I've been following your saga with your daughter and the wonderful support and advice from Stella and SmilerDeb.
You are on the right track. Be patient. It is going to take some time for your daughter's recovery.... maybe even quite a bit of time... Give her space and love. You are a wonderful Mum!
You're on the right track Debbie - Don't question it. It sure beats the other options you were given at Rogers.....
This takes time as we talked about and Sally says... One step at a time - especially with multiple gland issues.
Bumping this up as its MONDAY in Australia ...hehehehe
You guys are 16 hrs behind me lol.
Let us know how all goes today Debbie.
Bumping up as its TUESDAY in Oz lol
I'm giving a status report, but I don't think we really know anything more definite than last week. As I said earlier, Kalina was extremely lethargic all weekend. We just simply let her rest as she seemed to need it. Yesterday (Monday) she rode the bus to see her regular counselor (no connection to the local psychiatric hospital) and ended up relaxing the rest of the day at Barnes and Noble. Although I wasn't home for much of the evening, when I did pop in I saw she had cooked dinner and was VERY energenic and playing an animated improv game with her dad and sister. Later she apparently stayed up late (maybe the whole night, like she did last Thursday), and she was too tired to join us for breakfast. I DID bring her meds to her so she at least could get them at the same time of day.
We are still waiting to hear from the new thyroid doctor. I know I am only looking at a week's time, but Kalina's pattern for the last few days is 2 days of exhaustion, 1 day of unusual energy and insomnia, then back to 2-3 days of lethargy with a day of increased activity. It almost seems like her period of high energy is so intoxicating that she can't resist staying up. I could certainly speculate on the causes for this uneven pattern, but I'd like to find out the actual lab test and scan results from her doctor.
Not too much to repport. Kalina still craves stillness and quiet, just her and her laptop. Her new endo doc wrote a script for more blood tests: the antibody test(s) for Hashimoto's that was inadvertantly left off the previous script, test to look at the ratios for the adrenals (not as accurate at the saliva test, but we can't afford that right now), and test of her female hormones. The doc also OK'd a vitamin/mineral supplement formula that we can order. Once the blood test is completed (it needs to be drawn on the 19th day of Kalina's cycle), then the new doc wants to see Kalina to go over all of the lab and scan tests with her. At least progress is being made!!!
I tell you, I am singing the Hallelujah Chorus from being validated! Kalina has a LOT wrong, but most seems fixable. 1) Magnesium was SO extrememely low she had to have an IV treatment of one bag of magnesium and one bag of B vitamin. It was low enough that she was in danger of a seizure! She also needs to get 2 more IV treatments in the next week. 2) Ferritin is very low, and B12 and D3 are suboptimal; 3) Thyroid tissue is still present. TSH is 0.14 (0.34-5.60), Free T4 is 0.6 (0.6- 1.2), FreeT3 is 5.6 (2.5-3.9). Keep in mind that these levels were taken on 6/3 after Kalina had been on .180 Armour thyroid (taken all at once first thing in the morning) for 2 days. New thyroid doc says pattern fits Hashimoto 's, but will confirm with 1 more blood test & explain more at appt. next week. 4) Adrenals will be tested via blood test in the next couple of days. Not as precise as the saliva test but should show some ratios.
I think she's trying to process all this. My goal is to get a vitamin and mineral supplement called Fatigue to Fantastic that this doc OK'd ASAP and get Kalina on it.
Have a great weekend, everybody!
I bet you must be really happy to finally get some answers.
Hugs all the way from Australia xxxxxxxxxxxx
I just posted a photo of my daughter at 17 with a painting she had created that won a silver key award with the Scholastic Art contest. I share this photo not to brag about my daughter but to point out (and remind myself) how resilient she is. She painted this picture of herself in December of 2006 when her Grave's disease was raging but as yet undiagnosed. She forced herself to attend school so she could complete this painting and submit it for the contest. Her old high school later asked her to donate an art piece, and this was the one she chose. Her painting is framed and up on the wall by the auditorium in her old high school next to the paintings by a handful of other former high school artists.
You can go to my page and see the painting there. My daughter is at a hard place now because she is resistent to advice from her doctor, her counselor, and us (her parents). She is still following some of the health recommendations, but I would appreciate your thoughts and prayers as we seek to persuade her to complete 2 more magneseum IV treatments and another visit or 2 to her thyroid doctor. Thanks again for all of your comments and encouragement--it means a lot!
I don't know what to say. After my husband and I had gone to sleep, our daughter came up to talk to him and told him she had taken about 20 Mirtaxapine (Remeron) 30 mg. pills. I think she just wants to get well, so this may have been a way to get the psychiatric treatment she feels she needs. Needless to say, I took her to the nearest emergency room...The nurse told me that she was physically OK after they gave her something to absorb all of the medicine in her stomach.
I was able to give this sympathetic nurse a pretty detailed recent history of the thyroid, low magnesium, and possible adrenal problems. She said she would relay all of this history to the doctor. I hope they at least will administer IV magnesium if her level is still critically low.
I requested that Kalina get to make a choice in which psychiatric facility they take her to. I can call in a few hours (if I'm awake) or else in the morning to see where they take her. I am kicking myself a bit that I didn't take her a few miles further away to a hospital that makes sure they check physical issues pretty thoroughly before sending a person to the psychiatric section. I was worried that it might take too long and Kalina would suffer needless ill effects during the ride there.
Your thoughts and prayers are much appreciated.
I see this as a cry for help.......in all honesty..if your daughterKalina wanted 'out' then she wouldnt have told her Father she had taken them as by taking this many anti-depressants, she would be pretty drowsy, dizzy and low blood pressure within 15-30 mins of taking these pills.
