Thursday, November 3, 2011
Day 3
It's Day 3 and I'm still tired and sleepy. The Ativan seems to be effective at keeping my anxiety levels down despite it being the weakest of the benzos I've tried. The sedation isn't the worst, but I'm not as energetic as I would like. I'm having issues focusing on work-related tasks. It's hard to get going. Difficulty concentrating and getting organized.
Wednesday, November 2, 2011
Journaling Again
I really should have started this when I began seeing my psychiatrist. I could have had a daily record of how certain medications made me feel at certain dosages and in combination with other meds. But I'm here now, and I always think it's better late than never.
Anyway, I started seeing my psychiatrist in late September after 4 weeks of getting nowhere with my family doctor. I had been on Celexa with nothing to show for it except jaw clenching and insomnia that eventually turned into fatigue. The type of fatigue that even 12 hours of sleep can't quench. It was awful.
My psychiatrist doesn't take insurance. I put off seeing a specialist for a long time for that very reason. But by now I was desperate. I came to terms with the fact that I can't put a price tag on my well-being. So, I made my first $300 appointment to see her, and it was the best decision I've made on the road to getting better.
She started me on Zoloft and Klonopin. Immediately I noticed my anxiety levels come down to a point so close to normal that I haven't felt in a long time. Within a few weeks I was able to return to work after extending my maternity leave an extra 6 weeks. Driving anxiety has also lessened, I wouldn't say it's non-existent, but it's gotten easier. I even drove on 495! That's huge for me. Especially with all the new traffic patterns and areas without shoulders due to all the road construction.
So the most recent news about the medication is that it was making me really sleepy again, like the Celexa made me, but not as bad. She prescribed Wellbutrin to energize me without making me feel anxious. I felt like it worked for about a week and then I started feeling tired again. She suggested I take double my original dose for a few days and see how I felt. The extra dose made me more anxious and gave me a panic attack so bad I actually called 911. Super embarrassing. But at the time, all I could think of was if something happened to me, no one would be around to take care of the 4 month old that I was holding onto at that moment. I called for him, really.
Anyway, I met with my psychiatrist this past Monday and we discussed everything. She admits she has a difficult time managing my symptoms because I am so sensitive to medication. And the fact that I am still breastfeeding doesn't make it any easier, as she has to be sure that the medications are safe for babies as well. We came to the conclusion that I would again increase my Zoloft dose from 50 to 75mg. Stop taking Klonopin, as it may have been causing the extra sleepiness. She prescribed Ativan instead because it was supposed to be a weaker benzo, but she said if it wasn't keeping me calm enough, to go ahead and take the Klonopin again. Then she prescribed Wellbutrin 150 - the middle road between the 100 that worked at first and then stopped, and the 200 that caused my panic attack.
I have been on this regimen for 2 days now and so far I am feeling pretty good. I can't give a firm verdict on how the Wellbutrin is helping with the somnolence just yet because I had two beers with my husband yesterday and those pretty much knocked me out. So last night doesn't count. I'll see how I feel when I try to wake up tomorrow and decide how this cocktail is working for me then.
Overall though, I am not feeling the anxiety or panic physical symptoms which is a plus. And in all honesty, I would trade the anxiety for the tiredness any day. I just still have high hopes that I can be as close to normal as possible. I'm at least shooting for it.
Anyway, I started seeing my psychiatrist in late September after 4 weeks of getting nowhere with my family doctor. I had been on Celexa with nothing to show for it except jaw clenching and insomnia that eventually turned into fatigue. The type of fatigue that even 12 hours of sleep can't quench. It was awful.
My psychiatrist doesn't take insurance. I put off seeing a specialist for a long time for that very reason. But by now I was desperate. I came to terms with the fact that I can't put a price tag on my well-being. So, I made my first $300 appointment to see her, and it was the best decision I've made on the road to getting better.
She started me on Zoloft and Klonopin. Immediately I noticed my anxiety levels come down to a point so close to normal that I haven't felt in a long time. Within a few weeks I was able to return to work after extending my maternity leave an extra 6 weeks. Driving anxiety has also lessened, I wouldn't say it's non-existent, but it's gotten easier. I even drove on 495! That's huge for me. Especially with all the new traffic patterns and areas without shoulders due to all the road construction.
