tapping, and rocking, and so on -- but it's not anxiety related. It's annoying, but it's something I can live with. (Hey, it burns calories, right?) Prozac can cause agitation and anxiety at first, especially for someone who's primed to panic about drugs.
Good luck. I hope that helps somewhat.
Posted by Phillipa on November 26, 2006, at 21:26:37
In reply to Long response » Phillipa, posted by Racer on November 26, 2006, at 20:41:49
Racer well you were right it's long. So I won't remember it all.
You asked about taking benzos and thyroid?
Benzos I started when I was only 23 and it was an ahhhh I'm so relaxed feeling so that's why them
Synthroid I gagged and nearly threw it up as I felt my body had failed me. Cause I said I'd never get sick. Hey Shaklee for years, running, Aerobics you name it everything that is supposed to be good for your health. And it failed. I was devasteated
Now the ad's. First one was paxil. I spent three months in a hammock. Couldn't move, no energy, diarrhea horrible. At l0mg as the pdoc said low doses were all I could tolerate cause of the anxiety I've had all these years.
It worked for two years I stopped cause my Son was coming to live with us and he hated meds. He is the Blind one and I'd do anything he said at the time. So I gradually tappered off it. Continued working
Then my thyroid changed again and luvox was given to me. I tolerated it. And got up to 250mg without any side effects. Reason the pdocs keep putting me on it.
Then other pdocs tried all the other SSRI's and SSNRI's and I was going through perimenopause so that could have been the reason I felt like my head was in outerspace. I hit a mailbox with my car. That of course made me afraid to drive.
For some reason all the pdocs I've had think small doses are better? Ask them?
Now you may have hit on something with the zoloft as this pdoc put me on it once. And neither of us can remember why I only went to 50mg? I don't remember side effects.
The others lex included made me feel like my head would explode so number one on the list of intolerable. Number 2 I have to be able to get out of the house ride my bike. So nothing can interfer with that as it is my out let for stress. Number 3 Would be not being able to function and want to sleep all day.
Not as far as stigma. My neighbors all are on SSRI's and benzos so here it's no problem
But for some reason the docs here all have a problem with psych meds. And for the life of me I can't figure out why as Charlotte is a pretty large city.
When my thyroid became hyper I called my pdoc and she said get stable first before we try other meds. Just do what you like.
So according to the endo guy my enzymes were back in the normal range. I didnt follow-up with an US of the liver with the GI guy as it seems the GP does nothing but refer you to a specialist.
Anyway that's the status at this time. Love Jan
Posted by Phillipa on November 26, 2006, at 21:35:43
In reply to Long response » Phillipa, posted by Racer on November 26, 2006, at 20:41:49
Racer forgot one thing can't take inderal with thyroid disease. The first pdoc gave me 25mg of lopressor which dragged me and made me too tired. And I don't get a racey heart with my anxiety. Used to now it's just an overwhelming feeling of dread.
Posted by Racer on November 27, 2006, at 0:38:34
In reply to Re:Thanks Racer » Racer, posted by Phillipa on November 26, 2006, at 21:26:37
>
> For some reason all the pdocs I've had think small doses are better? Ask them?The rule is to take the lowest effective dose, which makes sense, right? For some people, very low doses may be appropriate. It depends on how your body metabolizes medications. (That's different from "your metabolism," it's not about how fast your body burns off fat, etc. It's a function of how certain enzymes break down medications. For some medications, a slow metabolizer will need a higher dose than a faster metaboliser. And vice versa.) And there are two schools of thought on starting doses: some say starting at a higher dose actually minimizes the adjustment phase difficulties, especially with certain medications. Others, of course, say start low, go slow, and that's necessary for certain medications, too.
>
> Now you may have hit on something with the zoloft as this pdoc put me on it once. And neither of us can remember why I only went to 50mg? I don't remember side effects.
>Why only 50mg? Maybe because that's all you needed. It could be that 50mg is an appropriate dose for you. But in order to find out, you really have to stay on it, at least 4 to 6 weeks.
I hope it works out.
