Psycho-Babble Medication Thread 363567

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Re: Disappearance of chronic pain with Effexor? flipsactown

Posted by Sad Panda on July 8, 2004, at 4:27:09

In reply to Re: Disappearance of chronic pain with Effexor? Sad Panda, posted by flipsactown on July 8, 2004, at 0:24:56

> Hi Panda,
>
> I did try Amitriptyline for nearly 2 months, but gave it up in favor of Prozac because of weight gain and the fact that I was still depressed. In retrospect, I probably should have added Amitriptyline to augment Prozac.
>
> I have not tried Nortriptyline. I will keep it in mind should Lexapro fail. Another idea would be to ask my pdoc to Rx Nortriptyline or Amitriptyline to augment Lexapro. I probably will try this first before I try Effexor again because of my previous terrible experience with Effexor's SEs.
>
> Thanks for the advice.
>
> FST
>
> > Hi FST,
> >
> > Have you tried or considered Amitriptyline or Nortriptyline? I don't want to deter you from trying Effexor but these two have a pretty good track record for treating neuropathic(nerve damage?) pain.
> >
> > Cheers,
> > Panda.
> >
>
>

Hi FST,

I am in the process of switching from Effexor + Remeron to Effexor + Nortriptyline. I'm trying to understand the P450 system since I don't think my pdoc spent too much time thinking about it when she gave me the script for Nortriptyline. Looks like Nort & Effexor raise each others levels somewhat, so I have to be carefull with the dosages. Prozac & Paxil look to be bad choice for combination with TCA's because they are inhibitors of CYP2D6 which is the enzyme that is responsible for the metabolism of a lot of drugs.

Cheers,
Panda.

 

Re: Disappearance of chronic pain with Effexor?

Posted by SLS on July 8, 2004, at 7:52:21

In reply to Re: Disappearance of chronic pain with Effexor? flipsactown, posted by Sad Panda on July 8, 2004, at 4:27:09

FST:

> Another idea would be to ask my pdoc to Rx Nortriptyline or Amitriptyline to augment Lexapro. I probably will try this first before I try Effexor again because of my previous terrible experience with Effexor's SEs.

I agree with you. I think augmenting the Lexapro makes sense, especially since you are expereriencing a partial response to it. If you opt for nortriptyline instead of desipramine, be sure to use blood levels to help determine proper dosing.


Panda:

> Looks like Nort & Effexor raise each others levels somewhat, so I have to be carefull with the dosages.

According to my reference, they do, but not to a large degree. However, since dosage is so critical with nortriptyline when treating depression, you should test for blood levels. It will make things easier.

> Prozac & Paxil look to be bad choice for combination with TCA's because they are inhibitors of CYP2D6 which is the enzyme that is responsible for the metabolism of a lot of drugs.

I don't think they are necessarily bad choices so much as they are choices that require knowledge of pharmocokinetic interactions and appropriate adjustment of dosages. You can pretty much cut the dosage of the TCA in half. Prozac or Paxil + desipramine makes for a reasonable combination. I combined Paxil with desipramine with no trouble at all. Again, blood tests are available to make this a viable option.

I'm surprised that I found the following abstract so easily. It is important to consider that the blood concentrations of desipramine were controlled. Many previous reviews of such combinations offered as discussion the possibility that the increased rate of antidepressant response observed was due to increased blood levels of TCA produced by the CYP2D6 inhibition produced by the SSRI.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14744472

Good luck with your new combo!


- Scott

 

Re: Disappearance of chronic pain with Effexor? SLS

Posted by Sad Panda on July 8, 2004, at 10:28:04

In reply to Re: Disappearance of chronic pain with Effexor?, posted by SLS on July 8, 2004, at 7:52:21