Debbie, you are NOT superwoman...you cant control other peoples actions and as much as you wish that you had taken Kalina to another hospital..you did what you thought best at the time it happened.
You know my prayers are with you Debbie...that you can be sure of.....but all you can do for the moment, is try and get some rest as this would be pretty mentally draining on you and your family.
You was right to take Kalina to the nearest hospital and not delaying as if the tablets had got into Debbies bloodstream , it wouldve been a lot more serious that it is.
These medications cause the blood pressure to drop pretty low and eventually can cause her to become comatose so that that is why I say that Kalina wouldnt have taken them long before she told her Father.
A cry for help is what it looks like to me.
Try and get some sleep...our prayers are with you xxxxxxxx
Bumping this up..........
Well, I haven't spoken to my daughter yet, but I called a couple of hours after her ER admission and found she has chosen to go back to the same psychiatric hospital as before. Yes, THIS IS THE ONE THAT RECOMMENDED THE ELECTROCONVULSIVE THERAPY!
My husband and I need to proceed firmly but carefully in this. I don't know yet if our daughter will allow us access to her medical docs and information. She explained to me that she did not allow me in the room at her discharge simply because it was too much stimulation for her to have more than 1 person in the room (which is consistent with the effects of extremely low magnesium and possibly cortisol imbalance). I am going to do everything in my power to get the hospital staff to consult with Kalina's thyroid specialty doctor. Please pray that we can retain our daughter's trust and help her get the best care possible.
I am going to type this posting and I hope and pray that you are not offended by it but can see it from both sides. Please dont take this as an attack as thats not what it is but please see it as advice.
I am an outsider in regards to all this but there are a few things that I have picked up on.
I say it as I see it Debbie.......that is ME and this is my thoughts on it.
If I offend you, I deeply apologise xxx
I have gone through my life bringing up 3 children alone.....2 Daughters and a Son.
I too , like many other parents only wants what is best for my children, to protect them, to shield them from harm and to love them unconditionally.
But there comes a time in our kids lives when there is only so much we can do. As the child grows, they take their own road in life and may do things and say things that as parents , we disagree with.
A classic example is the last few weeks with me.....
For the last 9 months, my youngest daughter has been on her own (partner gone) and has been struggling with an uncontrollable 5 year old who is abusive, aggressive, vilent and just DOES NOT sleep.
With the passing of my best friend and also my Father this year...my so called strength dwindled a little,,,thyroid levels went haywire and I was constantly trying to take on my daughters problems.
I would babysit Joshua (grandson) whenever my daughter needed it and would be pulling my hair out an hour after she left , having extreme anxiety from trying to handle a 5 year old who puts holes in walls etc. My daughter would sob that she wasnt getting sleep etc and I was there to support her through this.
Then one day something happened....she turned round and said to me..."Mum, let ME deal with this!"
Unbeknown to me, I was actually taking ALL control off my daughter of her own life, her own desisions etc and didnt even realise it.
She would hit out at me with abuse...yelling to let HER do it.
I was only trying to support her and all along thought I was doing good when in actual fact, I was SMOTHERING her.
To cut a long story short...I promised my daughter I would BACK off and let her make the desisions.
I couldnt see that I was doing more harm than good. I was doing what any MUM does for their kids...love and support.
My partner Rob then said to me...wait until she falls Deb then be there to catch her ...as she will fall
I did just that.
I withdrew all support,,, kept in touch, let her whinge and moan about no sleep then bang! she came to me one day in tears asking for MY help.
I then got Josh into a paediatric specialist who deals with ADHD only, got him assessed, sorted out her paperwork, bills etc and Josh WAS diagnosed as having ADHD (his fathers brother has it too).
I now have a daughter who loves me to death for pulling her out of the rut she was in....a grandson I can babysit who doesnt destroy my place and a daughter who turned around and said to me only last week...Thanks Mum...thanks for all yr support when I needed it."
This is all in a matter of 3 weeks.
It is hard for a Parent to sit back and watch our kids go through he// but sometimes we HAVE to let go a fraction and let them decide which path or road to take and be there for them , should they take the wrong path.
Debbie...I know you are not going to like me saying this but it is TIME to let Kalina choose her road/path.
She is 20 years old ...3 years younger than my daughter and you have to let her manage her thyroid issues. You have to let her be an Adult who can make her own desisions.
As much as your family loves her....by making the desisons for her, you are suffocating her , making her feel worthless without even realising it.
Kalina HAS to be active in her medical management.....she has to say yes or no to desisions.....you cant do that for her anymore.
All you can do is be there for her.
Regardless of what desisions she makes or doesnt make..this is her ballgame now.
All I can advise is that you be there if and when she falls.
Dont try to live her life or she will resent you (like my daughter did for a while).
Be there for her but let her make her OWN choices.
It is the HARDEST thing to do...to take a step back and let HER decide whats best for her but I am telling you that if you dont step back a fraction, she will resent you and retaliate against you ...which is what I think she is doing now.
Kalina is hitting out at you for not allowing her to CONTROL her own mind and desisions.
Let Kalina make the desisions but step in with regards to the ECT but other than that...let her fall...let her feel pain...let her know that you are there when she needs you.
If you dont do this....your daughter will resent you very much and hit out at you with extreme irrational behaviour.
Kalina is not a baby anymore, she is a young woman and does have a mind of her own.
I know this posting will hit hard but as an outsider who has been through it with 3 children....take some of my advice...please.
And once again, I apologise deeply if I have offended you or hurt you .
I now have a happy loving daughter, a beautiful controllable grandson and support that my daughter needed from outsiders and also myself....all in the space of 3 weeks.
We as Parents can only guide our children and hope they take the right path in life...if they stray away from that path...then we try to get them back on the right path but we cannot control our children when they get to be an Adult or their way of thinking.
