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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Karen44 on June 10, 2006, at 23:20:26
Could someone explain what this is, what causes it, and what are the symptoms. Thanks.
Karen
Posted by SLS on June 11, 2006, at 8:26:39
In reply to Serotonin Syndrome Reaction, posted by Karen44 on June 10, 2006, at 23:20:26
> Could someone explain what this is, what causes it, and what are the symptoms. Thanks.
Serotonin syndrome is a serious and potentially fatal reaction that sometimes occurs when combining drugs that potentiate serotonin neurotransmission. It can even happen with one drug. The greatest risk is probably when combinating a MAOI with a SRI. One must be careful whenever two serotonergic drugs are given simultaneously. Even adding lithium to a SSRI can precipitate an episode.Having said all of that scary stuff, serotonin syndrome is a very infrequent event when combining drugs except for MAOIs. Most cases are relatively mild.
Probably the most dangerous symptom is hyperpyrexia - a high fever. When body temperature gets too high, organs shut down. Other signs and symptoms include confusion, delerium, agitation, elevated heart-rate and blood pressure, nausea, muscle rigidity and involuntary movements, exaggerated reflexes, extreme restlessness, tremors, incoordination, sweating, and hyperventillation.
Some of the drugs used to treat serotonin syndrome include lorazepam (Ativan), propranolol (Inderal), and cyprohepadine (Periactin).
- Scott
Posted by Karen44 on June 11, 2006, at 13:40:31
In reply to Re: Serotonin Syndrome Reaction, posted by SLS on June 11, 2006, at 8:26:39
> > Could someone explain what this is, what causes it, and what are the symptoms. Thanks.
>
>
> Serotonin syndrome is a serious and potentially fatal reaction that sometimes occurs when combining drugs that potentiate serotonin neurotransmission. It can even happen with one drug. The greatest risk is probably when combinating a MAOI with a SRI. One must be careful whenever two serotonergic drugs are given simultaneously. Even adding lithium to a SSRI can precipitate an episode.
>
> Having said all of that scary stuff, serotonin syndrome is a very infrequent event when combining drugs except for MAOIs. Most cases are relatively mild.
>
> Probably the most dangerous symptom is hyperpyrexia - a high fever. When body temperature gets too high, organs shut down. Other signs and symptoms include confusion, delerium, agitation, elevated heart-rate and blood pressure, nausea, muscle rigidity and involuntary movements, exaggerated reflexes, extreme restlessness, tremors, incoordination, sweating, and hyperventillation.
>
> Some of the drugs used to treat serotonin syndrome include lorazepam (Ativan), propranolol (Inderal), and cyprohepadine (Periactin).
>
>
> - ScottThanks for your response, Scott. My psychiatrist thinks this is what occured with me when the Risperidone was added to the Parnate. I had confusion, slurred speech (not realizing this), would forget what I was saying in the middle of a sentence (not realizing this), mild incoordination, and I suffered from nausea, fluctuating blood pressure, chills and mild fever, involutary movements, stiff muscles and soreness in muscles. I was away from home where no phone service was available including cell phones. I did not know what to do when the confusion got really bad. But since the Risperidone was added to help with sleep at night, I had been taking it only two weeks with increasing symptoms after increasing the dose from .25 to .5 mg in the p.m. I decided to stop the Risperidone, and this brought on almost immediate improvement with the exception of some residual restlessness and involuntary movements that I am told should resolve in another week.
My psychiatrist said he researched this (is at a top University and said he has never heard of this before-- with an MAOI and an antipsychotic but said it is possible since both deal with serotonin levels. Thanks for your input.
Posted by Phillipa on June 11, 2006, at 18:48:06
In reply to Re: Serotonin Syndrome Reaction, posted by Karen44 on June 11, 2006, at 13:40:31
Wow that must have been very scarey. No hospitals either right? Love Phillipa
Posted by SLS on June 12, 2006, at 8:39:48
In reply to Re: Serotonin Syndrome Reaction, posted by Karen44 on June 11, 2006, at 13:40:31
> > > Could someone explain what this is, what causes it, and what are the symptoms. Thanks.
> >
> >
> > Serotonin syndrome is a serious and potentially fatal reaction that sometimes occurs when combining drugs that potentiate serotonin neurotransmission. It can even happen with one drug. The greatest risk is probably when combinating a MAOI with a SRI. One must be careful whenever two serotonergic drugs are given simultaneously. Even adding lithium to a SSRI can precipitate an episode.