> FST:
>
> > Another idea would be to ask my pdoc to Rx Nortriptyline or Amitriptyline to augment Lexapro. I probably will try this first before I try Effexor again because of my previous terrible experience with Effexor's SEs.
>
> I agree with you. I think augmenting the Lexapro makes sense, especially since you are expereriencing a partial response to it. If you opt for nortriptyline instead of desipramine, be sure to use blood levels to help determine proper dosing.
>
>
> Panda:
>
> > Looks like Nort & Effexor raise each others levels somewhat, so I have to be carefull with the dosages.
>
> According to my reference, they do, but not to a large degree. However, since dosage is so critical with nortriptyline when treating depression, you should test for blood levels. It will make things easier.
>
> > Prozac & Paxil look to be bad choice for combination with TCA's because they are inhibitors of CYP2D6 which is the enzyme that is responsible for the metabolism of a lot of drugs.
>
> I don't think they are necessarily bad choices so much as they are choices that require knowledge of pharmocokinetic interactions and appropriate adjustment of dosages. You can pretty much cut the dosage of the TCA in half. Prozac or Paxil + desipramine makes for a reasonable combination. I combined Paxil with desipramine with no trouble at all. Again, blood tests are available to make this a viable option.
>
> I'm surprised that I found the following abstract so easily. It is important to consider that the blood concentrations of desipramine were controlled. Many previous reviews of such combinations offered as discussion the possibility that the increased rate of antidepressant response observed was due to increased blood levels of TCA produced by the CYP2D6 inhibition produced by the SSRI.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14744472
>
> Good luck with your new combo!
>
>
> - Scott
>

Thanks Scott! :)

I get a lot of my info from http://www.psychotropical.com/
The pdoc that has that site, Dr. PK Gillman, like to prescibe Zoloft + Nortriptyline or Desipramine. His site has recently been updated & it looks prettier, but half the info on it has gone.

Cheers,
Panda.


 

Re: Disappearance of chronic pain with Effexor?

Posted by starlight on July 8, 2004, at 17:40:24

In reply to Re: Disappearance of chronic pain with Effexor?, posted by Buckeye Fan on July 6, 2004, at 23:10:16

It's very common for pain management specialists to prescribe antidepressents for neuropathic pain, so it's not surprising that you would have positive results for your pain with effexor. Congrats!
starlight

 

Re: Chronic pain -best med and weird reactions

Posted by Cairo on July 9, 2004, at 21:42:59

In reply to Disappearance of chronic pain with Effexor?, posted by Colleen D. on July 6, 2004, at 19:44:18

I have Fibromyalgia with atypical depression/HPA axis hypofunction and SSRIs make me worse. At very low doses they disrupt my already unrestful sleep and my muscles start to feel like I have a severe case of the flu! Effexor is supposed to work for some people with FMS, but I've never been able to up the dose to get past the SSRI action to the norepi reuptake inhibition component.

Would Strattera or another NRI make sense? I use Desyrel for sleep, but I don't think the quality of my sleep is good and it probably worsens the sleep apnea that you get with HPA dysfunction. I use a CPAP machine.

I need something for depression and pain, but as I've said, I can't up the SSRI doses. Neurontin works a bit for pain and muscle relaxation, but poops out after awhile. I used Elavil years ago when I was first diagnosed and it did help with pain and sleep, but that was before my symptoms worsened. Weight gain has been a problem on Elavil, Neurontin and Remeron, so that's why I was switched to Desyrel.

A trial of low dose Risperdal (0.125mg)for a couple of weeks successfully aborted a Fibromyalgia flare awhile ago, but a repeated course for the next flare did not seem to work as well. Upping the dose to 0.5mg or higher made symptoms worse (muscle aches, flushes, nervousness).

At this point, I don't care about weight gain. I need to help the pain and depression. My doctor won't touch narcotics, so I use only aspirin. NSAIDs cause elevation in BP.

How would you rate Elavil compared to other TCAs for pain? Would it help the atypical type depressive symptoms? How about med combos? I think that if some of the pain and muscle tightness could be controlled, some of my depressive symptoms would improve.

Thanks!

Cairo

 

Re: Chronic pain -best med and weird reactions Cairo

Posted by Sad Panda on July 10, 2004, at 9:40:23

In reply to Re: Chronic pain -best med and weird reactions, posted by Cairo on July 9, 2004, at 21:42:59

> I have Fibromyalgia with atypical depression/HPA axis hypofunction and SSRIs make me worse. At very low doses they disrupt my already unrestful sleep and my muscles start to feel like I have a severe case of the flu! Effexor is supposed to work for some people with FMS, but I've never been able to up the dose to get past the SSRI action to the norepi reuptake inhibition component.
>
> Would Strattera or another NRI make sense? I use Desyrel for sleep, but I don't think the quality of my sleep is good and it probably worsens the sleep apnea that you get with HPA dysfunction. I use a CPAP machine.
>
> I need something for depression and pain, but as I've said, I can't up the SSRI doses. Neurontin works a bit for pain and muscle relaxation, but poops out after awhile. I used Elavil years ago when I was first diagnosed and it did help with pain and sleep, but that was before my symptoms worsened. Weight gain has been a problem on Elavil, Neurontin and Remeron, so that's why I was switched to Desyrel.
>
> A trial of low dose Risperdal (0.125mg)for a couple of weeks successfully aborted a Fibromyalgia flare awhile ago, but a repeated course for the next flare did not seem to work as well. Upping the dose to 0.5mg or higher made symptoms worse (muscle aches, flushes, nervousness).
>
> At this point, I don't care about weight gain. I need to help the pain and depression. My doctor won't touch narcotics, so I use only aspirin. NSAIDs cause elevation in BP.
>
> How would you rate Elavil compared to other TCAs for pain? Would it help the atypical type depressive symptoms? How about med combos? I think that if some of the pain and muscle tightness could be controlled, some of my depressive symptoms would improve.
>
> Thanks!
>
> Cairo
>
>