Please know Debbie...that the desision to back off my trying to control (fix) my daughters situation....broke my heart but it paid off.
I cried and cried more than you will ever know :o(
Actually, your comments don't offend me at all. I am at a different place right now than I was a few weeks ago. I was just telling my husband in the car today that I think we should back off and ask Kalina what she wants out of her treatment and how we can support her. I do agree with you when it comes to ECT. I will not argue against it, but I will tell her that based on her low thyroid, magnesium, and possible adrenal levels that medically I believe it is too risky for HER.
I also plan on telling Kalina that if any of the psych. hospital docs/staff contact us at all, I want to request that we only exchange info. in Kalina's presence. This hospital has already had contact with Kalina's counselor, so I have no doubt that will continue (and this counselor has a pretty detailed idea of the physical problems that are going on for Kalina). In regards to the thyroid specialty doc who seems to have such a good handle on things, maybe I will just ask Kalina if she wants her involved as a consultant at all. If she doesn't, I guess I will just have to accept that (and I think I'm beginnning to understand what you mean about the tears, because they are coming right now...).
Thanks again...so much!
Its hard being a Mum...isnt it ? :o(
Let us know how everything is going with Kalina as soon as you know xxxx
Debbie - you still have the information I gave you on how wrong ECT is with her condition. I have you solid resources to read. Your daughter may not let you have a say right now on her treatment but the doctors will want to cover themselves if they realize her issues.
Go right to the director of the hospitol and show them the facts about her thyroid condition and it wouldn't hurt to put the bug in their ears that IF - your daughter comes out disabled or worse ... you WILL then have rights for her and you will sue the pants off of them for doing this treatment on her.
I tried those links from your May 28th post, but most of them didn't work. Could you post them again? I will give these hospital docs a couple of days to get on board with the thyroid facts, and if Kalina's health and safety is at risk, then we can go to the director with these research facts.
The nurse at the hospital promise that the psych. docs WILL consult with the thyroid specialty doc. I will keep tabs on this.
I have promised Kalina that if any of the hospital staff wants to talk with us, I will ask them to do it in Kalina's presence. It is so important for her well being that we protect her trust. This is also the best way to gain the cooperation and respect of the staff if we DO need to intervene for Kalina's safety.
I agree about the ECT....dont allow it but I also think that you and your Hubby need to work WITH kalina as support. In regards to thyroid issues....Kalina herself HAS to become pro-active in her illness as she has to live with Graves for the rest of her life.
I know shes fragile at present but this message has to be got through to her.
You can do a lot for Kalina ..Debbie but she also has to help herself.
Just keep the Docs on their toes.
There were lots of positive signs today. At least for today, Kalina seems to have emerged from her thyroid fog! She was proactive in making plans for doctors to see after she is discharged. In fact, she gave ME a homework assignment: I need to prompt Kalina's thyroid specialty doc to give me a name of another endo who can bill Kalina's insurance by Wednesday (since we simply can't afford to pay out of pocket right now). Kalina was also asking me to explain the different aspects of her condition that she can ask future docs about. I figured all along that Kalina could do this, but so many of her hormone and nutrient levels were so off that she couldn't even begin to put the pieces together. So, today starts a new chapter in Kalina's life--one that she is able to write about!
Why dont you get her to join MedHelp?
I think it would be great for her as she could read others postings and know shes not alone in this.
I'll resend you the links Debbie if need be. No problem. Here is where the confusion will set in with changing docs. Remember as I said - your "network" of doctors is so important with treatment of this disease. Some doctors only use Synthroid therapy and some are more open to conversion issues and use other meds to help when this situations arise.
I understand the insurance issues but the last thing you want is to have her fall back at this stage of the game when she has made huge strides in starting the healing process.
I feel getting a referral from her doctor now would be best so you can find both cost and treatment easier to manage.
Aussie Deb bring up a great thing Debbie that you may want to see would work. I do feel she needs to see the horror of others and know this can be fixed. You will not read anyone here that did not have their own thyroid nightmare first after they found their health returned. She needs to know others were/are in the same position to convince herself she is not alone.
Brain Fog lifting was huge for me. That was my turning point of regaining strength to fight to get well. You have to really be in it to fully understand but it is the greatest gift to "think" again when that symptom controls you.
Thinking of you ...
Here's another step forward: Kalina's thyroid specialty doc just made a referral to a family medicine doc in the area who thinks along the same lines, and I was able to make an appt. for next Tues. June 29th! This doc will be able to bill Kalina's insurance, so hopefully her care will not be disrupted very much.
Another positive sign: this morning when I was talking to the psych. hospital social worker about making this new appt., the guy said something like, "it is very important to discover physical conditions that may be the underlying cause of psychological symtoms." Woo-hoo! Now I only wonder why the other social worker and set of docs at THE SAME HOSPITAL couldn't figure this out the 1st time!!! Gosh, I guess I shouldn't complain. Doesn't everyone go for 3 psychiatric hospitalizations in the span of about 2 1/2 months?
Thanks again for everyone's thoughts, prayers, and information/advice. I think things may be finally coming together so that Kalina can take charge of her health and start to have a life again.
I just wanted to thank everyone and ask one question. Your support and prayers have been SO helpful to me. I try to protect my daughter's privacy, so I haven't told poeple in our church (except for a few) about the hospitalizations. It's a bit hard when the pastor asked my husband, "Is she in sin?" Felt like asking him if HIS elderly father was "in sin" because he was recently diagnosed with Parkinson's! Anyway, I got over being hot about that one, and we are working hard to EDUCATE folks about how complex these endocrine disorders are and how they mask as mental illness.
