What the hell is going on with me
May 11, 2010 1:22 PM   Subscribe

Followup to an earlier health-related question. Kind of long; more under the cut.

This is a follow-up to an earlier question.

On the advice of family members and answers from the earlier question, I saw an endocrinologist. He seemed to think everything was normal, but ordered some blood work just to be sure. Those numbers came back within normal ranges. I lost my copy of the report, though I will have another copy by tomorrow, and missed the follow-up appointment (these have to be booked months in advance), but my psychiatrist seemed to think everything was OK when I handed him the report to go over as part of an evaluation before starting ADD meds.

In the meantime, I'm still feeling tired and run-down most of the time, and alternate between barely sleeping at all and sleeping for ten or more hours at a stretch. I'm on a 40mg dose of Vyvanse for ADD, and while it helps me focus and stay on task, I get tired and confused doing simple things, and my short-term memory is shot. Today alone I've forgotten a co-worker's name, locked my keys in my car (for the first time in my life), made a mistake taking a customer's order that cost $50 to fix, and all that before 2:00. I've also had trouble speaking clearly, which is a problem since my main duty at work is phone service- I find myself slurring a lot.

The depression is still present, and often alarmingly sudden in its onset. I'll be at work and suddenly be hit with a crushing feeling of hopelessness, and often won't be able to stop myself crying at my desk. This can last for hours, and has sometimes been so bad that I end up taking a high dose of Trazodone and some wine and going to sleep at seven or eight o'clock just to make it stop.

The skin problems have also gotten worse. I'm continuing to shed hair, but now it's more noticeable and there are frequently pieces of skin attached to the root or along the shaft of the shed hairs. On closer examination, they also look like they're splitting or "peeling"- not split ends as such, but very fine fibers splitting away from the hair about halfway down. And over the past couple of weeks, I've somehow gotten a red rash along my eyebrows, on either side of my nose and mouth, and most of my scalp. It flares up painfully, seemingly when I'm tired or stressed, and if I don't wash my face with dandruff shampoo it constantly flakes.

And last of all, I suspect this doesn't have much to do with anything, but on the off chance it makes someone go AHA!, I've been having a lot of stiff, popping joints- my neck, knees, shoulders, wrists, hip (when I cross and uncross my legs), everything. It's not painful, and probably not significant, but it's new, and so maybe worth mentioning...

I'm bringing up the depression with my psychiatrist, on the off chance it's a side effect of the Vyvanse, and I definitely need to at least see a dermatologist about the skin problems, but is it worth pursuing the endocrinology angle if my lab work came back OK?

And second, how exactly do I find a good dermatologist? The last one I saw definitely didn't inspire any confidence- examined my head for less than five minutes, didn't ask any questions, and very confidently and authoritatively wrote a prescription for medication that ended up doing nothing.
posted by Merzbau to Health & Fitness (10 answers total) 1 user marked this as a favorite
Lyme disease?

I don't know if you are located in a place that even has Lyme disease, but all of the symptoms which you mention have occurred in various family members who have later been diagnosed with Lyme. I hope you don't have it, but it might be worth looking into...
posted by kataclysm at 1:35 PM on May 11, 2010

I don't know what blood work your endocrine specialist ran. If you didn't get a vitamin D level taken, you might consider asking to have it checked-- vitamin D deficiency can cause cognitive problems and exhaustion as well as aches and pains.

Other specialists who might be able to pinpoint a cause for your symptoms include rheumatologists (who handle autoimmune disorders, fibromyalgia, and joint issues), infectious disease specialists (Lyme disease and the like), and neurologists (the slurring speech is something they would be interested in finding a cause for, as well as your cognitive difficulties).
posted by fairytale of los angeles at 1:51 PM on May 11, 2010

Have your doctors considered lupus?
posted by vytae at 2:36 PM on May 11, 2010

Do you have a good gp? That seems incredibly important to me . If you can find one a nurse practitioner would likely spend more time with you. You should definitely be checked for Lyme.

Totally off the wall suggestion: you have a lot of the same symptoms a friend had when she had lead poisoning. Acquired from her backyard vegetable garden.
posted by fshgrl at 2:42 PM on May 11, 2010

Short on time, but your symptoms sound a lot like low thyroid. Please look at the recommended labwork for hypothyroidism here. Note: It is not always as easily diagnosed as endos would have you believe, and you will want to make sure free levels of T3 and T4 are tested. I hope you find what helps you.
posted by vers at 3:37 PM on May 11, 2010

How long have you been on the Vyvanse? ADD meds can cause almost all of your symptoms. I've found that when I'm off my meds, I get more cranky or emotional for no good reason. I know you say you take yours, but do you take them with orange juice or some other acidic food? That can kill the efficacy of my Adderall and thus leave me foggy-headed.

