Cardiology And Neuro Appts

[MightyMouse]

Hi All,

two appts yesterday--

neurology: he was bummed that Teri couldn't come b/c he wanted her input on my memory problems; she in St. Louis running a conference. Doctorguest--I know you expressed concern that perhaps the memory stuff was the general anesthesia 2x in a week--which certainly didn't help, but the issues predate that by a year and are getting worse. What concerned him most was that when someone gives me more details from things I've forgotten, I still don't recall. He ordered a new set of EEG's, a new brain MRI (last one in 2005), and a full neuropsychological evaluation.

ep cardio visit at U of Penn--went b/c I've been having near syncope from things that didn't used to provoke it, like getting from a seated position to standing...also, I have been having fluttering with my heart for the past few months that last just a moment, to a 5 or so seconds especially under exertion. He believes that Cozaar has been bringing my bp too low overall, not just in the Summer (I've had to stop taking bp meds in Summer before), and that my symptoms (both near syncope and fluttering) were from an overflow of catecholes trying to counter the low bp. So, it's off the Cozaar for now, and a bp log to bring with me in Sept for my stress echo. He said that if I'm feeling more functional, we may just have to tolerate the high end of the bp range. If not, then we may go for a very low dose of florinef, which used to work for me in the past.

actually had 3 appts yesterday --PT too, but nothing new there other than more exercises! Long day!

Nina

[doctorguest]

Hi Nina,

Have you had basic lab tests done recently, like an electrolyte panel, thyroid function tests, and serum vitamin B12 level? In a young person, such as yourself , cognitive complaints are likely to be secondary to metabolic/hormonal abnormalities and not a primary memory disorder, i.e. Alzheimer's.

A second possibility is the medication side effects. From your signature list, I see a few medications that can cause memory disturbance. One known culprit is Benadryl - that's a common one if taken continuously for prolonged periods of time. Cyclobenzaprine is another one that can cause memory problems. If you're taking any other pain medications on a regular basis, which I think you are, some of those may have the same effect.

I doubt that you have a seizure disorder, so EEG most likely would be normal for you. Neuropsychometric testing is a good idea to get, although prepare to be tested for 6 hours!

Finally, another cause may be a sleep disorder. What are your sleep patterns? Chronic insomnia or obstructive sleep apnea can cause a wide range of problems during the daytime, including memory impairment. Well, I hope I gave you some "food for thought." I am sure your neurologist is already exploring these possibilities.

[MightyMouse]

Yes, we did the blood work before this appointment, and the only possible finding was that my blood sugar was a little high, but I hadn't been fasting, so that's likely. The neuro and i expect the eeg to be normal too. I hear ya on the neuropsych being long... i had it done 2 x, once before and once after my spinal fusion. My cognitive skills improved as did my speech/swallowing.

Benedryl- i've been taking the same dose for many years without problems. I take flexeril less than once a week...and oxycontin even less than that; maybe once every 2 to 4 weeks?

actually, the most sensible would be sleep disturbance--sometimes from pain; but Teri will tell you i snore like a buzz saw, but not always. I had a sleep study many years ago and it was 'normal'. I wonder if it wouldn't have been as 'normal' if I was allowed to take my normal meds or drink my coffee the morning before the test... my body was in an 'abnormal' state for me. does that make any sense?

Nina

[doctorguest]

I'd go with another sleep study and with your "normally abnormal" habits - i.e. coffee, meds, etc. Regarding Benadryl, that's exactly what I meant - taking it for years may cause memory disturbance in the long run. It's a known anticholinergic and all of the anticholingergics taken for a long time are bad for your brain! Do you have to take it? Would be good if you could discontinue it or take it on as needed basis only.

[MightyMouse]

I could probably go off of benedryl briefly, at least until ragweed blooms here -- and then i'll need to be on it until first frost. I was on it for sleep and because my allergies had gotten out of control a few years ago with hives all the time. Also, i've had trouble getting any of my docs to write for ambien long term, other than Dr. Grubb, and I've not been able to get out to see him in a few years.

nina

[mkoven]

Doctorguest--I wanted to ask what you mean by anticholinergics being bad for the brain. I've also been having some memory issues that are new-- remembering names, concentrating. I assumed they were hormonal, but maybe not-- haven't yet talked to a doc. But I am on a lot of antihistamines and have been for a year-- zyrtec 10mgs, allegra 180 mgs, both dailys, and benadryl 25-50 prn (usually about 3 times a week). Could those antihistamines at those doses be the smoking gun??? Are zyrtec/allegra less likely to cause problems because they are nonsedating (in principle)?

