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Question: Hx: gastric bypass, adhd, recent abnormal stress, chronic depression, sleep apnea, obesity (morbid) htn, Meds: exforge5/160 qd, vyvance 50qd, prozac40 qd, wellbutrin200 bid, b12 2500mcgs sl qd, xanax 1mg qhs ,ambien 10 mg qhs ,vit d LAB Values: Iron-33, TIBC 417, Sat% 7.9, Ferritin 7, Folate 19.2, b12 1426, h/h 10.7/32.2- Question: new- headaches, loss of hearing one side, "echo-like or drum like" when I talk, manic-like activity/episodes especially when stressed, about to lose my job-work nights- I need potential diagnoses.. help? (aside from cut the b12 down, doing that tomorrow, just got labs back today)
I did not mean abnormal stress test. I meant way more than usual stress in my life
I did not mean abnormal stress test. I meant way more than usual stress in my life
Brief Answer:
investigation is needed
Detailed Answer:
Hello,
you've mentioned some symptoms and lab results that require careful investigation. Let me comment on them:
- headaches and hearing loss: an ENT (ear-nose-throat) should examine you and check your otogram to establish a diagnosis about your impaired hearing. Potential causes may include obstruction of the external canal by cerumen, inner ear damage, neural pathway damage or brain lesions. The headaches have to be evaluated about suspicious signs like headache of high intensity that started abruptly (like being hit with a hammer), vomiting, worse headache when lying down which may awake the patient, etc
- you seem to be out of iron: iron deficiency always needs investigation. Common causes include reduced iron intake (not enough meat usually) or increased losses (gastrointestinal bleeding, hematuria, skin losses like in psoriasis, etc). Your doctor should first try to identify the cause by taking a complete medical history and perhaps also ordering tests like an upper gastrointestinal endoscopy and a colonoscopy.
- manic episodes: I can't address this issue just like that. You should have a long talk with a psychiatrist, in order to assess your situation. Your increased psychological pressure regarding your job perspectives is not helping!
I do not understand what 'h/h' is. Please clarify what this test is about.
Until you do the above, you can take some iron supplements to correct the deficiency.
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.
Kind Regards!
investigation is needed
Detailed Answer:
Hello,
you've mentioned some symptoms and lab results that require careful investigation. Let me comment on them:
- headaches and hearing loss: an ENT (ear-nose-throat) should examine you and check your otogram to establish a diagnosis about your impaired hearing. Potential causes may include obstruction of the external canal by cerumen, inner ear damage, neural pathway damage or brain lesions. The headaches have to be evaluated about suspicious signs like headache of high intensity that started abruptly (like being hit with a hammer), vomiting, worse headache when lying down which may awake the patient, etc
- you seem to be out of iron: iron deficiency always needs investigation. Common causes include reduced iron intake (not enough meat usually) or increased losses (gastrointestinal bleeding, hematuria, skin losses like in psoriasis, etc). Your doctor should first try to identify the cause by taking a complete medical history and perhaps also ordering tests like an upper gastrointestinal endoscopy and a colonoscopy.
- manic episodes: I can't address this issue just like that. You should have a long talk with a psychiatrist, in order to assess your situation. Your increased psychological pressure regarding your job perspectives is not helping!
I do not understand what 'h/h' is. Please clarify what this test is about.
Until you do the above, you can take some iron supplements to correct the deficiency.
I hope you find my comments helpful!
You can contact me again, if you'd like any clarification or further information.
Kind Regards!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answers! h/h is hematocrit/hemoglobin, I was wondering if all symptoms- the stress, low iron , and/or the psych medicines could be interacting in a way to be causing the manic and the headaches. I see where the stress can cause the mania. Just wasn't sure if the rest (the low iron, low sat%) of it contributed to the mental status especially combined with those drugs. I know low iron causes fatigue, but so does depression and stress
. And I have tried cleaning the ear out, there wasn't much ....there time for ENT
Low iron is probably from the gastric bypass, I just had a colonoscopy and egd about 3 weeks ago and he said "see you in 10 years for a check up"
I guess my question should have been - - does low iron cause any mental side effects.
