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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Squiggles on August 11, 2002, at 19:11:00
Does anyone know what "retinal sheen"
means exactly? I have searched just about
every medical dictionary on the net including
ophthalmology and i cannot find it; it is part
of the nephritis symptomatology so i would
like to know what it is - lithium long-term use
induces NDI so i am concerned.Thanks
Squiggles
Posted by katekite on August 12, 2002, at 10:13:16
In reply to retinal sheen, posted by Squiggles on August 11, 2002, at 19:11:00
Wouldn't you be urinating over 4 liters a day and drinking like a fiend if you had DI of any cause? And would pee throughout the night as well?
Easy to measure.
Kate
Posted by Squiggles on August 12, 2002, at 10:21:46
In reply to Re: retinal sheen, posted by katekite on August 12, 2002, at 10:13:16
Hi Kate,
I urinate once at night and more than normal
during the day - but that is for a long time;
what worries me is the weird symptoms i have:- white tongue
- salty taste
- mucous membranes dry
- peripheral neuropathy - hands
- gastrointestinal reflux
- frequent a.m. diarrhea (esp. after Synthroid)
- bright eyes (is that the sheen?)
- edema
- fatigue
- dyspnea
- bubbles in the urineI am putting my trust in my dr. that I don't
have NDI after 23 yrs of lithium therapy;
- i have become vigilant after some
medical adventures in the past 7 years.Squiggles
Posted by katekite on August 12, 2002, at 15:06:27
In reply to Re: retinal sheen » katekite, posted by Squiggles on August 12, 2002, at 10:21:46
I don't know about the symptoms. But why don't you measure your urine output on a day when you are home all day, use a bowl or something and then a measuring cup, no need to save it all for 24 hrs just add up the amounts. Just start and stop at the same time each day so that you collect exactly 24 hrs worth. Something between 800 and 1500 milliliters is normal. More than 3 liters is definitely abnormal, the inbetween is a grey area to definitely monitor and mention to your doc (regular doc not pdoc).
I'm sure you really don't need to know my most private details, LOL, but I'm somewhere between 2.0 and 3.5 liters a day -- probably a cortisol thing since that's the only thing they've found wrong with me. Until I had to do a 24hr urine collection for the cortisol test I had absolutely no idea I was abnormal -- I had assumed I peed frequently due to anxiety and never noticed that I drank more. Now, looking back, the times I've been most emotionally unstable in the past were I think accompanied by even greater urination and really dry mouth, cracked lips indicative of dehydration. I've been hospitalized twice and both times was told over and over I looked dehydrated, should drink, was even bought drinks and sodas by the nurses and I was already thirsty and drinking on my own. If only they'd done more labwork they might have figured it out. Seems to be an intermittent problem. Anyhow..... more than you needed to know I'm sure.
If it turns out you urinate a normal volume over 24 hrs but urinate more frequently than 8-10 times a day that in itself is a finding that needs work-up: people can develop all sorts of interesting bladder things. Sometimes with menopause urination becomes more urgent. Or there are other frequency issues -- would again be something to tell a doc.
Doctors tend to want to blame increased volume of urination, in people with a history of psychiatric problems, on a pyschological reason. The truth is that true psychological over-drinking is very very rare.
Check it out and get some numbers to work with.
kate
Posted by Squiggles on August 12, 2002, at 15:15:13
In reply to Re: retinal sheen, posted by katekite on August 12, 2002, at 15:06:27
You're an angel Kate - very helpful and
you work hard here. I appreciate your
hints - i get thirsty at night - i have
to drink a bottle of water (sometimes
more thirsty than other times - this
has only happened in the past couple of
years;- i have not measured the output, but if that
is significant (especially now that my mouth seems weird)
I will do it - yucky poo - one or two days
is enough i hope.BTW, my dr. gave me a diabetes test and i
am clear on that - perhaps that is indicative
of the dreaded glomuronephritis (sp?);thanks :-)
Squiggles
Posted by IsoM on August 12, 2002, at 15:39:21
In reply to Re: retinal sheen » katekite, posted by Squiggles on August 12, 2002, at 15:15:13
Retinal sheen isn't something you can see. It shows when a fundoscopic exam is done & is something that an examiner would recognise when looking at the retina. I don't know what it's supposed to look like, but would only be seen when doing a visual inspection of the INTERIOR of the eye.
It's probably just what it says - a sheen that's seen on the retina that's different from what it should normally look like. When a person has fluid in their inner ear, a doctor can tell by looking at the eardrum (through the ear canal) & seeing a small degree of bulging. Simple visual signs are often used to diagnose certain conditions.
