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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by dragonblack on June 18, 2011, at 16:41:15
Hi Everyone,
I've been on lithium for 3 months now, and I've settled at a dose of 900 mg/day. I take it all at night and my last blood level was .7. My plan has been to just sit tight at this level for the time being, at least until I work out the issues with my other meds, mainly Parnate. On the whole, lithium seems to be working pretty well for me. Doesn't stop the depression, but I'm not cycling and am calmer. It's also cheap, and I have no insurance.
Several weeks ago, I started waking up with back pain. It was pretty bad and I couldn't figure out where it was coming from. I've been sleeping on the same mattress for over a year, never had anything like this. So I've been analyzing my sleep and various other things, trying to figure out what I did or what I changed, etc.
This morning I had what may have been an epiphany. It only hurts in the morning, and gradually goes away. This back pain, which is primarily on both sides of my back, where my ribs start to taper, is actually kidney pain, and it hurts when I wake up because I dose at night and this is the period following my peak plasma levels, greatest stress load on the kidneys, and during which I don't drink water (due to being asleep).
Is this crazy, or am I spot on? I can see this being the kind of thing that one might never connect, I'm kinda shocked that I saw it (if I did). Of course I could be completely wrong....
Would love to know what you guys think. Best of weekends to everyone.
db
Posted by larryhoover on June 18, 2011, at 18:07:46
In reply to Is my 'back pain' actually kidney pain (Li)?, posted by dragonblack on June 18, 2011, at 16:41:15
Hey db.
I did a pretty extensive search, and there is no clear indication that back pain is associated with lithium carbonate.....it is reported, but it is considered to be idiosyncratic, i.e. an individual experience, unrelated to pathology or other adverse effects. I'd wonder if your sleep hasn't changed, so maybe you're not moving around enough to keep relaxed? Dr. Goldberg was asked this precise question, and he saw no link to the medication. But the fact that somebody else asked the question may indicate some sort of link. Is it worth dropping the lithium to find out if your back pain remits?
Lar
Posted by dragonblack on June 18, 2011, at 21:43:38
In reply to Re: Is my 'back pain' actually kidney pain (Li)? » dragonblack, posted by larryhoover on June 18, 2011, at 18:07:46
> Hey db.
>
> I did a pretty extensive search, and there is no clear indication that back pain is associated with lithium carbonate.....it is reported, but it is considered to be idiosyncratic, i.e. an individual experience, unrelated to pathology or other adverse effects. I'd wonder if your sleep hasn't changed, so maybe you're not moving around enough to keep relaxed? Dr. Goldberg was asked this precise question, and he saw no link to the medication. But the fact that somebody else asked the question may indicate some sort of link. Is it worth dropping the lithium to find out if your back pain remits?
>
> LarHey, thanks for your response. Just googling around I came across the same stuff, but then again kidney problems are supposedly only associated with long-term use of lithium and back when I was researching lithium I came across plenty of anecdotal accounts of people going off of lithium due to kidney-related issues, even in the first few months of treatment. So, while I don't want to be paranoid, I don't want to just dismiss it either, as the particular way in which the pain manifests strikes me as odd and matches with my lithium dosing schedule. If it was actual back pain, why do I only feel it in the first hour or two after rising? And if it was back pain due to my sleep/mattress, etc., why only now is this occurring, when I haven't changed anything? If anything my sleep hygiene has improved. So, I'm at a loss. I do intend to drop down in lithium and see if I can tell a difference; I had wanted to play with lowering the dose anyway but I wanted to be conservative and try to minimize variables while I am trying to trial Parnate. The pain warrants a trip to somebody, I had thought a chiropractor, but if it is kidney related it may prove a deal breaker - even dropping the dose, how can I feel safe taking lithium when after 3 months I had intense kidney pain (if that is what it is)? I go to a free clinic (and see a nurse practitioner) and my next appointment is in a couple of weeks, hopefully I'll be less clueless by then.
