Tuesday, July 10, 2007

Matters Medical

This week's Grand Rounds is up; thanks for including me, Tara!

Elsewhere on the medical front, Gary had a routine checkup with our primary-care doc yesterday, and I went back with him to ask about my stress-echo results. I know this was obnoxious, but our doctor was very nice about it. (I offered to pay my own co-pay, and she said, "No, no, that's all right.")

Her take on what happened was, basically, "The cardiologist who read your test is excellent, and if he says it was a false positive, it was a false positive."

"But this EKG was worse than the one three years ago, wasn't it? Can you compare the two?"

So she obligingly did. "I'm not sure it's worse."

"But last time the ST depression was one millimeter; this time, the PA told me it was two or three millimeters. Isn't that worse?"

"I'm not sure it's worse, and if it is worse, that's probably because of the nortriptylene." (The reason we added Effexor rather than upping the dose of the nortrip was because I'd had a few short episodes of tachycardia.)

"So you don't think we should do a thallium test? The PA said that provides better pictures than the stress echo."

"No. The stress echo is the best test for women; it's better than the thallium test."

I've spent the past week reading about coronary microvascular disease in women, which classically produces abnormal EKGs but normal visual scans. I told her that, and then said, "But I gather there's really no way to test for it, and anyway, I'm already as risk-reduced as I can get." (Regular exercise, low cholesterol, healthy weight, good blood pressure, non-smoking, yada yada.)

"You took the words out of my mouth. Even if we knew you had that, what else could we do?"

Actually, some things I've read about the WISE study indicate that SPECT can pick up microvascular, but she'd already dismissed that study because it hasn't been reproduced. And even if we saw the problem on a test, there's still the "what else could we do" problem. And I'm sure SPECT's even more expensive than the stress echo; when Gary and I were driving home, he said, "Well, at least we won't have an eight thousand dollar copay for another test."

I like our doctor a lot, but I'm not thrilled with all this. I really wish she'd said something like, "I know you're nervous, but you're really okay." She's usually more empathetic, but I was being obnoxious by horning in on Gary's appointment, and she's entitled to bad days too.

I'm still having chest pain, but I guess now we go back to square one and chalk that up to GERD. Mind you, it's not like I want to have heart disease, but at least that theory accounted both for the chest pain and the fatigue. If cardiac issues aren't causing the fatigue, the most likely candidate is our old friend depression. Although, to complicate matters, depression is its own risk factor for cardiac issues.

I saw my psychiatrist yesterday, too, before the other appointment. She suggested that I try taking B vitamins, which can help with energy. She wants to see me again in a month, and if I'm not feeling better, she's going to take me off the nortrip (probably a good idea anyway, if it made the EKG worse) and put me on Lexapro, and then take me off the Effexor so I'm only on Lexapro.

Welcome to the medication merrygoround.

I. hate. this.

Especially since we don't know for sure that the fatigue's from depression, anyway; during the two or three hours a day when I'm not too tired, my mood's fine. I really wish there were a handy at-home blood test for depression, a depressometer.

I wish even more that I could just be off meds. The other day I met someone with a much more serious depression history than mine (multiple hospitalizations, suicide attempts) who tried every antidepressant on the planet, was still depressed on all of them, and has now foregone all medication in favor of yoga and ACT therapy.

I ran that story by my shrink. She wasn't impressed.


Okay, I'll stop whining now. Maybe the B vitamins will work. Wouldn't that be lovely?

And now I have to drive Gary to the lab for fasting bloodwork.


  1. Ambiguity - ugh.

    I'm sorry that you are living in somewhat of a miasma. But it also reads as if you have some high functioning coping strategies, and lots of loving and caring around you. I hope you can hold on to those, and that they can make it easier to live through the uneasy times.

  2. Anonymous1:39 PM

    Susan, i suspect a psychologist would be more amenable to something like ACT than a psychiatrist. Try looking up "energy therapy" or something like that. Look for Seemorg which combines something like ACT with charkras.


  3. Anonymous1:50 PM

    What n=1 said - can't say anything better than that! But hope you know that we're all thinking of you, and wishing good things for you,


  4. ::hugs::

    Sorry about the general non-reassurance. I hope it's all on the up-and-up from here.

  5. Susan, I'm sorry about all of the ambiguity! I can definitely understand the frustration. I hope that the Vitamins help the fatigue.

  6. Is there any chance the nortriptyline itself is either causing or exacerbating the fatigue? I ask because the drug is known to have sedating properties, and years ago when I took a similar drug, amitriptyline, I was very fatigued/sedated. The sedating properties of nortriptyline are not listed as a "side effect," presumably because they are a MAIN effect. Hope something will work out.

  7. blood test? i'd let 'em look at my brain close up if they could tell for sure if it was depression or thyroid or not enough b or just the arthritis flaring or what. jumpin' jiminy, i'd sign right up for that.

  8. Sorry. God help you.


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