I would suggest you try Nortriptyline, it is a NRI type TCA. It is an active metabolite of Elavil(Amitriptyline) & has a lot less of the side effects while retaining most of the good things.

Amitriptyline & Nortriptyline, besides being effective antidepressants, are good at treating neurological pain, preventing migraines & treating IBS.

Cheers,
Panda.


 

Re: Chronic pain -best med and weird reactions Cairo

Posted by King Vultan on July 10, 2004, at 11:12:28

In reply to Re: Chronic pain -best med and weird reactions, posted by Cairo on July 9, 2004, at 21:42:59

I quite agree with Panda. I've tried this med myself and found it the most effective of the ten or so I've tried for my chronic headaches, and I think it is an effective antidepressant. It is not as sedating as amitriptyline, but it has much more mild side effects.

Todd

 

Re: Chronic pain -best med and weird reactions

Posted by SLS on July 10, 2004, at 11:30:24

In reply to Re: Chronic pain -best med and weird reactions Cairo, posted by King Vultan on July 10, 2004, at 11:12:28

> I quite agree with Panda. I've tried this med myself and found it the most effective of the ten or so I've tried for my chronic headaches, and I think it is an effective antidepressant. It is not as sedating as amitriptyline, but it has much more mild side effects.
>
> Todd


I also like the idea of using nortriptyline. It's a great suggestion.


- Scott

 

Re: Chronic pain -best med and weird reactions Cairo

Posted by BarbaraCat on July 14, 2004, at 13:33:31

In reply to Re: Chronic pain -best med and weird reactions, posted by Cairo on July 9, 2004, at 21:42:59

Hello Cairo,
We are in the same boat. I have fibro, HPA axis dysfunction, have sleep apnea and depression (actually bipolar disorder). I also have hypothyroidism. I had a thorough workup and found that my hormones were malfunctioning, which is typical with HPA dysfunction. I am menopausal and was already on natural hormones, but tests showed they were way off. Getting my estrogen, progesterone, testosterone, DHEA balanced helped my pains alot. Another thing is thyroid. If your thyroid is even a little low your fibro pains will be increased. Some theories say that fibro is really an undertreated hypothyroid condition. Your TSH scores should be under 2.0.

I still get depression, anxiety, and insomnia, but since getting the hormones balanced, at least my muscle pains and flares are greatly diminished. In fact, I recently went back on lithium because my bipolar disorder just wasn't getting better. Lithium can make hypothyroid worse. I started feeling the old muscle cramping, aching, tired sluggish feeling again and sure enough, my TSH values were 8.5. Upped my thyroid and the pains went away.

When the pains get bad I take oxycontin. It doesn't really get rid of the pains. Not much will get rid of that drawing pulling ache. But it helps me to not care so much about the pain. I take just one pill. There's no fear of addiction, I can take or leave opioids. But it does help.

You may need to find a progressive doctor who is willing to look at a more comprehensive picture for you. I go to a naturopath have an appointment with an Environmental and Functional Medicine MD next week for this thing. Let's keep in touch. I will let you know what I find out. - BarbaraCat

 

Re: Chronic pain -best med and weird reactions

Posted by ravenstorm on July 16, 2004, at 16:29:57

In reply to Re: Chronic pain -best med and weird reactions Cairo, posted by BarbaraCat on July 14, 2004, at 13:33:31

When I was on paxil I had muscle pain and worsened headaches which I didn't reallize were from the SSRI until I got off of it.

I'm a massage therapist and based on client information (I see a lot of people with chronic pain) it seems to be the norep. not the serotonin that helps with pain. I have clients who have gained relief from Wellbutrin, nortriptyline, desipramine and effexor. Non of the SSRIs on there own have helped with pain relief. Again, totally anecdotal.

