Question: I am concerned about my sister, who is 63 and experiencing many physical and mental problems since around Thanksgiving. Her medical history is complex and includes the following, as I can relate as nearly as possible:
1. Bipolar Disorder since mid 1980's (controlled very well controlled for all that time with Lithium). Mirtazipine was added a couple of years ago but I don't think she takes that now. In the past 5 years or so, she had been experiencing some unusual body movements such as shuffling and an awkward gait with some falls, hand tremors and difficulty in writing, so upon recommendation from her psychiatrist, she went to see a neurologist who specializes in movement disorders. She also complained frequently of poor memory and attention span. The neurologist originally suspected Parkinson's and prescribed a Parkinson's drug (sounds like Cinnamon with a t on the end) but it didn't help so he did many tests, including an MRI and finally determined that her long history of taking Lithium was most likely the cause of her movement problems. He recommended that she be taken off the Lithium and left it to her psychiatrist to actually prescribe her new medication. The psychiatrist took her off of Lithium and started her on Latuda about 3 months ago. He took her off the Latuda and put her back on Lithium around Thanksgiving, because he felt she had become "destabilized"'. Her symptoms at that time included: irritation and easily angered, slightly pressured speech and poor memory, cognition and attention span. Since the reintroduction of the Lithium, she started experiencing a lot more memory and cognition problems, and two weeks ago started into an intermittent pattern of halting speech and an occasional feeling that she describes as "dreamlike' even when she's awake. She went back to the psychiatrist on Jan 3rd and he lowered the dosage of the Lithium, and said that the RFA treatments (See #2) that she received in October and November, as well as the change from Latuda back to Lithium might be causing these recent symptoms, and he mentioned again that she had become "destabilized".

2. Arthritis and possibly Fibromyalgia and after effects from a slight car accident in Sept. 2016 - not sure what meds she takes as she cannot take most pain medications anti-inflammatories due to her severe GERD. Sees a rheumatologist, a D.O for manipulation and in the past few months has been going to a pain center to have multiple RFA procedures on her lower spine and neck areas. I think she had as many as 8 treatments during October and early November and she mentioned that some of the treatments included having steroids injected, with little or no relief from her chronic pain and even more pain than she normally experiences. Last week her muscle and body pain and stiffness was so severe that she could barely move so her husband took her to the emergency room where she was diagnosed (after 5 or 6 hours) as having 'inflammation' possible due to the RFA treatments. They prescribed pain pills and muscle relaxants, which she has not taken due to her severe GERD problem and sent her home to "rest and take it easy" and to follow up with her primary care physician if necessary.

3. Plantar fasciitis - both feet, treated in October from her D.O. with a couple of injections, which she swore was not steroids, but I don't really know.

4. GERD - ongoing and sometimes severe for many years, for which she takes a (very expensive) prescription medication but not Prilosec or the other common one. She has had previous scope procedures done and the diagnosis is always GERD.

5. Irritable Bowel Syndrome, which causes her a lot of problems and has for years. I'm not sure that she takes any medication for this other than fiber. Previous tests always show a result of IBS.

6. Recent Hemorrhoid surgery in Aug 2016, shortly after having a colonoscopy procedure, which showed small benign polyp, which was removed and internal and external hemorrhoids. In mid- December, she went back to her GI doctor because of renewed rectal bleeding which the doctor said it was not from her surgery, but that her lower intestines were inflamed and she was prescribed a course of Steroidal enemas - Mesalamine Rectal Suspension 4 grams, to be used for a period of 28 days. This treatment was started about a week ago and discontinued two days later, due to my sister's inability to administer the enemas for herself, because of her recent bout of severe body pain and stiffness plus the family's concern to add even more steroids on top of the ones given for the spinal procedures.

7. CLL - diagnosed about 3 years ago, for which she sees a blood specialist (oncologist?). He does not actively treat her medically since her blood count is usually good, but he is taking a 'watch and see' stance and so she has frequent blood work and visits to him every 6 months.

As you might expect, her family's concerns about her recent symptoms are many, but I am focusing on the recent bout of inflammation, body pain and of course mainly her mental and cognition issues. She does not seem to be in either a manic or depressive state such as she has experienced in the past and this pattern of halting speech, poor memory and reduced ability to understand what is being said to her is very disturbing to us all.

In addition, I feel that she should be seeing her neurologist, but her husband is reluctant because he feels that a visit to him would be considered 'doctor hopping' and would just make things worse. I guess I need for you to look at all of this and let me know if a visit to the neurologist would be our next step as she is not improving as much as the psychiatrist thought she might. I also think we should get a report from the pain center and send that to the neurologist as that might be helpful to him.
Please let me know if you have any other suggestions that might be helpful.

Thank you in advance for you attention to this matter.