doctorguest

Although the advertisement for Straterra emphasizes that it is a non-stimulant, it is still a NorEpi receptor inhibitor and with its vasoconstricting properties, it may also act on cardiac receptors and possibly exacerbate arrhythmia. I would be cautious in trying Straterra if you cannot tolerate caffeine. Perhaps you can start on a pediatric dose and see how you do with the drug before going up to the adult therapeutic dose.

Interesting response. I will have to read their entire article to comment further, but I wonder how they defined "hypotension" and how they selected their subjects. Hypotension is very common among healthy asymptomatic women, but certainly it seems even more prevalent in young adult patients with autonomic dysfunction. I share with you your skepticism about that particular statement.

Angela, I remember you mentioning taking Zofran for nausea. Just wanted to let you know that constipation can be a side effect of Zofran. Regarding the X-ray interpretation, it's not uncommon to see stool in the colon and rectal vault on the X-ray without actually having the urge to go. You've got some excellent suggestions for treatment of constipation from others. One other thing that I want to mention is that Mestinon can be helpful with improving swallowing as well as promoting peristalsis of the bowels - i.e. a side effect of Mestinon usually is diarrhea.

Congratulations on your pregnancy! There have been several case reports published on the topic of pregnancy and labor and delivery in women with POTS. Most involve either an elective C-section or some type of intervention during the labor. These reports are just isolated cases and by no means represent the standard of care or practice. However, these do raise awareness as to the special precautions and considerations that should be made for women with POTS who is ready to deliver. I know that spinal block, which is the type of anesthesia typically used for C-section, can have various side effects because it induces a block of all of the outflow information - sensory, motor and autonomic - below the upper thoracic level, whereas the epidural block has much less consequences because it blocks sensation at the lumbar level. I am also aware that in certain cases, a C-section can be done under epidural rather than spinal anesthesia, but this should be discussed in details with the OB and an anesthesiologist who will be performing the procedure, if this is elected as an option. I think the choice ultimately depends on your POTS status now and immediately before pregnancy, as well as the general pregnancy status, size of the fetus, number of prior pregnancies/deliveries, etc. Additionally, as you get closer to the due date, things may also change to influence whether vaginal delivery or C-section is indicated. One other thing that I want to add is that natural birth without analgesia may not be the best choice for POTS patients, in my opinion, since pain is a very strong stimulus that normally causes BP and HR changes in a healthy person. However, for a woman with an autonomic dysfunction, it may create an even bigger problem during the labor and delivery. Good luck with the rest of your pregnancy, and I hope your labor and delivery goes smoothly.

A nutritional deficiency certainly sounds like a possible cause of your symptoms. Have you had your vitamins and minerals level checked? Are you taking a multivitamin? Hope you get some answers soon.

Thyroid function tests are the most routine lab tests; these are typically done first, along with blood counts and electrolytes, for evaluation of any problem. You should definitely get tested for thyroid function and adrenal function either from your PCP or an endocrinologist.

Sophia, don't apologize, you didn't hijack my thread because it was not mine to begin with . I posted the information for others because it seems that quite a few people with dysautonomia are also treated for Lyme disease. It's always wise for people to be armed with the most updated research information to then discuss it with their doctors. Together they can then make informed decisions about their treatment.

Migraine is now thought of as an event mediated by the autonomic dysfunction. Beta blockers have been used to as preventative medications for headaches. There can always be unusual reactions, such as what you're having with the use of Toprol. Switching to another beta blocker, like propranolol or atenolol, may be wise. Since your doctor was able to diagnose you correctly, she/he should know what the next step would be. Another thing is that XL may not be the right form for you, and trying regular release tablets may help you to understand when/how it causes the headaches in relation to the heart rate and blood pressure at that time.

Cardiactec, If you have questions/concerns about your rash, I'd suggest asking your PCP to request a dermatology consult. Dermatologists are best qualified to evaluate a skin condition.

Hi everyone, I am glad that you found the information useful. Everyone raised good questions, but for the sake of time, I'll concisely reply that the link and the abstract posted by Pamyla are obviously very abbreviated versions. The full-text article provides great details to the methodology - i.e. selection of the particular studies, their data and the conclusion reached in analyzing the combined data from the included studies. I do want to point out that these Practice Guidelines are written by a group of highly qualified scientists-physicians from very reputable institutions in the US and Europe. This group, called Practice Committee, gathers to review and discuss the best available data in the current scientific literature and then provides a summary of the available data on a specific topic which results in these guidelines. This is extremely important in medicine because it determines how physicians provide patient care and ensures that they are armed with the best scientific evidence to do so. Having said that, these are just that - guidelines, not rules etched in stone. Thus, there are some situations where cases are evaluated and treated on an individual basis, but in general, it's imperative for physicians to review the Practice Parameters to make sure that what they do for patients is compatible with the recommendations set forth by the professional organizations. I would say that until future studies demonstrate otherwise, the conclusions reached by the practice guidelines are the best evidence we have right now regarding Lyme disease treatment.