I have been on those meds for a long time and never had these kind of problems before- the mania problems,, of course the stress- which is out of control-- is working a night shift in an ER, stuck with 2 houses in Florida (one is mine and one my father left me) both have mortgages- can't sell without owing, up here in Ohio, cause I can't find work there (I broke both knees running to a car accident and can't do 12 hour shifts anymore- so now I half sit half walk for 12 hours as a case manager), My renters left with a 9 day notice. I don't have money. I used up all my retirement money while my parents were dying. And now I'm trying to work on my master's degree to better myself for case management job. I have always had some level of stress, but maybe all this is the straw the is breaking the camel's back, so to speak.
. And I have tried cleaning the ear out, there wasn't much ....there time for ENT
Low iron is probably from the gastric bypass, I just had a colonoscopy and egd about 3 weeks ago and he said "see you in 10 years for a check up"
I guess my question should have been - - does low iron cause any mental side effects.
I have been on those meds for a long time and never had these kind of problems before- the mania problems,, of course the stress- which is out of control-- is working a night shift in an ER, stuck with 2 houses in Florida (one is mine and one my father left me) both have mortgages- can't sell without owing, up here in Ohio, cause I can't find work there (I broke both knees running to a car accident and can't do 12 hour shifts anymore- so now I half sit half walk for 12 hours as a case manager), My renters left with a 9 day notice. I don't have money. I used up all my retirement money while my parents were dying. And now I'm trying to work on my master's degree to better myself for case management job. I have always had some level of stress, but maybe all this is the straw the is breaking the camel's back, so to speak.
Brief Answer:
probably no relation to the iron deficiency
Detailed Answer:
Hi,
you're welcome and thanks for the detailed info. It helps to understand a patient's complaint better.
I see that you focus on the psychological aspects of your situation. The iron deficiency is not supposed to cause them. Iron deficiency (when severe, with low hematocrit) may cause concentration problems, headache, shortness of breath etc but it's not supposed to cause manic episodes. I would consider attributing psychiatric symptoms to iron deficiency in older individuals because of the detrimental effects of aging on their brains but you're not that old.
So I believe that your main problem is the stressful situation that you've got into. In any case you should talk to the psychiatrist for further evaluation. Perhaps you did have a problem that waited for the right circumstances to make its appearance or it could be just a reaction to the highly stressful situation. Your psychiatrist is the best person to judge that.
One more thing... the iron deficiency is probably due to the gastric bypass (indeed) but we can't say for sure until we do the tests. The negative colonoscopy is good. An upper endoscopy would be useful and reassuring (if you haven't done any recently) because the anastomosis site may develop tumors which may cause iron deficiency among other symptoms or findings.
I really hope that you find a solution to this situation both the financial and the psychological!
If you'd like to discuss anything more, I'll be glad to help!
Kind Regards!
probably no relation to the iron deficiency
Detailed Answer:
Hi,
you're welcome and thanks for the detailed info. It helps to understand a patient's complaint better.
I see that you focus on the psychological aspects of your situation. The iron deficiency is not supposed to cause them. Iron deficiency (when severe, with low hematocrit) may cause concentration problems, headache, shortness of breath etc but it's not supposed to cause manic episodes. I would consider attributing psychiatric symptoms to iron deficiency in older individuals because of the detrimental effects of aging on their brains but you're not that old.
So I believe that your main problem is the stressful situation that you've got into. In any case you should talk to the psychiatrist for further evaluation. Perhaps you did have a problem that waited for the right circumstances to make its appearance or it could be just a reaction to the highly stressful situation. Your psychiatrist is the best person to judge that.
One more thing... the iron deficiency is probably due to the gastric bypass (indeed) but we can't say for sure until we do the tests. The negative colonoscopy is good. An upper endoscopy would be useful and reassuring (if you haven't done any recently) because the anastomosis site may develop tumors which may cause iron deficiency among other symptoms or findings.
I really hope that you find a solution to this situation both the financial and the psychological!
If you'd like to discuss anything more, I'll be glad to help!
Kind Regards!
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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