Best,
db
Posted by Phillipa on June 18, 2011, at 22:37:46
In reply to Re: Is my 'back pain' actually kidney pain (Li)?, posted by dragonblack on June 18, 2011, at 21:43:38
Funny my first thought was kidney pain. Did you ever have kidney stones? I"d see your medical doc and get a U/A and C&S of urine to rule out infection. Any chance of taking the lithium in the morning when awake and then you could really hone in on what's going on. Phillipa
Posted by dragonblack on June 19, 2011, at 1:32:36
In reply to Re: Is my 'back pain' actually kidney pain (Li)? » dragonblack, posted by Phillipa on June 18, 2011, at 22:37:46
> Funny my first thought was kidney pain. Did you ever have kidney stones? I"d see your medical doc and get a U/A and C&S of urine to rule out infection. Any chance of taking the lithium in the morning when awake and then you could really hone in on what's going on. Phillipa
My father had kidney stones and my older brother has chronic kidney stones, but I have never had them. Though I imagine I am at an elevated risk for them, my father and brother both have a number of physical factors that I don't; they are both obese, have poor diets, various other health problems, etc., so despite the familial incidence of kidney stones, I haven't been worried. Aside from mental issues, I am in pretty good physical health. Your suggestion about morning dosing is smart - I may try that. My whole plan was to sleep through the worst of the side effects with night dosing, but this might be a good way to figure this out. As for the tests you mentioned, I'm not sure what I've had. Before I started lithium I had a thyroid test, urine specific gravity, and maybe something else. After that just blood levels. Thanks for your response!
Posted by Phillipa on June 19, 2011, at 19:12:16
In reply to Re: Is my 'back pain' actually kidney pain (Li)?, posted by dragonblack on June 19, 2011, at 1:32:36
How did the switch in dosing work? Kidney or backpain still there? Phillipa
Posted by dragonblack on June 19, 2011, at 23:54:18
In reply to Re: Is my 'back pain' actually kidney pain (Li)? » dragonblack, posted by Phillipa on June 19, 2011, at 19:12:16
> How did the switch in dosing work? Kidney or backpain still there? Phillipa
Well, I didn't switch dosing time yesterday, as I was still trying to decide what to do up through the evening. I did drop from 900 to 600, though. I had the same pain today upon waking, though I do think it was less severe. Today I moved to split dosing, midday and night, so tomorrow should tell me more.
Posted by Phillipa on June 20, 2011, at 0:00:39
In reply to Re: Is my 'back pain' actually kidney pain (Li)?, posted by dragonblack on June 19, 2011, at 23:54:18
It is starting to sound like the lithium if lesser dose less pain? I'm going to google. Got my curiosity up. Phillipa
Posted by Phillipa on June 20, 2011, at 0:11:18
In reply to Re: Is my 'back pain' actually kidney pain (Li)? » dragonblack, posted by Phillipa on June 20, 2011, at 0:00:39
Actually seems pretty safe all I found to do with backpain was an old blog I copied it for you. Read and don't get frightened at one as under it are positive ones. Phillipa and hope it works
http://livingbipolar.blogspot.com/2008/01/lithium-question.html
Posted by dragonblack on June 20, 2011, at 17:51:25
In reply to Re: Is my 'back pain' actually kidney pain (Li)?, posted by Phillipa on June 20, 2011, at 0:11:18
> Actually seems pretty safe all I found to do with backpain was an old blog I copied it for you. Read and don't get frightened at one as under it are positive ones. Phillipa and hope it works
>
> http://livingbipolar.blogspot.com/2008/01/lithium-question.htmlThanks, Phillipa. I found and read this when I first started looking into a possible connection. It's reassuring that the guy's doctor wasn't concerned, but then again he said that it wasn't really "pain" per se but a feeling that it was there. Having gone down to 600, and then splitting the dose yesterday, the pain upon waking today was diminished much more - still very much there, but not acute like it had been. I'm drinking fluids like a madman to see if that forms part of the picture, but I felt as if I was drinking a ton before, too, so it's hard for me to believe that the pain could simply be due to me not drinking enough water. Anyway, I guess I'll see how things progress. Take care!
db
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