Here is my question: the psych. docs just put Kalina on Cymbalta (don't know what dosage) about last Wednesday. Has anyone heard of any interaction issues with Cymbalta and Armour thyroid? Just on Tuesday it seemed to me that the brain fog was lifing and Kalina was starting to actively plan about getting discharged. Now she is reporting to her dad that she is having trouble sleeping, her anxiety is increasing, and she is trying to make fine cuts on her arms (with the plastic wrist band that she pried off). Sounds like bad side effects to me!
Right now I am going to check out 2 other hospitals that have mental health inpatient units. This currentl hospital is not only NOT helping her, it seems to be making things worse. One of the hospitals I will check out is a hospital where the new doc she has an appt. for tomorrow morning has privleges. Since it doesn't look like she will be ready to be discharged today, maybe this will be a way to finally get her thyroid treatment pushed into first priority. I would appreciate your thoughts and prayers!!!
Well, we got through the meeting. The social worker is sympathetic to Kalina's plight and even shared his own medical history of having thyroid surgery for his own depression. However, a couple of important things came out of the meeting: Kalina needs continuing treatment for an eating disorder (which her insurance will not pay for within an affiliation of this psych. hospital) as well as for her depression. The social worker will see if she can be transfered to another local hospital that has an eating disorder unit (one which is in the hospital system where her new doctor has privleges). Also, it is apparent that Kalina's doctor (both a psychiatrist and a family medicine doc) did NOTHING in terms of follow up RE: her thyroid problems. There are no transferred medical records in the file, there is no evidence of any thyroid testing at all, and I heard through the grapevine that Kalina's psychiatrist made a statement like, "I've never known a patient to die of low magnesium." So, it is probably just as well that she goes to another facility. I'll let everyone on the forum know what happens in the next couple of days.
Scratch out the part above about Kalina possibly transferring to another local hospital. I just reviewed the info., and I made a mistake. That hospital does NOT have an eating disorder unit. There is one other possible hospital. I have to talk to Kalina and the social worker and see what she wants to do.
Bumping this up for others to see...........
Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for Cymbalta should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose.
There have been reports of hepatic failure, sometimes fatal, in patients treated with Cymbalta. These cases have presented as hepatitis with abdominal pain, hepatomegaly, and elevation of transaminase levels to more than twenty times the upper limit of normal with or without jaundice, reflecting a mixed or hepatocellular pattern of liver injury. Cymbalta should be discontinued in patients who develop jaundice or other evidence of clinically significant liver dysfunction and should not be resumed unless another cause can be established.
Cases of cholestatic jaundice with minimal elevation of transaminase levels have also been reported. Other postmarketing reports indicate that elevated transaminases, bilirubin, and alkaline phosphatase have occurred in patients with chronic liver disease or cirrhosis.
Cymbalta increased the risk of elevation of serum transaminase levels in development program clinical trials. Liver transaminase elevations resulted in the discontinuation of 0.3% (82/27,229) of Cymbalta-treated patients. In these patients, the median time to detection of the transaminase elevation was about two months. In placebo-controlled trials in any indication, elevation of ALT > 3 times the upper limit of normal occurred in 1.1% (85/7,632) of Cymbalta-treated patients compared to 0.2% (13/5,578) of placebo-treated patients. In placebo-controlled studies using a fixed dose design, there was evidence of a dose response relationship for ALT and AST elevation of > 3 times the upper limit of normal and > 5 times the upper limit of normal, respectively.
Because it is possible that duloxetine and alcohol may interact to cause liver injury or that duloxetine may aggravate pre-existing liver disease, Cymbalta should ordinarily not be prescribed to patients with substantial alcohol use or evidence of chronic liver disease.
Serotonin Syndrome or Neuroleptic Malignant Syndrome (NMS)-like Reactions
The development of a potentially life-threatening serotonin syndrome or Neuroleptic Malignant Syndrome (NMS)-like reactions have been reported with SNRIs and SSRIs alone, including Cymbalta treatment, but particularly with concomitant use of serotonergic drugs (including triptans) with drugs which impair metabolism of serotonin (including MAOIs), or with antipsychotics or other dopamine antagonists. Serotonin syndrome symptoms may include mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Serotonin syndrome, in its most severe form can resemble neuroleptic malignant syndrome, which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. Patients should be monitored for the emergence of serotonin syndrome or NMS-like signs and symptoms.
SSRIs and SNRIs, including duloxetine, may increase the risk of bleeding events. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs, warfarin, and other anti-coagulants may add to this risk. Case reports and epidemiological studies (case-control and cohort design) have demonstrated an association between use of drugs that interfere with serotonin reuptake and the occurrence of gastrointestinal bleeding. Bleeding events related to SSRIs and SNRIs use have ranged from ecchymoses, hematomas, epistaxis, and petechiae to life-threatening hemorrhages.
Patients should be cautioned about the risk of bleeding associated with the concomitant use of duloxetine and NSAIDs, aspirin, or other drugs that affect coagulation.
Activation of Mania/Hypomania
In placebo-controlled trials in patients with major depressive disorder, activation of mania or hypomania was reported in 0.1% (2/2,489) of duloxetine-treated patients and 0.1% (1/1,625) of placebo-treated patients. No activation of mania or hypomania was reported in DPNP, GAD, or fibromyalgia placebo-controlled trials. Activation of mania or hypomania has been reported in a small proportion of patients with mood disorders who were treated with other marketed drugs effective in the treatment of major depressive disorder. As with these other agents, Cymbalta should be used cautiously in patients with a history of mania.
Hyponatremia may occur as a result of treatment with SSRIs and SNRIs, including Cymbalta. In many cases, this hyponatremia appears to be the result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Cases with serum sodium lower than 110 mmol/L have been reported and appeared to be reversible when Cymbalta was discontinued. Elderly patients may be at greater risk of developing hyponatremia with SSRIs and SNRIs. Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk [see Use in Specific Populations]. Discontinuation of Cymbalta should be considered in patients with symptomatic hyponatremia and appropriate medical intervention should be instituted.
