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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Bob on September 23, 1999, at 11:43:13
In reply to Racing Heart...& thoughts..P.S., posted by dj on September 23, 1999, at 10:29:43
[ah, but dj, my moaning was done with tongue firmly planted in cheek ... despite being Irish and Polish, I escaped being baptised and/or raised in the Church ... but given the immigrant population of my home neighborhood, I could certainly claim to be Catholic by association]
As for the Wellbutrin -- the violent dreams raise a red flag for me. While awake, is it just your anxiety that's up or is your temper being affected as well? Wellbutrin, for me, was like a long-term stay at the Bates Hotel. It did an adequate job at keeping my depression at bay, but it also imbued me with these terrible, easily-provoked, hard-to-control blind rages. Once it became apparent that this was not just a once or twice phenom, my pdoc put me on a low dosage (4mg/day) of an antipsychotic, perphenazine (brand name Trilafon, I believe). That certainly did the trick in calming me down. Also a good/bad news thing for sleep -- it would knock me out by sacktime, but relaxed me so much I had some apnea problems. If the wellbutrin is addressing your AD needs well, maybe perphenazine or something similar is a viable option for the side effects. I'd just be careful if later your pdoc wanted you to try a wellbutrin/SSRI combo. If you remember my little tale of woe about my wellbutrin/prozac/perphenazine nightmare (cogwheeling and ER visit might jar your memory), that's what I'm warning about.
Good luck,
Bob
Posted by dj on September 23, 1999, at 12:17:40
In reply to Re: Racing Heart...& thoughts..P.S., posted by Bob on September 23, 1999, at 11:43:13
However I feel pretty mellow right now, having just come from the gym and perhaps the non-sedating sedative is still at work. However during the week of Wellbutrin trial I at times certainly felt despair -- partly about doing bloody chemicals -- but certainly did not touch on rage though I will keep my eye on myself for this...
Posted by Noa on September 23, 1999, at 13:58:47
In reply to Re: Thanks for the heads up Bob, posted by dj on September 23, 1999, at 12:17:40
I'm glad Bob mentioned the apnea, cuz waking suddenly with a racing heart is on possible sign.
As for the church...for some it is a stressor, for others an incredible support.Am I stating the obvious?
Posted by dj on September 23, 1999, at 14:45:24
In reply to Re: Racing Heart...& thoughts..P.S., posted by Bob on September 23, 1999, at 11:43:13
The wellbutrin seems to stimulate me and contribute to early awakenings, though last night was the first one in a week in which I noted the racing/pounding heart which I believe was related to nightmares.
However, what would signs of apnea be besides the racing heart mentioned by Noa?
>. Also a good/bad news thing for sleep -- it would knock me out by sacktime, but relaxed me so much I had some apnea problems.
Posted by Bob on September 23, 1999, at 16:30:20
In reply to Re: Racing Heart...& apnea?, posted by dj on September 23, 1999, at 14:45:24
> However, what would signs of apnea be besides the racing heart mentioned by Noa?
My experiences included:
- snoring so loud I woke myself up (I kid you not!)
- snoring so loud I kept waking my partner up (whereupon she would push me over onto my side or just pound on me til I woke up, too)
- waking up in the middle of the night, panicked that you are suffocating (which, actually, may be the case)That last one was the worst symptom for me -- I'd wake up three or four times a night in a panic that I was drowning, whatever. And until I did sit up, I usually couldn't draw enough breath to stop the panic. My GP took a look in my head and thought that some of the tissue in the back of my throat was swollen. He put me on an inhalent of some sort -- it might have been a steroid-based med -- and that did help with the apnea for me. Otherwise, next step would have been a sleep study.
Hope that helps,
Bob
Posted by Noa on September 23, 1999, at 20:52:57
In reply to Re: Racing Heart...& apnea?, posted by Bob on September 23, 1999, at 16:30:20
Bob, are you sure you aren't me?
I also figured out it was apnea from the drowning dreams. I guess that is my only referent experience for suffocation. before the drowning dreams, I had intermittent suspicions of apnea. Have snored my whole life. In recent years, with age and weight gain, the snoring seemed to be getting louder. sometimes I would dream a wild animal was roaring or growling and I would wake up (it wasn't actually the noise that woke me, it was the fact that I wasn't breathing). I had a sleep study and now use a cpap. Dj, other signs are excessive sleepiness, which I had previously just attributed to my depression, but once the apnea was treated that symptom disappeared, particularly because of the activating effects of the ADs. Also, headache in the morning, difficulty waking in the morning (also an overlap symptom with depression). Another possible symptom is nightime gastric reflux (due to the push and pull of straining to breathe--some say negative pressure in chest).
