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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by missliz on June 14, 2002, at 3:21:45
Hi, I'm new, I'm upset. I did a trial of Parnate- Nardil was a miracle drug for me for about four years till it turned on me. The Parnate was equally impressive in my head, but after eight weeks it was just too obvious that I was in serious heart trouble. Of course the psych MD just told me to take more Valium- turning gray and keeling over are classic symptoms of anxiety. (sarcasm) Fortuneately my medicine doctor has more sense and sent me for an EKG, a very scary messy one.
I'm off the Parnate, feel pink again, but I'm so anxious and the nasty phobias are creeping back in. My anxiety is so bad I've needed massive (for me) doses of Valium for the last four days. It's the chest pain type of anxiety, and so it's extra terrifying since I'm scared about my heart. The pain is different than it was on the Parnate and I have a GAD diagnoses, a heart scare, and withdrawal from a powerful antidepressant so it makes sense but has anyone else ever had this ?
Most of my adult life I've been a competetive athlete and I know how to take an exercise pulse, I know how to use my heart rate moniter, and I think I know my body well enough to tell when something is wrong. I guess my feelings are hurt that the psych guy basicly told me I was nuts when there was a very real problem. I'm having a halter(?) monitor and an echo next week to make sure there's no lasting damage.
So has this happened to anyone else or am I the one in a million? Dr. Shrink is all hot to put me on selegiline next, but I wonder if It will be more of the same given the amphetimine metabolite thing? I'm running out of things to try.
Thanks
missliz
Posted by katekite on June 14, 2002, at 9:52:15
In reply to Parnate, cardiac arrythmia, completely freaked, posted by missliz on June 14, 2002, at 3:21:45
I got the same attitude after having chest pain while hiking and taking 5 mg of ritalin (was diagnosed with ADD this spring). Since ritalin can increase anxiety I was told that I had anxiety. When I argued with "but I take ritalin to go to sleep, it really helps my anxiety" I simply got a blank look. It was as if I'd said "my teeth turn orange every morning at 7am". That polite blank look. So I started monitoring my blood pressure and pulse and noted that when I exercised my pulse now went to 180 rather easily (rather than topping out at say 150) (and not on ritalin at the time either!), and my blood pressure just was all over the place. My pdoc took up the cause (because I was scared to go back to my GP who had been dismissive) and ordered urine catecholamines and a few other things to look for an epinephrine secreting tumor. That was negative. He also ordered a urine test for cortisol... that was quite a bit higher than normal (4 x normal for someone my age). I don't have all the classic symptoms, just a few, I look normal, but its also a fairly recent thing, I think. Now seeing an endocrinologist to work on the cause of this.
I asked my pdoc, so how long do you think I've had this high cortisol thing going on? His response: how long have you had psychiatric symptoms? I doubt that's totally true as I've had mild anxiety since 13, but it is hope-inducing for getting rid of what I'm currently experiencing (moodiness, worse stress and insomnia and some confusion/ADD, blurry vision).
So definitely pursue the holter monitor and stress testing or whatever else you read up on and think you need. Your mind won't be at ease until you have ruled out heart problems for sure (and everything that can look like heart problems).
Many things can cause heart problems or predispose to them. With me it was abnormal hormonal influence making my heart extra sensitive. So I recommend checking cortisol and thyroid. Research the heart arrythmia you had and find out all the things that would predispose to it (high potassium? or other metabolic things), then get them ruled out. Be assertive. You are allowed to go in and say "I would like to get....". If they deny you they are then open to a later lawsuit if something happened, so it becomes less likely they will deny you. It will at least make them evaluate all the options with you. If I go in like I used to and said, my chest hurt what should I do? they are more free to let the fact that I am a 30 year old anxiety prone woman get in the way, and they will respond 'have you been stressed lately?' and send me away.While waiting for appointments focus on eating healthy and moderate exercise and going on with normal life, whatever you would tell someone if they did have the conditions you're concerned about.
Then, if you do happen to rule everything out and nothing is truly wrong medically, if you are anxious about those things you will be able to tell yourself in the moment, that you did everything possible to ensure that you are healthy and now need to work on what you can work on, which is the anxiety component.
