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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 3 to 27 of 27. Go back in thread:
Posted by CarolAnn on May 27, 2000, at 13:34:03
In reply to Conversion episode !??, posted by Cynthia M on May 27, 2000, at 9:56:37
Cynthia, I was on Hydro-codone(painkiller with codiene in it)for some dental work. One evening, I took my dose on an empty stomach and then ate a whole bunch of pure chocolate. I ended up having almost exactly the same experience as your daughter! Had she thrown up at all? I never could find anyone (doctor or pharm)who could explain what happened.
Well, don't know if this is any help, but maybe you can explore with her any sort of 'legitimate' combinations that could set off her attack. my thoughts are with you, hope it is all resolved soon. CarolAnn
Posted by stjames on May 27, 2000, at 17:40:00
In reply to Conversion episode !??, posted by Cynthia M on May 27, 2000, at 9:56:37
> Ok- here's the problem. My daughter (15) came home from school the other day and had to have a neighbor give her a ride from the bus stop... she said through gesstures she was unable to talk
James here...
Most illicets will make you eyes dialated for no more than a day after they are ingested so if this is continuing and you know she did not take anything it is clear illicet drugs are not the cause here.
james
Posted by Cynthia M on May 27, 2000, at 19:13:42
In reply to Re: Conversion episode !??, posted by stjames on May 27, 2000, at 17:40:00
Well the saga continues... we went shopping today and she said she felt weird and I looked at her and her eyes were almost a pinpoint and then she said she felt weird about and hour and a half later and her eyes were back dialated again.... I guess I will take her in to an optometrist and then in to the psych to rule out any psychiatrict symptoms..( I know this will be a negative ruling) maybe then the medical community will take us seriously .. she really is feeling bad today and it occured to me that both my oldest son and I are both experiencing severe fatigue and he comes home from school and falls right to sleep .. in this manner his symptoms are similar to his sister... I know that the only regular meds she has taken are the paxil and her thyroid if anyone has any ideas I am open...?
Posted by medlib on May 28, 2000, at 8:59:35
In reply to Conversion episode !??, posted by Cynthia M on May 27, 2000, at 9:56:37
Cynthia--
I share your frustration with many of the medical community, and you seem to be afflicted by some real duds. Your daughter's symptoms (Sxs) interested me and evoked a "niggle" in the back of my mind, so I did some searching.
My best guess (and I must emphasize GUESS) is that your daughter is suffering from atypical migraines. If that *is* the case, neither of the specialist-types you mentioned is likely to be of much help (and that potential diagnosis might not occur to either of them). If your pediatrician or internist thinks it's worth investigating, perhaps they could refer you to a headache specialist.
I could blather on for pages about what I found, but I'm aware that I have an unfortunate way of sounding pedantic, pompous and/or patronizing (which is too bad, because it *isn't* the way I feel). I also have a vague recollection that someone on this board whose name starts with "C" has a medical background. (My short-term memory is the pits!)
Sorry for the personal digression. The "quick and dirty" synopsis:
--Migraines are poorly understood; thought to be a cardiovascular phenomenon in which cerebral arteries suddenly spasm shut (causing brain oxygen deprivation) which is followed by rebound vasodilation (causing pain, nausea, other symptoms). Sxs can last for days and can include profound fatigue.
--Many substances or conditions can "trigger" migraines--many individual differences. Onset can be preceded by warning signs (again, differing) and can be acompanied by usually brief, stroke-like Sxs such as visual, auditory, communication and motor disturbances.
--Migraines are connected with seratonin mechanisms and have a statistical association with other seratonin-mediated disorders like depression and PMS. They are more common in women and onset typically happens in teens--twenty.
--Both migraines and mydriasis (pupil dilation) have been reported as "infrequent" (between 1/100 to 1/1000) adverse reactions to Paxil. (We all know how inaccurate these estimations are.)I'd be interested to know if your daughter is near or "at" her period. Also, if she is still symptomatic, if she has any reaction at all to immersing her hands in very warm water for several minutes. How does she react to sudden direct bright light (flashlight in the eyes)? Do her pupils constrict? Does she complain of increased pain? None of this is diagnostic; if her problem is migraines, her clinical presentation is not average. BTW, there are even headache-absent migraines (new to me).