[pat57]

doctorguest,

me to, as I am on Norpace- longterm.

thanks!

[doctorguest]

Hi guys,

Didn't mean to alarm everyone with the statement about anticholinergics, but it's true. Mkoven, new generation of allergy medications - zyrtec, allegra - typically do not have the same effect as benadryl on cognitive function. Benadryl, being a first generation of allergy meds, has a potent anticholingeric effect. Usually benadryl is used on "as needed" basis, but if you have a severe case of allergies and your allergist recommended benadryl on a daily basis for extended periods of times, then I guess you have to do what you have to do. Taking benadryl intermittently, like 3 times/week, is definitely better than taking it daily.

Obviously, complaints of memory difficulties are common and require complete evaluation from your doctor. These can be caused by various medical and psychological conditions/states (including depression and anxiety). Long-term benadryl use is definitely one possibility in a patient with cognitive complaints, but in the same patient, other conditions can also be the cause or a contributing factor.

Pat57, I am not aware that Norpace can cause memory problems.

[flop]

Doctorguest,

sorry to carry on the anithistamine / anticholinergic theme. I take Acrivastine tds and have taken it continuously for >2years (prior to that was on Fexofenadine for 9 months per year for 5 years, and other antihistamines prior to that). I know that acrivastine isn't available in the US (there are 3 different antihistamines sold under the brand name "Benadryl" in the UK - acrivastine, clorpheniramine and cetirizine) but I was wondering if it could cause cognitive problems when taken longterm?

Thank you,

Flop

[pat57]

flop,

this site has a list of anticholinergic medicines

http://www.innerself.com/Health/medications.htm

[Maxine]

Wow!

I would have never guessed some of those medications as causing memory problems.

Something to think about.

Thanks for the information Doctorguest and Pat57.

Maxine :0)

[doctorguest]

Hi Flop,

You're right, we don't have this medication in US, so I have no experience with it and not aware of its side effects. I suppose that if it has similar properties to diphenhydramine (aka Benadryl), that it may also have similar side effect profile.

Maxine and Pat, I just want to point out that anticholinergics DO NOT CAUSE memory problems, rather these MAY CAUSE memory problems/cognitive complaints. I should have provided more details in my original statement. Furthremore, elderly patients are more at risk for these POSSIBLE problems than younger patients because "older" brain is different than "younger" one, to put it in crude terms.

I also want to say that subjective cognitive complaints are very different than objective evidence of cognitive impairment. Everyone has a moment of forgetfulness here and there, some perhaps more than others. Add a chronic illness, like POTS or NCS, to the mix, and those "moments" can become more frequent. This DOES NOT in any way signify a cognitive disorder or abnormality by any standards. This is why Nina is referred for neuropsychometric tests - to establish whether there is objective evidence to her complaints.

Another very important point is that having poor concentration/poor focus is not the same as having memory problems. I want to reassure everyone here that you are not loosing your memory.

[Maxine]

Thanks doctorguest---

I know what you meant, but I still thought the information was interesting.

I have some memory problems, but I still think I do fairly well for dealing with all the health problems I've been dealing with.

I'm worse with lack of sleep----a lot worse. Having sleep apnea doesn't help. My apnea is caused from malformed larnyx area, and I also stop breathing when I sleep on my side.

My neck is a wreck from the EDS, and my EDS doc thinks my apnea could be related to that. I don't fit the usual apnea profile. I have a few brain lesions, but they are small. However, the radiologist thought I should be evaluated for a possible MS or small vessel ischemic disease. This was a while ago. the local neurologist said migraines prpbably caused the leasions------but I don't have migraines--------- Any headaches I get are at the base of my skull.

My memory problems get worse the more I try to do physically----even sitting up too long. My speech is affected also.

Although the meds I take are on the list of causing POSSIBLE memory issues, I don't think they have affected me. I've been on the beta blocker since 1990, and I worked for 10 years with no memory or cognitive problems on it. My memory problems have been more recent.

Maxine :0)