Member Comments are provided by individuals and reflect their personal opinions only. Under NO circumstances should you act on any advice or opinion posted in this forum. ALWAYS check with your personal physician before taking any action regarding your health! MedHelp International and our partners, sponsors and affiliates have no obligation to monitor any comments posted on this site, or the content and/or accuracy of such exchanges. MedHelp International does not endorse the views of any user.
Anxiety Community
This patient support community is for discussions relating to generalized anxiety, anxiety and eating, anxiety and sleeping, mood swings, and phobias.
interesting diagnosis
by cal7902, May 07, 2007 12:00AM
Well, I went to a specialist last Friday. The doctor was a cardiologist specializing in the dysautonomia associated with Mitral Valve Prolapse. While he said that I do not have MVP, he said that I do suffer from dysautonomia. He said that the symptoms are very much like anxiety symptoms, but that with some medication, I should be ok. So he gave me some Corgard and Klonopin. I started taking last Friday night and I feel better today than I have in 4 months. I find this amazing, and I thought I would share it. Has anyone heard of dysautonomia? He mentioned something about hypercatechlominia being my problem. I am very interested in knowing if anyone has experience with this, but I am so excited that I feel better. Maybe this is what some others are suffering from.
Very intelligent Cardiologist you have found. Most others would've dismissed your symptoms as "panic" or "anxiety" attacks, rather than Dysautonomia.
Dysautonomia is a malfunction of the autonomic or sympathetic nervous system. This is the system that controls your heart rate, blood pressure, vagal responses, "fight or flight" response etc. Any minor "glitch" in this very balanced system will cause symptoms (generally, dizziness, lightheadedness, fainting spells, tachycardia, intense feelings of fear, numbness/tingling of the extremities, etc). Almost identical to a panic attack, but usually with some minor underlying pathology.
There are numerous causes, including:
-Autoimmune Diseases
-POTS
-Chronic Fatigue Syndrome
-Fibromyalgia
-Mitral Valve Prolapse
-Post Viral Infections (Epstein-Barr)
-Immunization (Hep B vaccine, Flu vaccine)
At present time, these disorders are misunderstood, primarily because there is little clincal evidence to fully explain them. However, I assure you that they are indeed very real, and can be very disturbing. Perhaps in the near future, an explanation will be established.
Corgard is a beta-blocker, and blocks the effects of Catecholamines (Adrenaline) on the myocardium. This reduces tachycardia (rapid heart rate), and it may also reduce the effects of Catecholamines on anxiety type symptoms. Catecholamines are released during "fight or flight" responses, or during instances of autonomic upset.
Klonopin is a Benzodiazepine anxiolytic used to treat panic disorder. Klonopin is a central nervous system depressant, and will slow down the autonomic nervous system during periods of imbalance. This, in combination with Corgard, will greatly improve your symptoms. The drugs are NOT a cure, but will offer you great relief. At present time, this is the best combination that modern medicine can offer to you.
I also suffer from Dysautonomia, a result of Dilated Cardiomyopathy. For mine, I take Atenolol (cardio-selective beta-blocker), and Klonopin. The combination has proven to be invaluable.
Congratulations on finding a knowledgable doctor, one who made the correct diagnosis. The only thing I might add is a test to rule out Pheochromocytoma (an Adrenaline secreting tumor of the adrenal glands). This is accomplished with a 24-hr urine collection, a blood test, and a CT scan of the abdomen. An autoimmune workup would likely turn up a positive ANA in your case. This would be "proof" that your body is producing "auto-antibodies", that is, antibodies that attack the body, rather than disease. The antibodies are targeted towards the nervous system in the case of Dysautonomia.
Best,
Ryan
Also, how much of the Klonopin do you take and how do you take it? My DR has me on a .5 mg tablet before bedtime. I take 5 mg of the Corgard in the morning and then again at night. It's working so I am good with it, but I wonder if the dosage will have to be increased as my body gets use to it.
Again, thanks for your insight. I have enjoyed reading your responses to other on here as well, as you seem very knowledgeable. I think it helps that my cardiologist has a specialty in dysautonomia and also has a Phd in clinical pharmacology!
cal7902
"Also, how much of the Klonopin do you take and how do you take it? My DR has me on a .5 mg tablet before bedtime. I take 5 mg of the Corgard in the morning and then again at night. It's working so I am good with it, but I wonder if the dosage will have to be increased as my body gets use to it. "
end quote
(1) No. The 24-hr urine fractioned Catecholamines and Metanephrines are the most specific for detection of a Pheochromocytoma. No further workup is indicated here. Some labs will use the plasma Metanephrines (blood test) instead, but it is less specific.