Hi everyone, I just received this by E-mail. It was embargoed for press release until 4 pm today, so this is extremely hot off the press. The guidlines are from the American Academy of Neurology. Hope this link works. http://www.aan.com/press/index.cfm?fuseact...amp;release=514

I don't think MRI or the contrast are the cause in this case. You've probably did "work youself up too much". Hope you feel better.

"Is it okay to say, at this point, I don't care WHY they are working, I just know they are working?? That is a question for those who disagree with my choice to think about" Emily, It is perfectly OK to continue treatment that seems to be helping regardless of the cause or the mechanism of action. There are plenty of similar situations in other diseases: we don't know why or how, but it works, the risks and benefits are understood, the patient and the doctor are both aware of these, and that's what matters. In terms of "chronic Lyme", this can occur if Lyme is untreated for a period of time, and typically there is clinical evidence to this, as well as laboratory evidence with blood tests and also Lyme being present in cerebrospinal fluid (CSF). My personal opinion is that if a blood test/CSF test performed at a major academic institution is positive for Lyme, then I'd treat it as "chronic Lyme". Conversely, if it is negative, I will not likely to proceed with antibiotics treatment, although each case should be evaluated on an individual basis, and perhaps, in a case such as yours where all other treatment options were explored and had failed, then I may consider using a low dose of certain oral antibiotics but not for the treatment of Lyme, but rather for a trial of possible improvement due to its anti-inflammatory and neuroprotective properties. There is some evidence in literature that, for example, minocycline - from the same category as doxycycline - may help patients with ALS and other neurodegenerative disorders. In fact, I believe there is a trial in Europe of minocycline for ALS, MSA and other diseases. There have also been some studies showing benefit of erythromycin in patients with fibromyalgia. Thus, when I hear that people with certain types of autonomic dysfunction are improving with the use of antibiotics, I attribute the improvement to these yet unknown properties of antibiotics rather than treatment of "possible" infection which is hard, if not impossible, to prove serologically. I hope you continue to improve with treatment to the point of complete recovery! You're completely justified in your decision - when all else fails, one is willing to try almost anything in hope of an improvement. It may not be the right decision for someone else, but it is for you, and you have nothing to feel bad about.

How soon after the injection did you start to experience symptoms? Gadolinium reactions typically occur within 20 min after the administration.

Here is something else to consider in cases where people get better with antibiotics: Some antibiotics have anti-inflammatory and other, yet unidentified, properties that perhaps may influence the peripheral nervous system, neurotransmitters, etc. My personal opinion, unsupported by any concrete data because there is none at this point , is that the prevalence of the actual Lyme disease is probably less than what's being diagnosed, i.e., Lyme is probably over-diagnosed by LLMDs. Thus, the fact that the antibiotics treatment is working for some people does NOT in reality support an infectious agent as the cause. There are clear risks with the extended use of antibiotics - thus, physicians loose licenses, etc. - so this is not like taking vitamins. I will not get any further on this controversial topic, but I will say that the first rule in medicine is to do no harm. It's unfortunate, and in some cases, illegal, when greed, ignorance, ego, etc., override this rule.

The first thing to do is to check whether the original MRI of the cervical spine was read by a general radiologist or a neuro-radiologists. There is a very specific criteria for a radiographic diagnosis of Chiari I malformation, and there are many radiologists who overcall the finding. Thus, there should be a distinction between "low-lying" cerebellar tonsils vs. frank Chiari I. Secondly, if you scan 100 people walking down the street without any neurological complaints, some WILL have Chiari I, which is asymptomatic clinially in many cases. Third, there is a specific symptom complex associated with Chiari I malformation, and in most cases, it doesn't include POTS. Fourth, intervention for Chiari I includes decompressive neurosurgery, and this most often is used as a last resort, when all other treatment options fail. You can give a copy of the report to the cardiologist, but it is probably useless, as this is not their area of expertise. If you want to confirm whether or not you have a radiographic finding of Chiari I malformation, I would suggest getting your original films, preferably on a CD, and then ask your neurologist to send it for a second opinion to a qualified neuro-radiologist for interpretation. Even if Chiari I malformation is confirmed, there may be no therapeutic implications of this finding in your case, as outlined above.