 

Re: Chronic pain -best med and weird reactions ravenstorm

Posted by BarbaraCat on July 16, 2004, at 19:29:59

In reply to Re: Chronic pain -best med and weird reactions, posted by ravenstorm on July 16, 2004, at 16:29:57

This is very interesting because I was having a very similar discussion with m/husband yesterday who has recently stopped smoking. The class he went to said that nicotine acts primarily on dopamine but there's a very close tie between dopamine and endorphins as far as pleasure seeking and reward is concerned. The lines are a little blurred with the question, is it pleasure enhancement or pain relief? Narcotics act on dopamine as well as the opiod system.

Since dopamine is in the same pathway as NE, and if there's some correlation with dopamine and endorphins, then sounds logical. - BarbaraCat


> When I was on paxil I had muscle pain and worsened headaches which I didn't reallize were from the SSRI until I got off of it.
>
> I'm a massage therapist and based on client information (I see a lot of people with chronic pain) it seems to be the norep. not the serotonin that helps with pain. I have clients who have gained relief from Wellbutrin, nortriptyline, desipramine and effexor. Non of the SSRIs on there own have helped with pain relief. Again, totally anecdotal.

 

Re: Chronic pain -best med and weird reactions BarbaraCat

Posted by Cairo on July 19, 2004, at 15:19:54

In reply to Re: Chronic pain -best med and weird reactions Cairo, posted by BarbaraCat on July 14, 2004, at 13:33:31

Hi, Barbara Cat!

When my TSH started creeping up past 3, I was started on T4, but it has not made any difference with pain, muscle tightness or any other symptoms, despite my TSH coming down to .86. A trial of estrogen/progesterone replacement therapy didn't do anything and the progesterone days made me feel like I had the flu. I'm not a candidate for estrogen only as I still have a uterus and a family history of breast cancer makes me nervous about the estrogen anyway. Testosterone level was OK.

I'm convinced that I'm a candidate for a CRH augmentor as I look and feel like Addison's disease: I crash and burn in the afternoons after ANY stressor as small as making dinner. I'm waiting for my latest cortisol levels, including an 11pm salivary cortisol to see how low they are. Last time the 4pm was lowish, but that really doesn't show if I can mount a response to stress.

Me thinks I will ask for nortriptyline, as Elavil was the only one that seemed to help, but that was quite awhile ago.

I went to a holistic doctor who gave me nutritional IVs. Because my magnesium was probably low at the time, I did feel better. But I think that is treating the problem downstream; nutritional deficiencies can be caused by stress, so I've taken supplements, but this only helps minimally. The root problem goes higher, I think.

Also, while I've not been diagnosed with BP2, my Fibromyalgia doctor says that Lamictal has helped many of her patients. I've read posts on this forum about the similarity of atypical depression (which I think I have) and BP2. I'll be talking to my psychiatrist about this. I went off all meds except for the Desyrel in anticipation of trying something new, but unfortunately my doc broke his leg and had surgery, so my appointment got cancelled.

I also am prone to neck injury due not to disc disease, but those #*%% tight muscles! I went to Universal STudios with my daughter and went on the Mummy ride which I didn't know was a roller coaster. I grabbed my neck and thought I did OK, but two weeks later went on the Cat in the Hat ride and had what looks like a whiplash injury. Everything went downhill from there and my FMS flared big time. The only think that consistently helps is a wonderful physical therapist that I go to that does hands on work on my back and neck. Far better than trigger point injections or myofascial and spray and stretch massage therapy. But, alas, the effects don't last as long as I would like.

Back to the TSH, my endo will not try T3 or higher dose as she says that while I may feel better short term, feedback inhibition will shut the thyroid down. I have wondered, however, about what is suggested in the book, The Thyroid Solution, about substituting some of the T4 that I take with T3 in an amount that approaches the "natural" ratio in the body (forgive this approximation as I cannot recall exactly). I dunno, maybe I'll try what Larry Hoover suggests in another post about supplementing with selenium, tyrosine, etc.

Let's do keep in touch as the FMS road is a difficult one and we've got to keep everyone on their toes.

