![[dr. bob]](/dr-bob-sm.gif)
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 Vincent_QC on August 20, 2012, at 10:14:48
Hi Everyone,
Really need some help, im stuck with incredible high state of anxiety, like a panic attack who last all day long with no break and of courses I have a lot of debilating chronic symptoms (headache all the time, IBS with constipation, chest pain at rest with tingling and numbness of the left arm, depersonalisation feeling, tachycardia, muscles spasm, low exercise tolerance, tired all the time and exhausted, memory loose, forget recent things,just to name a few).Im now on 10 to 20 mg of propanolol every day for the tachycardia but cant take more cause my blood pressure is very low since a while.
I also gradually tapering my high dose of clonazepam, im at 7.5mg and will be down to 7.25 soon. I didnt see an increase of somatic symptoms since I start reducing the dose but I do feel more anxious than usual but not from the benzo reduction but probably more because I deal with real health problems right now (intestinal problems and 1 surgery that I will have in the next fall to repair the wound on my belly who dont want to heal since 10 months now).
Im stuck with high anxiety about negatives thoughts of having a heart disease cause of the chronic symptoms I have and feel all the time. Its especially very bad in the evening but even worse when I get up in the morning.
Right now, the headache is driving me insane, the only way to have some relief is to apply one ice pad behing my head and one ice pad on my head. No meds help me to reduce the pain, try all of them with no luck.
For the IBS symptoms I need to apply an electric heat pad on my belly half the day and when I sleep. Cant have a normal bowel movement and no oral laxatives works for my constipation. The only thing who help me to pass some stools are 5 to 8 glycerin suppositories at the same time and even with all those suppositories I need to strain very hard to the point that my head is throbbing and all red...can strain for 20 in in a row, 3 times a day, to feel a little bit better. I saw a Gastro Doc and had long colonoscopy and a gastroscopy and she dont see anything wrong and she want me to do biodfeedback with a physiotherapist to learn how to relax my pelvic muscles, apparently my pelvic floor is low and tense so I cant pass stools and gas so thats why im in pain and bloated all the time.
Anyway I just start seeing a new therapist, can only see him every 2 weeks cause its expensive and I dont work so no money, will hope that he will help me to cope and live with the chronic symptoms.
In the meantime, I see my Doc at the end of August, so just wanted to know if a med can help me, at least for the headache. , topomax, lyrica and neurontin are not an option, I try the. At high dose in the past with no improve. Im also meds sensitive now, so for me 1 mg of Paxil will feel like 20 mg and no its not all in my head and some peoples are really meds sensitive and can have increase anxiety and side effects from a very low dose of a SSRI or any kind of meds. As an example, in the past I was used to treat with success my migraine with 600mg of Ibuprofen in 1 dose and now I take childs Advil of 100mg and have heart related.side effects like low blood pressure with orthostatic hypotension and tachycardia with chest pain, not linked to Gerd since I take 1 prevacid each day for my stomach.
Well how I can survive this? Having the same horrible symptoms every day make me feel hopeless. Also I know that when I get up I will have to live the same symptoms all day long and cant focus on another thing, its seem almost like OCD, im stuck with many chronic symptoms who make my life miserable, I cant enjoy anything in my life right now because im in pain all the time.
Is it possible to learn to live like that and be able to have my life back soon or I will stay like this forever?
Well thanks for your help and advises.
Vincent
Posted by Phillipa on August 20, 2012, at 10:19:54
In reply to Somatoform disorder...im alone here to have it?, posted by Vincent_QC on August 20, 2012, at 10:14:48
Vincent before I forget I heard a show or watched a show that indeed supported the fact with the surgery that now meds are being absorbed very quickly as less intestine. So you were and are right. Phillipa
Posted by phidippus on August 20, 2012, at 11:41:21
In reply to Somatoform disorder...im alone here to have it?, posted by Vincent_QC on August 20, 2012, at 10:14:48
Have you tried Treximet for the headaches? How about Keppra?