> >
> > Having said all of that scary stuff, serotonin syndrome is a very infrequent event when combining drugs except for MAOIs. Most cases are relatively mild.
> >
> > Probably the most dangerous symptom is hyperpyrexia - a high fever. When body temperature gets too high, organs shut down. Other signs and symptoms include confusion, delerium, agitation, elevated heart-rate and blood pressure, nausea, muscle rigidity and involuntary movements, exaggerated reflexes, extreme restlessness, tremors, incoordination, sweating, and hyperventillation.
> >
> > Some of the drugs used to treat serotonin syndrome include lorazepam (Ativan), propranolol (Inderal), and cyprohepadine (Periactin).
> >
> >
> > - Scott
>
> Thanks for your response, Scott. My psychiatrist thinks this is what occured with me when the Risperidone was added to the Parnate. I had confusion, slurred speech (not realizing this), would forget what I was saying in the middle of a sentence (not realizing this), mild incoordination, and I suffered from nausea, fluctuating blood pressure, chills and mild fever, involutary movements, stiff muscles and soreness in muscles. I was away from home where no phone service was available including cell phones. I did not know what to do when the confusion got really bad. But since the Risperidone was added to help with sleep at night, I had been taking it only two weeks with increasing symptoms after increasing the dose from .25 to .5 mg in the p.m. I decided to stop the Risperidone, and this brought on almost immediate improvement with the exception of some residual restlessness and involuntary movements that I am told should resolve in another week.
>
> My psychiatrist said he researched this (is at a top University and said he has never heard of this before-- with an MAOI and an antipsychotic but said it is possible since both deal with serotonin levels. Thanks for your input.I can't figure how risperidone would cause SS. I would have thought that it might be neuroleptic malignant syndrome (NMS). This is very rare, but occurs with drugs that alter the dopaminergic system.
- Scott
Posted by Donna Louise on June 13, 2006, at 21:28:43
In reply to Re: Serotonin Syndrome Reaction, posted by SLS on June 12, 2006, at 8:39:48
> > > > Could someone explain what this is, what causes it, and what are the symptoms. Thanks.
> > >
> > >
> > > Serotonin syndrome is a serious and potentially fatal reaction that sometimes occurs when combining drugs that potentiate serotonin neurotransmission. It can even happen with one drug. The greatest risk is probably when combinating a MAOI with a SRI. One must be careful whenever two serotonergic drugs are given simultaneously. Even adding lithium to a SSRI can precipitate an episode.
> > >
> > > Having said all of that scary stuff, serotonin syndrome is a very infrequent event when combining drugs except for MAOIs. Most cases are relatively mild.
> > >
> > > Probably the most dangerous symptom is hyperpyrexia - a high fever. When body temperature gets too high, organs shut down. Other signs and symptoms include confusion, delerium, agitation, elevated heart-rate and blood pressure, nausea, muscle rigidity and involuntary movements, exaggerated reflexes, extreme restlessness, tremors, incoordination, sweating, and hyperventillation.
> > >
> > > Some of the drugs used to treat serotonin syndrome include lorazepam (Ativan), propranolol (Inderal), and cyprohepadine (Periactin).
> > >
> > >
> > > - Scott
> >
> > Thanks for your response, Scott. My psychiatrist thinks this is what occured with me when the Risperidone was added to the Parnate. I had confusion, slurred speech (not realizing this), would forget what I was saying in the middle of a sentence (not realizing this), mild incoordination, and I suffered from nausea, fluctuating blood pressure, chills and mild fever, involutary movements, stiff muscles and soreness in muscles. I was away from home where no phone service was available including cell phones. I did not know what to do when the confusion got really bad. But since the Risperidone was added to help with sleep at night, I had been taking it only two weeks with increasing symptoms after increasing the dose from .25 to .5 mg in the p.m. I decided to stop the Risperidone, and this brought on almost immediate improvement with the exception of some residual restlessness and involuntary movements that I am told should resolve in another week.
> >
> > My psychiatrist said he researched this (is at a top University and said he has never heard of this before-- with an MAOI and an antipsychotic but said it is possible since both deal with serotonin levels. Thanks for your input.