Posted by blueberry on November 27, 2006, at 18:15:18
In reply to What Do I Do? Thyroid and Antidepressants and Stuf, posted by Phillipa on November 26, 2006, at 12:26:18
Phillipa,
Whatever happens I think it is extremely important - just an opinion - that you should be very forthright with your doctor and share your concerns with the attitude behind of, "who went to years of medical school and who has seen hundreds of odd cases and who is paying who here anyway?" As the customer, demand the very best the doctor can do, above and beyond what he/she would do on a normal workday.
You know who is real good with thyroid stuff and liver stuff? Naturopath doctors. At least in my experience anyway. I saw a nurse practitioner with a specialty in psychiatry, and she works in the same office as a full fledged doctor fully trained in naturopathy, and they really know their stuff when it comes to thyroid and liver issues. They give tests that normal doctors might not or that normal doctors don't even know about. Their treatments are usually aimed at fixing the problem but with your overall health in mind as a high priority.
For starters, milk thistle herb is well known for protecting and stabilizing liver function.
Get a Vicks Speed Read thermometer. First thing in the morning when you wake up, stick it under you arm until it beeps (about 10 seconds). Record your tempurature. If it is below 97.5 for 2 weeks in a row, a normal doctor will say you are fine. A naturopath doctor will take a closer look. Whenever you feel strange or a change in mood or whatever, take your temperature. See if it is abnormally low, abnormally high, fluctuating erratically, or showing some kind of odd pattern. Thyroid issues often show up in your temperature readings. Some doctors will treat thyroid issues based on your temperature patterns, regardless that your TSH, T3 and T4 are in the normal range (though probably barely in the range).
In any case, make that doctor you have perform to his/her highest on the day of your appointment.
Posted by Phillipa on November 27, 2006, at 18:30:26
In reply to Re: What Do I Do? Thyroid and Antidepressants and Stuf » Phillipa, posted by blueberry on November 27, 2006, at 18:15:18
Going to post to each of you separately in order of posts. Love Phillipa ps here goes
Posted by Phillipa on November 27, 2006, at 18:45:45
In reply to Re:Thanks Racer, posted by Racer on November 27, 2006, at 0:38:34
Racer starting with the fast vs slow metabolizer I would think a fast metabalizer would need a higher dose? I don't know though it's new to me.
Now the zoloft was supposed to be increased to 200mg. I just didn't do it. My fault. And I was on the 50 for over six weeks. I think we just moved or were getting ready to so she switched me to the luvox again.
Last night I took my standard luvox, valium and went to sleep no problem. In 31/2hours wide awake. Sweating like a pig I've been through menopause. The temp in the house was 62. I took ibuphrophen as I knew it would lower my body temp and my last of the valium 5mg and added an extra 5mg . Nope didn't go back to sleep.
Since the pdoc said no changes in meds til the thyroid is straightened out. Called endo. Then cancelled the 5hour ride to the pdocs for tomorrow as no point in it.Then a call to the GI doc. As of now the endo called back. Having the bloodwork repeated tomorrow as what is going on is the opposite of what should which is what I told the nurse. I said anxiety on a lower dose should be going down and the sweating too. As the tests indicated hyper and on a lower dose close to a month now. But getting worse
Then the GI doc's office called back and said he still wanted an Ultrsound of the liver as a lot of things gallbladder included could be going on. That blood work indicated an autoimmune form of hepatitis not communicable but treated with the dreaded prednisone and anti cancer meds. Google ASMA and ANA. My ANA is l:l80 low for me and the other is elevated low indicating type l autoimmune hepatitis.
Maybe Things will start to fall into place now as to why I react the opposite to meds than others? Who knows. I'll keep you posted but the fast vs slow metablizer can you explain more? Thanks Jan
Posted by Phillipa on November 27, 2006, at 18:54:47
In reply to Re:Thanks Racer, posted by Racer on November 27, 2006, at 0:38:34
Blueberry funny you should mention a naturapath as at the vitamin shoppe we have one here there was an MD's card there he believes in the natural approach to medicine and sends a lot of his patients in for vitamins, herbs, etc,. So called and am on the waiting list. Was told since I live in Matthews suburb of Charlotte higher dollar area that I go to the top of the list as Matthews is where his practice is. Don't know how long it will take to get in but was impressed that people are coming from out of State to see him. The folks that work in the store love him say he's great. So another option. And I've always said if needed I would take my money out of money market and use it on my health. That is what it's there for. Funny years ago I always feared something like breast cancer and for the advanced treatment at the time wasn't insurance approved I held on to the money from my first marriage of 21 years. So it's there even though he takes medicaire. Thanks Jan/Phillipa ps wish you'd figure out the babblemail thing or babble me and e-mail.