Eric
Posted by Vincent_QC on August 20, 2012, at 15:19:58
In reply to Re: Somatoform disorder...im alone here to have it? » Vincent_QC, posted by Phillipa on August 20, 2012, at 10:19:54
> Vincent before I forget I heard a show or watched a show that indeed supported the fact with the surgery that now meds are being absorbed very quickly as less intestine. So you were and are right. Phillipa
Hi Phillipa, thats what my Doc think. I remember that to test that theory he rx a low dose of Imipramine and had a blood test to see the level of it in my blood after 8 days...he was surprise to see that the level of imipramine was a lot higher than the normal range. Wasnt able to tolerate the imipramine, like all the tca's, or SRNI's who hit the NE receptor, even worse with second generation TCA'S like nortriptyline with the crazy fast heart rate I had at only 10mg and it was when I was a heavy drinker of coffee so I was used to more than 8 cups of coffee a day with no increase of my pulse rate or cardiovascular side effects... thats crazy how the body can change over the years. For me, the coffee was the main source of energy, now that the stupid PDoc I had ask me to stop my anxiety reach a level that is not tolerable. Of course I try to drink coffee again but now have the fast heart rate and panic from it...
Well where you hear that???
Thanks for your answer -;)
Posted by Vincent_QC on August 20, 2012, at 16:04:48
In reply to Re: Somatoform disorder...im alone here to have it? » Vincent_QC, posted by phidippus on August 20, 2012, at 11:41:21
> Have you tried Treximet for the headaches? How about Keppra?
>
> EricTreximet and the tryptan are a no no for me, almost die from Imitrex and another one who melt under tongue..huumm zomig or something like that. Heart related side effects mainly arrytmia and chest pain.
Keppra, try it 3 years ago without having improve, had some moods changes and agitation from it...
Also, im med sensitive now so dont think being able to cope with another anti seizure med...
I see a neurologist but have to wait until the end of october.
The only one med who help is an old nsaid call indomethacin (indocin) but cant use it now cause its lowering too much the blood pressure and cant stay
up and have to go in bed if i take it and I dont want to stay in bed all day long...already have no life, I want at least to be able to take my shower and sit on the couch and watch tv.Im looking more into a preventive med outside the normally AD, seizure med or painkiller...
Maybe I ask for too much?
Also asking for help to find tests to be done before I see the neurologist. I already have a CD with images of my brain without contrast dye, who is normal but from 3 years ago so kinda old... Maybe some blood tests? I had some blood test recently and everything is fine, no anemia, no inflammation (protein c reactive test)...maybe another ct scan of the brain with a contrast agent??? Have to ask it to my Doc and go to a private clinic to have the test done faster and have my result before I see the neurologist.
Maybe my eyes are not ok? Not sure since my Optometrist look at them back in january and she said they are ok and no vision problem.
My pain is most of the time higher behind both eyes and upper both ears and in the forehead. Its bilateral kind of pain so both side but worse on the left side. Also I wake up with headache so cant be tension headache all the time and no nausea or vomiting but have throbing pain when I strain or just walk about 80% of the time. Also being around too much peoples or exposed to a stressful event like just be in a car lead to higher pain. Everything who ask for mental alertness like read a book, watch a movie, talk with friends, doing minimal cognitives activities like playing cards games lead to worse pain...cant point out what kind of pain I have...and dont know what to do to live with it. In the past I had those headache only when I was out of the house so far away from my savety zone but now I have it at home. I try so many things, change my diet, cut all sugars, eat mostly vegetables and a little bit of protein and some fruits only, avoid raffined products, add magnesium who worse my condition, add potassium with no results or change, add calcium but worse the constipation, add B2 vitamin with no change... the only one thing I dont stop is smoking cigarette but again I was at the hospital for a whole month after my 2 surgeries for the intestinal obstructions last october and dont smoke for the whole month and had that horrible headache but mostly in the evening...perhaps its was because most of the peoples wwho come to visit me comes in the evening so I was more under stress?
Well living with chronic pain and not being able to live a normal life or being free of pain for 2 minutes in a row is not easy... I understand that its maybe related all to the high anxiety but really dont know how I will be able to accept it and livd like that all the time, well until I see the neurologist at least...im so tired of all those symptoms...I dont even have full blow panic attacks now but have a lot of chronic symptoms and pain and also chronic high anxiety like im having a panic who last all day long...I dont even know what kind of anxiety I have, only know that I have somatoform disorder with high anxiety.