Signs and symptoms of hyponatremia include headache, difficulty concentrating, memory impairment, confusion, weakness, and unsteadiness, which may lead to falls. More severe and/or acute cases have been associated with hallucination, syncope, seizure, coma, respiratory arrest, and death.
Use in Patients with Concomitant Illness
Clinical experience with Cymbalta in patients with concomitant systemic illnesses is limited. There is no information on the effect that alterations in gastric motility may have on the stability of Cymbalta's enteric coating. In extremely acidic conditions, Cymbalta, unprotected by the enteric coating, may undergo hydrolysis to form naphthol. Caution is advised in using Cymbalta in patients with conditions that may slow gastric emptying (e.g., some diabetics).
Cymbalta has not been systematically evaluated in patients with a recent history of myocardial infarction or unstable coronary artery disease. Patients with these diagnoses were generally excluded from clinical studies during the product's premarketing testing.
Clinical Worsening and Suicide Risk
Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to observe for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.
Signs and Symptoms
In postmarketing experience, fatal outcomes have been reported for acute overdoses, primarily with mixed overdoses, but also with duloxetine only, at doses as low as 1000 mg. Signs and symptoms of overdose (duloxetine alone or with mixed drugs) included somnolence, coma, serotonin syndrome, seizures, syncope, tachycardia, hypotension, hypertension, and vomiting.
Thanks for posting the warnings for Cymbalta. We really have no idea why the psychiatrist put Kalina on this new antidepressant, especially when we were observing Kalina improving in mood, thinking, and planning as of last Tuesday. We asked serveral of these questions at the meeting with the social worker yesterday, but of course the psychiatrist was NOT at the meeting, so we got no answers. Below is an expanded update.
Well, we got through the appointment. The social worker was fairly sympathetic with both thyroid issues as well as depression, since he shared that he has had his thyroid removed to help deal with his depression.
We learned a couple of things. Kalina DOES need further treatment for both her depression as well as a bulimia eating disorder. She has been telling us about the eating disorder (which has been active since about March), but for weird insurance reasons the current psych. hospital was unable to treat her for it there. We are fine with her getting further treatment. The other thing we learned is that Kalina's psychiatrist/family medicine doc has only paid lip service to follup up with Kalina's thyroid specialty doc. There are NO transered lab reports/records from the thyroid doc in Kalina's file, there is NO record that the current hospital has done any thyroid tests, and I heard through the grapevine that Kalina's psychiatrist made the comment, "I never heard of anyone who died from low magnesium." He may have called Kalina's thyroid doc, but I think he discounts this doctor because she is a D.O. rather than an M.D. D.O.s have just as much or more training than M.D.s, but I guess there are mainstream physicians that don't take them seriously.
Well, Kalina is looking at 2 other hospitals that CAN give her treatment for her eating disorder and depression (although I'm not sure if it will be inpatient, outpatient, or somewhere in between). I asked Kalina what she had found helpful to her during her current stay, and she really couldn't think of anything (although I think she DID learn the value of journaling to help her sort through the thoughts and feelings she is struggling with).
I've asked Kalina if she will please advocate for herself when she gets into this next phase of treatment to ask that her medical doctor be brought on board along with the other treatment people. One of the unfortunate things that is happening is that Kalina was SUPPOSED to be seeing her new doctor this morning, but because she is not discharged from the psych. hospital she can't make the appointment. I am hoping and praying that the clinic will be able to squeeze her in another appointment soon, since this new doc will be gone on vacation for part of July.
My last thought on all of this is that I truly believe that Kalina's struggles are very closely linked with her recent thyroid troubles. I do NOT know for certain that Kalina's newly diagnosed Hashimoto's disorder (which was never properly discovered 3 years ago) has caused her depression and eating disorder, but all of these problems are concurrent. The stress of college, going a few months as a vegitarian, the possibility that Kalina is gluten intolerant, and her low nutrient levels of magnesium, B12, and ferritin all play into her current psychological issues. For this reason I will continue to urge Kalina to actively involve her medical doctor in any psychiatric treatment she receives from here on out. Kalina asked me yesterday if she could just concentrate on "one thing at a time." She may choose to do that, but I truly believe she will just be setting herself up for a longer recovery time.
I know the process of all this is time consuming but now as she gets on another anti-depressant it could drop her back with the thyroid meds functioning well for her.
The Psych doesn't know fo anyone dying with low magnesium levels? - That my dear - is scary. Obviously she doesn't know how to do her job and really treat someone appropriately.
Again - this is another "fill her with scripts to mask than truly treat her condition"
If the Hashi's is raging which they will and as I speculated from the beginning that she had the meds will counter act more antibodies and cause issues.
I hope the new doctor can see her and she leaves that hospitol for good.
BTW - the "D.O" is possibly looked down on byt them?
Ha - she has more brains than they ever had.
( I could be bias however since she was apart of me maintaining absolute wellness personally)
I'd laugh at them and tell them to put their egos totally away and TREAT your daughter the right way.
Yes, there is NO DOUBT that the D.O. is looked down by the (male) psychiatrist/family medicine doc. The comment about the magnesium levels WAS made to someone in the treatment picture but told to me in confidence, so I promised that it would not get back to the original D.O. doc nor the psychiatrist/family med doc. The psychiatrist/family med doc also commented to Kalina that "there was a difference in philosophy" between him and the D.O., that he was more of a "mainstream" doc--code for "that D.O. is a quack." And yes, I AM very angry at this psychiatric hospital...but I have to be careful to counsel Kalina in a way that is condusive to her eventual recovery. Right now, Kalina is totally on board with going to the new referral doc, and I don't want to jeapardize that open attitude.