No, there is no connection between POTS and your skin condition. Consider seeing a dermatologist for further evaluation and treatment.

Cymbalta is a popular medication these days in the US and is used for many purposes. You stated that you felt "high" after you had started on Cymbalta and from what you wrote, this feeling lasted about 6 months, while now you have a very low mood. This is interesting and definitely should be addressed by your physicians. I am not diagnosing you, so please, do not think that you have bipolar disorder based on the following statement, but you may have a similar reaction nevertheless. Many patients who have bipolar disorder can feel "high" and accomplish many things with little sleep when they first start taking an SSRI/SNRI, while eventually returning to their baseline mood. This is why if one has a bipolar disorder, they should not be on an antidepressant alone and should always be on a mood-stabilizing agent as well. Again, I am not saying that this is your case, but just pointing out a well-known example in medicine where this does happen - in bipolar disorder. I hope you get back to your functional state soon. Good luck!

Startle response is mediated by many structures, including parts of the brain, as well as the peripheral autonomic nervous system. It's a very primitive reflex that is also a component of the "fight and flight" system. Increased startle response can be seen in many neurologic diseases, but what is pertinent to this discussion is that it can indicate "an overactive state of alertness". It can also be associated with anxiety states, as both anxiety and autonomic dysfunction are mediated by the same output system.

Congratulations on your recovery! You state that you found the right physical therapy to restore your orthostatic tolerance. Can you share what type of exercise have you been doing, other than propping up your bed? Have you been taking any medications for orthostatic hypotension? You also mention that your circulation is now normal. Have you had any studies to demonstrate this, like a repeat tilt table test? I think the answers would be very helpful to others. Thanks.

Hi Tessa, You've already received some excellent advice. I agree that a consultation with an allergist for allergy testing is in order. One other thought is that the injection that I assume you received as an analgesic treatment for a painful shoulder likely contained a high dose of the two medications, whereas in the dental office, they use a significantly smaller amount for anesthetic purposes. Of course, if you do have a true allergic response, the amount of substance may not matter that much. If you suffered a vasovagal syncope and reaction that is NON-allergic, however, then you may have no problems with dental anesthesia even though you've reacted poorly to the shoulder injection. In any case, an allergy testing for novocaine/lidocaine would differentiate whether you have a true allergy to that anesthetic or a non-allergic reaction. Hope you get answers soon to alleviate your worries. By the way, as you stated, I would not blame your doctor for injecting you with these drugs, but I would expect at least a short discussion about possible side effects from any physician who either gives you a prescription for a new medication or injects medications in the office.

Jacquie, I hope your doctor's appointment is productive. Usually an allergist would wait until your system calms down before doing a full scale allergy testing with multiple allergens administered. In what context did your second reaction occur? In a situation where recurrent episodes of some type of reaction take place, a full allergy work up is necessary. In terms of treatment, you doctor will probably choose among benedryl, allegra, zyrtec or claritin to address your symptoms.

Reactions are often separated into "allergic" vs. "non-allergic" categories. Since you have not received any contrast, which would be an obvious source of allergens, then one should look for possible contact materials that may have touched your skin on the chest and cause hives. Did you have a rash on your chest only? Or did you also have rash on your face, arms, legs? What type of rash was it? Were these raised, itchy lesions? Or was it more like a flush with continuous redness on the skin? Cardiactec's idea about possible contact agents - whether from cleaning solutions used for MR table or on the hospital gown itself - is reasonable. Another possibility is non-allergic reaction. Do you have a mast cell activation disorder? With this type of disorder, histamine release from mast cells can be precipitated by a variety of circumstances, including emotional stress. This is not the same as being caused by anxiety or "nervous reaction", but rather, emotional stimuli can trigger a response that is similar to what people call "allergic reaction", despite an absence of a specific causative allergen. I notice that you said that you had an open MRI. Are you claustrophobic and could not have a closed MRI? Also, have you had similar reactions under other circumstances, such as other types of emotional or physical stressors, eating spicy food or chocolate or drinking wine? These can often precipitate a reaction due to mast cell activation disorder, which is sometimes associated with autonomic dysfunction. Hope you are feeling better, doctorguest

Deucykub, Yours is a pretty accurate understanding of the disorder. Unfortunately, many medical conditions have unknown mechanism and symptomatic treatment only. The difference is that conditions of the autonomic dysfunction is a relatively new field in medicine, and therefore, recognition and knowledge of these disorders by mainstream physicians is limited compared to the well-known conditions, although younger physicians appear to be much more knowledgeable in these because of better education and training in the area of autonomic dysfunction now compared to 10-20 years ago.

Did you have IV contrast injected prior to experiencing a reaction?