Cairo

 

Re: Chronic pain -best med and weird reactions Cairo

Posted by BarbaraCat on July 19, 2004, at 18:04:53

In reply to Re: Chronic pain -best med and weird reactions BarbaraCat, posted by Cairo on July 19, 2004, at 15:19:54

HI Cairo,
I never heard about T3 shutting the feedback loop down, but maybe your doctor is on to something. My personal feeling is that this is an ideal opportunity to see if adding T3 would make a difference. Have you had your thyroid antibodies checked for hashimoto autoimmune thyroiditis?

The other thing is, like you mentioned, your adrenals. Your holistic doc can order an adrenal stress index to check the state of your cortisol. I was hoping mine was off since I'd been feeling so bad, but it wasn't. However, my husband's was very low, which explained the weird symptoms he was getting with slow healing, dragging energy. She has him on a natural cortisol supplement and he's slowly getting back to normal.

Heavy metals are another area, but huge. Hope you don't have to go down that road. - Barbara

 

Re: Chronic pain -best med and weird reactions

Posted by ravenstorm on July 19, 2004, at 18:30:23

In reply to Re: Chronic pain -best med and weird reactions Cairo, posted by BarbaraCat on July 19, 2004, at 18:04:53

I have a thyroid question for you two experts!

The last time I was checked it was at 2.85 they said that anything from .5 to 4.0 they consider normal but I have read elsewhere (holistic type doctors) that anything over 2.0 should have some other tests run. What other tests? I just had one thyroid test done at my regular doctors. I don't think that included a t-3 or a t-4. Is that what I'm suppossed to have done. I have also heard about the (now I can't remember how to spell it) Hashimoto autoimmune thing, but don't really understand it. How do you get that checked?

Thanks, and hope I'm not intruding.

P.S. remeron seems to be helping with my headaches and joint pain. Its great if you don't mind being a zombie the first part of the day and hungry all the time. LOL (NOT)

 

Re: Chronic pain -best med and weird reactions ravenstorm

Posted by BarbaraCat on July 19, 2004, at 20:42:39

In reply to Re: Chronic pain -best med and weird reactions, posted by ravenstorm on July 19, 2004, at 18:30:23

First, the Remeron. I was on it two years ago and it was great for two months but then pooped big time. I wasn't on lithium at the time and had to keep raising it. I found that after 45mg, the NE kicks in and that dopey feeling and food lust goes away. I got up to 90mg and was zooming about. Unfortunately, I didn't know I was BP-II and you can imagine how the buzz factor really exacerbated things. It was during Christmas party time at my company and wine has a wild effect on me. The combination had me starting conga lines at the parties, belly dancing in the middle of a hooting crowd. I cringe to remember but oh well, someone had to get theose parties going...

The thyroid: 2.85 is not too bad as numbers go, and many doctors won't push it higher, but I've found as have others, that we start to really feel better at around 1.9. It really depends on how you're feeling. Are you taking your temperature during the day? That's probably the best indicator. The test numbers do not tell you what you're actually metabolizing in the cells. The gold standard is if your temperature rises, which means you are properly metabolizing your energy and enzyme reactions. The test is to take your temperature with a mercury thermometer for three days - not during menstruation. Take it orally (forget the armpit thing) when you first get up, at 11:00am and right before dinner, or at 6pm. Average it over three days. You might not at this early stage be at 98.6, but keep doing this. If after 2 weeks you're still subclinical, here are the tests to consider. But a word of advice, most doctors will NOT order these tests, unless they are holistically oriented. Most doctors seem to rely on the TSH as the word of God and many HMO's don't even test for these extras. But you have to insist and educate your doctor if need be. They will have to send out for them if you feel you're not getting a good response. It helps if you can produce data sheets with subclinical temperatures:


- TSH (you've already had that)
- T4 Panel (these following show how much T4/T3 is floating around in your blood)
Total T4
T3 Uptake
Free Thyroxine Index (FTI)
- T3 Total
- Free T3
- Free T4
- Thyroglobulin level (Tg) (the following check for autoimmune antibodies)
- Antiperoxidase Microsomal Antibody Titer
- Antithyroglobulin Antibody Titer

In addition, your adrenals should be checked:
- Cortisol levels 8am and 10pm
- DHEA and DHEAs levels
- Adrenal stress index
- Cortosyn stimulation for adrenal reserve

Your sex hormones definitely need to be tested. All these hormones interplay with each other.