If any of this sounds like a possibility to you (and you are feeling masochistic), one of the best sources of web info is the JAMA Migraine Center available from the American Medical Association homepage at www.ama-assn.org.
Good luck on unraveling your medical mystery; it's scary when something you can't understand (or get any help with) happens to your child. Odds are high that, by the time you can get in to see anyone after the holiday, whatever it is will have resolved itself. (Isn't that always the case?) If it's migraines, it *will* happen again.
Well wishes----medlib
(Wish I could learn to express myself succinctly like Noa!)
Posted by Joanna on May 28, 2000, at 12:19:06
In reply to Conversion episode !??, posted by Cynthia M on May 27, 2000, at 9:56:37
My son got dilated pupils from Ritalin but it went away when the drug stopped working. Have you thought about seeing a neurologist? They tend to take these things a bit more seriously. A neurologist could also tell you whether or not your daughter has migraines. I guess what got my attention was her inability to talk. I hope you find your answer.
Joanna
Posted by Cynthia M on May 28, 2000, at 18:24:33
In reply to Re: Unexplained symptoms--Long, posted by medlib on May 28, 2000, at 8:59:35
Medlib- do not apologize for your lack of brevity.. I think we may have found something here ! Ye s many of the symptoms you have described my daughter has experienced.....extreme pain in bright light ( she has been wearing sunglasses even indoors ) with slight to no constiction of the pupils..and she took a shower yesterday ( immersion in very warm water) and came out feeling horrible and she said she almost passed out.... and she started her period on Thursday, the first day of symptoms ( and her first period in two months due to undiagnosed hypothyroidism) thank you for the web site I will definitely investigate further.. I am wondering at this point if maybe we should remove her from the paxil to rule out any reaction from that... what is your opinion? Thnaks so much for the info... I cannot express how valuable the people here are for so much support I have recieved... any other opinions are welcome.. we definitely know there are no drugs involved other than her synthroid and 40mgs a day of paxil.. thanks again...Cynthia
Posted by Sara T on May 28, 2000, at 18:47:57
In reply to Re: Conversion episode !??, posted by Joanna on May 28, 2000, at 12:19:06
> My son got dilated pupils from Ritalin but it went away when the drug stopped working. Have you thought about seeing a neurologist? They tend to take these things a bit more seriously. A neurologist could also tell you whether or not your daughter has migraines. I guess what got my attention was her inability to talk. I hope you find your answer.
>
> JoannaCynthia-
Joanna has a very good suggestion, see a neurologist. She may have migraines, or she may have had a seizure. But the fact that she could not speak is very troubling, as is the continuation of her symptoms. Below I have copied an excerpt from an article I found in Medscape, under Neurology, on the Differential Diagnosis of Migraines.Migrainous infarction. Migrainous infarction has previously been termed "complicated migraine."[1] The IHS describes it "as one or more migrainous aura symptoms that are not fully reversible within 7 days and/or are associated with neuroimaging confirmation of ischemic infarction."
Patients who suffer from migraine with aura who smoke and are taking oral contraceptives are at increased risk for stroke.[6-8] These typically young women have a 13.9% (odds ratio) higher relative risk for migrainous infarction compared with community- and hospital-based controls. If other risk factors for stroke such as hypertension, hyperlipidemia, protein C or protein S deficiency, or antiphospholipid antibody syndrome are present, such patients need to be very carefully monitored. They should also be confronted about the need to either stop smoking and/or discontinue oral contraceptive use.If such patients experience persistent focal weakness, numbness, and/or visual or speech difficulties that last longer than an hour, they should undergo a formal evaluation just as if they've had a stroke or a transient ischemic attack.[9]
Good luck,
Sara T.
Posted by Cynthia M on May 28, 2000, at 19:58:22
In reply to Re: Conversion episode !??, posted by Sara T on May 28, 2000, at 18:47:57
Medlib- you were right about the masochism!!! I have spent the last two hours searching the jama site and have found reference to aphasia and vertigo .. I am trying to find any mention of pupil dialation in migraine.. if you have any idea where you may have found this could you give me the site please... interestingly enough I gave my daughter a dose of my migraine medication , fioricet, and she is feeling better... SaraT thanks for the great info the mention in this article of antiphospholipid antibody syndrome just about shocked me off my chair.. I have this and it is rarely mentioned as a lot of poeple have no idea what it is... my daughter has tested ANA positive which leads me to believe that she is dealing with a lot of the same autoimmune make-up that I have..thank you so much for your time and trouble...now I just need to find info on pupil dialation in migraine headaches. Thanks again...Cynthia M
Posted by forth meg on May 28, 2000, at 20:25:41
In reply to Re: Unexplained symptoms--Long, posted by Cynthia M on May 28, 2000, at 18:24:33
Cynthia, I was thinking the same thing.