So the most recent news about the medication is that it was making me really sleepy again, like the Celexa made me, but not as bad. She prescribed Wellbutrin to energize me without making me feel anxious. I felt like it worked for about a week and then I started feeling tired again. She suggested I take double my original dose for a few days and see how I felt. The extra dose made me more anxious and gave me a panic attack so bad I actually called 911. Super embarrassing. But at the time, all I could think of was if something happened to me, no one would be around to take care of the 4 month old that I was holding onto at that moment. I called for him, really.
Anyway, I met with my psychiatrist this past Monday and we discussed everything. She admits she has a difficult time managing my symptoms because I am so sensitive to medication. And the fact that I am still breastfeeding doesn't make it any easier, as she has to be sure that the medications are safe for babies as well. We came to the conclusion that I would again increase my Zoloft dose from 50 to 75mg. Stop taking Klonopin, as it may have been causing the extra sleepiness. She prescribed Ativan instead because it was supposed to be a weaker benzo, but she said if it wasn't keeping me calm enough, to go ahead and take the Klonopin again. Then she prescribed Wellbutrin 150 - the middle road between the 100 that worked at first and then stopped, and the 200 that caused my panic attack.
I have been on this regimen for 2 days now and so far I am feeling pretty good. I can't give a firm verdict on how the Wellbutrin is helping with the somnolence just yet because I had two beers with my husband yesterday and those pretty much knocked me out. So last night doesn't count. I'll see how I feel when I try to wake up tomorrow and decide how this cocktail is working for me then.
Overall though, I am not feeling the anxiety or panic physical symptoms which is a plus. And in all honesty, I would trade the anxiety for the tiredness any day. I just still have high hopes that I can be as close to normal as possible. I'm at least shooting for it.
Monday, April 18, 2011
Tough Weekend
The pregnancy, I think, is hindering my ability to really assess how much the beta blocker is helping with my anxiety and panic levels. I feel like it's definitely helped to control the rapid heart rate, but on Friday night, I started having a bunch of palpitations out of nowhere again. Granted, I did have a Pepsi that day, but I also had one the day before without problems, which was why I thought one caffeinated soda wouldn't hurt. Maybe I was wrong.
The rest of the weekend was peppered with small episodes of shortness of breath, most notable after a meal. I really need to start eating smaller meals more frequently during the day, instead of my usual 2 - 3 large meals a day. I'm not even really overeating. It's just that with the baby taking up so much more room nowadays, pushing my inner organs further up and crowing my lungs, I'm a lot more winded after meals. I honestly have no idea how I am just supposed to get bigger and bigger over the next 10 weeks I have left in this pregnancy. I feel like my tummy's been stretched to max capacity already.
So like I said, I have been really kind of on edge lately, but I don't know if the pregnancy is solely to blame, if the Lopressor just isn't working, or if the Lopressor IS working, but that the pregnancy is getting in the way.
The rest of the weekend was peppered with small episodes of shortness of breath, most notable after a meal. I really need to start eating smaller meals more frequently during the day, instead of my usual 2 - 3 large meals a day. I'm not even really overeating. It's just that with the baby taking up so much more room nowadays, pushing my inner organs further up and crowing my lungs, I'm a lot more winded after meals. I honestly have no idea how I am just supposed to get bigger and bigger over the next 10 weeks I have left in this pregnancy. I feel like my tummy's been stretched to max capacity already.
So like I said, I have been really kind of on edge lately, but I don't know if the pregnancy is solely to blame, if the Lopressor just isn't working, or if the Lopressor IS working, but that the pregnancy is getting in the way.
Wednesday, April 13, 2011
Severe Shortness of Breath but Otherwise Still Hopeful
Yesterday started out a normal day, except that I made myself swear not to make my usual stop at the Starbucks in Tysons Galleria. I know it's still bad for me even though I always order decaf. The sugar content alone in those drinks are probably enough to trigger side effects.
