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Avatar universal

What do I tell my doctor....

I recently went to see my doctor due to low sex drive. I take opiates every day and my dr visits have been normal. However, last time I went my doc ran a hormone test on my found elevated levels of prolactin and ordered an MRI of my head. I'm scared ******** right now and want to come clean with my doc but I'm not sure if that's the smart thing to do. If I mention my opiate use, it might change her recommendation for an MRI but I'm not sure what to do. I'm deathly afraid of there being a real problem like a tumor. If my DR knew about my opiate abuse, it may explain the low hormones and maybe this MRI wouldn't be necessary. He assumes I'm healthy and that I dont take opiates so hormone levels like this along with elevated prolactin are abnormal for someone my age. I really need some advice. I will be talking to my DR in a few days but I dont know what to say. Will my telling the doc about the opiates go on my medical record? Whats the best way to approach this? I cant sleep at night cuz I think I'm dying. Please give me some advice.
14 Responses
271792 tn?1334979657
Do you think coming up with a plan to get off of the drugs is more important right now?
199177 tn?1490498534
Well if one is abusing opates on a daily basis  that right there can kill your sex drive its a major complaint from addicts .Also here is some info  on prolactin .

From what I can tell it tends to be a bigger problem for the females but I am sure can effect males as well
Prolactin is one of many hormones produced by the pituitary gland. It is primarily responsible for milk production during lactation.

The pituitary's hormone production rises and falls depending on hormonal instructions from another gland, the hypothalamus. In the case of most pituitary hormones, including FSH and LH, the presence of hypothalamic hormones signals the pituitary to increase production. For prolactin, however, the signal works in reverse: An increase in the hypothalamic hormone dopamine tells the pituitary to stop releasing prolactin. In some cases, however, the dopamine cannot reach the pituitary gland by passing through the veins of the pituitary stalk. When that happens, there's no signal to suppress the secretion of prolactin, and the pituitary continues to release prolactin.

When prolactin levels rise, the hypothalamus manufactures and releases more dopamine in an effort to stop prolactin production. This increase in dopamine has other effects. In particular, it suppresses the hypothalamus' production of the hormones that promote release of FSH and LH. This, in turn, leads to a drop in LH and FSH, causing low estrogen levels and amenorrhea (lack of menstrual periods).

High prolactin levels can often cause both amenorrhea (absent or irregular menses) and galactorrhea (milk production from the breast). Some common causes for prolactin elevation include:

-- pregnancy
-- a type of pituitary tumor (growth) that produces prolactin
-- stress, exercise, nipple stimulation, chest wall lesions (scars, pacemakers), or sexual stimulation
-- medications such as certain blood pressure medications, anti-nausea drugs or antipsychotics
-- kidney failure
-- cirrhosis of the liver
-- primary hypothyroidism (underactive thyroid gland)
-- compression of the pituitary stalk from tumors, empty sella syndrome or sarcoidosis

An MRI test or CT scan enables a radiologist to see if a tumor is present or if compression of the pituitary stalk is causing the problem. There is presently some controversy as to when the MRI or CT scan is necessary, and in the current cost-cutting climate, the use of these types of tests is being evaluated with a more critical eye. One rationale is this: Levels of prolactin above 100ng/ml are usually due to prolactin-secreting pituitary tumors. Pituitary tumors and other forms of hyperprolactinemia (elevated levels of prolactin) are treated with the same medications, so it would seem that the scan adds little benefit and offers no insight into treatment choices. If the tumor is large, however, it may press on the optic nerve fibers and cause visual defects. So if you have headaches or visual problems along with hyperprolactinemia, an MRI scan is a must.

What about patients with lower levels of prolactin that are still above normal? The first thing we do is repeat the blood test early in the morning in a nonstressed setting. If the elevation persists, and if thyroid disease or medications have been ruled out as causing the elevated prolactin, the MRI may be helpful in making sure the pituitary stalk is not compressed by tumors or other masses. Smaller tumors are called microadenomas. If they are larger than one centimeter in size, they are called macroadenomas.

Pituitary tumors in general are not rare at all. Autopsies show that up to 10 percent of people have some sort of pituitary tumor. So don't be alarmed if your doctor wants to check for a pituitary tumor. Still, most women with prolactin elevations do not have a pituitary tumor. When they do, the condition is usually easily treated with medication; surgery is rarely needed.

There are two medications commonly used. Parlodel is a pill taken two or three times per day. The dosage must be increased gradually to minimize the risk of postural hypotension (dizziness when changing positions). Upset stomach is also not unusual with this medication. A novel approach to minimize these side effects is to administer the tablet via the vagina.

Dostinex (cabergolide) is a pill taken twice weekly. While postural hypotension and nausea can still be seen, many who cannot tolerate Parlodel find Dostinex acceptable. This medication is considerably more costly.

Avatar universal
I've read all that about prolactin. I'm just trying to figure out what the repercussions are if I tell my dr that I'm using opiates. My prolactin is borderline but basically normal. Not sure what to do. I'm cutting down on the opiate use already in an effort to quit for good but now I have this MRI, pituitary thing going on that's scaring the life out of me.
271792 tn?1334979657
I think now may be a good time to come clean with your doctor. Your use/abuse may effect the MRI as you suspect and since this is a very important test, honesty is important now also.