I've had migraines with auras, And they do cause
changes in the dilation of my eyes (sometimes
constriction, sometimes dilation).They've also caused photophobia (oversensitivity to light),
The big clue for me was that you said she couldn't speak.
That sounds like aphasia, which can happen with migraines
as well - I had a very brief period where I couldn't
understand what people were saying - I heard sounds,
but it sounded like gibberish. At that time I don't
think I tried to talk - but I'm not sure i could
have spoken either.Migraines don't have to have headaches associated.
They often also have nausea or a lack of appetite
associated.Does she have numbness or tingling - especially
around the mouth or hands/arms? Those are big migraine
symptoms - I always get some numbness or tingling
in my mouth and cheeks.My concern here is that this is going on so long.
Usually the "aura" associated with migraines last
from minutes to hours.I had only one experience where I had multiple
subtle symptoms gradually build up over days and then
culminated with a very bizarre acid-like
experience. But the most severe clear-cut symptoms
lasted only an hour or two.I would say that you *need* to get your daughter to
a neurologist to rule out a serious problem.
And, I guess there's really no way to tell for sure
if she IS taking anything illicit either. But
that's a possibility too I suppose.> Medlib- do not apologize for your lack of brevity.. I think we may have found something here ! Ye s many of the symptoms you have described my daughter has experienced.....extreme pain in bright light ( she has been wearing sunglasses even indoors ) with slight to no constiction of the pupils..and she took a shower yesterday ( immersion in very warm water) and came out feeling horrible and she said she almost passed out.... and she started her period on Thursday, the first day of symptoms ( and her first period in two months due to undiagnosed hypothyroidism) thank you for the web site I will definitely investigate further.. I am wondering at this point if maybe we should remove her from the paxil to rule out any reaction from that... what is your opinion? Thnaks so much for the info... I cannot express how valuable the people here are for so much support I have recieved... any other opinions are welcome.. we definitely know there are no drugs involved other than her synthroid and 40mgs a day of paxil.. thanks again...Cynthia
Posted by forth meg on May 28, 2000, at 20:51:04
In reply to Medlib-info please?, posted by Cynthia M on May 28, 2000, at 19:58:22
> Medlib- you were right about the masochism!!! I have spent the last two hours searching the jama site and have found reference to aphasia and vertigo .. I am trying to find any mention of pupil dialation in migraine.. if you have any idea where you may have found this could you give me the site please... interestingly enough I gave my daughter a dose of my migraine medication , fioricet, and she is feeling better... SaraT thanks for the great info the mention in this article of antiphospholipid antibody syndrome just about shocked me off my chair.. I have this and it is rarely mentioned as a lot of poeple have no idea what it is... my daughter has tested ANA positive which leads me to believe that she is dealing with a lot of the same autoimmune make-up that I have..thank you so much for your time and trouble...now I just need to find info on pupil dialation in migraine headaches. Thanks again...Cynthia M
Cynthia - an infarction is a stroke. A complicated
migraine is a migraine that causes a stroke.
From Sara's post it sounds like ANA is a risk factor.If your daughter is STILL experiencing clear cut
symptoms you need to call up your doctor and explain
what you think is going on and see if you can't get her
checked out immediately - by a neurologist.It's not important to find out whether dilated pupils
go with migraines - I can tell you they do. But right
now you have to call your doctor and tell him what you
think is going on.Also you CAN'T go giving medications to your daughter
without checking with your doctor - she's already
on two psychotropic medications, and you have no
idea if there are interactions with the fioricet.
There probably aren't but you have to be careful!!!Same thing goes with stopping the Paxil - you need
to check with her doctor, who'll probably
tell you to do it gradually if at all. Abruptly stopping an
antidepressant can cause a withdrawal reaction.I know your doctor's are duds, but right now it's
better to be dealing with them then winging it.