>
> I can't figure how risperidone would cause SS. I would have thought that it might be neuroleptic malignant syndrome (NMS). This is very rare, but occurs with drugs that alter the dopaminergic system.
>
>
> - ScottI wonder..I haven't felt too well lately. I wonder if 9mg EMSAM and 300-400mg provigil could be causing a problem. I have occasionally had slurred speech but after taking my tiny dose of klonopin. ,25mg. The past few days my BP has been fluctuating. It dropped very low at first with EMSAM but yesterday I felt like it must have been sky high. It was just 128/78 which is not high but is a big difference from the 90/60 it was a few days before that. I am always fiddling with the A/C thermostat. Hot then cold...hot at night while trying to sleep especially. I have just felt kind of drug sick if you know what I mean. I spent all last week practically manic with house cleaning to the point of not eating until 3pm, not getting but 6 hours of sleep which isn't much for me, and now the past two days I can't seem to do a thing but sit around and eat. And feel bad. No energy, tired easily. Maybe I am just crashing from last week. oh, and an off again on again migraine since Sat. night. ugh, I am sick of worrying about myself.
Donna
Posted by Karen44 on June 13, 2006, at 23:15:28
In reply to Re: Serotonin Syndrome Reaction » Karen44, posted by Phillipa on June 11, 2006, at 18:48:06
> Wow that must have been very scarey. No hospitals either right? Love Phillipa
Yes it was very scary because though there is a 14 bed hospital in the town and one or two GP's, I am not sure they would have known what was going on.
Posted by Karen44 on June 13, 2006, at 23:17:35
In reply to Re: Serotonin Syndrome Reaction, posted by SLS on June 12, 2006, at 8:39:48
> > Thanks for your response, Scott. My psychiatrist thinks this is what occured with me when the Risperidone was added to the Parnate. I had confusion, slurred speech (not realizing this), would forget what I was saying in the middle of a sentence (not realizing this), mild incoordination, and I suffered from nausea, fluctuating blood pressure, chills and mild fever, involutary movements, stiff muscles and soreness in muscles. I was away from home where no phone service was available including cell phones. I did not know what to do when the confusion got really bad. But since the Risperidone was added to help with sleep at night, I had been taking it only two weeks with increasing symptoms after increasing the dose from .25 to .5 mg in the p.m. I decided to stop the Risperidone, and this brought on almost immediate improvement with the exception of some residual restlessness and involuntary movements that I am told should resolve in another week.
> >
> > My psychiatrist said he researched this (is at a top University and said he has never heard of this before-- with an MAOI and an antipsychotic but said it is possible since both deal with serotonin levels. Thanks for your input.
>
> I can't figure how risperidone would cause SS. I would have thought that it might be neuroleptic malignant syndrome (NMS). This is very rare, but occurs with drugs that alter the dopaminergic system.
>
>
> - ScottScott,
I thought as you do that it might have been NMS. I will ask my psychiatrist when I see him on Friday.
Karen
Posted by SLS on June 14, 2006, at 7:58:16
In reply to Re: Serotonin Syndrome Reaction, posted by Karen44 on June 13, 2006, at 23:17:35
> > > My psychiatrist said he researched this (is at a top University and said he has never heard of this before-- with an MAOI and an antipsychotic but said it is possible since both deal with serotonin levels. Thanks for your input.
> > I can't figure how risperidone would cause SS. I would have thought that it might be neuroleptic malignant syndrome (NMS). This is very rare, but occurs with drugs that alter the dopaminergic system.
> I thought as you do that it might have been NMS. I will ask my psychiatrist when I see him on Friday.
So much for trying to figure out the brain. On Medline, there are a few reports of risperidone producing serotonin syndrome when combined with SRIs. Perhaps your doctor was right afterall. Either that, or the reports on Medline failed to differentiate between SS and NMS.
- Scott
Posted by silvercoin on June 14, 2006, at 15:44:20
In reply to Re: Serotonin Syndrome Reaction, posted by Karen44 on June 11, 2006, at 13:40:31
>
> Thanks for your response, Scott. My psychiatrist thinks this is what occured with me when the Risperidone was added to the Parnate. I had confusion, slurred speech (not realizing this), would forget what I was saying in the middle of a sentence (not realizing this), mild incoordination, and I suffered from nausea, fluctuating blood pressure, chills and mild fever, involutary movements, stiff muscles and soreness in muscles. I was away from home where no phone service was available including cell phones. I did not know what to do when the confusion got really bad. But since the Risperidone was added to help with sleep at night, I had been taking it only two weeks with increasing symptoms after increasing the dose from .25 to .5 mg in the p.m. I decided to stop the Risperidone, and this brought on almost immediate improvement with the exception of some residual restlessness and involuntary movements that I am told should resolve in another week.