I can dream about a future time that I will be able to bring non-refutable lab and treatment records to show these ignorant, arrogant ******** (you can just fill in the blank). I also hope to be able to bring good news back to the thryoid specialty D.O. in terms of Kalina's eventual treatment outcome. I have been telling many people that this one D.O. discovered more in about 2 week's time than 4 teams of doctors found out in 3 years!
WOW! I 17 year old with depression (in adolescence depression is released through risky behavior, anger, sadness, lack of motivation for school difficulty with friends)
For the past year and a half my family has been sooooo struggling with our beautiful daughter's depression. She was diagnosed as hypoacitve in the fifth grade. She has always been a very well behaved student who made As Bs and Cs, until the past two years in high school. She has begun skipping school and smoking marijuana. Cries constantly, and often becomes out of control when she is grounded for worng doings.
We have taken her to counseling but it did not do much good. The doctor tried her on conerta top help her focus in school. She felt that it did help her stay focused, but it did nothing fo rher impulsive behaviors. She is now taken lexapro, which is not doing much for her beahviors either. She is 17 and will not rmember to take her medicine,. i have to watch her take it, or it will be forgotten. She takes levothyxine and cytomel ( generic) The doctor never did test her free ts, he just said to try the cytomel, becasue soe research shows it can help with focus.
After reading this forum, I wonder what my next step should be to see if her thyroid is causing these behaviors. I feel pretty certain some of this behavior is stemming from the "cycle" she has created for herself. . But she just remains so depressed and does not think rationally even for a 17 year old. She has totally blown her chance of getting inot a four year college now, because her grades are too low due to partying. Any ideas??
Just a quick comment for now because it's late, but you and I will have to post and/or private message each other later. I did a quick Google on Cytomel. I believe it is a synthetic T3 med. It may be that your daughter's doc is giving it because she may have the same problem converting T4 (levothyroxine) into usable T3. The article I read said it is important to start at a low dosage and gradually increase it. It also said that it may be best to break the dosage into about 3 parts during the day (since T3 gets absorbed and used up quickly by the body).
I wonder if it is possible that your daughter is alternating hypo and hyper (the hyperactive diagnosis in 5th grade may have been her hyper state). Was she ever tested for the antibodies for Grave's disease as well as Hashimoto's? There can be other things going on such as what has been discovered or suspected for my daughter. When the thyroid is out of whack, the adrenals have to take over things like some heart functions; magnesium and ferritin levels can become critically low (just google low levels of both of those nutrients); and the involvement of female hormones at the start of the period can really send the girl's entire system into physical/emotional overload.
Your daugher is desperately trying to self-medicate herself by smoking marijuana--I doubt that she has much interest in drugs to be "cool." I think it is really important to get the following tests from her current doc or have her referred to someone who will test for them: TSH, free T3, free T4, antibody test for Grave's disease (TSI), and 2 tests for Hashimoto's (I think they are TPO and Tg ab). The conditions I mention are 2 autoimmune conditions that may be causing your daughter's suffering. Grave's produces antibodies that make the thyroid overproduce thyroid hormone, and Hashimoto's thyroditis causes those antibodies to destroy the hormone. Sometimes the two conditions together may be called thyrotoxicosis. I think this is what my daughter has, but she has not formally been diagnosed yet due to the series of psychiatric stays. She was treated for Grave's at 17 but has only been discovered to have Hashimoto's as well just recently at 20. If you click on my name you can see a picture of her with a painting she made when her Grave's was really bad before it was diagnosed.
I am sure your daughter is beautiful, smart, and full of life--but she sounds like she is sick first and depressed second. The real trick is to convince doctors to explore all of the physical possibilities first. Also really try to get your daughter on board. Explore this site and google some of the things I listed here to ask her if the descriptions match her symptoms. Also please check back to let us know how things are going. I know my thoughts and prayers will be with you!
oh thank you so much for your response. Again her family doctor only tested tsh in the fifth grade and it was high so he prescribed synthroid. Since then, when I became concerned aabout her grades, he said lets try cytomel. he did not ever do any free t testing. I am making an appt today and will ask for all the testing. I want to be sure I ask for all that need to be done:
free t 3
total t3 and total t4
can you think of anything else??
She is on lexapro, although i do not see it doing much for her. she misses a lot of doses which i know is not good, It gets much harder when your children are at that age to give them their medicine because they are no longer in my same routine, for ex. get out of bed mid afternoon(ugghhh) when I have been long gone. I can remind her as I walk out the door, but she forgets anyway. I can hand it to her only to find it at the bottom of her pocketbook.
A wise lady once reminded me, "No martter how much pain your teenage child brings into the family, remember... they are hurting even more." Any advice at all is sooo welcomed! Thank you! We are so desperate.
Jumping in here to say that the total t3 and t4 are not necessary, just make sure the FREE t3 and FREET4 are tested along with the TSH and TPOab and Tgab antibodies test for Hashimotos and the Graves test-TSI (?). Also have them throw in the vitamin D,iron (folate), and b level while they are at it. My dayghter is nine and born without a thyroid gland, and she always remembers to take her pills as she knows how important it is too her good health. Your daughter must understand this and take ownership of her health. Other meds and of -course the "pot" smoking can cause havoc for her system and make it impossible for her to get truly well if it is thyroid disease she is suffering from. Do you have her latest labs with date and reference ranges for us to comment on? If she is on a t3 medication as well as a t4 medication, then the doctor should be monitering these levels often with blood labs and you must always get copies of these labs-it's law if you request. I surly hope that her last labs were not done in the 5th grade with her being 17 now? I hope I read that wrong in your post? Your daughter can be well, however you may need a new doctor who moniters her symptoms and labs better. Thyroid disease can cause lots to go wrong if not treated appropriatly and taken seriously. Be very careful of other medications prescribed to treat symptoms and not the real cause of the illness.
