Dear Madeleine:

The cardiologist should be notified of your condition, as orthostatic hypotension can be from alot of things.  We first rule out cardiac etiologies.  A tilt table, some basic labs, blood pressure with lying and then standing etc.  It is curious that you get light headed from prolonged standing.  Orthostatic hypotension is usually from the initial getting up and then goes away.  Maybe an ENT to rule out anything in the inner ear.  

I am not sure what you should ask the neurologist, except to tell your symptoms.  Outside of the swimming in your head-feeling, there is not anything neurologically focal in your symptoms.  This symptoms may be part of the hypotensive episodes.

Sorry, I am not much of help.

Sincerely,

CCF Neuro MD

Dear Doctor,

I have been having trouble with lightheadedness, irregular heart beats, fatigue, and headaches for about three months.  I have falled twice, once injuring myself. I was sent to a cardiologist who diagnosed two problems:
(a) atrial fibrillation with some atrial tachycardia.
(b) postural hypotension.

He did an echocardiogram, and ECG, and treadmill test.  Although there was some enlargement of the left atrium and slight atrial stenosis, he said the heart structure was good and he gave me some tambocor to stablilse the heart rhythm.

He thought problems (a) and (b) were unrelated and that the postural hypotension might be due to my traying Zenical to lose weight.  And asked me to stop it for two weeks and let him know how I felt.

I have not taken it for 2 weeks now but made notes so I could give him an accurate picture of symptoms.

I am still getting some postural hypotension - but it is intermittent (measured sitting then standing). However, the dizziness continues. It is hard to stand up for any length of time and not fall over. But I also get this sitting down now and even lygin down.  I fell like my head is swimming and I feel nauseous.  I wake up with a headache most mornings. I have also been getting some strange visual things - hard to focus my eyes sometimes and seeing small black shapes out of the corner of my eye sometimes. Also I feel like there are spiders on my arms sometimes - but there is nothing there. (Sorry this sounds so odd! - I'm not drunk (smile!))

My main problem apart from the dizziness is terrible tiredness - all I really want to do is sleep and I do so whenever I can. I actually think the rest helps me.

My GP has tried stemetel this week but no difference and she thinks I now need to see a neurologist.  I also have to go back to the cardiologist this week.  

I am rather worried as it is certainly interfering with my work - I have a demanding job which is largely brainwork and I am stuggling to concentrate at the moment and sometimes "losing the words".

Can you tell me if there are any tests you would recommend.  And if I see a neurologist what questions should I ask?

I'm grateful for any help you can give.

Thank you

Madeleine

Dear Andreas:

They act by different mechanisms, and at low doses they probably do not interact to cause problems.  If your anxiety is better, then ask about weaning off the zoloft, if not then do what your GP suggests.

Sincerely,

CCF Neuro MD

Hi
(I'm the original poster)

Thanks for the answers.
I went to see my GP again about the problems with not getting enough sleep and having headaches. He said that it could be sideeffects from the zoloft or that I was tense from my anxiety.
I got an earlier neuro appt. and to help me sleep better until then he prescribed Flunitrazepam  (Rohypnol) (It is legal in my country) to be taken just before bedtime.
My question is if there could be any problems taking both Zoloft and Flunitrazepam ? (I take 50mg Zoloft in the morning and 0.5 mg Flunitrazepam at night). I've searched the net but all I could find was that the combination of Zoloft and other CNS active drugs hasn't been studied.
I know that I should trust my GP but as I understand Flunitrazepam is pretty strong which is a little scary.

Thanks for your time

/Andreas

I HAVE HAD CHRONIC PROGRESSIVE MS FOR 3 YEARS NOW.  I AM 54 AND HAVE HAD NEUROPATHIC PAINS NOW FOR APROX. 1 MONTH. IT HAS BEEN MODERATE TO SEVERE PAIN.  THE PAIN SEEMS TO BE GENERATING FROM THE BUTTOCK (LFT.) ALL THE WAY DOWN TO THE FOOT.  IT FEELS LIKE A BURNING NERVE ON FIRE!

I DO NOT WANT TO TAKE ANY STEROID TREATMENTS OF ANY KIND.  WHAT, IF ANYTHING "ALTERNATIVE" IS AVAILABLE TO DATE? I AM HIGHLY SENSITIVE TO CODEINE AS WELL.

MY MEDICATIONS ARE AS FOLLOWS:  +INTERFERON BETA 1A (AVONEX 30 MCG)., 1 X A WK.)  + ALTHOUGH, THE NEUROLOGIST WANTED ME ON THE BETA SERON; MY INSURANCE WOULDN'T GO IT.  SO I HAVE REMAINED ON THE AVONEX FOR 1 YEAR (FEB. 2000).  I HAVE BEEN WALKING SINCE THAT TIME, WITHOUT THE USE OF THE WHEELCHAIR, BUT SOMETIMES STILL NEED THE CANE OR WALKER.  +I ALSO TAKE PRESCRIBED 800 MG. IBUPROFEN; FOR THE SIDE EFFECTS OF THE INJECTION.

THANK YOU FOR ANY HELP IN THIS AREA...D. D'ANGELO, Ph.D.

Dear Dr. Dorleen D'Angelo:

The beta interferons all have about the same efficacy. What you need to watch out for is antibody production by your body to the beta interferon.  If this happens, the dose will have to adjusted.  Steriods are the mainstay for MS exacerbations.  They reduce the damage, shorten the exacerbation, and therefore retard the disease somewhat.  If you are going through an exacerbation I would tell you to take the steriods.  There are medications to help control neurogenic pain.  I would talk to your MS specialist about these medications.  Medication like neurontin and tegratol help with neurogenic pain.

Sincerely,

CCF Neuro MD

thanks for your comments.

CCF Neuro MD

Dear Andreas,

Anxiety can cause the feeling that one has a lump in the throat. It is due to tight muscles in the throat area. I know this because I am a clinician, but also because when I was younger I had this same symptom. It was a persistent tight, thick feeling in my throat. I also have had muscle twitches. Anxiety can cause muscle tension and this may result in muscle twitches or spasms due to the prolonged contraction of the tense muscles. Zoloft usually takes several weeks before its full effects kick in and can help with your symptoms. My suggestion is to concentrate on relaxation by practing meditation, relaxation exercises, taking warm baths, working with a therapist, etc. When your anxiety levels decrease, I believe you will be feeling much better and you won't notice the tightness in your throat.  

Dear Andreas:

Usually the progression of bulbar type ALS is rapid and most patients usually have a very short time from diagnosis to death, about 1 year.  So, the fact that you have two months of symptoms without speech problems, weight loss, difficulty chewing, and noticable muscle weakness then the changes of ALS are very, very slim.  The headache can be from the Zoloft.  It is always good to tell your doctor concerning any medication that is giving you side effects.  I would think that that twitching is benign in nature and the others may or may not be due to the zoloft.

Sincerely,

CCF Neuro MD