Having to make a choice between 2 bad options

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_Christina
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Date Joined Feb 2007
Total Posts : 553
   Posted 5/12/2011 9:30 AM (GMT -6)   
As everyone already knows I have bipolar as well as rheumatoid arthritis. I also have Seasonal affective depression disorder, sleep apnea, very mild asthma, and a host of (every season) seasonal allergies.   I suspect that I might have fibromyalgia, but I haven't had anyone actually look to see if I might have it.
 
At the beginning of each spring when the light increases my psychiatrist decreases my antidepressant (Cymbalta) to keep me from "bottle rocketing" into a hypomanic/manic state.  In the fall as the season gets colder and the light gets shorter she increases it again.  This has worked well for the past 3 years.
 
Over the past year or so my pain levels have increased dramatically. This spring when the Cymbalta was decreased the general "non-joint" aches and pains increased significantly.  At first my psychiatrist suggested that it may be a rebound effect and that it may drop off after a while.  Well, I gave it 8 weeks and if anything the aches only increased in strength.
 
My pain psychologist who is in active communication with my pain clinic says that they were concerned that this would happen when I decreased the Cymbalta and feel that it should be increased again, in fact to a higher level than it was before to make it more effective to my "non-joint" pain.
 
My psychiatrist did give an option of what we could do to increase the Cymbalta if needed.  To keep me from "going off the deep end" I would need to first increase the mood stabilizer that I am on (Lamictal) which would take 8-12 weeks to take effect, then increase the Cymbalta, taking another 6-8 weeks to take effect. Looking at up to 20 weeks (5 months) if everything goes smoothly.
 
One thing to consider is that it is the side effects that the Lamictal causes.  It inhibits my word recall. (in a conversation you know what it is you want to say, but you just cant remember the word you want to used) It is enough right now that it is very annoying and is a noticeable change for me.  Also, it inhibits the comprehension of math figures.  Basic addition, subtraction, multiplication, division is occasionally beyond me.  It is the most annoying, unnerving, embarrassing thing.  
 
If I increase the Lamictal these side effects will be more pronounced.  It has been known to slow thought, effect memory, decrease sexual desire (word recall problem there, there is a word for it on the tip of my tongue, but I can't remember)  If I increase the Lamictal I may loose some of who I "am".  It is a common fear for those with bipolar.
 
I have a choice between possible (probable) decrease in pain and possible (probable) personality changes.  Which is worse?  Which am I more afraid of? 
 
Every medical decision has a trade off, and many are a choice of 2 bad situations.  I am aware that sometimes I trade health for functional time.  Years at the end for health now. energy for pain relief..... So, pain for mood stability or comprehension/personality for lack of pain?
 
I really don't know yet.  I wish I could get these drs to sit down and talk to each other in person.
Treatments: gluten-free diet, Cpap
Medications: omeprazole, probiotic caps; multi-vitamin supplement; docusate sodium, fiber chews; zertec, ferrous sulfate, cymbalta, lamotrigine, ambien, alprazolam, plaquinil, sulfasalazine, methotrexate, leucovorin calicium, folic acid, motrin, tramadol, pennsaid, aspercream, nasonex, albuterol sulfate inhaler

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 5/12/2011 9:38 AM (GMT -6)   

 

   Christina, I'm willing to bet everyone here will relate to you're post big time!

       That is one of the main reasons I hate taking the pain med's, as I suffer loss of several body functions, and the worst is the memory problem. As for me, I would rather have the pain treated in trade of the losses.

          Thanks for posting this, and it will be interesting to see some of the comments on it.

        Excellant Topic!

       SE wink


Moderator Chronic Pain Forum

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straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16273
   Posted 5/12/2011 10:00 AM (GMT -6)   
Christina it does sound like you really are caught in the middle of trying to make a decision on two difficult situations. Seems like nothing is ever easy anymore for a lot of people you know. I am sure you will make the right choice on whatever you decide.

