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    Suggest treatment for diabetes and hormonal imbalance

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Posted on Tue, 7 Mar 2017 in Bones, Muscles and Joints
Question: I am a complex mix of health issues and am experiencing new symptoms in the last month. I am on XXXXXXX Disability and do not have a full time job. I am a freelance graphic designer with a light work load. However I have ongoing stress (significant) in my life at the moment.

History: Diabetes-not well controlled, PCOS (irregular menstrual cycle and hormone imbalance, high testostorone and depressed levels of FS'H and estrogen) , HBP-under control with meds, Depression (even with two meds I still feel very depressed and lack enthusiasm or enjoyment of the things which used to make me happy) and Anxiety (relatively well controlled with meds AFTER attack has taken place - no control over when/where the attacks will happen), Fibromyalgia,(I have a lot of flare-ups) Post traumatic arthritis in both feet, Migraines and Cluster headaches ( not controlled, meds don't seem to work. Also have been experiencing these daily since the age of 18 and started at 15)

Due to taking ibuprofen at 800mg up to 3x a day for 20 years my kidneys are now only functioning at 50%.

I have been diagnosed with Gastroparisis.

Med list:
DAILY
Cymbalta - 90mg ER daily
Wellbutrin - 150 IR mg daily
Toporol ER - 50mg daily
Diovan - 320mg daily
Lasix 40mg daily
Janumet - 2.5/1000mg 2x daily (Januvia/Metformin Combo)
Lantis - 40 units at night
Apidra - 10 units with meals and sliding scale thereafter
Opana - 10mg 3x a day (have seen a new pain doctor and he has upped the dosage to 20mg ER 3xa day. I have not started as I just got the prescription yesterday)
Xanax - 1mg 2x a day as needed.
Zanaflex - 8mg at night
Linzess - opiod constipation

AS NEEDED
Ambien - 10mg at night as needed
Reglan - 10mg as needed
Protonix - 40mg as needed
Zofran - 4mg as needed
Promethazine - 25mg every 4 hours - as needed

Surgeries
1996 - Tonsils Removed
1997- Breast Reduction
2004 - ACL Replacement Left Knee
2007 - Repair Broken Nose and Turbinate Reduction
2010 - Right foot Lisfranc Injury Repair #1 (surgery failed)
2011 - Right foot Lisfranc Injury Repair #2 (surgery failed)
2011 - Gallbladder Removal
2012 - Right foot Lisfranc Injury Repair #3 (joints finally fused)
2013 - Carpal Tunnel BOTH hands.
2014 - LEFT Foot Lisfranc Injury Repair
2014 - Stent in Heart/Right Coronary Artery (RCA)
2014 - Removal of a Pin that started backing out of my Left foot.
2014 - Half Toe Amputation (Third toe, Right foot) resulting from cellulitis & MRSA infection.
2015 - Surgery to straighten 5 claw toes LEFT FOOT (partial failure)
2015 - Surgery to straighten 5 claw toes RIGHT FOOT (partial failure)
2015 - Surgery to cut tendons/ligaments under toes to straighten some out LEFT foot.
2015 - Surgery to cut tendons/ligaments under toes to straighten some out RIGHT foot.
2015 - Adding Permanent pins to straighten toes on LEFT FOOT
2016 - Adding Permanent pins to straighten toes on RIGHT FOOT

Present and current NEW SYMPTOMS
Extreme fatigue. Example
I wake up in the morning, use the restroom, and then change clothes to go outside and walk the dog. By the time I get the leash on my 9lb dog I am so tired and weak I need to sit down and rest before I am able to go out and walk him. The feeling is much like that of the sense of weakness you feel after a huge adrenaline rush. Also sometimes accompanied by shortness of breath. If I am active at all in the morning I will need a nap by the afternoon just to get through the day and if I cannot get a nap... I will sleep for 12 to 14 hours the next day.

Constant Nausea and Dizzy/Light-headedness
I take a lot of pain medication (only opioid in the last 6 years) and for most of my life most opioid meds have made me nauseated to the point of vomiting. So, I take either Dramamine , Zofran, or Promethazine approx 10 minutes before I take my pain meds. I've developed somewhat of a tolerance and can now take the pain meds without the nausea. However in the last month I've been just constantly nauseated and with extreme sensitivity to motion. So I've been taking the aforementioned nausea meds multiple times a day.

Muscle Cramps
Daily cramping in my calves enough to wake me up at night and also sometimes in my hamstrings.