Come lunchtime, I decided to walk over to the mall to grab a sandwich, something that I have done on an almost daily basis for a year now with no issues whatsoever. Imagine my surprise when I barely made it to my lobby and started feeling like I need to catch my breath. Refusing to stop, I continued through the footbridge that connects my building to the mall and tried to walk as slowly as I could to prevent feeling worse. I reached a point in the footbridge where there was no turning back, and the only way I could go was forward, because there was nowhere for me to stop and sit to catch my breath. I did the only thing I could, which was to keep walking, while leaning against the wall, praying both that no one would walk past me to see me, and praying that someone would walk past to see me just in case I passed out. Surprisingly, I managed to catch myself in that thought process and was able to laugh about it. Then it dawned on me: I felt like I couldn't breathe, I was leaning against the wall as I walked toward the mall, and what's this? I wasn't panicking? The entire thing was so foreign to me, that I almost panicked that I wasn't panicking. Yes, completely absurd, I know. But for years I have been conditioned to expect my mind and my body to react a certain way to certain stimuli that it almost bothered me that I wasn't so predictable anymore. That panic, though, quickly turned into a sense of relief and appreciation when I realized that this was exactly what I had been aiming for all this time: a break in the cycle of panic. For once, I could feel sensations of shortness of breath and it could stay just shortness of breath instead of morphing into this full-blown panic attack where I am scared I am going to pass out and die because no one finds me in time. Pretty big victory if you ask me.
Still, the shortness of breath was severe enough for me to want to at least see my doctor and rule out anything serious caused the Lopressor and discuss whether I needed to increase the dosage or stop taking it altogether. His primary concern when I got there was making sure that it wasn't a pulmonary embolism. When everything checked out okay, he basically gave me 2 options: to continue taking the Lopressor or to stop taking it. He definitely seemed to think that the shortness of breath could be blamed on the beta blocker and said that it was up to me which symptoms I felt needed the more management. If I continued taking the Lopressor, the palpitations and anxiety stopped but the compromise was having to deal with the shortness of breath, which is a well-known side effect. On the other hand, if the shortness of breath was too much for me, I could stop taking the Lopressor and choose instead to experience the palpitations and anxiety, at least until I deliver.
Ultimately, I decided that the absolute worst symptom to have is the panic attacks. And the palpitations trigger the panic attacks. Taking the Lopressor already showed me that I was capable of feeling short of breath (another thing that used to trigger a panic attack before) without having that sense of panic creep up on me. So I'm still on the Lopressor and just trying to take it easy until the end of the pregnancy. Thanks to my wonderful husband who helps out around the house so I don't have to.
My doctor also seems confident that after the pregnancy, the beta blocker therapy might work even better, since I won't have all the extra demands on my body. And he doesn't think that beta blockers are something that I will need to be on everyday at that point. According to him, we just need the medication to block the negative feedback loop that my body has been caught up in for so long. Once we've done that, he's hopeful that I can be panic free without medication. Which is really, really comforting. This is something that I have been thinking about and shooting for for so long. It's nice to know that my doctor is in agreement and is willing to help get me there.
Come lunchtime, I decided to walk over to the mall to grab a sandwich, something that I have done on an almost daily basis for a year now with no issues whatsoever. Imagine my surprise when I barely made it to my lobby and started feeling like I need to catch my breath. Refusing to stop, I continued through the footbridge that connects my building to the mall and tried to walk as slowly as I could to prevent feeling worse. I reached a point in the footbridge where there was no turning back, and the only way I could go was forward, because there was nowhere for me to stop and sit to catch my breath. I did the only thing I could, which was to keep walking, while leaning against the wall, praying both that no one would walk past me to see me, and praying that someone would walk past to see me just in case I passed out. Surprisingly, I managed to catch myself in that thought process and was able to laugh about it. Then it dawned on me: I felt like I couldn't breathe, I was leaning against the wall as I walked toward the mall, and what's this? I wasn't panicking? The entire thing was so foreign to me, that I almost panicked that I wasn't panicking. Yes, completely absurd, I know. But for years I have been conditioned to expect my mind and my body to react a certain way to certain stimuli that it almost bothered me that I wasn't so predictable anymore. That panic, though, quickly turned into a sense of relief and appreciation when I realized that this was exactly what I had been aiming for all this time: a break in the cycle of panic. For once, I could feel sensations of shortness of breath and it could stay just shortness of breath instead of morphing into this full-blown panic attack where I am scared I am going to pass out and die because no one finds me in time. Pretty big victory if you ask me.
Still, the shortness of breath was severe enough for me to want to at least see my doctor and rule out anything serious caused the Lopressor and discuss whether I needed to increase the dosage or stop taking it altogether. His primary concern when I got there was making sure that it wasn't a pulmonary embolism. When everything checked out okay, he basically gave me 2 options: to continue taking the Lopressor or to stop taking it. He definitely seemed to think that the shortness of breath could be blamed on the beta blocker and said that it was up to me which symptoms I felt needed the more management. If I continued taking the Lopressor, the palpitations and anxiety stopped but the compromise was having to deal with the shortness of breath, which is a well-known side effect. On the other hand, if the shortness of breath was too much for me, I could stop taking the Lopressor and choose instead to experience the palpitations and anxiety, at least until I deliver.
