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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Lamdage on July 21, 2011, at 17:05:58
Hey guys..
a good friend of mine takes clozapine, a strong antipsychotic, which she needs because on other meds shell become psychotic. (Schizophrenic)
She has vertigo so bad that her life is affected severely. Shes anxious to go out alone because of this.
A med change is out of the question right now..Oh she has a blood pressure of 60/90 which she says is natural for her but i believe it could make the issue worse.
What do you think about it? Any meds or remedies to adress the vertigo? Help would be greatly appreciated, id like to see my friend get back her life!
Posted by Lou Pilder on July 21, 2011, at 20:14:02
In reply to Severe life altering Vertigo please HELP, posted by Lamdage on July 21, 2011, at 17:05:58
> Hey guys..
>
> a good friend of mine takes clozapine, a strong antipsychotic, which she needs because on other meds shell become psychotic. (Schizophrenic)
>
> She has vertigo so bad that her life is affected severely. Shes anxious to go out alone because of this.
> A med change is out of the question right now..
>
> Oh she has a blood pressure of 60/90 which she says is natural for her but i believe it could make the issue worse.
>
> What do you think about it? Any meds or remedies to adress the vertigo? Help would be greatly appreciated, id like to see my friend get back her life!
>
>
>
> Lamdage,
You wrote,[...takes clozapine...She has vertigo...help would be appreciated...].
>
In order to go further here, I would need to know:
A. Was the vertigo there before the clozapine?
B. If not,how long did she take the drug before the vertigo manifested itself?
C. Do you now the difference between vertigo and ataxia and has ataxia been ruled out?
D. If not, could you have a diagnosis made as to which it could be or something else?
E. Is there nausea and if so, how bad?
Lou
Posted by Phillipa on July 21, 2011, at 21:47:22
In reply to Severe life altering Vertigo please HELP, posted by Lamdage on July 21, 2011, at 17:05:58
Hi Lamadge a call to the pdoc is in order. As you say Schizophrenia is a hard disease to treat. And I know common meds for vertigo. But seriously could be the dose of the med. Do not let your friend go out alone please til this is straightened out for her safety. Thanks Phillipa
Posted by Lamdage on July 22, 2011, at 2:25:45
In reply to Re: Severe life altering Vertigo please HELP » Lamdage, posted by Phillipa on July 21, 2011, at 21:47:22
> Hi Lamadge a call to the pdoc is in order. As you say Schizophrenia is a hard disease to treat. And I know common meds for vertigo. But seriously could be the dose of the med. Do not let your friend go out alone please til this is straightened out for her safety. Thanks Phillipa
Phillipa:
Well i am willing to walk her to a doc for sure.. Id never push her to go anywhere, at least not alone. I am pushing her to agree to go try treatments for her vertigo.
She tried about 10 different antipsychotics.. all of which were not enough to treat her schizophrenia and i think she is too anxious that her psychosis might come back to try other meds. Yes FOR SURE IT IS THE MED / THE DOSE OF THE MED.
But when you know what she has been through with her last psychosis (very very severe and didnt get treatment for 2 month, she simply refused, didnt even know anymore what a doctor is), youll understand that she is happy she doesnt have any psychotic symptoms anymore with clozapine and very anxious it might come back.
Also she would have to go back to the hospital to try other meds, thats what her pdoc (she goes to hospital once a week) told her about the issue. They are willing to try other meds but they say she needs to go back into hospital for that and although i hate these doctors (i know them), i agree with them on that issue.The problem with that pdoc is that she told my friend that there isnt any treatment for her vertigo and i simply didnt want to believe that. I googled "vertigo drugs" and saw that there IS treatment for this that she might want to try with a doc. Maybe shell need to go to another physician because that one (i know her) is very self sufficient and ... stupid, i hate that doc. She simply would have had to turn on google and find out about vertigo treatment. But that doc "knows everything".......
Posted by Lamdage on July 22, 2011, at 2:41:15
In reply to Lou's response-gmypstwrt » Lamdage, posted by Lou Pilder on July 21, 2011, at 20:14:02
> > Hey guys..
> >
> > a good friend of mine takes clozapine, a strong antipsychotic, which she needs because on other meds shell become psychotic. (Schizophrenic)
> >
> > She has vertigo so bad that her life is affected severely. Shes anxious to go out alone because of this.
