![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by RICHARD MD on October 16, 1999, at 21:58:21
I am Ophthalmologist who has specialized in cornea and transplant work. During the past two years I developed problems from severe Carpal Tunnel Syndrome not correctable with surgery and was also diagnoses by multiple sources as bipolar. I have filed for total disability on the basis of both problems. I'm currently on lithium and Klonopin and have been experiencing the following reactions which I presume are side effects from the meds; tremors,proprioceptive difficulties with both vision and gate, and increase in my diplopia caused by an increase in both horizontal and vertical strabismus as documented by and independent Strabismologist at the local University University, moderate impotency, and of course frequency. Other significant meds include Synthroid and Lipitor. A Sleeping EEG and MRI were negative. I would appreciate any references that could be offered which support the problems a microsurgeon could have with biplar disease and the meds used for therapy. Learning of any possible drug interaction with my total regime, learn if the side effects i'm describing are common or are the caused in other ways including supratentoral, suggestions on management or rather sugesstions to best assist my therapist.
thanks
Richard
Posted by JohnL on October 17, 1999, at 4:42:34
In reply to Bipolar Disease & side effects from med. therapy , posted by RICHARD MD on October 16, 1999, at 21:58:21
Hi Doc. Nice to have you here. Sorry for the problems you're dealing with. I almost feel silly sharing suggestions with someone of your knowledge. I am a layperson. I do have however considerable real life personal experience with bipolar, depression, Carpel Tunnel issues, and Workman's Comp nightmares. So I can definitely relate to your struggles.
I don't know the character of your bipolar illness. Also don't know what dose Lithium. We do know however that a very common side effect of Lithium is tremors, and it is also not very good by itself in treating depression. It is best with an antidepressant. By itself it is best for acute mania. So if your bipolar is depressive in nature, Lithium alone might not be the way to go. Especially if the tremors are bothersome. They are dose-related and will endure as long as the Lithium is continued.
Though it isn't common, the partial impotence could be related to the Lithium. Or perhaps the high cholesterol situation. At a site called druginfonet.com a doctor mentions that he has had two patients complaining of impotence on Lipitor. It isn't common, but it does happen.
Something else I found interesting was that a side effect of Lipitor is muscle aches and pains....related to Carpel Tunnel maybe??? A coorelation might be something to consider. Don't know. Seems a possible contributing factor in the overall picture. I believe another choice with fewer side effects is Zocor? Believe it or not, there are effective herbs as well.
If your bipolar is primarily depressive, you will likely need a mood stabilizer and an antidepressant. Wellbutrin is the least likely to cause a switch to mania, and would likely boost the sex department considerably. And a newer generation mood stabilizer like Lamictal or Neurontin would be much preferred over Lithium. Lamictal in particular has few, if any, side effects and has more potent antidepressant qualities than other choices. I take it. It is completely benign.
Also assuming a depressive nature, a TCA antidepressant like Nortriptyline is often used for chronic pain. It would be very helpful for any depression and the Carpel Tunnel both. My pains are completely gone a couple hours after dosing Nortriptyline and it lasts nearly 24 hours. TCAs are more likely to throw someone into mania though, so a mood stabilizer would be important if there is that risk.
In summary, of the drugs you take, I would be skeptical of the Lithium and the Lipitor. Newer generation mood stabilizers are quickly becoming first-line treatments over the more established treatments like Lithium. The side effect profiles and efficacies are often superior. In an assumption of a depressive nature, an idea that immediately crosses my mind is Wellbutrin (for depression and improved sex) plus Nortriptyline (for depression and chronic pain) and Lamictal for the bipolar. And maybe find a way to ditch the Lipitor for a substitute of either prescrip or herbal variety (there are good herbs for this). Of course, there are a lot of assumptions here, but perhaps some of these ideas might be helpful.
My Dad is an orthopaedic surgeon. You know what he always tells me? "The hurting goes away as soon as the pain stops". Thanks doc! Big help! Anyway, wishing you a smooth day. JohnL
Posted by dj on October 17, 1999, at 11:27:31
In reply to Bipolar Disease & side effects from med. therapy , posted by RICHARD MD on October 16, 1999, at 21:58:21
Doc,
Though some of the folks on this forum have scientific background and understand your medical jargon, many (probably most) of do not. Some of those non-med. folks might be able to give you some useful feedback IF you translate some of your symptomatic overview into plain English.For intance, what the heck are:
- proprioceptive difficulties;
- strabismus;
- difficulties with... gate;
- supratentoralJust a thought.Perhaps, Bob (not Doc or Doc) may well translate all of these for you & us...
Sante!
DJ
> following reactions which I presume are side effects from the meds; tremors,proprioceptive difficulties with both vision and gate, and increase in my diplopia caused by an increase in both horizontal and vertical strabismus as documented by and independent Strabismologist ..., moderate impotency, and of course frequency... the side effects i'm describing are common or are the caused in other ways including supratentoral,
Posted by jamie on October 17, 1999, at 13:02:17
In reply to Re: jarrrrrrgonnnnnnnnnnnnnnn, posted by dj on October 17, 1999, at 11:27:31
I don't know these medical terms either. But I do know bipolar, carpel tunnel, and what lipitor is for. I agree with the other post that medicines you're taking are not the right ones. Whatever those other sypmtoms are that I don't understand will probably take care of themselves with the right medicine. I don't even have to know what all those medical words mean to say with some confidence they are all side effect related. I think a decent pharmacologist could sort it all out.