I've found it helpful to set aside an hour a day to worry about 'medical issues'. Since really worrying about it more does not make any difference, only freaks me out. Definitely I need to think about it some, though, so I figured an hour was plenty. During that hour I make appointments and do research and make a plan, and cry if I need to. The rest of the time I try to attend to life as if all was totally normal. I find it hard to stick to the one hour thing but when I can it helps a lot.
It took me a long time to get assertive about my medical issues as I assumed doctors knew best. I do have anxiety issues and so I tend to doubt myself and the overwhelming attitude is that anxiety explains anything and everything and for a long time I let myself be badgered into agreeing. But we know, obviously, that it doesn't, so we are the ones who have to be assertive and get what we know we need.
Chest pain is a particularly hard thing, as you said you do get a particular kind of chest pain that IS anxiety. Most docs can't believe we would know the difference between that and the life-threatening kind. You obviously do know.
You also seem to know what you need. It's a shock to have to change over from being passive about medical care, assuming that we will get aggressive care, to realizing that in a situation like this we must be a squeaky wheel, we must be persistent because they are biased. Try not to think of it as a battle, just pursue diagnosis determinedly and adjust to knowing it may take 5 doctors or 5 appointments to get a reasonable outcome. We are at a disadvantage but with patience and perserverance it will work out.
Let me know how the tests go.
Sorry this is so long but its a near and dear subject.
take care,
kate
Posted by Seamus2 on June 14, 2002, at 9:59:36
In reply to Parnate, cardiac arrythmia, completely freaked, posted by missliz on June 14, 2002, at 3:21:45
Has no one suggested taking a beta blocker to counteract the increase in sympathetic tone induced by the Parnate?
Posted by missliz on June 14, 2002, at 17:45:21
In reply to Re: Parnate, cardiac arrythmia, completely freaked, posted by katekite on June 14, 2002, at 9:52:15
Thanks so much, Kate. I've always been assertive with docrors, and the ones that like a team approach are still my docs. I've fired a few psychiatrists in my time.
This cortisol urine thing interests me. I've never heard of it, but I'll ask about it first thing Monday morning. I'm a little burnt and sick feeling to do much more research now but I am going to try to walk and see if it helps me relax. Yesterday in physical therapy (knee scope) I had the anxious chest pain, and pushing some bigger whieghts made me feel better, got some endorphins going. My athletic pursuits have probably been the best possible tool for controlling the anxiety and because of injury I haven't been able to go out and play for almost two years.
At the recent APA meeting somebody presented a paper on the high correlation between anxiety disorder, asthma, and heart disease. It included a lot of immune system chemitry I don't understand but my medicine doc (the triathelete) is very interested to see it and I'll ask him about cortisol. He loves that I will bring stuff to the table. My psydoc is the one that is totally bewildered by me.
Anyway, thanks again. I needed to know I wasn't the only one.
Miss Liz
Posted by missliz on June 14, 2002, at 18:40:01
In reply to Re: Parnate, cardiac arrythmia, completely freaked, posted by Seamus2 on June 14, 2002, at 9:59:36
Why add more drugs to a drug that might kill me?
Parnate was a wash for me. I don't have organic heart trouble. I had very serious artificially induced heart trouble that seems to have resolved with the withdrawal of the drug. We'll know for sure after a few tests that there's no permanent harm done.
Complicated and dangerous is not an appropriate practice of medicine when just trying something else that may work better and not screw me up is so easy.
Beta blockers will also kill an asthmatic (me) pretty quickly. I'm not suicidal. There are whole populations that shouldn't use beta blockers. They're for really sick people. I had two gruesome knee surguries so that I could go back to racing my bikes- screwing over my heart doesn't fit into the plan.
But thanks for the suggestion. I just think simpler meds are better meds.
Miss Liz
Posted by Seamus2 on June 14, 2002, at 20:37:38
In reply to Re: Parnate, cardiac arrythmia, completely freaked » Seamus2, posted by missliz on June 14, 2002, at 18:40:01
You're welcome.
This is the end of the thread.
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