Posted by Squiggles on August 12, 2002, at 15:49:26
In reply to Re: retinal sheen » Squiggles, posted by IsoM on August 12, 2002, at 15:39:21
OK - if it turns out I pee like a stallion
i'll go to optometrist - need glasses anyway;
hey, maybe i can be of benefit to the medical
profession;Squiggles
Posted by IsoM on August 12, 2002, at 18:21:15
In reply to Re: retinal sheen » IsoM, posted by Squiggles on August 12, 2002, at 15:49:26
Don't know if optometrist is qualified or has the right diagnostic tools to diagnose for such problems. You may need an opthamalogist, but I'm sure a phone call to your optometrist would clear it up. The tools & training needed to differentiate may not be available to optemtrists.
Posted by Squiggles on August 12, 2002, at 19:35:38
In reply to Optometrist vs Opthalmologist » Squiggles, posted by IsoM on August 12, 2002, at 18:21:15
Posted by katekite on August 12, 2002, at 20:06:37
In reply to Re: retinal sheen » katekite, posted by Squiggles on August 12, 2002, at 15:15:13
With all respect, I would guess you are barking up the wrong tree with glomerulonephritis and nephrogenic diabetes insipidus. (Luckily I think). I would guess other more common things can cause excessive urination and eye complaints.
I think an optometrist would be qualified to look at your fundus, but an ophthamologist would be better. I like ophthamologists better but they are more expensive with longer waits.
Let me know how much you pee.
Kate
Posted by Squiggles on August 12, 2002, at 20:14:44
In reply to Re: retinal sheen, posted by katekite on August 12, 2002, at 20:06:37
Yup,
I'm starting a cellar with discarded
GATORADE bottles - will let you know tomorrow;
trying to be reasonable about my consumption
of water. In the summer one tends to drink
more - these past two summers are exceptionally
hot and polluted - i think my peripheral neuropathy
may be caused by that and the dryness, etc.Thanks for the encouraging words.
Squiggles
Posted by medlib on August 13, 2002, at 23:41:49
In reply to Re: retinal sheen » katekite, posted by Squiggles on August 12, 2002, at 10:21:46
Hi Squiggles--
I'm sorry, but I haven''t followed your earlier posts (don't get on Babble as much any more); and not knowing helpful stuff like your gender and what level med knowledge/lingo you may have makes foot-in-mouth disease even more likely than usual for me. I was hooked by your subject line and have some thoughts on your symptoms (Sx) that haven't been mentioned, so I hope that you don't mind if I belatedly butt in. So...
--Retinal sheen can be attributed to kidney or liver disease, but it can also be a sx of hypertension (high BP). [Note: Although elevated thyroid level can cause hypertension, most hypertension isn't related to thyroid excess.]
--Diarrhea is one sx of too much thyroid replacement hormone (TRH). Since each episode is short-lasting and occurs after taking Synthroid, a sudden spike in hormone blood level may be causing a temporary excess. This could indicate that the med is dissolving too rapidly, and/or your thyroid level may be borderline high. You may want to consider asking for a TSH test. Dividing your med and taking the 2nd half several hours later might help.
[Note re TSH level: Some pdocs prefer to see a TSH near 2, while GPs, internists, and printed lab test results will call anything below 5.0 and *above* 2.0 "normal".]
--Systemic Candidiasis (a fungal, or yeast, infection) is one possibility that could account for most of the rest of your sx. Standard blood tests do not indicate fungal infections or ID the culprit, so you might ask your doc about it, if appropriate. (Btw, yeast feeds and grows on sugars; so, if present, Gatorade would be "mother's milk" to it.)I could blather on (and on) and ask several obvious questions; but, since odds are high that this is belated, irrelevant and/or boring already, best quit before I get any further behind. Good luck, and let us know how it goes.