People here probably could offer more input based on experience if they could relate to the terminology. Regardless, it sounds like a drug choice issue to me.
Posted by Bob on October 17, 1999, at 17:38:00
In reply to Re: Bipolar Disease & side effects from med. therapy , posted by JohnL on October 17, 1999, at 4:42:34
... I only translate TLAs and the like.
Hi Richard,
I'm sure your RSI is far worse than mine, but the big question (of course) is what are you doing in terms of lifestyle changes to keep from activities or actions that make it worse? What kind of keyboard are you using? The "wave"-style keyboard works wonders for me. I used to get pain all the way from the tip of my left pinky through my arm to the middle of my back and neck, and my keyboard (and some better posture) has eliminated that pain. Before, I also had a special pair of fingerless spandex gloves designed for aleviating pain from RSIs. APS Technologies used to sell them ... I checked their site (www.apstech.com) but they weren't listed there. I sent them some email, so hopefully I'll get a reply I can pass along.
As for Lipitor, that's one of my five current meds right now (along with the psychotropes zoloft, nortriptyline, and clonazepam). I haven't experienced any muscle aches as JohnL talked about, and from what I know of RSIs I doubt that this side effect would cause a flare-up, let alone RSI-like symptoms in the first place. Again -- you're the doctor, so I shouldn't need to tell you this, but I'm getting this twisted sense of please giving a doctor the same lecture I got from my doctor ;^) -- what are you doing about lifestyle issues? I had problems with my chol levels before being on pmeds, but zoloft (and other ssris) aggravate it considerably. But for various reasons, I had to stay on zoloft, so I've been on Lipitor for the last four months or so. The main problem since I've started taking it has been GI upset (pardon me for mentioning but I think the amount of gas I've produced could easily light and heat all of Staten Island since I've been on Lipitor) ... nothing a little simethycone couldn't handle ... mostly. Hopefully some charcoal tabs will take care of the rest. Other than that, the Lipitor has been smashing my chol levels down ... I've also wondered this -- I don't know the mechanism by which Lipitor works, but I know my other meds can be hard on the liver. Can Lipitor actually alleviate some of the stress on that organ? Just speculating.
Anyway, the Lipitor hasn't adversely affected the efficacy of my SSRI, TCA, benzo cocktail, so I hope that eases some concerns.
Good luck!
Bob
Posted by Elizabeth on October 19, 1999, at 13:39:00
In reply to Bipolar Disease & side effects from med. therapy , posted by RICHARD MD on October 16, 1999, at 21:58:21
Hi, Richard.
I'm sorry to hear of your troubles! I hope you're able to get approved for disability without undue delay. (Don't give up on the first try; apparently it can be harder than it should.)
I take lithium too. Because I take it for unipolar (non-manic) depression along with an antidepressant, I'm probably taking a lower dose than you are. Serum levels vary quite a bit and can't always be predicted from the dose. (My last level was 0.5 mEq/L, which is on the low end for me and probably wouldn't be effective at all for you. I'm guessing your target level is somewhere between 0.8 and 1.4.)
Tremor is a common side effect of lithium, as you probably know. I use propranolol; some people need anticholinergics such as Cogentin. The visual disturbances and ataxia might be caused by either the lithium or the Klonopin; if they were started simultaneously, it's hard to know for sure. Certainly these are not so common for either drug. Polydipsia/polyuria is very common with lithium; sexual dysfunction is fairly common too, I think.
A number of drugs interact with lithium, and you probably will want to do some reading on that. (One that comes to mind is caffeine; apparently the thing to be careful about is withdrawing from caffeine too rapidly while taking lithium.) Klonopin is fairly innocuous in this regard (be careful with alcohol, which you should be anyway).
Take care, and good luck again.
Posted by Bob on October 19, 1999, at 16:15:38
In reply to Re: Bipolar Disease & side effects from med. therapy , posted by Elizabeth on October 19, 1999, at 13:39:00
Got the word today ... those anti-RSI gloves are no longer being made.
Dang!
Bob
Posted by saint james on October 21, 1999, at 4:02:46
In reply to Bipolar Disease & side effects from med. therapy , posted by RICHARD MD on October 16, 1999, at 21:58:21
> I am Ophthalmologist who has specialized in cornea and transplant work. During the past two years I developed problems from severe Carpal Tunnel Syndrome not correctable with surgery and was also diagnoses by multiple sources as bipolar.
James here...
Try these resources....
http://www.dr-bob.org/tips/ (put in bipolar for search)
and http://www.psych.helsinki.fi/~janne/ikg (the collected writings of Ivan Goldberg MD, more key word search)
Join the psycho-pharm list (For Doc's only)
Mail your request to majordomo@psycom.net
With subscribe psycho-pharm in the bo
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.