It sounds like you possibly just started them, which would make my point moot. However, you might inquire as to a possible dose increase, especially if you're "crashing" at a certain time in the afternoon (or to split your dose and take one early, one later....it's what I do).

Have you tried SSRIs? They are pretty low risk for a possible great payoff. The ads on TV that say "Depression hurts" are not joking. It can hurt, and cause many of the physical symptoms you are exhibiting. Also, certain SSRIs and SSNIs can help you with your anxiety which you mention you have had a history of....perhaps killing two birds with one stone or at least eliminating one or two diagnoses from the differential.
posted by nursegracer at 11:02 PM on May 11, 2010

Response by poster: I've been on the Vyvanse for about a month, and had my dose upped from 20mg to 40mg after the starting dose wasn't having any effect. I take them every day shortly after 9 AM, and stay away from highly acidic foods for other reasons (they can upset my stomach early in the morning).

I have tried SSRIs and other antidepressants before, but never found one that worked consistently and didn't have unacceptable side effects. The latest was a course of Pristiq, which only made things worse.

I'm going to see if I can get an appointment with my GP as soon as possible to at least discuss the skin problems, because they fucking hurt- right now I feel like I have sunburn across my entire face, scalp and partway down the back of my neck. And no, I know it's not sunburn; I barely go outside and use sunscreen when I do.
posted by Merzbau at 11:12 PM on May 11, 2010

Try using Burts Bees shampoo or another shampoo that doesn't contain sodium laurel sulfate. It's not enough for it to say no sulfates. Look specifically for no SLS. Look to see if whatever face wash you are using has SLS as an ingredient as well. It is a foaming agent used in shampoo, face wash, and toothpaste and it is commonly known to cause itchy scalp, and even mouth ulcers if you are allergic to it.
posted by tamitang at 12:01 AM on May 12, 2010

So I'm not sure if you're already aware of this, but there's kind of a saying in medicine:

"If you hear hoofbeats, don't think of zebras."

Think of horses. Lupus and lyme disease are zebras.

(There's an important rejoinder to that though: Sometimes hoofbeats are actually zebras.)

All of your symptoms can be explained by depression. I can't say that all of them are due to depression though.

Sometimes, family docs miss thyroid problems, but they're endocrinologists' bread and butter. If an endocrinologist said you don't have thyroid problems, then I'm inclined to believe them.

It sounds to me like you're working carefully with a doctor, and are frustrated that your problems aren't resolving, and that new symptoms may be developing. It doesn't mean that your doctor is missing anything. Sometimes, depression takes a long time to treat. Sometimes, people treated for depression don't get better. There is, however, always the possibility that your doc is missing something, even if your doc is a very caring person that you work well with.

The second most likely cause of your symptoms is your medications. This stuff doesn't always work the same for everybody; drugs intended to improve mood or attention can sometimes degrade them.

I don't believe that you need to see a dermatologist. If you'll forgive me being a little silly, they're all bad :) The problems that you describe can probably be treated by a family practitioner / GP. If they can't, the doctor will refer you to a dermatologist.

If you've been in treatment for a very long time and feel hopeless, and have been working with a single doctor, you need to talk with that doctor about those feelings. There's nothing wrong with second opinions, and docs realize that; anyone's capable of missing things. If you express your worries and what you want to happen, your doctor will be supportive and will help you find a way to make that happen.

If you are just seeking better strategies to get this thing taken care of, I'm going to recommend a symptom diary. Now, this diary isn't going to be very much use if nobody reads it, so you have to be super concise, because you know how doctors are :) Every day, you should rate your mood, on a scale of 1-10. You should address each symptom (hair, skin, attention) in a similar way. Significant events, like passing out, should be included in a day's entry. This diary will allow you to establish a baseline for evaluation of treatment changes, because our memories are faulty (yesterdays so often seem greener, don't they?)

If you find yourself unable to keep this diary for some reason, but agree that it would be useful, then you have to enlist help. Have there been any people that you've been sharing this information with in the real world? You want to pick the one you trust a lot and tell them that you need their help.

When is your next doctor appointment?
posted by nathan v at 12:26 AM on May 12, 2010

Response by poster: I'm regularly seeing my psychiatrist to stay up to date on my meds, potential side effects, etc. My next appointment is in a little over a week. I've been treated for depression for a little over half my life (I'm 26), and what concerned me about these recent attacks was the severity and the sudden onset. They've been coming for a few months now, during periods when I've been unmedicated, on Pristiq, and on Vyvanse, with the only noticeable difference being that Pristiq seemed to make them harder to deal with.

I'm not a doctor, obviously, but I doubt it's Lyme disease, since I live in suburban New Jersey and haven't been near a wooded area in years (and wear long pants year-round and long shirts on all but the hottest days of summer).
posted by Merzbau at 7:40 AM on May 12, 2010

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