Not a doc---medlib (a former RN and medical librarian)
Posted by Squiggles on August 14, 2002, at 7:52:25
In reply to Re: Symptoms » Squiggles, posted by medlib on August 13, 2002, at 23:41:49
Hi Medlib,
You are very generous to provide all this
concrete information; it helps very much;
I think that NDI can probably be ruled out
for the following reasons- dr. took diabetes test and I'm cleared;
- i have normal blood pressure
- i get diarreah after taking Synthroid first
thing in the morning - very close in time;- i am hypothyroidic, but dr. said don't take
the higher dose because it gave me panic and
anxiety and heart palpitations, so i guess
i am borderline safe;
- i don't know about the bloods but i just
got them for lithium, TSH, and urine, and not
getting a call means i am ok;- i think i have Candidiasis because when
i eat sugars the symptoms get much worse - thank
you for the Gatorade hint;- i am menopausal
You are very kind to provide medical info. -
thanks
Posted by Squiggles on August 14, 2002, at 8:32:09
In reply to Re: Symptoms » medlib, posted by Squiggles on August 14, 2002, at 7:52:25
The last TSH levels i have
on record are from March 2002:TSH 12.9
(the one in Jan. 2002, was 5.96)
Squiggles
Posted by katekite on August 14, 2002, at 13:35:28
In reply to Re: Symptoms » medlib, posted by Squiggles on August 14, 2002, at 7:52:25
Hi Squiggles,
This is long so is separated into part I and II.
Part I, increased urination.
You are right: if you have had a recent urinalysis that showed no protein or glucose and showed your urine was normally concentrated you most likely do not have either kidney problems or diabetes of any sort.
However, you still pee too much.
This can be caused by problems at the level of the kidney, whole body metabolic problems, or a hormonal problem.
The workup of your excessive urine would be a urinalysis, and a blood chemistry panel. The important values on the urinalysis are protein (not normally present but present in the dreaded nephropathy, and sometimes in infections), glucose (present in bad diabetes mellitus) and how concentrated it is (if well concentrated all forms of diabetes insipidus are unlikely). The important values on the blood chemistry are glucose (which would be elevated in diabetes mellitus), electrolytes like calcium and sodium (which would be off in a metabolic problem) and creatinine (increased value means poor kidney function.)
If a blood chemistry panel and urinalysis are normal then you are looking at one of two things: either a hormonal problem or a side effect of lithium (or that you were just drinking too much).
Most hormonal disorders (Cushing's, probably hyperthyroid though I hadn't heard of that before, DI, DM) can cause increased urination.
Lithium can cause increased urination by itself as a weird known side effect. In order to show it was the lithium causing the extra urination you would reduce it and see if the urine volume went down: I don't know how long it takes to get out of your system or even if that's a wise thing to just do on your own. I remember you tried reducing lithium in the past to see if the neuropathy was due to it: do you recall if you peed less?
So -- in summary for the increased urination -- a regular doctor could rule out many problems by doing a urinalysis and a blood chemistry panel. If they do not find the cause you should be referred to an endocrinologist. If you can, try to discover if it is the lithium or not. Do not ignore this problem as it could be an indication of something serious, though I hope it is nothing.
Part II. Bubbles, TSH, candida.
You mentioned your urine has bubbles in it. If it is foamy that can be an indication that there is protein in the urine, which should not be there. Bubbles occur too in some urinary tract infections but you would probably have other symptoms of a urinary tract infection like urgency or burning.
I saw a note somewhere on the net from someone taking lithium and tegretol who was asking about bubbles in urine, so maybe it is a drug side effect. If the bubbles are new and haven't been there the whole time you've been taking lithium I would ask a doctor. A urinalysis would be able to show if there was protein or a urinary infection.
Your TSH went up over the last year. Which means, I think (but do not know for sure) that your thyroid gland is becoming less sensitive or less active, that your thyroid problem worsened.
Not getting a call about results does not mean anything. Always call. I have had several personal experiences where no one called even though my results were abnormal.
I read a little thing on the web about research showing benzodiazepines (they were talking only about valium though) interact with the proteins that carry thyroid hormone around in the blood. To me this says that restarting klonopin could possibly affect your thyroid level and you might need to tweak your thyroid dose. It might affect the amount of free thyroid hormone. Sometimes it is not enough to test TSH: the actual T3 and T4 levels might be useful to test as well. How you feel is of course a good indication of your thyroid level as well and you are probably pretty good at knowing if it is too high.
Not everyone can stay on lithium very long term. It sounds like it has worked for you and of course it is not great to change what has worked. On the other hand it may continue to make your thyroid problem worse and can have other long term effects so it might be good to have a back up drug in mind.
I don't know much of anything about systemic candidiasis. I have had the more common oral candidiasis infection recently with having high cortisol (I have reduced immune function) and took the drug Nystatin, which cleared it up in a few days. With oral candidiasis, when you wipe off the white part there should be a red raw area underneath. I would guess if it isn't raw at all underneath it is not candidiasis.
My feeling is you should ask to be referred to an endocrinologist and go to them and tell them you are urinating too much and just let them work it up. The regular blood chemistry and urinalysis will probably be normal if you are not feeling on death's door. You seem worried about your health so I wouldn't just ignore the increased urination.