Posted by Karen44 on November 27, 2006, at 20:19:29
In reply to Re: What Do I Do? Thyroid and Antidepressants and » Phillipa, posted by Racer on November 26, 2006, at 12:51:16
> Jan, you really do sound as though you're, as you put it, "What should I do I'm driving myself ... crazy with the worrying?" The best thing you can do is work on the worry itself, and wait to see what the doctors say about the issues with your thyroid, etc.
>
> The doctor mentioned a weak link to autoimmune hepatitis? That's very, very different from saying that he thinks *you* might have hepatitis.
>
> You're afraid that your medications may have damaged your liver? Autoimmune diseases are just that -- autoimmune. They are not caused by medications you take.
>
> You have no symptoms of hepatitis. I'm sure you've had liver function panels done? Have they come back normal? If so, your liver is functioning well, and that's what matters.
>
> The more you can catch the thoughts involved in the worries, the more you can challenge your own thinking before it leads you to panic, the more you can reduce your own anxiety. That's the good part of CBT type exercises. When you start thinking about this, and you can feel yourself getting worked up, take a deep breath and check the reality of the thoughts. Is it possible that something is horrendously wrong with you? Of course it is -- but is it likely? No, it's not likely. If you stop and think about it, you probably know that, right?
>
> As for the pdoc, how about saying something along the lines of, "Doctor, I'm afraid. I have some thyroid stuff going on, and I'm afraid anything that you prescribe might create problems in working that out. Will you communicate with the doctor who's treating that, so that neither one of you get in the other's way?" Often that works best -- the doctors can worry about things like how Drug A will interact with Drug B and what influence it will have on Test X. That's their job. Your job, as a patient, is to work with the doctors, not to do their jobs for them. And frankly, I think it's very possible to scare yourself into bigger problems through the information you can get online. That's a general statement, not you in particular, but I have to say I think it does apply to you, too. (Sorry, I don't mean that in a mean way -- I do it, too, sometimes. I'm pointing it out in hopes that you'll find the feedback helpful.)
>
> What do I think would help you most? You won't be surprised if I say "psychotherapy," since you know I believe it's very helpful for most everybody, right? ;-) I also think that finding an SSRI to help reduce your anxiety more effectively would be the best thing that pdoc can do for you. I know you say you've tried them all, but I think you can try again and maybe if you worry less about side effects, you can find one that works.
>
> Good luck.
Racer, I couldn't agree with you more re your recommendations. Jan; I don't mean this in a mean way, but why do you so often have a come back for why something will not work or why you can't do that which someone suggests? Racer was right on target re recommendations. You don't have to see a psychiatrist for therapy; you could see a psychologist or a social worker. To work on the now is not a bad idea either (for starters) to help you get a handle on all the physical stuff and anxiety and depression that is right now.Jan, You know I have some of the same issues--lots of physical problems. When one resolves or is being managed, it seems another pops up. I have put on hold dealing with some of the past stuff until I can get a handle on my physical health and can find a medication or maybe ECT after all to help me be less depressed and so I can work on putting to rest some old issues. Please don't be dismissive of what others recommend. Okay?
Karen
(Karen44)
Posted by Phillipa on November 27, 2006, at 21:38:16
In reply to Re: What Do I Do? Thyroid and Antidepressants and, posted by Karen44 on November 27, 2006, at 20:19:29
Karen I haven't replied to your e-mail yet. But I have appointments for all the physical stuff. Pdoc is on hold til the thyroid results come back. I'm not the one who suggested the autoimmune hepatitis that is why the GI doc wants an Ultrasound to r/o liver diseases or gallbladder. I'll return it now. Love Jan
This is the end of the thread.
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