>
> My psychiatrist said he researched this (is at a top University and said he has never heard of this before-- with an MAOI and an antipsychotic but said it is possible since both deal with serotonin levels. Thanks for your input.
>
>It sounds very likely you were indeed suffering symptoms of serotonin syndrome, given the combination of medications and your symptoms. What many clinicians appear to be unaware of is that serotonin syndrome can propagate through not just the serotonin 2A receptor but through the 1A receptor, as well. This makes it exceedingly problematic given that Risperdal is a strong 2A antagonist and would tend to generally be regarded as an antidote for serotonin syndrome because of the widespread belief that the 2A receptor is the culprit.
However, if a particular individual happens to be vulnerable to serotonin syndrome propagating through the 1A receptor, adding an agent such as Risperdal can actually worsen the situation because blockading the 5-HT2A receptor reinforces the gene expression on 1A. It sounds like this is what happened in your particular case, and serotonin syndrome has also been reported in at least 2 cases where Risperdal was added to the SSRI paroxetine. My feeling is that we may see more case reports of serotonin syndrome in the near future with increased use of the EMSAM patch and concomitant prescription of atypical antipsychotics by unwary clinicians.
Todd
Posted by SLS on June 14, 2006, at 17:37:25
In reply to Re: Serotonin Syndrome Reaction, posted by silvercoin on June 14, 2006, at 15:44:20
> However, if a particular individual happens to be vulnerable to serotonin syndrome propagating through the 1A receptor, adding an agent such as Risperdal can actually worsen the situation because blockading the 5-HT2A receptor reinforces the gene expression on 1A.
Is there a latency between the time the 5-HT2a receptors are antagonized and the reinforced expression of 5-HT1a? In your estimation, should cyproheptadine be used as an antidote to SS?
- Scott
Posted by silvercoin on June 15, 2006, at 8:37:51
In reply to Re: Serotonin Syndrome Reaction, posted by SLS on June 14, 2006, at 17:37:25
> > However, if a particular individual happens to be vulnerable to serotonin syndrome propagating through the 1A receptor, adding an agent such as Risperdal can actually worsen the situation because blockading the 5-HT2A receptor reinforces the gene expression on 1A.
>
> Is there a latency between the time the 5-HT2a receptors are antagonized and the reinforced expression of 5-HT1a? In your estimation, should cyproheptadine be used as an antidote to SS?
>
>
> - Scott
>Obviously, there must be some kind of latency, but I don't know if it's a matter of minutes or days, probably hours, but you would have to ask a psychopharmacologist to be sure. The key to being an effective SS antidote is the ability to blockade both 5-HT1a and 5-HT2a receptors. I believe that cyproheptadine does blockade 2a, but I have no idea if it blockades 1a. If it antaogonizes both and does not also blockade serotonin reuptake, this could very well be a good choice to treat serotonin syndrome with.
Todd
Posted by SLS on June 15, 2006, at 10:00:47
In reply to Re: Serotonin Syndrome Reaction » SLS, posted by silvercoin on June 15, 2006, at 8:37:51
> > > However, if a particular individual happens to be vulnerable to serotonin syndrome propagating through the 1A receptor, adding an agent such as Risperdal can actually worsen the situation because blockading the 5-HT2A receptor reinforces the gene expression on 1A.
> > Is there a latency between the time the 5-HT2a receptors are antagonized and the reinforced expression of 5-HT1a? In your estimation, should cyproheptadine be used as an antidote to SS?
> Obviously, there must be some kind of latency, but I don't know if it's a matter of minutes or days, probably hours, but you would have to ask a psychopharmacologist to be sure. The key to being an effective SS antidote is the ability to blockade both 5-HT1a and 5-HT2a receptors. I believe that cyproheptadine does blockade 2a, but I have no idea if it blockades 1a. If it antaogonizes both and does not also blockade serotonin reuptake, this could very well be a good choice to treat serotonin syndrome with.Out of desperation, I once foolishly tried a small test dose of venlafaxine while taking Parnate. Serotonin syndrome appeared within 1/2 hour. I was delerious and unable to sit or stand for over an hour. Luckily, I did not have a fever.