Hope this has been helpful. Please do not consider anything I say as substitute for asking a doctor. Even though I sound knowledgeable sometimes I might be just plain wrong.
Kate
Posted by Squiggles on August 14, 2002, at 14:23:16
In reply to Re: Symptoms, posted by katekite on August 14, 2002, at 13:35:28
Hi Kate,
Well, if you are not a doctor you could have fooled me. :-)
> Hi Squiggles,
>
> This is long so is separated into part I and II.
>
> Part I, increased urination.
>
> You are right: if you have had a recent urinalysis that showed no protein or glucose and showed your urine was normally concentrated you most likely do not have either kidney problems or diabetes of any sort.**** I think my dr. was looking for that, so it can be excluded;
>
> However, you still pee too much.**** I believe my dr. said i just drank too much water;
>
> This can be caused by problems at the level of the kidney, whole body metabolic problems, or a hormonal problem.**** Once change i have noticed is the terrible thirst at night -
i now must have at least a glass of water at night by my bedside;
I think this is recent (2 yrs); it could be related
to Rivotril withdrawal which really screwed my thermometer;
>
> The workup of your excessive urine would be a urinalysis, and a blood chemistry panel. The important values on the urinalysis are protein (not normally present but present in the dreaded nephropathy, and sometimes in infections), glucose (present in bad diabetes mellitus) and how concentrated it is (if well concentrated all forms of diabetes insipidus are unlikely). The important values on the blood chemistry are glucose (which would be elevated in diabetes mellitus), electrolytes like calcium and sodium (which would be off in a metabolic problem) and creatinine (increased value means poor kidney function.)**** I recently had an electrolyte test and it was normal;
i don't know what my dr. saw but it could proteinurea; in the
past 2 years i pee more frequently and with greater force -
that seems coincidental with menopause too.
>
> If a blood chemistry panel and urinalysis are normal then you are looking at one of two things: either a hormonal problem or a side effect of lithium (or that you were just drinking too much).***** Of course lithium always makes you pee a lot; but recently it has
been noticeably more;
>
> Most hormonal disorders (Cushing's, probably hyperthyroid though I hadn't heard of that before, DI, DM) can cause increased urination.**** No way I am hyperthyroid with a 12.96 TSH i think; and my
dr. knows i am hypothyroidic - i have edema and since
my Synthroid was reduced from 0.155 to 0.112 it is very
hard to lose weight, and recently my neck seems to be
getting wider;
>
> Lithium can cause increased urination by itself as a weird known side effect. In order to show it was the lithium causing the extra urination you would reduce it and see if the urine volume went down: I don't know how long it takes to get out of your system or even if that's a wise thing to just do on your own. I remember you tried reducing lithium in the past to see if the neuropathy was due to it: do you recall if you peed less?
>
**** I don't recall, but I can test again - not for too long, because
the Synthroid picks up and I get terribly speedy - not surprising;
do you think a couple of days of skipping every other day for 4 days or
so would be indicative - if the urine output went down?
> So -- in summary for the increased urination -- a regular doctor could rule out many problems by doing a urinalysis and a blood chemistry panel. If they do not find the cause you should be referred to an endocrinologist. If you can, try to discover if it is the lithium or not. Do not ignore this problem as it could be an indication of something serious, though I hope it is nothing.
>
> Part II. Bubbles, TSH, candida.
>
> You mentioned your urine has bubbles in it. If it is foamy that can be an indication that there is protein in the urine, which should not be there. Bubbles occur too in some urinary tract infections but you would probably have other symptoms of a urinary tract infection like urgency or burning.**** I told my dr. about the bubbles - there is also a
seemingly glycerine look to the urine unlike before;
He said don't worry about the bubbles (and it is not foam - just
occasionally bubbles - again since menopause but maybe
that is coincidence);
>
> I saw a note somewhere on the net from someone taking lithium and tegretol who was asking about bubbles in urine, so maybe it is a drug side effect. If the bubbles are new and haven't been there the whole time you've been taking lithium I would ask a doctor.**** Yes as i said i did.
A urinalysis would be able to show if there was protein or a urinary infection.**** It is possible that it is an infection and that the
therefore did not consider it worthy pursuing.
>
> Your TSH went up over the last year. Which means, I think (but do not know for sure) that your thyroid gland is becoming less sensitive or less active, that your thyroid problem worsened.***** That is what my dr. said and we tried 0.125 Syntrhoid
instead of 0.112 and i had a heart block feeling; he told
me not to go on - since my Synthroid crisis i suppose
i became very sensitive to thyroxine. BTW I called
just now the nurse, and asked for my results, so i hope
to see if the TSH is getting even lower.