Magpieannie, thanks for adding to the explanation. What I have found with my daughter is that a lot of these nutrients get so depleted from thyroid imbalance that it becomes even harder to metabolize the thyroid meds, even when T3 (Cytomel) is added. Your daughter's doc may be on the right track, but magpieannie is right, there needs to be FREQUENT lab tests and check on her symptoms to get her system back working again.
If I were you I would get all of the listed tests from her regular doc. Oh, be sure to take your daughter to the lab in the morning BEFORE taking either levothyroxine or cytomel so that those meds don't skew the results. Also keep in mind that it might be tough to get an accurate reading of your daughter's adrenals. I guess there is some blood test that may give a general idea of what is happening with adrenals, but I understand a 24 hour saliva test is the most accurate, and I don't know how many docs will order that test. There IS also a 24 hour urine test, but I think it only gives an average of the cortisol for that day rather than highs and lows at various times of the day. If free T3 is either low or too high, and/or any of the antibody tests come back positive, then I think you are well within your rights to ask for a pediatric endocrinologist. You will need to keep your daughter's doc on your side, since an "ASAP referral" from a physician could be your ticket to see a specialist in a few days to a week or two rather than the end of the summer! I would think that an endocrinologiest would want to do an iodine uptake scan (something that was skipped with my daughter) to see what shape your daughter's thyroid is in. Keep in mind that if either Grave's and/or Hashimoto's conditions are present, you will need the expertise of a good endocrinologiest to complete the diagnosis and figure out long term treatment.
When you talk with her, try to talk REALLY softly, since I found out that low magnesium/adrenal levels causes a hyper startle response. Try telling your daughter that you have found that a lot of these things are really complex but that you'd like to help her get to the bottom of why she has been feeling so awful for so long. Also tell her that unfortunately, many mental health and general physicians are not up on all of this endocrine medicine. Perhaps your daughter would be willing to write up a list of symptoms she has been having, along with notes if symptoms change according to time of the month or time of the day. She could share that list with the doctor (and know that when a teen says she is really bored a lot of the time, that may mean she is depressed). We have seen a physical change of exhaustion come over our daughter's face in the early evening, and we are guessing that it is when she is most affected by low magnesium, low cortisol from her adrenals, and low T3.
I hope these additional details will help. It sounds like your daughter's doctor is trying to give her the right meds, but there may be a lot more going on than he/she realizes. If your daughter is given the right tests and gets a good diagnosis/treatment plan, then perhaps by the end of the summer she will finally start feeling human again. We wish you well; hope you will be able to report some positive progress!
My daughter entered an eating disorders inpatient program yesterday, and we plan on supporting her in her efforts toward emotional and physical wellness. Our daughter has been asking this psych. hospital for help with her eating disorder in addition to depression treatment since the beginning of her 1st stay. We think it is a bit odd that the hospital only yesterday figured out a way for her to be treated at their affiliate institution only a few short hours after we had presented 2 other area psychiatric hospitals with eating disorder programs (competition). Her doctor only yesterday ordered thyroid tests after we asked in a family meeting on Monday if lab tests/medical records were transferred from her doctor or if any thyroid tests had been taken while our daughter was in this hospital. Forum members can reach your own conclusions on all of this.
I WANT my daughter to get effective treatment for her depression and her eating disorder. However, I feel it is crucial for her to have her physical system (including thyroid, any low nutrients, and possibly low adrenals) attended to WHILE she is receiving her mental health treatments. Otherwise, she may be banging her head up against a wall because she is experiencing physical symptoms that interfere with her treatment. I am also aware that LEARNING about her physical thyroid condition may help her adjust her thinking and expectations, especially with her eating disorder. If she realizes that normal food intake may result in gained weight when in a hypo state and pounds may shed too easily if she returns to a hyper state, she will be better equipped to deal with her food and body issues.
I plan on encouraging my daughter to advocate for her own psychological and physical health. I believe it is very difficult to be young and have all of this happening to her. She needs all of the encouragement she can get from family, friends, and health professionals. If you can spare a thought or prayer directed her way, I'd apprecicate it.
Here is the latest from my daughter's medical doctor in the inpatient eataing disorders program: basically he said that nothing is critical right now with either her thyroid or adrenals. The TSH was low (he didn't tell me the result or the range) on May 30th, and the TSH and free T4 were repeated yesterday (I asked if the free T3 was taken, but he said they didn't need that info.). He said if the TSH would be low again, he would slowly reduce her Armour thyroid dosage.
Kalina is currently on two 60 mg. pills, taken at once in the morning. I asked him if Armour should be taken in 2 or more doses, and he said taking it all at once is fine. Kalina was previously on .150 mg., was reduced to .125 back in April (before her first crisis) due to a low TSH, and was upped to alternating .125 and .137 when in her 2nd psychiatric stay before she saw the D.O. doc who put her on two 60 mg. tablets of Armour. This doc also said that prescribing of Armour was "unusual."
This doc also said he gave Kalina a morning cortisol blood test, and it was in normal range (again, he gave me no value), so he believes her adrenals are OK. He explained to me that the binging and purging Kalina did from March through June has likely disrupted her thyroid function and it may take a few months for it to return to normal. This doc highly recommended that Kalina see an endocrinologist in addition to a primary physician just be monitor her after she is discharged from this program.
I am just wondering people's thoughts on all this. I AM relieved that this doc does not think that she has any critical problems with either her thyroid or adrenals at the moment. One of the reasons I encouraged Kalina to ask about adrenal testing is that she had not been able to sleep well at night for the past several weeks so that this hospital put her on Ceraquill a few days ago. She is better able to sleep, but she still wakes up briefly throughout the night.