> > A med change is out of the question right now..
> >
> > Oh she has a blood pressure of 60/90 which she says is natural for her but i believe it could make the issue worse.
> >
> > What do you think about it? Any meds or remedies to adress the vertigo? Help would be greatly appreciated, id like to see my friend get back her life!
> >
> >
> >
> > Lamdage,
> You wrote,[...takes clozapine...She has vertigo...help would be appreciated...].
> >
> In order to go further here, I would need to know:
> A. Was the vertigo there before the clozapine?
> B. If not,how long did she take the drug before the vertigo manifested itself?
> C. Do you now the difference between vertigo and ataxia and has ataxia been ruled out?
> D. If not, could you have a diagnosis made as to which it could be or something else?
> E. Is there nausea and if so, how bad?
>
> LouHey Lou
i will try to answer your questions to the best of my knowledge.
A: The vertigo wasnt there before clozapine. Absolutely not in this life altering fashion, she could go to places alone etc.
B: The vertigo manifested itself right away in full severity as she started the drug.
C: I am not 100% sure about the difference between ataxia and vertigo.. I just googled it and although of course i cant rule it out with my lay knowledge, if id had to bet id say that thats not it. Is ataxia is this typical antipsychotic movement disorder with strange movements of the mouth and arms etc? In this case no she doesnt have that. She is moving normally to my eye. She has had that typical movement disorder on risperdal, thats why she changed.
D: I can ask my friend to go with this question to her pdoc. But i dont think that pdoc will be of much help honestly. Im trying to get her to go to another doc, who is eager to banish the vertigo!
E: There is nausea but i think that one is coming from "Kalinor" she takes for her heart. Its ingredients are potassium citrate and potassium hydrogencarbonate. But i can definitely ask her about this one next time i see her. But to give an answer right now, no i think nausea is not a "bad" problem.
thanks,
Ld
Posted by Lou Pilder on July 22, 2011, at 6:29:06
In reply to Re: Lou's response (friends vertigo), posted by Lamdage on July 22, 2011, at 2:41:15
> > > Hey guys..
> > >
> > > a good friend of mine takes clozapine, a strong antipsychotic, which she needs because on other meds shell become psychotic. (Schizophrenic)
> > >
> > > She has vertigo so bad that her life is affected severely. Shes anxious to go out alone because of this.
> > > A med change is out of the question right now..
> > >
> > > Oh she has a blood pressure of 60/90 which she says is natural for her but i believe it could make the issue worse.
> > >
> > > What do you think about it? Any meds or remedies to adress the vertigo? Help would be greatly appreciated, id like to see my friend get back her life!
> > >
> > >
> > >
> > > Lamdage,
> > You wrote,[...takes clozapine...She has vertigo...help would be appreciated...].
> > >
> > In order to go further here, I would need to know:
> > A. Was the vertigo there before the clozapine?
> > B. If not,how long did she take the drug before the vertigo manifested itself?
> > C. Do you now the difference between vertigo and ataxia and has ataxia been ruled out?
> > D. If not, could you have a diagnosis made as to which it could be or something else?
> > E. Is there nausea and if so, how bad?
> >
> > Lou
>
> Hey Lou
>
> i will try to answer your questions to the best of my knowledge.
>
> A: The vertigo wasnt there before clozapine. Absolutely not in this life altering fashion, she could go to places alone etc.
>
> B: The vertigo manifested itself right away in full severity as she started the drug.
>
> C: I am not 100% sure about the difference between ataxia and vertigo.. I just googled it and although of course i cant rule it out with my lay knowledge, if id had to bet id say that thats not it. Is ataxia is this typical antipsychotic movement disorder with strange movements of the mouth and arms etc? In this case no she doesnt have that. She is moving normally to my eye. She has had that typical movement disorder on risperdal, thats why she changed.
>
> D: I can ask my friend to go with this question to her pdoc. But i dont think that pdoc will be of much help honestly. Im trying to get her to go to another doc, who is eager to banish the vertigo!
>
> E: There is nausea but i think that one is coming from "Kalinor" she takes for her heart. Its ingredients are potassium citrate and potassium hydrogencarbonate. But i can definitely ask her about this one next time i see her. But to give an answer right now, no i think nausea is not a "bad" problem.