Anyway thanks for your help Eric -;)
Posted by phidippus on August 20, 2012, at 19:23:22
In reply to Re: Somatoform disorder...im alone here to have it? » phidippus, posted by Vincent_QC on August 20, 2012, at 16:04:48
Try Mexiletine
Eric
Posted by Vincent_QC on August 20, 2012, at 19:51:35
In reply to Re: Somatoform disorder...im alone here to have it? » Vincent_QC, posted by phidippus on August 20, 2012, at 19:23:22
> Try Mexiletine
>
> EricWhy using an anti-arrhythmia drug? I have arrhytmia only when I take triptan...
Most of the time I have tachycardia at rest in the morning so thats why the Propanolol was rx by my Doc. Can take more if I have to go out of the house since it will trigger a fast heart rate but its always a regular heart rate. Cant take more than 20 mg cause it lower too much my blood pressure.
All the EKG i had, and I had a lot since 2 years, show some sinus arrhythmia who occurs when your heart rate cycles with your breathing. When you breathe in, your heart rate speeds up slightly and when you breathe out, your heart rate slows back down. My Cardio Doc say its normal not dangerous at all, childs have it and some adults as well, even he say its good...its also call respiratory sinusale arrhytmia.
And using an anti-arrhytmia drug to prevent arrhytmia from a triptan is not a good thing...more dangerous than the headache. You dont play with heart meds especially anti-arrhytmia since they can harm your heart and lead to cardiac arrest or worse arrhytmia...
Posted by phidippus on August 20, 2012, at 20:15:17
In reply to Re: Somatoform disorder...im alone here to have it? » phidippus, posted by Vincent_QC on August 20, 2012, at 19:51:35
I used Mexilitine for a month to treat my headaches.
Eric
Posted by Vincent_QC on August 20, 2012, at 21:25:49
In reply to Re: Somatoform disorder...im alone here to have it? » Vincent_QC, posted by phidippus on August 20, 2012, at 20:15:17
> I used Mexilitine for a month to treat my headaches.
>
> EricOh didnt know it was use for headache. What was the dosage, I guess it was lower than the dose need to treat arrhytmia no? What about the side-effects? Same as the beta-blocker or worse?
Thanks again, Vincent.
Posted by jono_in_adelaide on August 20, 2012, at 22:53:19
In reply to Re: Somatoform disorder...im alone here to have it? » phidippus, posted by Vincent_QC on August 20, 2012, at 21:25:49
How are you seperating what is physical and what is hysterical?
Posted by Vincent_QC on August 21, 2012, at 8:08:08
In reply to Re: Somatoform disorder...im alone here to have it?, posted by jono_in_adelaide on August 20, 2012, at 22:53:19
> How are you seperating what is physical and what is hysterical?
Hummm somatoform disorder is not hysterical...its anxiety who manifest with chronic symptoms. Those symptoms are REAL, mean that its not hysterical... the symptoms sometimes can transform into conversion disorder, who mean that a person can have all the symptoms of a specific disease but all the medical tests came back negative... some peoples can became blind, some others cant walk but nothing from a medical point of view can point to a disease or a medical diagnostic.
So overall somatization disorder or somatoform disorder is different than panic disorder since the symptoms tend to be chronic and its the way anxiety show up, someone with a panic disorder will have only panic attacks and anxiety and shymptoms will stop shortly after.
Now how separate what is physical and what is PSYCHOLOGICAL thats a good question. Like I just write above, the its the anxiety who manifest itself with chronic symptoms, the person dont mimic those symptoms, they are not fake or amplified, they are real. The person should start a therapy to learn how to cope with those symptoms, learn and understand thats its only anxiety and accept those symptoms. Medication can help to decrease the intensity of the symptoms but overall someone who have a somatoform disorder will have big difficulty to deal with the side effects of the meds since the anxiety is so strong to start and the body is depleted of all kind of energy to fight those symptoms, so its a long process.