Ultimately, I decided that the absolute worst symptom to have is the panic attacks. And the palpitations trigger the panic attacks. Taking the Lopressor already showed me that I was capable of feeling short of breath (another thing that used to trigger a panic attack before) without having that sense of panic creep up on me. So I'm still on the Lopressor and just trying to take it easy until the end of the pregnancy. Thanks to my wonderful husband who helps out around the house so I don't have to.
My doctor also seems confident that after the pregnancy, the beta blocker therapy might work even better, since I won't have all the extra demands on my body. And he doesn't think that beta blockers are something that I will need to be on everyday at that point. According to him, we just need the medication to block the negative feedback loop that my body has been caught up in for so long. Once we've done that, he's hopeful that I can be panic free without medication. Which is really, really comforting. This is something that I have been thinking about and shooting for for so long. It's nice to know that my doctor is in agreement and is willing to help get me there.
Sunday, April 10, 2011
Setback on Day 3 of Lopressor
So today I felt my heart flutter twice. It was definitely disappointing. Maybe it's really still too early or maybe I'm on such a low dose that it isn't working yet. I'm supposed to go to a follow-up appointment with my PCP in 2 weeks to discuss my progress, so I'll give the Lopressor at least until then before I consider asking to increase the dosage or explore other options.
In addition to the heart flutters, I was walking up the stairs holding my kitten after dinner, when I felt so out of breath I had to put him down. I continued up the stairs but when I reached the top step, I called out to my husband to come upstairs. I wanted to make sure he was there to catch me in case I collapsed. That was the first time since taking the Lopressor two days ago that I felt that all-too-familiar feeling of adrenaline rushing over me. Thankfully, all I needed were a couple of extremely deep breaths to calm myself. Deep breaths are so hard to come by in the 3rd trimester. I'm trying not to make myself even more worried over it knowing that it only gets worse from here until the baby's born.
In addition to the heart flutters, I was walking up the stairs holding my kitten after dinner, when I felt so out of breath I had to put him down. I continued up the stairs but when I reached the top step, I called out to my husband to come upstairs. I wanted to make sure he was there to catch me in case I collapsed. That was the first time since taking the Lopressor two days ago that I felt that all-too-familiar feeling of adrenaline rushing over me. Thankfully, all I needed were a couple of extremely deep breaths to calm myself. Deep breaths are so hard to come by in the 3rd trimester. I'm trying not to make myself even more worried over it knowing that it only gets worse from here until the baby's born.
Saturday, April 9, 2011
Trying Lopressor
I've had palpitations on and off for years now, but now in my third trimester of this pregnancy, I recently started feeling them more frequently. I had been able to chalk the significant increase up to the increased demands on my heart for my growing baby, but when I had felt more than 30 flutters in on day while I was at work, it was hard to keep my anxiety and panic at bay. I had started taking Xanax again when the palpitations started up, even though I swore to stop taking Xanax for the entire duration of the pregnancy. That's when I knew I needed to explore other alternatives.
Last week, I finally called the advice nurse at my OB's office and asked if the palpitations were enough for them to be concerned. She suggested I get an EKG done at with my PCP and to let them know what they found.
I got the EKG done the following day and nothing showed up during the test other than a resting heart rate of about 104bpm. My PCP listened closely to my heart for a couple of minutes and finally decided that she wanted to investigate further with an echocardiogram. Apparently, she heard clicking sound that's most oftenly associated with Mitral Valve Prolapse (MVP). I've suspected MVP for years but never got any feedback from any of my doctors to suggest that MVP might be the reason I'd been having palpitations on and off. It was actually somewhat a relief to finally be on the road to having a diagnosis, after so many years of being told that everything was normal when I so obviously did not feel normal. My PCP wanted to prescribe me a low dose of a beta blocker, but didn't want to do anything without the consent of my OB.
The following day, I faxed my EKG results and also a list of beta blockers to my OB who called me and told me to try the following things first: avoid caffeine, avoid strenuous activity, and increase my fluid intake to prevent dehydration. All things that I honestly have already been doing on my own to combat the palps. I decided that I would give myself until my next scheduled OB appointment to see if doing these things would be enough to eliminate the occurrence of palpitations. Despite these measures, I continued feeling palpitations throughout the week and the weekend.