>
> thanks,
>
> Ld
>
>
> Ld,
I have read your answers and I think that there could be such a severe problem here that going to a neurologist could be warrented.
You see, I have severe vertigo at times but it is from the ear mechinism. I have made a study of this and have read a lot about ataxia, which is different as it being from damage to the brain. The damage could be from a drug, for one drinking to drunkeness experiances ataxi and can't walk a straight line. That is recoverable from but ataxia from a psychotropic drug could be different. Ataxia is not the same as dyskinesia as you mentioned movements from Risperdol.
Now in my experiance with vertigo, extreme nausea went along with the dizyness. I could not drive a car of even stand up straight during the bouts of vertigo. It can be life-ruining if it can't be stopped. But vertigo and ataxia are different. If it is ataxia from the drug and the drug is continued, then that could lead to a different outcome than vertigo.
I think that the stakes are high here in the situation that you describe in that if it is neurological, it could be life-ruining if it is not stopped. A neurologist is my pick here to see, not a psychiatrist, and I would do so promptly.
Lou
>
Posted by Lamdage on July 22, 2011, at 11:37:52
In reply to Lou's reply-chmknowvk » Lamdage, posted by Lou Pilder on July 22, 2011, at 6:29:06
Hey Lou,
thanks for your response. I just was on the phone with her and she says she doesnt have nausea at all! This is good i guess?
This ataxia thing sounds scary i hope she doesnt have that.I will read again more thoroughly about ataxia and then we may go to a neurologist. Maybe just for getting the diagnosis straight and HOPEFULLY ruling ataxia out.
I still think thats not it but as you say if it was shed need to know immediately.Anyway assuming it is just vertigo, what drugs could be worth a shot? And if its ataxia couldnt she still successfully take a drug against the vertigo? Her case might be different to yours..
I dont want to go to a doc with her without knowing about the issue and the possible treatments, so knowledge input please! ;)
Ld
Posted by emmanuel98 on July 22, 2011, at 18:15:00
In reply to Severe life altering Vertigo please HELP, posted by Lamdage on July 21, 2011, at 17:05:58
One other thing. She should be checked out to make sure that this is true vertigo (sense of spinning, not feeling like she's going to faint) and not light-headedness due to low BP. A BP of 90/60 is pretty low and might cause one to feel dizzy and light-headed. Increasing salt and fluid intake will raise BP.
Posted by emmanuel98 on July 22, 2011, at 18:28:55
In reply to Severe life altering Vertigo please HELP, posted by Lamdage on July 21, 2011, at 17:05:58
Repost - I think I forgot to click the confirm post button.
I had severe vertigo several years ago due to an inner ear problem. The only medications available for vertigo are those prescribed for motion sickness. I can't recall their names and they may be sold OTC. I don't recall. I do remember they did nothing for the vertigo.
I went to an ENT specialist at Mass Eye and Ear and he told me the inner ear is sending false signals about the body's position to the brain. The brain gets information about balance from both the inner ear and the body itself. The best way to counter vertigo is to exercise a lot so that the signals from the body to the brain become stronger and the brain begins to discount the false information from the inner ear.
When you're so dizzy you feel like you'll fall if you walk, this seems hard advice to follow. But I did follow it and used walking and yoga and other exercises that require the muscles to balance the body. Gradually, over a few months, the vertigo went away.
I will also add that neurologists are useless here. ENTs are the docs who understand vertigo. Presumably the clozapine is affecting the nerves from the inner ear.
Posted by Phillipa on July 22, 2011, at 19:44:22
In reply to Re: Severe life altering Vertigo please HELP, posted by emmanuel98 on July 22, 2011, at 18:28:55
I once also had vertigo crawled on hands and knees to bathroom. Shining a light in my eyes at the ER showed the doc was definitely vertigo.No nausea also for me. Gave me antivert and a shot of 2mg of ativan and said to rest. And it went away. Who said that the crystals in ears can get out of wack also and cause it. I know a person I mail with. Clozapine also effects the white blood cells and frequent testing is necessary. But have seen it work miracles when no other med would? Phillipa
Posted by Lamdage on July 23, 2011, at 1:27:37
In reply to Re: Severe life altering Vertigo please HELP » emmanuel98, posted by Phillipa on July 22, 2011, at 19:44:22
-----Emmanuel: "One other thing. She should be checked out to make sure that this is true vertigo (sense of spinning, not feeling like she's going -----tofaint) and not light-headedness due to low BP. A BP of 90/60 is pretty low and might cause one to feel dizzy and light-headed. Increasing salt -----and fluid intake will raise BP."