I guess the symptoms slowly reduce and can stop when the anxiety and the root of the problem is under control and clearly understand by the patient, whi is not my case...I have to learn how to cope with my symltoms and learn to live with them, stop worry about the symptoms, but its a hard and long process...
Posted by phidippus on August 21, 2012, at 16:33:11
In reply to Re: Somatoform disorder...im alone here to have it? » jono_in_adelaide, posted by Vincent_QC on August 21, 2012, at 8:08:08
Mexilitine can be used to treat headaches without the risk of hypotension. Its Lidocaine in pill form.
Eric
Posted by Vincent_QC on August 21, 2012, at 16:41:24
In reply to Re: Somatoform disorder...im alone here to have it? » Vincent_QC, posted by phidippus on August 21, 2012, at 16:33:11
> Mexilitine can be used to treat headaches without the risk of hypotension. Its Lidocaine in pill form.
>
> Eric
>
>Oh seem great...will ask my Doc!
Maybe I will avoid the extreme fatigue from the beta blocker, I feel so exhausted, its hard to walk or just get up from the bed. Everything make me feel tired, physical and psychological.
Anxiety give a lot of physical symptoms and they are not easy to live with. Im disable from work but will give everything I have to have a normal life again...or being pain free for 1 day or feel normal without the feeling that I will die in the next minute...
Anyway thanks Eric -;)
Posted by phidippus on August 21, 2012, at 16:50:38
In reply to Re: Somatoform disorder...im alone here to have it? » phidippus, posted by Vincent_QC on August 21, 2012, at 16:41:24
Somataformm disorders are usually treated with antidepresssants, in particular SSRIs. Is their an SSRI you can try and take?
Eric
Posted by Vincent_QC on August 21, 2012, at 17:26:43
In reply to Re: Somatoform disorder...im alone here to have it? » Vincent_QC, posted by phidippus on August 21, 2012, at 16:50:38
> Somataformm disorders are usually treated with antidepresssants, in particular SSRIs. Is their an SSRI you can try and take?
>
> EricHi again Eric,
We had that discussion months ago no? Lol I cant tolerate a tinny dose of any of the ssri's on the makert. I try often to start again the Paxil since its the only one ssri who work in the past for the panic disorder and decrease the social as well, but even at 1 mg I become extremely anxious, bedbound, and side effects dont decrease. I was use to take high dose of it, remember that I go to 60 mg at some point but the last time I took it for the panic disorder back at the end of 2009 , 15 mg was enough to stop the panic and was able to do everything I want with no anxiety at all but I had gain 40 pounds in 2 months and I wasnt happy with that so I stop it and thinking I will be ok without it since I was anxiety free and in control of my anxiety but it was the biggest mistake I done in my life. I had a surgery to remove internal hemmrhoids and it was so painfull that the panic attacks return with vengeance.The others ssri's never work on me, some of them like the prozac even give me panic attacks when I was free of them since a lot of years (was put on it for social phobia). Zoloft do the same, celexa and lexapro do nothing and just make me so tired that I had to take them with Ritalin and wellbutrin to have more energy.
The newer srni's like effexor xr, cymbalta and pristiq give same results than the prozac, more anxiety, more social phobia and panic attacks out of the blue.
The older med like Nardil never did a thing for the social phobia and had severe orthostatic hypotension on 60mg so never reach the 90mg, the Parnate almost kill me with 3 major hypertensives crisis without foods interractions, thanks god my Doc rx it with nefepidine emergency pills in case of hypertensive crisis, who save my life, was at 40mg day only and also had hypotension as well at night and faint several time so had to take a med that I dont remember the name but it was use to keep the salt in my blood system and avoid the hypotension.
The tca's are the worse of them, elavil, imipramine, clomipramine, they all affect me in a bad way, fast heart rate, panic who dont stop, insomnia...worse of them was the nortryptiline and desimipramine...
Overall the logical solution is to return on the paxil but I need to be involve in a therapy first, I just start it last week with a new therapist and the med sensitivity will be a part of the plan, learn to cope with side effects and go slow and increase the dose from 1mg every week or so...
The other solution will be the new AD from lundbeck who will be launch later in 2012 or 2013, my Doc say its like a ssri with some modulations of specific serotonin receptors to avoid side effects from the ssri alone, he said that it will be a very good med and more easy to tolerate for peoples with anxiety...