- Scott
Posted by silvercoin on June 15, 2006, at 12:54:30
In reply to Re: Serotonin Syndrome Reaction, posted by SLS on June 15, 2006, at 10:00:47
>
> Out of desperation, I once foolishly tried a small test dose of venlafaxine while taking Parnate. Serotonin syndrome appeared within 1/2 hour. I was delerious and unable to sit or stand for over an hour. Luckily, I did not have a fever.
>
>
> - Scott
Yes, I do recall reading your account of the experience. Perhaps it was a bit foolhardy, but I also think that calculated risks sometimes need to be taken in order to advance the frontiers of science.Todd
Posted by Karen44 on June 18, 2006, at 14:22:58
In reply to Re: Serotonin Syndrome Reaction » SLS, posted by silvercoin on June 15, 2006, at 12:54:30
I am happy to say I am back to normal if there is such a concept. I am going off of the Parnate as well (with psychiatrist's agreement). I have had a number of health issues that came on all at once and why I got depressed and sought out a psychiatrist who specilizes in persons with co-occuring physical and emotional problems. I am now down to 20 mg. per day Parnate and obviously cannot yet tell if this will be problematic. I have been on 20 mg. per day now for only four days. We agreed on the gradual reduction in case I start to feel depressed again. I am hoping not. My physical condition is improving, etc. though there are some issues from the past that we began to adress before my pulmonary condition took a down turn.
It has been suggested to me that we should consider Lamictal as an alternative to the Parnate. I am extremely concerned givin that I have ended up with so many adverse reactions and allergic reactions to the psychotropic medications in the past year.
Karen
Posted by laura k on June 19, 2006, at 8:16:51
In reply to Re: Serotonin Syndrome Reaction, posted by Karen44 on June 18, 2006, at 14:22:58
> I am happy to say I am back to normal if there is such a concept. I am going off of the Parnate as well (with psychiatrist's agreement). I have had a number of health issues that came on all at once and why I got depressed and sought out a psychiatrist who specilizes in persons with co-occuring physical and emotional problems. I am now down to 20 mg. per day Parnate and obviously cannot yet tell if this will be problematic. I have been on 20 mg. per day now for only four days. We agreed on the gradual reduction in case I start to feel depressed again. I am hoping not. My physical condition is improving, etc. though there are some issues from the past that we began to adress before my pulmonary condition took a down turn.
>
> It has been suggested to me that we should consider Lamictal as an alternative to the Parnate. I am extremely concerned givin that I have ended up with so many adverse reactions and allergic reactions to the psychotropic medications in the past year.
>
> KarenI had this happen to me, too. It started with a decrease in seroquel and ativan... just to try to increase my concentration at a new job (I'm a lawyer). Then my mood became unstable, I had a poor work evaluation and I had a panic attack. I went to the ER and they sent me to a psych hospital. The pdocs there discontinued the ativan and seroquel cold turkey then after 5 days, I was placed in outpatient group therapy. My depression continued and the doctor tapered me off celexa and sent me for EMDR therapy (which helped enormously). I remained on trileptal, tho she decided to discontinue the trileptal and switch to depakote ER because of the symptoms I was having. I'd had the same problems while on klonapin, lamictal and risperdal.
During this time, I developed profuse sweating, hot and cold flashes, severe muscle pain, severe upper body spasms (I thought it was convulsions) twitching, rigidity, nystagmus, irregular heartrate, nausea, vomiting, pain in my right abdomen, laughing and crying spasms, difficulty breathing and swallowing.
I went to the ER and the doctor said to discontinue all medication. He didn't really have a diagnosis. I followed up with my family doctor who said it was serotonin syndrome and withdrawal. He said to go off all medications. He ordered an abdominal scan which showed liver problems and he refered me to a liver specialist. Unfortunately, I lost my job due to all of this, and my insurance.. so I never got to go to the liver specialist.
I did a liver and gallbladder detoxification, went off all meds, all chemicals, went to organic food only. I was better for about 6 weeks. I stopped having to use a bipap with oxygen at night. Started sleeping better, stopped being suicidal.