Ask for help and you may be surprised.
Avatar universal
Your Physician will be able to help you best if he knows all the things that are invoved and that affect your health.  Be honest with him amd tell him all of your concersn.......
Avatar universal
I dont see how my use will affect the MRI. If anything, my use is probably causing my prolactin levels to elevate which is why the doc ordered an mri. I'd like to here from addicts that came clean with their docs and what the repercussions are. If my medical records will be plastered with info of my being an addict, I would much rather quit on my own.
228936 tn?1249094248
the bottom line is taking dope makes you less of a man. I know it's a tough thing to hear but's it's true. You can put it in whatever scientific or medical terms you want but it still comes down to a choice. Dope or being more of a man. I don't mean to be crude but sometimes if you boil things down to the lowest common denominater it works. If you tell your doctor you are on dope then I think it depends on him if he keeps it where it belongs or carry's it over to all your medical records. You have to trust the doc to tell him . all the best
Avatar universal
Question for you and be honest with yourself when you answer...
Are you concerned that if your records show that you have an abuse problem then you will not be able to get these meds from doctors because you are not ready to quit yet or that you might want to abuse them again in the future?
You seem pretty sure that the cause of the test being ordered is because of the pills and not an underlying condition so you basically know there is nothing to worry about there.
If the reason you want to know the answer to this has anything to do with protecting the source of your pills then why bother worrying about your sex drive or your health. Neither one of those things will be worth squat if you do not WANT to get off the opiates.
230262 tn?1316645934
your dr will probably order blood work, lots of it...and im sure he'll find out youre using opiates anyhow that way...so i would fess up now if I were you..
Avatar universal
To notgoingdown.

I'm not concerned at all about telling the doc out of fear of not being given pills. In fact, I'm not addicted to pills. I make poppy tea from poppy plants that I grow. Actually, I'm not really sure that the prolactin levels that came up in my tests are due to my opiate use or whether I do have a pituitary problem. I'm probably going to go ahead with the MRI. I guess what I'm looking for is re-assurance that maybe my habit is causing the elevated prolactin and not something totally unrelated.  On top of my addiction, worrying about a brain tumor is adding additional stress to my life. Stress is one of the main reasons I started using opiates.
600086 tn?1238418989
I think it is time for an honest inventory.  I agree I think you need to decide what your plan of attack is.  I can only tell you what I know myself.  I was arrested 5 months ago for altering a script.  It was stupid.  8 pills, 8.  Now I have given 2 years of my life to a probation officer.  You think you are not that bad or it can't happen to you?  It can and it will.  It NEVER ends well for anyone.  Decide it is your time to overcome this.  Be honest with your Doc.  I was.  I can honestly say I have no idea what my medical records say but you can't be withheld help for pain when it is REAL.  A month and a half ago I had a migrane.  I took my migraine meds and they didn't help.  I went in to my doc.  He asked if I wanted a script for Lortab. (Fully knowing my history)  I told him no.  He asked if I would like a shot of Demoral.  I said yes.  He gave it to me.  It helped.  The next morning, I called my counslor and told her about it.  I told my husband.  I am an open book.  Stop using and you will find you don't care what your records say.  IN fact I hope it says it all over so I can have help patroling myself.  (ps I had no sex drive either.  I stopped the pills and I now have a drive for EVERYTHING including excersing, being a real mom, helping others etc)  Thanks for your time.
942290 tn?1252618549
first of all, your med records are VERY private. doc's have too much going on to worry about your situation.  when I was using heavy half a year ago, I had an a major nightmare with a appendectomy that I tried to fight off by myself. it started bursting and I about died from being stubborn,thinking I will fight it off. one of my friends is a doc, he told me to get to the ER  ASAP. long story, but I can tell you when I was in teh ER they were shooting me up with dilaudid and morphine, and they did not work
. I told them I was taking methadone and pain pills, the nurse could not believe I was still breathing,after what he gave me. they had no idea where I got them, or even asked. other than the great surgeon, knew what was going on. he said" you been eat vikes like candy, I can tell. you need to stop it"  he never looked down at me for it.  and actually looked me up to talk about some other mutual interest we had. great guy. teh point is never once did they ask how I got them, nor were the cops called in. they got much bigger issues.

If you care about your health,you need to tell the doc what the hell is going on. I mean come on !! you do realize the pills could be causing the problem,right? you need to get off them, or it will be even worse later.
199177 tn?1490498534
notgoing  brings up some very good questions .i used to not want it on my records either because that might mean if I changed my mind and wanted to use it didnt want that on my record welll when I desised I want to get clean and I was done with lieing to myself and everyone else I told the truth.I have had a few times i have needed pain meds and never once have they made me suffer they and myself have been much more carfull when i have need pain relief .gave me small scripts and i gave meds to my hubby .
Avatar universal
I would have the MRI to rule anything out.  I don't know that the opiate use would cause changes in prolactin, but I am not a doctor.........

Now that you acknowledge your problem with opiates, you can work on tapering or if you feel it necessary to discuss it with your doctor then do so.  I am not an advocate on discussing opiate abuse with your doctor unless you can not get a handle on it yourself.  

I wish you the best.

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