Posted by dj on September 24, 1999, at 2:23:56
In reply to Re: Racing Heart...& apnea?, posted by Noa on September 23, 1999, at 20:52:57
Noa,
I dont' id with any of the symptoms you noted. I don't think I snore but I do wake up occasionally sputtering. I am curious how the nightime gastric reflux would manifest -- heartburn, dry mouth or...???
.> Another possible symptom is nightime gastric reflux (due to the push and pull of straining to breathe--some say negative pressure in chest).
Posted by Noa on September 24, 1999, at 13:24:48
In reply to Re:nightime gastric reflux?, posted by dj on September 24, 1999, at 2:23:56
reflux is awful. It can be a problem independent of apnea, and can be a source of sleep problems. For me it was caused by the apnea.
reflux is when stomach acid comes up the esophagus, due to a loosening of the muscle tone of the sphincter muscle at the opening of the stomach. This is Hydrochloric Acid, strong stuff, and it BURNS LIKE HELL. You might feel severe heartburn, and burning in the back of your throat, or sour taste. It can make you gag or choke. Apparently it also causes the chords of the larynx to react protectively by spasming (is this a verb?) closed, which makes you feel like you are REALLY CHOKING. I would have this and feel like I would never breathe again, absolutely no air going in or out, unable to get it open. I would panic, and say to myself, this is it, this is the time, I'm checking out for real this time. It would probably only last a few seconds, but it would seem like minutes. I learned from a respiratory therapist that I would not have choked. The vocal chord spasms are an acute reaction and the spasm ends. Afterwards, my throat would be scratchy and it would feel like I still had acid caught there, and I would cough for about an hour, until it cleared enough to feel like I was breathing freely. BTW, if the meds you are on might be causing low muscle tone, this might be an alternative possibility, rather than apnea caused by lowered tone.
Posted by Noa on September 24, 1999, at 13:27:36
In reply to Re:nightime gastric reflux?, posted by Noa on September 24, 1999, at 13:24:48
PS-untreated, severe reflux can lead to higher risk of cancer of the esophagus. Also, it frequently causes or contributes to asthma problems.
Posted by dj on September 24, 1999, at 18:14:57
In reply to Re:nightime gastric reflux?, posted by Noa on September 24, 1999, at 13:24:48
I've only been dong the meds for two weeks. I have had a sour taste in my mouth since April and the doc. did suggest reflux at the time though I didn't note much help from Cimetidine. I have had a powerful gag refelex for the past 12 years or so that kicks in when I am feeling verystressed (had it longer but not as powerful) and can result in me feeling like I'm being choked and in my spewing my stomach contents usually when there is little in there so gastric juices no doubt...so perhaps some reflux but not to the degree you've had by the sounds of things..And what did you take for it??
>. You might feel severe heartburn, and burning in the back of your throat, or sour taste. It can make you gag or choke. Apparently it also causes the chords of the larynx to react protectively by spasming (is this a verb?) closed, which makes you feel like you are REALLY CHOKING. ... The vocal chord spasms are an acute reaction and the spasm ends. ... BTW, if the meds you are on might be causing low muscle tone, this might be an alternative possibility, rather than apnea caused by lowered tone.
Posted by Noa on September 24, 1999, at 21:35:01
In reply to Re:nightime gastric reflux? -- Noa..., posted by dj on September 24, 1999, at 18:14:57
For a while, I kept over the counter antacid liquids on the night stand in case of reflux, but never took any serious meds for it. As I said, it went away when the apnea was treated.
It could be that you are having reflux at night and this is causing you to wake up feeling startled.
Posted by Deborah R. on September 25, 1999, at 3:51:20
In reply to Re:nightime gastric reflux? -- Noa..., posted by Noa on September 24, 1999, at 21:35:01
> For a while, I kept over the counter antacid liquids on the night stand in case of reflux, but never took any serious meds for it. As I said, it went away when the apnea was treated.
>
> It could be that you are having reflux at night and this is causing you to wake up feeling startled.G'day to Noa, dj & Bob - have been following your post re: gastric reflux and hope you dont mind me dropping a line - my Mum has quite bad gastric reflux and at times terrible choking episodes which frighten and concern me. Mum also has liver function problems which I believe are caused by the drugs she is taking for schizophrenia. It didnt occur to me that the reflux could also be a side-effect of the drugs as well. Add to all that glaucoma, td and 4 weeks in hospital with all the symptoms of Neuroleptic Malignant Syndrome - what's next I ask. I am a morbid old thing today - sorry! My best wishes to you all! Deborah R.
