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Diabetic, PCOS, high BP, Spinal stenosis, depression and Anxiety. On Lorazepam, lisinopril and fenofibrate. Have constipation, back pain

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Answered by

General & Family Physician
Practicing since : 2005
Answered : 2307 Questions
Age: 39 Gender: female Weight: 170 lbs Height: 5'3"
current medications:
carvedilol, fenofibrate, hydrocodone, lisinopril, lorazepam, omeprazole, Benadryl,
Cymbalta, Vitamin B12, Vitamin D3
Diagnosed Type 2 Diabetes, high blood pressure, Poly cystic Ovarian syndrome, hysterectomy retained right ovary. Diabetic Neuropathy, Depression, Anxiety, Lumbosacral radiculopathy with spinal stenosis bone spur, two previously fractured thoracic vertebrae (asymptomatic) no known cause.
My Diabetes is under the best control I have ever had yet I am rapidly loosing physical control of my body. My limbs are week, my legs frequently give out, I have poor balance. When I do to much I start to randomly twitch at any body location generally one twitch at a time. But can have more of a spasming as well. Recent EMG 4+ with no report. MRI found two spots of white matter "areas of high T2 signal are present within the white matter surrounding the atria bilaterally, right greater than left as well as within the right frontal carona radiata. These foci of white matter signal alteration, however this is an abnormal finding for a patient this age."
Other symptoms include Stomach boating, Gassy, constipation? more of a lack of ability to get my body to release stool not hard. difficulty swallowing quickly, fatigue, Low back pain nerves have been burned surgery scheduled for fusion in March.
Blood work over the last year at separate times showed low sodium, low b12, low vitamin D. different one each test. Had ct scans, barium swallow, multiple tests on stool. only result Gerd and a small ovarian cyst which has now resolved. Barium swallow may be inaccurate as I was actually gagging while trying to swallow and almost vomited but swallowed it back down could not drink as rapidly as they wanted without gagging.

Can all, or most of my symptoms (primarily physical and mental deterioration) be attributed to one cause?
What tests should my doctor run to figure out the cause of all the new symptoms.
If this is just Diabetes why is it worsening now when I have good control?
can fenofibrate be causing my stomach issues, nerve issues?
can any of my meds be causing fatigue, muscle spasm, weakness, noodle legs? week arms. Is this neuropathy or somthing else?
What caused damaged white matter in the brain? What does this mean?
What is overall prognosis? will I lose more brain function? Will I lose more physical function? How do I stop it or slow it? Can I get better and how?
Why am I not absorbing the vitamins from the food I eat? If I am not absorbing the nutrients from food am I even absorbing all these medications I take?
When I asked my Dr about the MRI results he said I was retarded, am I retarded? At first I thought he was joking now I'm not sure?
Posted Fri, 11 Oct 2013 in Brain and Spine
Answered by Dr. Prasad 9 hours later
Brief Answer:
You are not retarded...

Detailed Answer:

I went through the details provided with diligence. And I shall try to answer all your individual questions.

1. I presume you have been living with those symptoms for quite some time now. Chronic symptoms which spread across multiple body systems are usually not due to single cause; two or more causes co-exist. I suspect these might be due to nutritional deficiency (if low vitamin b12/vitamin D are recent findings); effects of some of your medicines; metabolic changes, GERD related indigestion as well as depression/anxiety. I would urge you to discuss about each of those possibilities and if appropriate get them treated.

2. You been through quite a few tests. you were to be my patients, I would check at your liver function test (effect of medicines); thyroid functions; lipid profile; homocysteine levels and complete hemogram. I would also recheck your vitamin b12 and glycosylated hemoglobin values too.

3. If blood sugar is under control, usually the fitness level is adequate. However if diabetes has been a problem since a long time (more than 10 years), there are some changes that happens irrespective of diabetic control. Neuropathy, eye functions and renal functions need to be assessed regularly. If diabetes is your long standing problem then I would include these in my list of investigations too.

4. Fenofibrate is reported to cause indigestion and abdominal bloating. It may also be responsible for muscular weakness.

5. Besides fenofibrate, you should also look if the effects of lorazepam persist overnight to make you feel drowsy and weak. Less likely omeprazole and your depression medication may be contributing.

6. White matter hyperintensity on T2 are mainly due to vascular causes. It is not looked as concerning if you have had no neurological symptoms similar to stroke. Less commonly these can be areas of demyelination which again doesn't signify much.

7. I haven't found any significant history to suggest that you will be worsening very soon. Work closely with your psychiatrist and internist. If needed you can seek help from a gastroenterologist. I expect them to figure out your problems and treat them.

