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Forum Name: Psychiatric Topics

Question: I REALLY need an answer-HELP


 hockeycatgirl - Tue Aug 09, 2005 4:56 pm

Okay,let's see if i can explain this well. For the past few months I have experienced a number of symptoms-upper abdomen pain,nausea,insomnia,pain in joints(right side only),headaches in one spot(back of my head),blurry vision,possible renal spasm an FATIGUE. I have had a number of diagnostic tests run-
CT of head-normal
MRI of head-normal
mri-c spine-normal
mra of head-normal
CT of chest-pulmonary lung nodule(this has been stable for 8 months,believed to be a granuloma)
Barium CT of abdomen and pelvis-normal except for a bit of centralized fluid in pelvis believed to be from a possible burst ovarian cyst and a 1cm cyst on my liver,i also have a large liver and spleen
Most recent CT from ER shows no change in any of this since April
All bloodwork-normal-this includes CBC,SED RATE,ANA,Epstein_Barr,Thyroid-ALL tests,Liver function,kidney function,amylase and lipase
I had my gall bladder removed last December-still have some pain in that area. Was diagnosed with occipital neuralgia by neurologist. Pulmonologist is following lung nodule-oh-tumor markers test came back normal as well. My primary care physician has ruled this as stress/anxiety/depression-does that sound reasonable? I'm taking cymbalta which has helped stabilize my moods. My son died 2 years ago of diffuse pontine glioma-is it possible my problems are psychological? Please help.
 DeLWolcott - Tue Sep 13, 2005 12:19 pm

How long have you been on the Cymbalta and how long have you had these symptoms?
 hockeycatgirl - Sun Sep 18, 2005 2:52 pm

I've been on cymblata now for about 2 1/2 months,I also take ambien occasionallyto help me sleep. My body doesn't seem to tolerate the ambien well,so actually i'm not taking it anymore as of about 5 days ago. The fatigue I feel is extreme,not normal-i'm tiredness. I feel so tired I have a hard time getting out of bed-it takes me about 2 hours to wake up and get out of bed. If that was normal for me I wouldn't worry about it,but I am normally a very high energy person who pops out of bed no matter how much sleep i do or don't get. My dr is certain that this is caused by depression and anxiety. My 10 year old son died just over 2 years ago-so that's where the depression and anxiety idea comes from. I had my gall bladder removed last december and I still get pain in the gall bladder area-under right ribcage and around to the back. I have very large liver and spleen,although all blood work comes back normal. I have no idea what to make of this. What do I do now? Any advice would be great-would give me a direction. Thanks so much.
 hockeycatgirl - Sun Sep 18, 2005 2:54 pm

I've been on cymblata now for about 2 1/2 months,I also take ambien occasionallyto help me sleep. My body doesn't seem to tolerate the ambien well,so actually i'm not taking it anymore as of about 5 days ago. The fatigue I feel is extreme,not normal-i'm tiredness. I feel so tired I have a hard time getting out of bed-it takes me about 2 hours to wake up and get out of bed. If that was normal for me I wouldn't worry about it,but I am normally a very high energy person who pops out of bed no matter how much sleep i do or don't get. My dr is certain that this is caused by depression and anxiety. My 10 year old son died just over 2 years ago-so that's where the depression and anxiety idea comes from. I had my gall bladder removed last december and I still get pain in the gall bladder area-under right ribcage and around to the back. I have very large liver and spleen,although all blood work comes back normal. I have no idea what to make of this. What do I do now? Any advice would be great-would give me a direction. Thanks so much.
 hockeycatgirl - Sun Sep 18, 2005 5:08 pm

I woke up mid May with what i thought was a virus-stomach nausea,fuzzy head-it went away after a few days-then I visited my dr about fatigue the 3rd week of May. When I say fatigue,I don't mean "oh gee,I feel sleepy"-it is the kind of fatigue where you have to unglue your eyes and it takes you a few hours to wake up. Very unnatural for me-I am normally a high energy,bounce out of bed person. Dr just put me on Nexium about 10 days ago,it helped the pain in my stomach,but not the nausea and I still have pain even though my gall bladder is gone. So,these symptoms have persisted since mid May. I feel physically weak,ill-I want to do stuff;I have a lot of plans,but I can't do anything because I feel so sick and tired. My Dr. says he's sure it's caused by depression-can I be depressed and not know it? Then,if it's caused by depression and I'm on depression meds,shouldn't I be getting better? I would love for a fresh pair of medical eyes to take a look at my posts and give me a reply. Thanks SOOO much!
 DeLWolcott - Sun Sep 18, 2005 9:21 pm

The Cymbalta could very well be causing all of these symptoms. Anything that affects serotonin has the potential of disturbing the liver, and anything in the "gut". Cymbalta is an SSNRI. Anti-depressants can make a person sleepy, or manic.

This was the reason I asked about the length of time for the Cymbalta. These symptoms can arise and tests come up negative. More questions for you:

1. Have you had any joint (ankle, hip, elbow, shoulder) pain that you had not experienced before?
2. Were you on any medication when your fatigue originally appeared in May?
3. How long has it been since your gall bladder removal?
4. Did you mention depression/anxiety/stress to your physician before he/she prescribed Cymbalta?

The right-sided pain and size of your liver point to the Cymbalta. The fatigue and inability to "get moving" point to the Cymbalta. Stomach pain, Cymbalta. Usually a person knows when they are "depressed" and yes, the Cymbalta should be helping that if you are indeed "depressed", unless your body does not metabolize the medication well.