Once the current situation is resolved - then it's
time to look for new ones I'd think.I know I sound scolding - I don't mean to. I'm just
worried.
Posted by medlib on May 29, 2000, at 0:52:13
In reply to Re: Unexplained symptoms--Long, posted by Cynthia M on May 28, 2000, at 18:24:33
> Medlib- do not apologize for your lack of brevity.. I think we may have found something here ! Ye s many of the symptoms you have described my daughter has experienced.....extreme pain in bright light ( she has been wearing sunglasses even indoors ) with slight to no constiction of the pupils..and she took a shower yesterday ( immersion in very warm water) and came out feeling horrible and she said she almost passed out.... and she started her period on Thursday, the first day of symptoms ( and her first period in two months due to undiagnosed hypothyroidism) thank you for the web site I will definitely investigate further.. I am wondering at this point if maybe we should remove her from the paxil to rule out any reaction from that... what is your opinion? Thnaks so much for the info... I cannot express how valuable the people here are for so much support I have recieved... any other opinions are welcome.. we definitely know there are no drugs involved other than her synthroid and 40mgs a day of paxil.. thanks again...Cynthia
-------------------------------Cynthia--
Thanks for the kind words. As usual, some of my attempts to be brief end up being cryptic; I'd better clarify a few points.
--By "headache specialist" I meant neurologist. Most neurologists will see new patients only by referral from a primary care physician or NP. Often neurologists specialize in major disorders, such as epilepsy, or Parkinson's--or headache. There's even a journal called "Headache" put out by the American Headache Society at www.ahsnet.org (linked from JAMA's Migraine Center under a slightly different name).
--My emphasis on cardiovascular changes was meant to describe the actions responsible for migraine
Sxs--cerebral ischemia (insufficient blood flow, oxygen delivery). Most Sxs are related to the areas of the brain initially deprived of oxygen; pain is caused by vasodilation. Although migraine Sxs resolve eventually, seratonin abnormalities (which cause the arterial changes) remain, hence the susceptibility to future attacks.
--Cerebral ischemia is also the mechanism responsible for stroke and TIA Sxs, so effects can be identical. Strokes are very unlikely in one so young, unless from a AVM (arteriovenous malformation) or the combination of contraceptives and smoking (neither of which you mentioned). I got the impression that the speech difficulties resolved rather quickly, and you did not mention them in your description of her second attack. (Of course, TIA Sxs are "transient", too, but there should be *no* lingering symptomology from a TIA.) The longer any stroke-like Sxs remain, the greater the possibility that something more than migraines may be involved, I suspect. Photophobia is a characteristic of most migraines, but is less likely to be a stroke Sx, I think.
--The "hands in warm water" test can be a home indicator of increased cerebral blood flow. When hands are heated, blood flows away from the head to the extremities (to "cool" the overheated hands). Many migraine sufferers experience some temporary lessening of headache pain (which, unfortunately, lasts only as long as the hands are heated). Hot water on the head in a shower would only further dilate the cerebral arteries and exacerbate the headache pain.
--It is very confusing that seratonin-based drugs can cause, prevent and/or treat migraines. I don't know enough to explain those mechanisms at the receptor level.
--I would not recommend discontinuing Paxil without checking with her doc first. Paxil, like Effexor, can have distressing withdrawal Sxs, and is best withdrawn sloooowly. NSAIDs such as Advil (not aspirin) are probably okay to reduce inflamation and pain. If she has *any* remaining ischemic (stroke-like) Sxs Monday, I would take her back to the ER and ask them to "rule out" stroke and/or migraines--just to be on the safe side. For instance, I would suggest ice packs to relieve pain, but, until a clot-based stroke is ruled out, it's not really safe to apply cold.BTW, I had a right parietal lobe hemorrhagic CVA (stroke) due to an AVM. I also have migraines, for which I take ergotamine tartrate. But, YMMV. I think my mind "niggle" came from imagining going from a dark bus to bright sun, and from parking lot glare to a dark department store. In a susceptible person, just that abrupt change in light levels can trigger a migraine.
Hope things go well with you and your daughter---
medlibP.S. At the JAMA web site check out the articles in the "Newsline" section for info on the seratonin connection. BTW, one of the problems I have posting here is not knowing how much to explain; if your preferences differ from my output, please let me know.