Posted by dj on September 25, 1999, at 11:40:11
In reply to Re:nightime gastric reflux? -- Noa..., posted by Noa on September 24, 1999, at 21:35:01
I'm not certain reflux is the problem as the Cimetedine didn't seem to help any and when I wake up at night, occassionally gastric distress is not the issue. Recently since starting Wellbutrin there seems to be a racing pulse/heart associated with it. Previously it was waking up sweaty all over, though I believe that partly had to do with an overheated apt. from a combo of summer heat and an aberrant heating sytem.
So I still have the flat taste in my mouth, since April, which is sometimes somewhat mettalic and sometimes somewhat saline. My regular doc. has no answers beyond reflux, which I don't believe is the source because the Cimetedine didn't seem to have any impact. Chinese medicine practitioners view it as a systemic imbalance that involves the liver and much more. Certainly it is a biochemical imblance which is very puzzling, annonying, distracting and bothersome. And no-one yet seems to have an answer that fits...
>
> It could be that you are having reflux at night and this is causing you to wake up feeling startled.
Posted by Bob on September 25, 1999, at 19:05:22
In reply to Re:nightime gastric reflux? -- to Noa, dj & Bob, posted by Deborah R. on September 25, 1999, at 3:51:20
> ... what's next I ask.
Just don't ask! You've got enough to handle as it is. You might as well pass the reflux/apnea ideas past her doc, tho -- I hope the nudge this discussion gave you helps your Mum ... please keep us posted.
Cheers,
bob
Posted by Deborah R. on September 25, 1999, at 20:19:54
In reply to Re:nightime gastric reflux? -- to Noa, dj & Bob, posted by Bob on September 25, 1999, at 19:05:22
> > ... what's next I ask.
>
> Just don't ask! You've got enough to handle as it is. You might as well pass the reflux/apnea ideas past her doc, tho -- I hope the nudge this discussion gave you helps your Mum ... please keep us posted.
>
> Cheers,
> bobHi Bob - will definately do that at our next appointment. I was so happy to find your post (and dj & Noa's) thankyou so much for just being there. We can learn a lot from each others experiences! Thanks to Dr Bob too for this fantastic site! Bye for now,
Deb.
Posted by dj on September 27, 1999, at 7:02:17
In reply to Re: Racing Heart...& thoughts..P.S., posted by Bob on September 23, 1999, at 11:43:13
Putting aside the hypothesis about apnea and the temper/rage concerns anxiety would seem to be the issue. Woke this a.m. about an hour or 2 ago feeling flushed and hot all over, with heart seeming to race. When I finally gave up on sleep and figured out how to check my pulse it was running at 65 beats per minute, roughly 2 per second. I don't know how that matches up to the average rate or not...decided to not try the Ativan this time as I would rather find a natural solution -- warm milk or what have you but if this continues...???
First time in a while that this has happened & there are some underlying genuine reasons for anxiety. Unfortunately this is just one more...
> As for the Wellbutrin -- .... While awake, is it just your anxiety that's up or is your temper being affected as well?
Posted by Bob on September 27, 1999, at 12:33:54
In reply to Back to ..Re: Racing Heart...& thoughts..P.S., posted by dj on September 27, 1999, at 7:02:17
Well, if you ask me, some good, real mashed potatos is the ultimate in comfort food. But that's me Irish showin'.
Have you checked out a health food store to check in with someone up on herbal teas? Maybe there's someone out there in Babbleland who has got some good, soothing tea advice.
Finally, here's an idea that is not as off the wall as it sounds. Hypnotherapy. My therapist shares the second floor of a townhouse with a CSW who is a trained hypnotherapist. She even works at a major NYC hospital do train surgery patients in self-hypnosis so they can deal with the operation without anesthesia. I saw her for three sessions to focus on my concentration problems. After those three sessions, she also gave me a tape, designed especially for me, to listen to as well. I hate to say it -- I've been out of practice waaaaay too long, but right after her treatment and for the next several months, when I kept it up, I could put myself in a trance easily, stay under for whatever time I wanted, and I always managed to come out of trance just a few seconds before my watch timer went off. The only thing that has even come close to relaxing me as much as self-hypnosis was sensory deprivation tanks. Unfortunately, you can't carry those things around with you.
Hope that helps,
Bob
Posted by dj on September 28, 1999, at 19:54:44
In reply to getting calm, posted by Bob on September 27, 1999, at 12:33:54
Thanks for the suggestions Bob. I've tried all of the above and a warm glass of milk plus consciously relaxing body part by part is as if not more helpful. I have some supposed hypnotherapy tapes which actually seemed to diistress my dreams more than not.