Finally, it was time for my 7 month OB appointment. And while I had seen a decrease in the number of palpitations I was having on a daily basis, it was still enough to invoke feelings of anxiety or panic intense enough for me to have taken either 0.25mg or 0.5mg of Xanax to calm myself.
My OB gave the okay for me to obtain a prescription for a beta blocker from my PCP, which was exactly what I had been hoping for. My PCP prescribed 25mg of Lopressor (aka: Metoprolol), which is apparently a really low dose compared to how much would be prescribed for lowering blood pressure. My blood pressure is ALWAYS lower than the normal 120/80, so the low dose is so that my blood pressure isn't lowered too much lower.
I took my first dose last night. I also took my pulse before taking the Lopressor and it was a whopping 136bpm. That's resting. I wasn't doing anything but lying in bed for at least an hour prior to taking my pulse. A couple of hours after taking the Lopressor, my pulse was back down to 80bpm. Still early to tell whether the beta blocker is going to have long-lasting effects, but I can say that I haven't felt so much as a flutter or a racing heartbeat since taking it yesterday, so I'd say that so far it seems promising. I just don't want to get my hopes up.
I've been reading The Mitral Valve Prolapse Syndrome/Dysautonomia Survival Guide by James F. Durante for information on the science behind all of this and there is an account of a patient with MVP Syndrome who tried beta blockers to help ease her palpitations and related panic attacks. She says that after 10 days on the beta blockers, the panic attacks stopped completely, and then when she stopped taking the beta blockers a couple of months later, the panic attacks never came back. I hope one day I can say the same about my own experience.
Last week, I finally called the advice nurse at my OB's office and asked if the palpitations were enough for them to be concerned. She suggested I get an EKG done at with my PCP and to let them know what they found.
I got the EKG done the following day and nothing showed up during the test other than a resting heart rate of about 104bpm. My PCP listened closely to my heart for a couple of minutes and finally decided that she wanted to investigate further with an echocardiogram. Apparently, she heard clicking sound that's most oftenly associated with Mitral Valve Prolapse (MVP). I've suspected MVP for years but never got any feedback from any of my doctors to suggest that MVP might be the reason I'd been having palpitations on and off. It was actually somewhat a relief to finally be on the road to having a diagnosis, after so many years of being told that everything was normal when I so obviously did not feel normal. My PCP wanted to prescribe me a low dose of a beta blocker, but didn't want to do anything without the consent of my OB.
The following day, I faxed my EKG results and also a list of beta blockers to my OB who called me and told me to try the following things first: avoid caffeine, avoid strenuous activity, and increase my fluid intake to prevent dehydration. All things that I honestly have already been doing on my own to combat the palps. I decided that I would give myself until my next scheduled OB appointment to see if doing these things would be enough to eliminate the occurrence of palpitations. Despite these measures, I continued feeling palpitations throughout the week and the weekend.
Finally, it was time for my 7 month OB appointment. And while I had seen a decrease in the number of palpitations I was having on a daily basis, it was still enough to invoke feelings of anxiety or panic intense enough for me to have taken either 0.25mg or 0.5mg of Xanax to calm myself.
My OB gave the okay for me to obtain a prescription for a beta blocker from my PCP, which was exactly what I had been hoping for. My PCP prescribed 25mg of Lopressor (aka: Metoprolol), which is apparently a really low dose compared to how much would be prescribed for lowering blood pressure. My blood pressure is ALWAYS lower than the normal 120/80, so the low dose is so that my blood pressure isn't lowered too much lower.
I took my first dose last night. I also took my pulse before taking the Lopressor and it was a whopping 136bpm. That's resting. I wasn't doing anything but lying in bed for at least an hour prior to taking my pulse. A couple of hours after taking the Lopressor, my pulse was back down to 80bpm. Still early to tell whether the beta blocker is going to have long-lasting effects, but I can say that I haven't felt so much as a flutter or a racing heartbeat since taking it yesterday, so I'd say that so far it seems promising. I just don't want to get my hopes up.
I've been reading The Mitral Valve Prolapse Syndrome/Dysautonomia Survival Guide by James F. Durante for information on the science behind all of this and there is an account of a patient with MVP Syndrome who tried beta blockers to help ease her palpitations and related panic attacks. She says that after 10 days on the beta blockers, the panic attacks stopped completely, and then when she stopped taking the beta blockers a couple of months later, the panic attacks never came back. I hope one day I can say the same about my own experience.
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