- Estrogen Levels
Estradiol level
Estrone Level
Estriol level
Total estrogens
- Estrogen fractionation
- Progesterone level
- Total Testosterone
- Free testosterone
- Prolactin


> I have a thyroid question for you two experts!
>
> The last time I was checked it was at 2.85 they said that anything from .5 to 4.0 they consider normal but I have read elsewhere (holistic type doctors) that anything over 2.0 should have some other tests run. What other tests? I just had one thyroid test done at my regular doctors. I don't think that included a t-3 or a t-4. Is that what I'm suppossed to have done. I have also heard about the (now I can't remember how to spell it) Hashimoto autoimmune thing, but don't really understand it. How do you get that checked?
>
> Thanks, and hope I'm not intruding.
>
> P.S. remeron seems to be helping with my headaches and joint pain. Its great if you don't mind being a zombie the first part of the day and hungry all the time. LOL (NOT)

 

Re: Chronic pain -best med and weird reactions

Posted by ravenstorm on July 19, 2004, at 21:22:21

In reply to Re: Chronic pain -best med and weird reactions ravenstorm, posted by BarbaraCat on July 19, 2004, at 20:42:39

Thank you sooo much.

The joke around our household is that if I'm registering 98.9 I must have a fever! I never reach 98.9 at the doctors office! I am always cold.

I'll look into all this. I would have to go to a holistic MD and pay for it all because my HMO would just not be interested!

I wish I could bump up on the remeron. When I tried bumping from 15mg to 30mg the sedation just got worse.

Because I can't bump up I have to find another med to add to it or start over with a new med because I'm only a partial responder at 15mg (No more anxiety, but still crying almost every day). Not a pleasant proposition as I get really sick starting and stopping these meds.

Thanks again for all your time. I have printed out everything so I won't forget it!

 

Remeron + SSRI ravenstorm

Posted by Sad Panda on July 19, 2004, at 23:32:07

In reply to Re: Chronic pain -best med and weird reactions, posted by ravenstorm on July 19, 2004, at 21:22:21

> > I wish I could bump up on the remeron. When I tried bumping from 15mg to 30mg the sedation just got worse.
>
> Because I can't bump up I have to find another med to add to it or start over with a new med because I'm only a partial responder at 15mg (No more anxiety, but still crying almost every day). Not a pleasant proposition as I get really sick starting and stopping these meds.
>

Hi Ravenstorm,

Now that you are on Remeron, I would try taking an SSRI or Effexor again. Remeron makes them a lot more palatable.

Cheers,
Panda.

 

Re: Remeron + SSRI

Posted by ravenstorm on July 20, 2004, at 8:51:46

In reply to Remeron + SSRI ravenstorm, posted by Sad Panda on July 19, 2004, at 23:32:07

Sad Panda--

I don't ever want to take an SSRI again after paxil.

I tried going on celexa, zoloft and lexapro. I don't want to take an SSRI. Doing a bit better on the Wellbutrin today. Thanks.

 

Re: Thyroid and cortisone BarbaraCat

Posted by Cairo on July 20, 2004, at 11:22:36

In reply to Re: Chronic pain -best med and weird reactions Cairo, posted by BarbaraCat on July 19, 2004, at 18:04:53

> HI Cairo,
> I never heard about T3 shutting the feedback loop down, but maybe your doctor is on to something. My personal feeling is that this is an ideal opportunity to see if adding T3 would make a difference. Have you had your thyroid antibodies checked for hashimoto autoimmune thyroiditis?
>
> The other thing is, like you mentioned, your adrenals. Your holistic doc can order an adrenal stress index to check the state of your cortisol. I was hoping mine was off since I'd been feeling so bad, but it wasn't. However, my husband's was very low, which explained the weird symptoms he was getting with slow healing, dragging energy. She has him on a natural cortisol supplement and he's slowly getting back to normal.
>
> Heavy metals are another area, but huge. Hope you don't have to go down that road. - Barbara
>
>


Both T3 and T4 would negatively feedback to the thyroid causing it to release less of it's own IF the thyroid gland is functioning. Same for exogenous cortisone:

http://courses.washington.edu/conj/bess/feedback/newfeedback.html

So if hypothyroid/adrenal functioning is due to factors other than a thyroid/adrenal gland that can't produce enough of it's own, you don't want to tell your functioning gland to produce less, hence the caution. I realize that there may be non-tumor reasons for this hypofunction such as nutritional deficiencies, but you would want to correct those rather than giving T3 or T4.

IMHO, those FMS patients who do great on thyroid long term have an underlying thyroid issue that presents with FMS-like symptoms and are technically not FMS. T4 doesn't do anything for my muscular complaints and there are probably receptor or other issues. I personally would not do the high dose thyroid route as Dr. Lowe advocates.