Posted by medlib on May 29, 2000, at 1:39:17
In reply to Re: Unexplained Symptoms-- Longer, posted by medlib on May 29, 2000, at 0:52:13
Cynthia--
The info on Paxil came from RxList drug monograph of paroxetine hydrochloride. Here's the URL:
www.rxlist.com/cgi/generic/parox_ad.htm#AR--In Table 1 under the Adverse Reactions section notice that 18% of Paxil users reported headaches (Body as a whole).
--Underneath Table 1 note >1% report back pain.
--Further down in the section called "Other events observed during the premarketing evaluation of Paxil", note "migraine" and "vascular headache" listed in the "Cardiovascular" paragraph.
--Further down in the same section, in the "Special Senses" paragraph, note "mydriasis" (pupil dilation).Of course, drug manufacturers are required to list every unwanted event that happened, and listing a Sx does not prove that the drug *caused* the Sx, just that they occurred together. But we are free to be suspicious.
Hope this is what you needed--medlib
Posted by Cynthia M on May 29, 2000, at 10:40:33
In reply to Re: Unexplained Symptoms-- Longer, posted by medlib on May 29, 2000, at 0:52:13
Medlib- I am not concerned with your amount of "output" all of this info is so valuable to be .. it is imperative that I become educated enough to be able to "argue " this point with the doctors in question..My daughter does not take oral contraceptives or smoke..so I think we are at less risk for stroke although her symptoms are somewhat similar..I thought it was interesting that you mentioned taking ergotamine tartrate as my mother takes this for her migraines.. I think with the familial factors here and the definitive Sxs , we probably have a tentative dx, now I just have to convince the docs that we need to be on this track and at least get the pediatrician ( who I am sure spends most of his time with ear aches and sore throats) to refer her to a neurologist...once again , thank you for such important and precise information...I will keep you posted...Cynthia
Posted by Cynthia M on May 29, 2000, at 10:43:11
In reply to Re: Unexplained Symptoms-- Shorter!, posted by medlib on May 29, 2000, at 1:39:17
> Cynthia--
>
> The info on Paxil came from RxList drug monograph of paroxetine hydrochloride. Here's the URL:
> www.rxlist.com/cgi/generic/parox_ad.htm#AR
>
> --In Table 1 under the Adverse Reactions section notice that 18% of Paxil users reported headaches (Body as a whole).
> --Underneath Table 1 note >1% report back pain.
> --Further down in the section called "Other events observed during the premarketing evaluation of Paxil", note "migraine" and "vascular headache" listed in the "Cardiovascular" paragraph.
> --Further down in the same section, in the "Special Senses" paragraph, note "mydriasis" (pupil dilation).
>
> Of course, drug manufacturers are required to list every unwanted event that happened, and listing a Sx does not prove that the drug *caused* the Sx, just that they occurred together. But we are free to be suspicious.
>
> Hope this is what you needed--medlib
Medlib- thanks for this info I will take a copy of it with me to the doc.. maybe we can rule out the involement of paxil with her Sxs and rule out any involvement ... Thanks again...Cynthia
Posted by medlib on May 29, 2000, at 16:54:36
In reply to Re: Unexplained Symptoms-- Shorter!, posted by Cynthia M on May 29, 2000, at 10:43:11
Cynthia--
Sorry for the medical jargon--sometimes I don't notice I'm using it. "Rule out" is an inane term, shorthand for " investigate a specific diagnostic hypothesis (educated guess) with the intent of confirming or denying it."
An example you may hear on "ER": Patient comes in with a "Rule out MI". They mean, "We think he's having a heart attack (myocardial infarction) so we will to do tests which prove or disprove that." It's sort of a pre-diagnosis. You can "rule out" a stroke with imaging tests such as a CAT scan, MRI or arteriogram. There is no definitive test for migraines, so a migraine can't be "ruled out." It is diagnosed by a preponderance of the evidence--med history, Sxs, and by eliminating other possible diagnoses.
I hope that, if it *does* turn out to be migraine, Paxil isn't the trigger. I'm guessing that her doc will want to wait for a possible recurrence before considering changing an AD that otherwise seems to work.