When I do wake from sleep it is my body that is racing and not my conscious mind, generally, whereas when up it is my mind when racing and obsessing which seems to derail me...and then there is all the unconscious or sub-conscious acitivity which may be the source of my awakenings, which kicks in my GAGGGGGG
response at various times....argggggghhhhhhhhh, when I am feeling tense and stresssssssseeeeeedddddddddddd....So keeping with my software analogy below I need some reprogramming, however hypnotherapy as I've exprerienced and psychotherapy and so on have had no long lasting re-programming effect, so far.... I need a new developer or code warrior...
Posted by Bob on September 29, 1999, at 10:08:47
In reply to Re: getting calm -- tweaking the system..., posted by dj on September 28, 1999, at 19:54:44
Try this one:
I repeat myself when under stress
I repeat myself when under stress
I repeat myself when under stress(... any King Crimson fans out there? ;^)
Generic hypnotapes can't be anything like the real thing. My hypnotherapist, besides putting me under and doing some work while my conscious mind was in LaLa Land, taught me some specific techniques for putting myself under. As it happens, I go into trance in an eyeblink, but I'm sure from what she told me that if I did have problems with (self-)hypnosis, she would have been able to work past them and teach me to do the same.
Now, unless you have some enlightened HMO (talk about an oxymoron), seeing a hypnotherapist probably wouldn't be covered. But if you have flexible spending plans north of the border, you could probably get it covered thru that.
Cheers,
Bob
Posted by Bob on September 29, 1999, at 14:23:33
In reply to Back to ..Re: Racing Heart...& thoughts..P.S., posted by dj on September 27, 1999, at 7:02:17
How's your Mum doing? This apnea info do any good?
Cheers,
Bob
Posted by Deborah R. on September 29, 1999, at 20:01:00
In reply to G'Day Deborah R!, posted by Bob on September 29, 1999, at 14:23:33
> How's your Mum doing? This apnea info do any good?
>
> Cheers,
> BobHi Bob - was so nice to see your post, I think you are a wonderful person. Have had a busy few days with Mum - an appointment with a gastroenterologist who referred Mum for a Barium meal and ultrasound, plus a full blood count was done. Not all results are in yet, so no full idea of what is happening! We will see! Next step may be an endoscopy depending on what initial tests show. Mum is such a wonderful, uncomplaining person - sometimes too compliant - I reckon she is too scared to question things too much, she has done so in the past and all they did was 'up' her medication. Anyway Bob, something is happening, which may improve Mum's quality of life, so a big thanks from me to you, dj & Noa too! Do you mind if I ask where you are from - I thought America? I am from Australia, although I think the g'day may have given it away! Bye for now!
Deb.
Posted by Bob on September 29, 1999, at 23:42:12
In reply to G'day Bob!!, posted by Deborah R. on September 29, 1999, at 20:01:00
>Do you mind if I ask where you are from - I thought America? I am from Australia, although I think the g'day may have given it away!
Nah! The "G'Day" didn't give it away one bit ...
I'm originally from Michigan, but have lived in NYC for a little over 5 years now. I tend to pick up accents -- still say y'all from a year of living in Balmore Murlynd, where they think they are Southerners inspite of historical fact -- so it was probably your own G'Day that made it stick for me.
Hope you're having a happy Spring down there.
Bob
Posted by Noa on September 30, 1999, at 18:08:07
In reply to Re: locale, posted by Bob on September 29, 1999, at 23:42:12
scuz me, but isn't Maryland below the Mason Dixon line?
Posted by Bob on September 30, 1999, at 19:43:21
In reply to Re: locale, posted by Noa on September 30, 1999, at 18:08:07
> scuz me, but isn't Maryland below the Mason Dixon line?
Could be, but Maryland was neutral during the Civil War. Truth be told, it felt as southern as Atlanta does to me.
Posted by Deborah R. on September 30, 1999, at 21:50:37
In reply to Re: locale, posted by Bob on September 29, 1999, at 23:42:12
> >Do you mind if I ask where you are from - I thought America? I am from Australia, although I think the g'day may have given it away!
>
> Nah! The "G'Day" didn't give it away one bit ...
>
> I'm originally from Michigan, but have lived in NYC for a little over 5 years now. I tend to pick up accents -- still say y'all from a year of living in Balmore Murlynd, where they think they are Southerners inspite of historical fact -- so it was probably your own G'Day that made it stick for me.
>
> Hope you're having a happy Spring down there.
> BobI just love spring - the promise of summer and lazy days at the beach are on their way! Yippeee. I guess you guys will be enjoying all the autumn colours and getting out those warm coats! Do you get snow in winter in NYC? Now that would be something...best wishes Bob,
Deb.
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