Just to clarify, Kalina was on Levothyroxine until June when she was prescribed Armour thyroid.
Obviously if Kalinas TSH is low, she would have sleeping problems. When the thyroid levels even out then she will sleep properly but as for not doing the FT3 test...thats not right.
This is the main hormone that dosing is based on.
The FT3. FT4 and TSH ALL have to be stabilised...not just the TSH.
I saw in an earlier posting that you said you was on a T4 med Debbie...what is your diagnosis and why are you on a T4 med?
Maybe there is something hereditary going on if you too have had thyroid issues?
When I said T4 med, I meant levothyroxine. Oh, I'm SURE there is a strong genetic component. My husband, oldest daughter, and I are all hypothyorid. My husband and I have been quite stable on our dosages (.112 mg. for him, .075 for me & now up a notch at .088) for quite a few years, so we apparently are well able to convert T4 to T3. My oldest daughter (23, living on her own in the northwest part of the U.S.) has had 2 or 3 experiences where she was sweating profusely, vomited, and passed out, but the events resolved before she had to go to an emvergency room. I have always wondered if these health problems were connected to thyorid problems. This daughter's hypo seems far less stable, so when she slows down from her work in the next few weeks I want to share all I have been learning about important lab tests, autoimmune conditions, and Hashimoto's. Actually, our oldest daughter once asked her youngest sister (now 15) when she was going to join the Thryoid Club (LOL)!
I agree that Kalina needs the T3 test, but this doc is not willing to run it for her. We will have to wait until we see either a family medicine doc versed in treating the thyroid or an endo in our area who treats thyroid frequently as well (whichever appt. we can get first!) to get ALL of these tests done.
Oh, since I posted this morning I learned that the Seroquel given for Kalina's sleep is actually considered a psychotic med. It is given to her for sleep help as well as an add-on for depression, but it is also commonly prescribed for depression in bipolar and for schizophrenics. We'll definitely want to see if Kalina can be weaned off that one once her thyroid levels stablize!
Once things start to settle down with Kalinas thyroid levels...kalina will know herself when she is ready to come off the Seroquel and always remember that Kalina must never be given Eyrythimycin (antibiotic) while on this edication as it will have adverse side effects.
I have heard in the USA that you can order labs online....they send out a testing kit and you send it back to the Labs.Other members may be able to help you with info on this.
Maybe even testing the FT3 yourself from Kalina with the home lab kit.
As for the strong history of Hashisin your family...it really has got me stumped why Kalina wasnt tested for it when she was diagnosed with Graves.
I have a sister with Graves and a sister with Hashis and have been checked for both.
At least things are now looking up when all hope was lost.
Just giving a report on my daughter's overall health, although we still won't have the whole picture on her until the end of August when she will see a family medicine doctor RE: thyroid and female hormone levels. She will be starting with our family insurance in mid-August, and she is required to go through a primary care physician before she can see a specialist like an endocrinologist. We are also are working through her counselor's office to get a referral to a psychiatrist who accepts our family insurance to monitor her psychatric meds.
Well, Kalina has been discharged from the eating disorders inpatient unit for 10 days now, and she is doing amazingly well. She is adhering to an "exchange system" type food program, and the rest of our family is joining her in it. Her mood and ability to think, problem solve, and recover after minor upsets are 1000% improved over her mental state during the past 3 months!
Kalina has also accepted an offer from her university in Philadelphia to take a leave of absense for the first semester. If financial aid and courses are still available she will sign up for general education classes at a local community college so she won't get too behind in her program. This time at home will allow her to stablize herself physically and psychologically before she goes back to Philly and a very challenging college major. She is majoring in illustration at her university, but she won't likely take art classes here in Milwaukee.
I am happy to report that Kalina has increased her dosage of Armour thyroid from 2 pills (120 mg.) to 3 pills (180 mg.) a day, and she is spacing them out between before breakfast until about 2 or 3 pm. Her prescribing doctor told her she could go up to 3 pills a day if she needed to, but the docs in the hospital kept her at 2 pills because that was what she started with. The spacing of the Armour allows Kalina to stay energized throughout the day and avoid an afternoon "crash" from lack of T3.
We may never know for sure what things led to Kalina's psychiatric problems, but I think it is fair to say that both thryoid and female hormones were involved. Kalina now accepts that she will need to work with doctors on an ongoing basis to compare her physical and emotional symptoms with accurate blood tests/scans and treat as necessary. She is willing to see a psychiatrist to monitor her psychiatric meds (Cymbalta and Seroquel XR), but she would like to look into weaning herself off of these drugs if and when she feels she is ready. The psychiatrists at the eating disorders hospital dropped a bomb on her on the last day: they told her they had changed their minds and thought that she DOES have borderline personality disorder. Kalina argued with them a bit, and of course they told her that arguing was just another symptom of the disorder! She IS thinking about getting dialectical behavior therapy for this disorder, but I will encourage her to hold off until both her thyroid and female hormones are reasonably balanced. THEN she can talk to a psychiatrist to see if the rapid mood changes and feelings of emptiness still exist OR if these were more driven by hormones. Time will tell...
I wanted to thank everyone here for all of the kind thoughts and prayers over the past 3 months. Support from people here has helped me research accurate info. to check with health providers as well as been a great help to me when I was unable to talk to some of my daughter's doctors about her thyroid problems. The information I have been able to pass on to my daughter is and will be invaluble as she monitors her hormone levels in the future.
It's so good to hear that things are going in a much better direction with your daughter. Thanks for the great report! You are a wonderful mother. God Bless!
Its a great start for her as she finally is gathering up what she needs to get better.
Thanks for posting and so happy to hear she is doing better.