Giving exogenous cortisone can also rev up your metabolism, taxing an already tired thyroid and making things worse.

Elevated cortisol due to stress (and I think many of our du jour ailments are due to stress), can affect many different systems and target tissues. My Rheumatologist, who is the sharpest diagnostician I've met, said that while supporting with meds is important, the root may be higher up in the hypothalmus, amygdala, etc. and stress reduction of all forms (meditation, CBT, physical exercise, removing dietary stressors, etc.) is crucial. Easier said than done when you feel like crap. The world doesn't stop for you to always do what you need.

Regarding checking adrenal function, there are several ways. 8am, 4pm and 11pm cortisol levels can indicate if you are normal, low or high. But some FMS patients present with normal levels initially; they have enough floating around, but in response to any stressor, they can't produce enough. Hence, some look like they have Addison's disease; their glands are working fine, but the feedback is not working right. Checking cortisol levels 30 and 60 minutes after administering ACTH can also show if you can mount an adequate response.

Instinctively, support with low dose and/or prn cortisone makes sense at least for awhile, but go to JR Becker's post about atypical depression and cortisol to read his caution:


http://www.dr-bob.org/babble/20000420/msgs/31619.html
http://www.dr-bob.org/babble/20030525/msgs/230047.html

If it were this easy, we'd be hearing more about people being "cured" of FMS by supplements and meds. I think they help, but darn if it isn't only partially helpful, at best. Though sometimes I wish I could go off all meds and try one thing at a time, a sort of medication tabula rasa.

BTW, had all my amalgam fillings out and mercury testing doesn't show elevated levels.

Hope you have a good week!

Cairo


 

Re: Thyroid and cortisone Cairo

Posted by BarbaraCat on July 20, 2004, at 14:58:15

In reply to Re: Thyroid and cortisone BarbaraCat, posted by Cairo on July 20, 2004, at 11:22:36

Thanks, Cairo,
Very interesting post. Especially the previous HPA-axis thread. This is an area of supreme interest to me, as I suspect an underlying 'upstream' HPA, hippocampal dysfunction. I was tested and have low GH as well. Was injecting myself with HGH for a year and didn't notice anything amazing, especially given the cost. But yes, your enlightened rheum doctor is on the target with needing to address those deep stress issues from a higher perspective. But in the meantime, we need to feel better to even have the energy to maintain these wellness practices.

Here's a wealth of information on thyroid and other matters:

http://personal.bellsouth.net/w/u/wurmstei/

Happy reading!

I have an appointment with a Functional MD on Thurs whom I fervently hope is hip to these myriad Ariadne's threads. At least, I need him to administer the tests I believe I need. Will keep you posted, and good luck in your search. - Barbara

 

Re: Thyroid Cairo

Posted by Sad Panda on July 20, 2004, at 22:18:39

In reply to Re: Thyroid and cortisone BarbaraCat, posted by Cairo on July 20, 2004, at 11:22:36

> So if hypothyroid/adrenal functioning is due to factors other than a thyroid/adrenal gland that can't produce enough of it's own, you don't want to tell your functioning gland to produce less, hence the caution.
>
>

Hi Cairo,

If your thyroid isn't making enough T3 & T4, what does it mater if you ask it to make less? I take 300mcg of T4 myself.

Cheers,
Panda.

 

Re: Thyroid Sad Panda

Posted by Cairo on July 22, 2004, at 17:24:12

In reply to Re: Thyroid Cairo, posted by Sad Panda on July 20, 2004, at 22:18:39

> If your thyroid isn't making enough T3 & T4, what does it mater if you ask it to make less? I take 300mcg of T4 myself.
>
> Cheers,
> Panda.

The thyroid is making enough T4 and the conversion to T3 is not faulty. There is either a problem with thyroid (receptor) resistance

http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/thyroid/receptors.html

or stress related inhibition of the thyroid axis:

http://www.endotext.org/adrenal/adrenal8/adrenal8.htm

Either way, your thyroid gland functions properly, but the problem is elsewhere. Giving T3 or T4 in these cases may initially produce improvement, but in the long run the negative feedback to the thyroid would cause it to produce less when your body needs it.