Take care of yourself.
Moderator Chronic Pain Forum

NiNi53
Veteran Member


Date Joined Mar 2011
Total Posts : 816
   Posted 5/12/2011 10:02 AM (GMT -6)   
I am so sorry you are having such a bad time.  SE is right about the trade offs.  I think life in general is a series of trade offs whether you are a cp patient or bi-polar, or any of the many many other things that effect our lives.
 
I believe that even if say for instance you are one of the lucky people that dont have the everyday trauma of the different diseases that all of us on all the different forums have.  Still even without that,  life is a series of tradeoffs.
 
Desicions that are made when you have children, change jobs, move to a different city or state.   Its always going to be that question, "did I make the right choice, did I research all my options, etc.
 
When you add on top of that bi-polar, cp, and all the others it is just that much more difficult.  I bet I second guess myself 10-20 times a day.  I think that you have to get to know as much as you can and then make the best decision you can, well thats all a person can do.  My heart goes out to you.  I am hoping and praying you find the best treatment available to you.
 
Is it possible to have all of your doctors actually set a meeting with you and each other at the same time.  That sounds like a really good idea.  Again with doctors, at least some of them, you have to let them think its their idea.
 
I really am praying for you Christina, and I know others are doing there share also.  With that much good karma going into the realm that surrounds us you just have to feel better, gentle hugs to you.
 
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

Jim1969
Veteran Member


Date Joined Jul 2009
Total Posts : 2042
   Posted 5/12/2011 7:09 PM (GMT -6)   
I don't know, but maybe you have a 3rd option. Talk to your doctors about adding Lyrica to your medication routine. That may help with the aches and pains the Cymbalta was covering at the higher dose and you may not have to mess with your other meds.

I don't know if that will work or is even an option for you, but it might be worth talking to your doctors about.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

_Christina
Veteran Member


Date Joined Feb 2007
Total Posts : 553
   Posted 5/13/2011 11:40 AM (GMT -6)   
Thank you for all the replies. 
Paula, I know that you are right there with me, and you don't know how much it means to me that there is some one who "knows" where I am.  I am very glad for my team of drs.  My PM dr has worked with my husband and my hubby has a very good opinion of him, The PM's nurse visits regularly with my pain PSY, making a great team.  My psychiatrist is thought to be the best in the area and has a huge waiting list.  She has to turn away a lot of clients.  I was lucky to get in several years ago.
 
One thing that my psychiatrist has said is that with all the changes that the other drs are doing, she wanted to keep what we do simple and when the other drs get things under control we will look again to see what is most effective.  The less things we change at a time, the more stable I am going to be.
 
At the begining of my treatment we tried a few diffrent meds and they just didn't seem to work well for me.  Until the pain increased the Lamictal/Cymbalta/Ambien/Alzapram combination worked well for me.
 
She says that it is very hard to control BP(bipolar) when the CP treatment is being changed all the time, and is particularly hard to control when on narcodics.  She says that I seem to be very sensitive to medications and seasonal changes and I shoot arround like a ping pong ball rather than slow sweeping changes. 
I can't seem to be able to so anything halfway or "normal".
 
I see the new rheumatologist on monday, then see my psychiatrist on tuesday, then the pain PSY on wednesday. 
I'm sure that there will be more options and opinions offered within these appointments.  I'm trying not to stress now because it won't do me any good and the issues will be addresed in due time.
I know that there won't be any quick changes, but in the meantime my moods and pain levels bounce arround like that pingpong ball I have been compaired to.
 
Treatments: gluten-free diet, Cpap
Medications: omeprazole, probiotic caps; multi-vitamin supplement; docusate sodium, fiber chews; zertec, ferrous sulfate, cymbalta, lamotrigine, ambien, alprazolam, plaquinil, sulfasalazine, methotrexate, leucovorin calicium, folic acid, motrin, tramadol, pennsaid, aspercream, nasonex, albuterol sulfate inhaler
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