Take care of yourself; this, too, will pass eventually.
medlib
Posted by Cynthia M on May 30, 2000, at 12:47:18
In reply to Re: Unexplained Symptoms-- Shorter!, posted by medlib on May 29, 2000, at 16:54:36
Medlib- thanks for the help I believe we are on the right track and my daughter will see her pediatrician again tomorrow.She is feeling much beter today and has even gone back to school.. the symptoms have subsided. Now , if I can convince her doctor that she is feeling better due to th nature of migraines and not the "wearing off" of "drugs" then we will be doing well.I have been searching through all of the material I have found , thanks to you, and am impressed with the number of corresponding Sxs and treatments.. I really am relieved that she is feeling better but in retrospect realize that this is not her first episode and that she has been plagued with these same or similar Sxs for quite some time. The episodic nature and consistency of her Sxs are very diagnostic.. I have little doubt that we are indeed looking at migraine.. now to get the doctor to concurr..........thanks again... Cynthia
Posted by Noa on May 30, 2000, at 15:09:24
In reply to Re: Unexplained symptoms--Long, posted by medlib on May 28, 2000, at 8:59:35
I was thinking along these lines, too, after rereading your post, Cynthia. Migraines, or other related phenomenon. A trip to a neurologist might be in order.
OTOH, have drugs been totally ruled out? I would want to be sure of that first.
Posted by Cynthia M on May 30, 2000, at 19:29:33
In reply to Re: Unexplained symptoms--possible migraines, posted by Noa on May 30, 2000, at 15:09:24
HI Noa! Glad to hear from you ... I am certain that we are on the right track here with the migraines.. I am definite that we are not looking at any drug use... there are several factors other than the obvious that my daughter has no means of obtaining any drugs..also everything else illustrates that it is not a probability, she is doing well in her classes, 'A's and 'B's and she is active in choir and has a promising singing career through school as well as church.Anyway, this is something that I agree requires the attention of a Neurologist... I am hoping that we can convince her Pediatrician that we are NOT dealing with drugs or a psychiatric condition... Thanks Noa , for your concern and opinion.. I am glad to hear from you...Cynthia
Posted by KarenB on May 30, 2000, at 23:43:00
In reply to Re: Unexplained symptoms--possible migraines, posted by Noa on May 30, 2000, at 15:09:24
Dear Cynthia,
This is a shot in the dark but these symptoms sound very much like those my friend experienced who was suffering "mini seizures," as her doctor described them. Turns out, it was from Nutrasweet(aspartame). She went from specialist to specialist to no avail until one doctor questioned her consumption of diet drinks. Bingo. She stopped the Nutrasweet altogether and no more seizures or pupil dilation.
Just a thought - hope it helps.
Karen
Posted by Cynthia M on May 31, 2000, at 9:50:07
In reply to Re: Unexplained symptoms--possible migraines, posted by KarenB on May 30, 2000, at 23:43:00
> Dear Cynthia,
>
> This is a shot in the dark but these symptoms sound very much like those my friend experienced who was suffering "mini seizures," as her doctor described them. Turns out, it was from Nutrasweet(aspartame). She went from specialist to specialist to no avail until one doctor questioned her consumption of diet drinks. Bingo. She stopped the Nutrasweet altogether and no more seizures or pupil dilation.
>
> Just a thought - hope it helps.
>
> KarenKaren- thanks this is an interesting observation... my mother inlaw is unable to use aspartame and is actually epileptic.. not that there is any connection there , just a personal observation she has made... my oldest son also had seizures when he was very small... and abnormal EEG's I am sure it wouldn't hurt to have my daughter tested for seizure patterns.. Here's hoping the doc will refer her on to a neurologist.. we find out today if he will even take us seriously or if he still is going to stick tothe assumption that if you are fifteen and have any problems "it must be from drugs".. wish me luck.. and thanks.. Cynthia
Posted by Cynthia M. on June 1, 2000, at 13:03:13
In reply to Re: Unexplained symptoms--possible migraines, posted by Cynthia M on May 31, 2000, at 9:50:07
We went back to the Pediatrician yesterday and I showed him al of the information I was able to gather regarding migraines and he was very impressed and decided to start my daughter on inderal right away ... He is also referring her to a Neurologist so we may be able to get more diagnostic work done..He was very apologetic and said that he would hate for a kid to be saddled with a psychatric "lable " so young....big switch! Anyway, I sure appreciate your input- Thanks so much to all of you for helping me out.. Thanks to medlib I am relieved we have a pretty concrete dx... thanks again! Cynthia
Posted by medlib on June 1, 2000, at 15:34:19
In reply to Finally- Success!, posted by Cynthia M. on June 1, 2000, at 13:03:13
Cynthia--
What great news! You really deserved a break from the med community after what you have had to put up with recently.