That is actually the first thing that came to my mind about her issue. Even if its not the sole cause of her problem i think raising it to like 70/110 might make her feel better. That is my blood pressure actually and even though its not nice to say about a friend-> Shes not as "sporty" as i am.
You know what im going to bring her a 48 oz water bottle with salt water and ask her to drink it spread out during the day. Think she will do it for me. If it helps shell feel it pretty much immediately right?----Emmanuel: "I had severe vertigo several years ago due to an inner ear problem. The only medications available for vertigo are those prescribed ------for motion sickness. I can't recall their names and they may be sold OTC. I don't recall. I do remember they did nothing for the vertigo."
----"The best way to counter vertigo is to exercise a lot so that the signals from the body to the brain become stronger and the brain begins to ---------discount the false information from the inner ear.
----When you're so dizzy you feel like you'll fall if you walk, this seems hard advice to follow. But I did follow it and used walking and yoga and other ----exercises that require the muscles to balance the body. Gradually, over a few months, the vertigo went away.That will actually be a hard thing to make her do;) I have thought about getting her a wii-fit for her birthday;) If she did this she will definitely have to start doing that at home. Right now her mother is with her because she just came from hospital recently so it might be a good time to start when someone is with her.
----Emmanuel: 'I will also add that neurologists are useless here. ENTs are the docs who understand vertigo. Presumably the clozapine is affecting ------the nerves from the inner ear."
I also think so honestly (sry Lou). The only thing of her condition that is even just a tiny bit close to ataxia would be "Vestibular Ataxia", from what ive read on Wiki. And there the "Nausea" and "Vomiting" is completely missing, she doesnt have that AT ALL. Also everything else ive read about ataxia and the movement problems sounds very bogus when thinking about her.
Ok so ear nose and throat doc.. that sounds like its worth a try. I, too am not sure it needs to be a psychiatrist at this issue plus they are really hard to get an appointment with in this country, thats a big minus. A med change of her psych meds is not possible anyway.
----Phillipa: "I once also had vertigo crawled on hands and knees to bathroom. Shining a light in my eyes at the ER showed the doc was definitely -------vertigo.No nausea also for me. Gave me antivert and a shot of 2mg of ativan and said to rest. And it went away. Who said that the crystals in ears ----can get out of wack also and cause it. I know a person I mail with. Clozapine also effects the white blood cells and frequent testing is necessary. ----But have seen it work miracles when no other med would? Phillipa"The german equivalent of Ativan is actually exactly what her Pdoc prescribed for her. It helps she says.. but not so much that she is daring to walk outside on her own.
Yes clozapine indeed is a miracle drug for her. Its like nardil for us depressed people, only that while its possible to (kind of) live with mediocre depression, its absolutely impossible to live with a psychosis of this severity. A change from clozapine to something else is out of the question.I think the ENT doc might be a first person to go to.. at the very least he can say more about the diagnosis or rule out things.
At some point i think it wouldnt be wrong to just try some drugs and see if they help.Phillipa: what are the drugs that might help her? Antivert seems to be one of them. If you know them well could you list them with pro and cons?
Posted by Lamdage on July 23, 2011, at 8:59:50
In reply to Re: Severe life altering Vertigo please HELP » emmanuel98, posted by Phillipa on July 22, 2011, at 19:44:22
She gets blood drawn every or every other week. Blood cell count is ok so far!
Posted by deepreason on July 23, 2011, at 11:07:50
In reply to Severe Vertigo HELP / Phillipa what drugs?, posted by Lamdage on July 23, 2011, at 1:27:37
> You know what im going to bring her a 48 oz water bottle with salt water and ask her to drink it spread out during the day. Think she will do it for me. If it helps shell feel it pretty much immediately right?Also a pair of "flight socks". You know those support stockings you can buy for planes? They helped a fair bit when my BP was very low.