(2) The target dose for Klonopin is 1/2 mg BID (every 12 hours). Taken in this manner, the drug reaches a steady-state plasma level which works to maintain the disorder it is helping to treat. 1/2 mg at night is not sufficient to cover an entire 24 hour period, and the plasma level would begin to "trough" after 12 hours. To assure an even plasma level, the drug should be dosed twice daily.
Corgard is typically dosed BID, which is what you're taking.
I take 50 mg Atenolol 1d, and Klonopin 1/2 mg BID.
Good luck,
Ryan
gee thanks... :o(
Good to see you around here...you've been absent a lot lately! I figured that post would turn you up sooner or later though.
It's interesting what you say about the .5 mg Klonopin not being enough to cover a whole day. I'm still convinced I'm having a little interdose anxiety that tends to occur about an hour before my scheduled doses, and then it takes another hour or so for it to kick back in. So there's about a three-hour window there that I can get anxiety-ish for a little while. I have an appointment for my next refill tomorrow which is about a week earlier than normal, and I'm going to take your advice and try to get that TEVA generic to see if it's a little better.
The heart thing, though...that's pretty rare, right? I mean people who suffer from anxiety and read that shouldn't let that get into their head.
I still owe you an e-mail!
The Caraco brand generic Clonazepam may not be as "potent" as the name brand. I know for sure that the Watson and PurePac brands aren't. The TEVA brand is very close to Klonopin/Roche in potency.
That's not to say the Caraco brand isn't *effective*, but perhaps, you aren't actually receiving the full 1 mg of Clonazepam (the target dose). I doubt that interdose anxiety is occurring (since you've only been exposed to one brand of Clonazepam), I would blame the increase in symptoms withtin the three hour window on potency instead (or perhaps, metabolism).
And, of course, everyone has a different metabolism. If 0.5 mg BID is not providing complete 24-hr coverage, it may be dosed TID instead. The extra 0.5 mg does not severely increase the risk of tolerance, nor does it "speed up" the risk of tolerance. Average doses after a prolonged period (> than four months) range from 1.5mg - 3 mg. The target dose of 1 mg daily is not an absolute, rather a recommendation from Roche based on a limited clinical trial. As with any drug, it must be individualized for the particular patient.
Before making any changes to the dosage, I'd try another generic brand (TEVA if possible). Try the new brand for two weeks and see if the symptoms improve. You may want to call the pharmacy in advance, so that they may order TEVA brand for you, before you fill the prescription.
Yes, the heart condition is rare. Folks should read this thread with a grain of salt. Sometimes there is an underlying cause for panic disorder, but usually not. It's mostly a psychological illness. IT is surprising how many, seemingly "real" physical symptoms can result from anxiety disorders.
Best,
Ryan
Yep, that's why I'm going to the doctor this week instead of next week. I'd already asked the pharmacy if they could get the TEVA and they said it would take a few extra days. They want the prescription first. I'm going to tell the doctor that's why I'm going early, too, so he knows I'm not trying to horde up the K or something, haha.
Not knowing about these things, I have to ask you a dumb question. My metabolism is slow. I'm a low energy, laid back sorta guy. If I eat too much I get fat, etc. Wouldn't this make the drug take effect a little more slowly but maybe make it last longer?
I really don't know what I'm talking about when I say things like "interdose anxiety". It just makes me sound smart. I do know that I sometimes have anxiety around the time I take the second dose of the day, and I also know that Clonazepam doesn't absorb immediately. So it sorta made sense to me. I experience the same kinds of things in the mornings, too, but there's more going on so the character of the feeling's a little different: either I'm more annoyed and anxious with sort of a sickish stomach, or I have just enough going on to distract me from it.
But, yeah, I really, really don't want to increase this dose unless I have to. I'd like to stay .5 bid forever, if possible, or eventually quit the drug for good.
Is your tapering still going well?
please don't use my real name in this forum, haha. I'm one of these obsessively, intensely private people.