Then I started waking up with severe anxiety, thirsty and the need to urinate. My blood glucose had been high while on medications, but my last test had been normal. In the 90s. So I don't think I am hyperglycemic. Anyway.. I am still off all meds.. Still have no job and no insurance.. but they county paid for me to see a pdoc, who said he would prescribe Ativan, but it has to be approved by the county and that hasn't happened yet. He said he would leave me off mood stabilizers since my mood seems ok and he would put me on one mood stabilizer only (he favors lamictal) if my mood becomes unstable.. no more mixing meds for me! He was very angry at the previous pdoc for missing the seratonin syndrome.
Posted by Karen44 on June 19, 2006, at 23:18:36
In reply to Re: Serotonin Syndrome Reaction, posted by laura k on June 19, 2006, at 8:16:51
> > I am happy to say I am back to normal if there is such a concept. I am going off of the Parnate as well (with psychiatrist's agreement). I have had a number of health issues that came on all at once and why I got depressed and sought out a psychiatrist who specilizes in persons with co-occuring physical and emotional problems. I am now down to 20 mg. per day Parnate and obviously cannot yet tell if this will be problematic. I have been on 20 mg. per day now for only four days. We agreed on the gradual reduction in case I start to feel depressed again. I am hoping not. My physical condition is improving, etc. though there are some issues from the past that we began to adress before my pulmonary condition took a down turn.
> >
> > It has been suggested to me that we should consider Lamictal as an alternative to the Parnate. I am extremely concerned givin that I have ended up with so many adverse reactions and allergic reactions to the psychotropic medications in the past year.
> >
> > Karen
>
> I had this happen to me, too. It started with a decrease in seroquel and ativan... just to try to increase my concentration at a new job (I'm a lawyer). Then my mood became unstable, I had a poor work evaluation and I had a panic attack. I went to the ER and they sent me to a psych hospital. The pdocs there discontinued the ativan and seroquel cold turkey then after 5 days, I was placed in outpatient group therapy. My depression continued and the doctor tapered me off celexa and sent me for EMDR therapy (which helped enormously). I remained on trileptal, tho she decided to discontinue the trileptal and switch to depakote ER because of the symptoms I was having. I'd had the same problems while on klonapin, lamictal and risperdal.
>
> During this time, I developed profuse sweating, hot and cold flashes, severe muscle pain, severe upper body spasms (I thought it was convulsions) twitching, rigidity, nystagmus, irregular heartrate, nausea, vomiting, pain in my right abdomen, laughing and crying spasms, difficulty breathing and swallowing.
>
> I went to the ER and the doctor said to discontinue all medication. He didn't really have a diagnosis. I followed up with my family doctor who said it was serotonin syndrome and withdrawal. He said to go off all medications. He ordered an abdominal scan which showed liver problems and he refered me to a liver specialist. Unfortunately, I lost my job due to all of this, and my insurance.. so I never got to go to the liver specialist.
>
> I did a liver and gallbladder detoxification, went off all meds, all chemicals, went to organic food only. I was better for about 6 weeks. I stopped having to use a bipap with oxygen at night. Started sleeping better, stopped being suicidal.
>
> Then I started waking up with severe anxiety, thirsty and the need to urinate. My blood glucose had been high while on medications, but my last test had been normal. In the 90s. So I don't think I am hyperglycemic. Anyway.. I am still off all meds.. Still have no job and no insurance.. but they county paid for me to see a pdoc, who said he would prescribe Ativan, but it has to be approved by the county and that hasn't happened yet. He said he would leave me off mood stabilizers since my mood seems ok and he would put me on one mood stabilizer only (he favors lamictal) if my mood becomes unstable.. no more mixing meds for me! He was very angry at the previous pdoc for missing the seratonin syndrome.
LauraI am so sorry to hear what happened to you. I hope you can get a job at some point soon and get on some insurance. My job does not know that I spent a week in a psy hospital; they think I was in the hospital for pneumonia which by the way I got while on the psy unit in addition to an adverse reaction to the medication I was on at the time--a horrible rashg all over my body. The nature of my work would make things very problematic for me should they know. That is all I can say about it. This sounds so unfair that they would let you go from your job; What about Americans with Disability Act???
Karen
This is the end of the thread.
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