Posted by emmanuel98 on July 23, 2011, at 18:38:09
In reply to Severe Vertigo HELP / Phillipa what drugs?, posted by Lamdage on July 23, 2011, at 1:27:37
She's lucky to have such a loving and concerned friend.
Posted by Phillipa on July 23, 2011, at 19:49:40
In reply to Re: Severe Vertigo HELP / Phillipa what drugs?, posted by emmanuel98 on July 23, 2011, at 18:38:09
Scopalamine patch behind ear used for sea sickness could also help. But the antivert quickly did the trick and was very relaxing for me. Phillipa
Posted by Lamdage on July 24, 2011, at 2:13:09
In reply to Re: Severe Vertigo HELP / Phillipa what drugs?, posted by emmanuel98 on July 23, 2011, at 18:38:09
> She's lucky to have such a loving and concerned friend.
> She's lucky to have such a loving and concerned friend.
And thats a very kind thing to say of you emanuel:) Im not used to getting this kind of compliments
Im not sure if antihistamines are very safe to take with clozapine.. This scopalamine drug sounds interesting because it is also a antipsychotic.
I will take her both to a nose-throat-ear doc and also like Lou suggested to a neurologist. On the german wikipedia it says that these are the docs to go for.. Also it recommends an orthopedist but i have no idea yet how they are supposed to help.
If anyone has anymore knowledge input (or nice compliments;) please go for it.
Thanks for all of your posts, ill let you know how it goes
Ld
Posted by Lamdage on July 24, 2011, at 3:54:51
In reply to Re: Severe Vertigo HELP, posted by Lamdage on July 24, 2011, at 2:13:09
Well im lucky to have her, too. She is a very cute person..
Posted by rculater on July 24, 2011, at 4:33:16
In reply to Severe life altering Vertigo please HELP, posted by Lamdage on July 21, 2011, at 17:05:58
Does she have vertigo or dizziness ? there is a difference.
Is it constant or does it come and go. When she has it, is she confined to the bed ?BPPV, Menieres or Labrnythitus spring to mind- you may want to do some research on these.
Posted by Phillipa on July 24, 2011, at 19:43:40
In reply to Re: Severe life altering Vertigo please HELP, posted by rculater on July 24, 2011, at 4:33:16
Great ideas. Both could be a source. Phillipa
Posted by Lamdage on July 27, 2011, at 0:05:16
In reply to Re: Severe life altering Vertigo please HELP » rculater, posted by Phillipa on July 24, 2011, at 19:43:40
She has had it all checked. Neurologist, nose-ear-throat. And her Pdoc told her there IS NOTHING against vertigo and this doctor is so in her head that, right now, there cant really be anything done.
Isnt it sad just how much power a pdoc has over a patients mind. THERE IS NOTHING. I mean does that doc talk to god or something? Maybe there is a freakin weed growing in the himalaya that would cure her. Know what i mean? Whats up with this attitude.
And its a big lie. But she is under the docs control so much that she believes the doc despite evidence that there ARE treatment options.
Well well, it was a big disappointment for me.
The salt, she didnt really drink alot but it helped "a tiny bit" according to her.
Posted by Lamdage on July 27, 2011, at 22:30:10
In reply to Bad news.., posted by Lamdage on July 27, 2011, at 0:05:16
Ill take the flightsocks advice for myself though.. its really getting bad in the morning and i dont know how much salt im supposed to drink. Takes some time off my day, too.
thanks for your posts.. i hope my friend will detach from the clinic over time and will be getting better.
Posted by Lamdage on July 27, 2011, at 22:39:12
In reply to Re: Bad news.., posted by Lamdage on July 27, 2011, at 22:30:10
Is it possible for my friends "underlying", i mean the psychosis shed have without clozapine, to get better over the years??
Posted by Phillipa on July 27, 2011, at 22:49:34
In reply to Is it possible for schizophrenia to get better?, posted by Lamdage on July 27, 2011, at 22:39:12
Right meds, theraphy and good support system can live a normal life. Know lots that have and do. Must continue the meds though and regular docs appointments. That's my experience as a psych RN. Phillipa
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