There is a Dr. Lowe who advocates very high dose thyroid to sort of bombard the faulty thyroid receptors and I think a gradient effect takes place, but I've been told by my endo that this is very dangerous long term and is not addressing the root problem. When I ask about physiologic doses of T3 however (eg. substituting a portion of the dose of T4 which stabilizes your TSH around 1.0, give or take, with T3 (as advocated in The Thyroid Solution book), but most endocrinologists won't go there if your T3 is normal saying that your body will produce needed T3 from T4. I know of one person who tried Armour Thyroid (a "natural" mix of T3/T4) who initially did well as her muscular and other hypothyroid symptoms improved, but after awhile everything came back with a vengeance, probably because her thyroid was shutting down.

What I would like to know is if psychiatrists find that adding only T3 is beneficial, or if using T4 has been tried. I haven't done a search for that, yet.

I'm not saying that the use of thyroid is never beneficial, but that you need to be careful and not indescriminately prescribe it.

Same goes for giving cortisone to people whose adrenals are hypofunctioning. There can be receptor resistance or HPA axis hypofunctioning:

http://www.dr-bob.org/babble/20030525/msgs/229989.html

I don't what the answer is, but I'd rather keep trying to find the right combo of ADs first to help the HPA axis recover from dysfunction rather than give thyroid or cortisone, though if you have primary hypothyroidism or Addison's, then of course it is indicated.

Cairo

 

Re: Thyroid Sad Panda

Posted by Cairo on July 22, 2004, at 17:41:40

In reply to Re: Thyroid Cairo, posted by Sad Panda on July 20, 2004, at 22:18:39

Regarding augmenting AD therapy with T3, I found this:

"Improvement with T3 usually occurs within 2 to 3 weeks, and should be discontinued thereafter.

* Monitoring thyroid function after discontinuation of T3 is important because endogenous thyroid hormone production may cease, indefinitely in some cases. Bridges, 1995:504 (7)"

http://www.med.nyu.edu/psych/psychiatrist/depression/slides/sld009.html

Cairo

 

Breakthrough Pain

Posted by corafree on September 19, 2004, at 16:44:13

In reply to Re: Thyroid Sad Panda, posted by Cairo on July 22, 2004, at 17:41:40

I really need help with my breakthrough pain. I take Endocet 650 x3 day (generic Percocet) for chronic pain. I have C2-3, 3-4, and 5-6 extruded discs. I cannot afford surgery and surgeons say I'm not bad enough, and, of course, I know it's because they think it's not bad enough. I am having extremely horrible breakthrough pain at this moment. Usually lasts 2-3 or 3-4 days.

This is the second breakthrough in a bit less than 2 weeks. My PCP doesn't prescribe a different med, just allows me 10 extra Endocets per month. IT'S NOT ENOUGH!!! Once he gave me some Vicodin, but messed with my head. And, I cannot take morphine because it does the same.

I feel fortunate that my PCP gives me what he gives me, and am afraid to tell him I need more.

On my back w/ a rolled towel under my neck, lying there crying. I am trying to go full speed ahead at working on myself, emotional illnesses, and other physical illnesses. I am so overwhelmed.

My anxiety med is Klonopin 2mg x2 a day, which isn't working either.

I think a lot of suicidal ideation involves chronic physical pain.

I am trying to get a TENS, but was just at therapy FRIDAY, used a TENS, and then had the breakthrough later in day. It was a very busy day, running here and there.

Seems like I do so much better in a quiet, calm environment, slower environment. Two men are calling me constantly and I'm crying over that...don't know what to do...need them, don't know if want them, but too much pain to pick up phone. They cause me stress. I would have to block quite a few phone numbers and there goes $ again. One guy is very nice and helping me through things; but he just clinging/crowding.

My intended focus right now is DBT therapy, and there is so much anxiety and pain interference. I don't know what way to turn.

Well, it's the next day, and last night my son took me to hospital where they gave me some Xanax 2mg and a shot of Toradol which didn't work, then later a shot of Demerol (which did work) and some Ativan.

I shouldn't have to go to the hospital ($) everytime I have breakthrough pain. Definitely can't afford.

Now, sitting here, I can feel the pain at 2:20p today, waiting like a crouching tiger between my shoulder blades. Need feedback ... cf

 

Redirect: Pain

Posted by Dr. Bob on September 20, 2004, at 7:16:14

In reply to Breakthrough Pain, posted by corafree on September 19, 2004, at 16:44:13

> I really need help with my breakthrough pain...

Sorry to interrupt, but I'd like to redirect follow-ups regarding pain to Psycho-Babble Health. Here's a link:

http://www.dr-bob.org/babble/health/20040729/msgs/392870.html

Thanks,

Bob


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