Get back to your physician and ask him to look into the possible side effects. You can also go to Cymbalta's website and look over the prescribing information for yourself.

Last, but not least, if your physician does decide to try another form of medication, make sure that you taper down to zero as there is a very good chance (68%) of "discontinuance syndrome". Fancy name for withdrawal symptoms. You may not have any symptoms at all, but just in case. Keep in close contact with your physician or find another physician who may have a little more knowledge into the effects from these anti-depressants.
 hockeycatgirl - Mon Sep 19, 2005 1:01 am

First,let me say how much I appreciate your time and answers, Next ,I'll try to give some clear ,concise answers to your questions.
1. I have had joint pain that is new-elbow,shoulder, and hip-has occurred since taking cymbalta
2.The only medication I was on when the symptoms began was synthroid . It was my usual dosage i've been on for 10 years-I've had that checked and all is well there.
3.My gall bladder was removed in 12/04. Pathology determined it was chronically inflamed. My cholesterol is 150. I am 124 pounds,not overweight. The pain I had then is similar to what I still have ,much more intense though.
4.I did mention depression/anxiety/stress to the neurologist who prescribed the Cymblata,she is also aware of my current physical complaints,but hasn't indicated that she thinks the meds are responsible. I had a sleep study done-my son died 2 years ago and I haven't slept well since then. I am sad,it was a devastating loss-but I don't feel depressed. I do feel sick however,and I'm trying to get a direction i need to pursue.
As for the size of my liver,it was looked at by ultrasound in August or September 04 and had a HIDA scan. What I do not know is the size of my liver then in comparison to the size it is now. Possible fatty liver was mentioned in the ultrasound and a note was made borderline enlarged spleen. So there you have it in a rather long nutshell. Thx so much for responding.
 DeLWolcott - Mon Sep 19, 2005 9:55 am

You are very welcome. I hope that I can help in some way.

Joint pain - Cymbalta. Especially if you could term it as "phantom", or changing joints with no rhyme or reason. Lowering of the dose could help alleviate this.

If you are suffering from depression, yes, the Cymbalta should have shown some improvement with your symptoms of depression by this time.

Right-sided pain - Could be liver, but if the pain is in the same general area as your gall bladder, this could be scar tissue that is just not flexible. The exact location of the pain needs to be evaluated by your physician, my opinion being to start this evaluation with your Family Medicine or Internal Medicine physician if possible. I am not discounting your neurologist at all, but considering his specialty is nerves... There are times to go back to the ROOT of the tree to find the proper limb of medicine for different symptoms.

The side effects of serotonin-related anti-depressants are just now coming into light. Many physicians do not get the needed information from their drug reps due to several different reasons, including the physician not having the time to discuss every medication all the way to the drug companies only now admitting that these side effects exist. However, Cymbalta's possible reactions with the liver are well-documented in their prescribing information, which you can find at http://www.Cymbalta.com. It's an Adobe document, listed as "Prescribing Information" towards the bottom of the page. Might be a good idea to print a copy out for your physician to reference.

As for the root of the problem, it's been a year since your last ultrasound. Another ultrasound to check progression of liver and spleen size would seem sensible. Cymbalta is not the cause for the root problem, but it's probably not helping.

I wish you the best and continue to ask any questions I may have missed or I can research more for you.
 hockeycatgirl - Mon Sep 19, 2005 12:38 pm

This is wonderful to get such quick responses. My mood does feel improved with the cymbalta,the physical symptoms that took me to the doctor in the first place do not. The liver and spleen concern me,but don't concern my primary care dr or the surgeon who removed my gall bladder. My liver function blood work was normal in April and July. My surgeon ordered the upper and lower GI because of the pain I was still having in the liver/gall bladder area. Nothing unusual was found. I have mentioned this to my primary dr-he evaluated the area last visit about 2 weeks ago-said he didn't feel anything unusual and doesn't think it's a big deal. I kinda laugh sometimes-he is not insensitive-he is a good dr,but I'm wondering if i'm not expressing myself well or something because I seem unable to get across that I'm unable to live a normal life-i have said just those words and yet-i've been nauseous for 4 months. I just want to feel better. I find myself all over the internet trying to dx myself,because I feel like the root of the problem has not been found. I understand that this isn't an exact science and my body doesn't seem to be giving out much info,but I appreciate just simply a direction to look. I did just call my primary care dr and I'm waiting to hear back from him. I expressed the symptoms that are bothering me and I would like further evaluation-either with him or a gastroenterologist. Sometimes a fresh pair of eyes can walk up to a puzzle and find the missing piece. I have had any number oc ct's over the past year,it seems like a comparison of spleen and liver should be already very available. Anyhow,your suggestions are appreciated.
 DeLWolcott - Mon Sep 19, 2005 1:19 pm

Fresh set of eyes can usually find my car keys. :wink:

Scar tissue could still be an option as a source of the pain. Nausea could be something as simple as something in the inner ear, such as allergies. I'm glad that there have been follow-up scans in the past year.

Anxiety/stress could also be causing the nausea, but if you don't feel you have an excessive amount of anxiety/stress/depression, all other options should be checked. Still keep a check on side effects from any medication alongisde your history and symptoms.

Keep in contact with those docs and surely something will poke its head out long enough for them to diagnose the problem! Again, you are very welcome. :)

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