Solving problems, finding useful information, and being able to be of help is a real "up" for me--I'm probably as happy about the outcome as you are! Migraines are miserably painful, but, with recent advances in understanding and treatment, they're one of the more manageable disorders.
While I was on Medscape yesterday, I happened across a newly posted update on migraine treatment. I think you will want to print out the last 2 sections of this report before your neurologist's appointment. The section entitled "Safety and Efficacy of New Migraine Therapies" is about 15 pages and contains several blue-colored charts that don't print well, but it has utterly relevant, pragmatic evaluations of what to use when, medical and monmedical--I printed a copy for myself. I'd suggest printing a complete copy for the doc, then photocoping the pages you find most relevant for you to keep. The final section "Panel Discussion" is short, but has a couple of useful parts on meds and menstrual cycles and use of combination meds--when and why.
This URL will take you directly to the "Safety +.." section:
www.medscape.com/Neurology/TreatmentUpdate/2000/tu05/tu05-05.html
You can highlight this address, go to Edit and choose Copy, then highlight the address line, then go to Edit and Paste and hit Enter. My apologies is you're already familiar with this trick to avoid retyping block-long URLs.
Inderal is a beta-blocker, one of the older migraine prevention drugs. It may work very well for your daughter. However, if she should complain of depression and/or fatigue, Inderal could be the cause. I'm sure your neurologist will review treatment options with you. That's why I thought that this latest word on the subject might be of use.
My view is that if docs don't like patients bringing in Internet info, they should get themselves up to date so they can say, "Yes, I've seen that." This report is certified for CME (Continuing Medical Education) credit for MDs.
And now, you'll undoubtedly be thrilled to hear that, since this report is the last word on migraines, it's *my* last word on it, too! Congratulations on having survived a medlib information overload.
Back to the rest of life----medlib
Posted by AndrewB on June 2, 2000, at 0:33:48
In reply to Re: Finally- Success! » Cynthia M., posted by medlib on June 1, 2000, at 15:34:19
Medlib,
I've been following this thread and I was heartened by the effort you took to do the research you did. You've made a difference in that young women's life. You should feel gratified.
AndrewB
Posted by Cynthia M. on June 2, 2000, at 20:25:18
In reply to Re: Finally- Success! » Cynthia M., posted by medlib on June 1, 2000, at 15:34:19
Medlib- O.K. my last word too- thank you , thank you , thank you.... I can't say it enough or adequately express my gratitude for all of your help, and, as far as I am concerned there is no such thing as an information "overload". The more you know the better you are able to handle what you are dealing with .. Remember, knowledge is power! I have never felt better than when my doc was sitting there saying" I didn't know that!". Hah! O.K. I will stop gloating , I guess, for now.Thanks so much , again ( ok , last time....) I couldn't have done it without you :) I will be keeping you posted! - Cynthia
Posted by Elizabeth on June 3, 2000, at 7:29:31
In reply to Re: Finally- Success!, posted by Cynthia M. on June 2, 2000, at 20:25:18
Hey Cynthia,
Good for you for persisting. Conversion episodes are real, but it's simply a mistake to assume that psychiatric patients don't get sick (or if they do, it's because they were abusing drugs)!
Especially since certain conditions (including migraines) tend to occur frequently in people with depression and anxiety disorders. Two of my three cousins - all of whom have had depression and/or panic disorder - suffer from migraines.Something else I'd thought of was that perhaps this was due to a reaction to an antidepressant or an interaction between the AD and thyroid meds.
Dilated pupils can be a symptom of the serotonin syndrome - when I had it, I got asked if I'd taken "LSD or anything like that," too. (I also experienced periods of mutism, disorientation, etc.) Oh, and this one godawful nurse accused me of faking it (she didn't even have the decency to label it a conversion reaction!). Fortunately, one symptom I *didn't* have was irritability.So, let us know how the propranolol works, eh? :)
This is the end of the thread.
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