8. Vitamin deficiency is generally due to diet reasons. Pure vegetarians; dark skin individuals and those who shy away from sun are prone to vitamin b12 and D deficiency. Besides those smokers and individuals with renal problems fail to keep up vitamin b12 and vitamin d levels respectively.
Inability to absorb vitamin b12 is more common than vitamin d. A small set of people with stomach problems and intrinsic factor deficiency fail to absorb vitamin b12 in any forms.

9. I think it is pretty much sure that you are not retarded. Your doctor should definitely be joking.

Hope I have answered all the questions to your satisfaction. Let me know if you need clarifications.

Above answer was peer-reviewed by
Follow-up: Diabetic, PCOS, high BP, Spinal stenosis, depression and Anxiety. On Lorazepam, lisinopril and fenofibrate. Have constipation, back pain 43 minutes later
"White matter hyperintensity on T2 are mainly due to vascular causes. It is not looked as concerning if you have had no neurological symptoms similar to stroke"

I have had a very difficult time thinking lately, I frequently stutter, and can't think of the word I'm looking for. There has been a definite change in my mental abilities not only noticed by me but also my family.

I was not aware that neuropathy could make you so weak I have never had the tingling things it says it starts with. There has been a rapid decline in my physical functioning. Two months ago I walked with a limp from pain related to my back now I have trouble standing, have to wall walk, or use a rolling walker for anything greater than the distance from my door to my car and even then am very wobbley. I am physically fatigued by simple activities like going to my daughters dance show. When I got home it was all I could do to make it to my bed and lie motionless for several minutes.

The stomach problems started in January
The thinking problems worsened a few months ago
and the weakness, instability, and fatigue symptoms became noticeable separate from my back issue about 3 months ago.

I have been diabetic exactly 10 years if you include the gestational diabetes that never went away after my 9 year old was born.

Your answers seem to make sense other than the persistence with the psychiatrist is quite annoying as I always keep my appointments with him and to have it insinuated that this is psychiatric in any nature is a bit offensive. Of course I have depression that comes with chronic illness but it is under control. The Lorazapam is only 1mg and the fatigue is worst in the evening.

so even given mental decline do you still feel the MRI is insignificant? and yes this was noticed before the MRI not after receiving the results?

It is the rapid decline that has me frightened you said this was inevitable after 10 years of diabetes so does that indicate I will most likely continue to decline?
Any indication of prognosis? Doesn't have to be a specific time frame but it is logical that if this is all caused by Diabetes it will eventually get worse not better?

Thank you for your guidance It helps to have specifics to discuss with my doctor as I am very forgetful.
Answered by Dr. Prasad 50 minutes later
Brief Answer:
Neuropathy isn't the cause....

Detailed Answer:

I think I need to make few of my statements clear.

1. I only mentioned that patients with long standing diabetes should screen for neuropathy, eye problems and renal problems regularly atleast once a year. It doesn't explain all your symptoms. And yes, diabetic neuropathy mainly involves peripheral limbs - you will have tingling, pins and needles and lower muscle weakness with diabetic neuropathy.

2. Couple of small white matter hyperintensities do not cause weakness, memory impairment, stuttering speech and your other complaints. Well, most of my patients with small hyperintensity are completely asymptomatic. Thus I said, it does not concern me.
I agree with your doctor that it is not common to see those spots in young patients; but that is unlikely to be responsible for any of your symptoms.

Long standing diabetes, hypertension as well as high cholesterol levels can cause small arterial blocks which can produce similar spots in your brain white matter. Since you are low on vitamin B12, I would like homocysteine levels to be checked too.

3. I am sorry I did not mean to offend you and I do not mean you are complaining because of depression. I added that to this list since there is a strong relation between depression and another condition named chronic fatigue syndrome (CFS). The spectrum of symptoms seen in CFS does fit your description. Your psychiatrist will know about CFS; therefore visiting him/her is a worthy option. And yes 1mg lorazepam is too low to produce the next day weakness.

I hope my answer is clear now. Feel free to post your doubts.

Above answer was peer-reviewed by
Follow-up: Diabetic, PCOS, high BP, Spinal stenosis, depression and Anxiety. On Lorazepam, lisinopril and fenofibrate. Have constipation, back pain 12 minutes later
That clarified it much better I apologize I'm a bit oversensitive in respects to having everything referred to a psychological cause I once had a psychiatrist give me permission to stop twitching after a reaction to medication. Ironically all I had to do was stop seeing him and go off my medication and the problem resolved itself.

I appreciate your candor and will follow up with both my doctor and psychiatrist.
Answered by Dr. Prasad 25 minutes later
Brief Answer:
You are wlelcome...

Detailed Answer:
I appreciate your comments and I wish you get this sorted and treated rightly as soon as possible.

Please close this discussion if you have no more questions for now. I will be very glad if you can leave your feed backs after closing.

Good luck!!
Above answer was peer-reviewed by
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