Persistent Heart Burn
I've only had occasional problems with this. Usually while taking strong antibiotics. However in the last month it's been almost daily.

Panic Attacks
I am having a much higher rate of panic attacks of late. In the past I've XXXXXXX able to not use my Xanax daily but sometimes at night if the ambient and zanaflex don't kick in after an hour or so. In the last two months I've had to use my full daily dose of 2mg. Sometimes I can get away with breaking up the 1mg tablet in half and spreading the .5mg throughout the day but there are days it takes a full 2mg to stop what feels like a heart attack with hyperventilating and being so dizzy it's similar to vertigo.

I am most concerned. I've never felt like this for this long of an extended period of time. I've had days when my fibromyalgia flares up and I simply cannot get out of bed for as long as the flare is happening. But this has been going on just over one month and I've never had a flare last that long.

If it helps... I had been living in Arkansas with my parents since all of those surgeries to my feet the recovery required complete and total non-weight bearing. I used a knee scooter for mobility. I just recently (November) moved to the XXXXXXX Metro area to be close to my brother, sister-in-law and my two nieces and nephew.

I am very sensitive to bariatric changes and temperature shifts. XXXXXXX has some huge shifts. And I'm much closer to sea level. I do not have a new doctor here because my health insurance situation is rather messed up. XXXXXXX does not offer the same coverage for the disabled as Arkansas does and so I'm trying to sort out what coverage I can get here in XXXXXXX

Any advice, suggestions or thoughts you have would be very much appreciated.

Thank you, XXXX

I also have visual hallucinations in the form of patterns. They are really only observable when I look at a flat, stolid-color surface. They look like hieroglyphs or the same glyphs that appear on the Mayan calendar. They are only bothersome when I am extremely tired and they do not disrupt my daily life. They are just always there in the background.

I do not smoke

I do not drink alcohol unless I refrain from taking any pain medication and then it is rare for me to drink. Perhaps 12 times in a year. But not necessarily divided out evenly. I might consume two drinks in one night and then have nothing for 5 months.

I do not use any illegal "street" meds.

I am 5'5" and I weigh approx. 180lbs. I flucuate between 178-184

Caucasion with French and Irish and German descent.

I was a slow healer long before I became diabetic.

I keep thinking of things to add to this report.

I currently have a broken sacrum. I fell at the beginning of October and broke it. I am still in the same amount of pain as I was when it first happened. I cannot sit for very long and if I sit on a hard surface I can feel the bones moving. The only position I can be in and be pain free is pretty much on my back on a soft surface.

For example... as soon as I finished this email I got up to go make dinner. I just finished and I'm so fatigued, dizzy and nauseated the thought of eating makes me gag.

I am now back in my bed with the fan on resting. Maybe my appetite will return later.

Also... massive brain fog. My short-term memory is shot. And sometimes I have to think twice about activities which are done by rote. I can't remember if I brushed my teeth or pay that XXXXXXX or when binge watching a series on Netflix I may have to watch an episode twice before I can remember the plot line.

This is scary to me. I've always been able to recall details. I have a degree from Baylor University in Communications and a minor in Art. Software programs I use regularly and with efficiency - suddenly I can't remember how to perform a task and I have to look up the answer in help. VERY frustrating.
doctor
Answered by Dr. Alexander H. Sheppe 21 hours later
Brief Answer:
Consultation

Detailed Answer:
Hello, and thanks for your question.

I believe from your description that in addition to your many medical problems, anxiety is playing a big role here. Anxiety is often the cause of dizziness, nausea, brain fog, fatigue, and panic attacks. I think you need some changes to your medications to address this. First, Xanax is an exceptionally bad medication -- it leads to rebound anxiety, tolerance, addiction, and withdrawal. I would instead advise increasing your Wellbutrin, up to 450mg of the XL extended-released version. This should help with anxiety significantly.

Please remember to rate and close this answer thread when you are finished and satisfied.

In the future, for continuity of care, I encourage you to contact me directly at my private web address below. After you ask a direct question, it would be my pleasure to be your dedicated personal physician on this website. My name is Dr. Sheppe, and I am an XXXXXXX doctor working in New York City at NewYork-Presbyterian Hospital, ranked #1 for Psychiatry in the United States (tinyurl.com/psyrank). For a personalized comprehensive evaluation, treatment recommendations, and individual therapy, ask me at HealthCareMagic at this private web address: tinyurl.com/DrSheppeAnswers
Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2242 Questions

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