>
> Not getting a call about results does not mean anything. Always call. I have had several personal experiences where no one called even though my results were abnormal.**** Ugh -we get call for my summer vacation shots,
or my cosmetic order but not for that - Not Good.
>
> I read a little thing on the web about research showing benzodiazepines (they were talking only about valium though) interact with the proteins that carry thyroid hormone around in the blood. To me this says that restarting klonopin could possibly affect your thyroid level and you might need to tweak your thyroid dose.It might affect the amount of free thyroid hormone. Sometimes it is not enough to test TSH: the actual T3 and T4 levels might be useful to test as well. How you feel is of course a good indication of your thyroid level as well and you are probably pretty good at knowing if it is too high.
**** I am convinced that my thyroid was affected when
i reinstated the Rivotril, but i have no proof -
i just felt slower, slept more, and got more edema,
esp. ankles and face;>
> Not everyone can stay on lithium very long term. It sounds like it has worked for you and of course it is not great to change what has worked. On the other hand it may continue to make your thyroid problem worse and can have other long term effects so it might be good to have a back up drug in mind.***** Yes, that is why I asked my dr. to lower the Lithium now that
he has lowered the Synthroid, and perhaps i don't need 900mg of it,
as in Europe they use less and it works. But he said
that my lithium levels have always been low i.e. 0.8 - 1.2;>
> I don't know much of anything about systemic candidiasis. I have had the more common oral candidiasis infection recently with having high cortisol (I have reduced immune function) and took the drug Nystatin, which cleared it up in a few days. With oral candidiasis, when you wipe off the white part there should be a red raw area underneath.***** Yes that is what is like for me and I think it
has become "systemic" but i don't think my dr.
saw it really - i showed it thinking something was
wrong with my tongue, but he said there was nothing
wrong with my tongue; sigh.
***** I would guess if it isn't raw at all underneath it is not candidiasis.
>
> My feeling is you should ask to be referred to an endocrinologist and go to them and tell them you are urinating too much and just let them work it up. The regular blood chemistry and urinalysis will probably be normal if you are not feeling on death's door. You seem worried about your health so I wouldn't just ignore the increased urination.
>
> Hope this has been helpful. Please do not consider anything I say as substitute for asking a doctor. Even though I sound knowledgeable sometimes I might be just plain wrong.***** You have been very helpful, and you are extremely
knowledgeable. I have gone to other drs. during
emergencies and i have always felt very guilty. I
really like my dr. - i am just very paranoid because
of some misadventures in medicine.********** Hey, i just got the nurse's call:
She said the reason the dr. did not call is because
there was nothing wrong; OK the TSH bounced back
to 6.8 - where's my Lamborghini?Well, i hope this has been as much fun for you
as it has for me; i thank you for all the tips.Squiggles
Posted by Squiggles on August 15, 2002, at 11:07:28
In reply to Re: Symptoms » katekite, posted by Squiggles on August 14, 2002, at 14:23:16
Kate,
Just in case the picture is more complete;
CLSC (Quebec Health Phone line) nurse told
me to go to ER for a urinary tract problem;
dr. gave me antibiotics at ER - i asked him
if i could just drink lots of water and Cranberry
juice, but he said it would not go away and i
already had a fever. He wanted to me to get the
stuff the same night and it was late;Anyway i took one and i did not get ill - i was
afraid of interactions and anaphylactic stuff;
i have to take the stuff for a week at least and
then check - it's a bacterial infection.My case is minor, there was a poor elderly lady
who came.... never mind, it was gruesome.Anyway, i am just telling you in case that was
the caUse of polyurination or perhpas the the
test did it - we do have a heat wave here and
those bugs grow.Squiggles
Posted by katekite on August 16, 2002, at 17:40:18
In reply to Antibiotics » Squiggles, posted by Squiggles on August 15, 2002, at 11:07:28
Sounds like when you think something is wrong, it is. Remember that and trust yourself. Glad you have antibiotics. -- kate
Posted by Squiggles on August 16, 2002, at 17:43:05
In reply to Re: Antibiotics, posted by katekite on August 16, 2002, at 17:40:18
Thanks Kate, the CLSC nurse really encouraged
me to go to ER and on another occasion many
yrs. ago i had extreme hypothyroidism and again
a nurse encourage me - so they really saved
my *ss, which is a good thing because i believe
and fear to be perceived a hypochondriac.:-)
take careSquiggles
This is the end of the thread.
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