For now the goal is to continue to reduce the clonazepam dose. When I will reach the 4 mg dose , can take more than 6 months, will switch to the valium. My Doc want me off the benzo meds, he think they worse my anxieth and I agree with him but the withdrawal will be a long process, 1 to 2 years...maybe more.
But well will talk about it to my therapist, for now I saw him only 1 time and we didnt had the time to make a plan for the therapy, but meds will be a part of the therapy for sure.
I repeat myself...lol
Oh and the 1mg paxil side effects are real, not anxiety or fears of meds... As an exemple, when I had my 2 surgeries for the intestinal obstructions back in last october, 25mg of IM Demerol was enough for me to stop the pain and even I had visual hallucinations from that small dose and a lot more side effecfs who normally happen at dose of 100 to 150 mg of Demerol. My body is under severe anxiety since almost 3 years now so I guess my cortisol, adrenaline, noradrenaline and many other things in my body are totally in a wreck.
Well eyes hurt now...but well thanks for the input.
Take care, Vincent
Posted by jono_in_adelaide on August 21, 2012, at 21:01:45
In reply to Re: Somatoform disorder...im alone here to have it?, posted by Vincent_QC on August 21, 2012, at 17:26:43
Have you tried mirtazepine? Ithas a different side effect profile, tends to be good at reducing anxiety, doesnt effect the heart or cause hypotension.
It can be quitte sedating, but this passes off over a few weeks, starting dose 15mg at night, then increase to 30mg
If you havent tried it, it would be well worth a shot.
Posted by Vincent_QC on August 21, 2012, at 21:43:21
In reply to Re: Somatoform disorder...im alone here to have it?, posted by jono_in_adelaide on August 21, 2012, at 21:01:45
> Have you tried mirtazepine? Ithas a different side effect profile, tends to be good at reducing anxiety, doesnt effect the heart or cause hypotension.
>
> It can be quitte sedating, but this passes off over a few weeks, starting dose 15mg at night, then increase to 30mg
>
> If you havent tried it, it would be well worth a shot.Yes of course I try it. Go up to 60mg at some point who was a way too much activating for me.
I use a very low dose before bedtime to help me to fall asleep, a dose of 3.5mg. I cant take more of it anymore, it tend to affect me in a bad way, too much noradrenaline effect who leave me with sedation at daytime with agitation and worse headache. It can cause hypotension, when I was at 45mg day I had hypotension and it was still a lot sedating for me...and to be honnest, mirtazapine is not good for anxiety, my Doc and the 2 Pdoc I had told me they never had a single case of anxiety who answer to mirtazapine...but when its add to another AD like a ssri, it can produce a stronger anxiolytic effect and decrease some of the ssri side effects...thats worked for me on 45mg day of mirt and 20mg of prozac but the Pdoc stop the mirtazapine slowly over a 3 months period and when I was only on prozac I start having panic attakcs...
Posted by phidippus on August 22, 2012, at 7:07:56
In reply to Re: Somatoform disorder...im alone here to have it? » jono_in_adelaide, posted by Vincent_QC on August 21, 2012, at 21:43:21
I htink you should go back to the Paxil and start some intense therapy.
I'm really sorry you're suffering so much.
Eric
Posted by Vincent_QC on August 22, 2012, at 9:30:05
In reply to Re: Somatoform disorder...im alone here to have it? » Vincent_QC, posted by phidippus on August 22, 2012, at 7:07:56
> I htink you should go back to the Paxil and start some intense therapy.
>
> I'm really sorry you're suffering so much.
>
> EricHi Eric, I know that I should start the Paxil but the side effects are 1000 worse than the high anxiety I have already. But like I wrote last evening, will have a surgery soon and will ask to start it when I will be at the hospital, will feel more secure.
For the intense therapy, I cant go more than 2 times a month to the psychologist. Its 120$ for 1 hour and im disable from work so on wellfare and cant pay for 4 times a months, I have only 500$ each month and have some bills to pay and the rent to my parents for the foods and others things...
Well, 2 times a month is better than nothing...
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.