Brief Answer: Consult a Psychiatrist for management Detailed Answer: Hi Mr. XXXXXXX Thanks for your query. It's unfortunate that the two drugs were used concurrently, leading to Serotonin Syndrome. This condition occurs due to excessive serotonin accumulation in the brain. You will be cured as soon as serotonin comes down to the normal levels. Please don't worry at all. You will certainly come out of it completely, with treatment. Consult a Psychiatrist and apprise him of your problems. Depending on the severity of your condition, he will either prescribe appropriate treatment (sedatives, such as, Valium or similar drugs and- if required- a drug called cyproheptadine); or- if the condition warrants- may hospitalize you (for a few days) for observation and treatment. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal

---

Brief Answer: Physical problems are apparently due to Zyvox. Detailed Answer: Hi Mr. XXXXXXX Nice hearing back from you. I had given my opinion based on the limited information provided by you. You had not elaborated earlier on the physical symptoms. Please clarify if the doctors had diagnosed Serotonin Syndrome or, it is your personal perception. I feel that most of your physical symptoms are probably due to Zyvox's side effects. Zyvox is an antibiotic, which- when used- commonly destroys the "good bacteria" of the gut and affect absorption of vitamins. This facilitates the "bad bacteria and other infections" to infect the gut. So, burning sensation in the mouth and rectal bleeding are apparently due to secondary infections: yeast infection in the mouth and inflammation of colon causing rectal bleeding. Numbness in the legs and mild coordination problem may be due to deficiency of Vitamin B12 due to its impaired absorption. For mouth and intestinal infection, a course of (a) an anti-fungal agent, such as, Fluconazole tablets; (b) Metronidazole for protozoal infection; (c) a Probiotic, such as, Lactobacilli; and, (d) Digestive enzymes will cure your gut/mouth symptoms. A high dose of Vitamin B12 (1500 micrograms/day) for a few weeks will cure your numbness and also- possibly- coordination problems. It is therefore suggested that you consult your local doctor and apprise him of my opinion. I am sure that he will fully agree with me: examine your mouth for evidence of yeast infection; and,get your stool examination done for isolation of the offending organism. He is the BEST JUDGE. Request him to prescribe the drugs in appropriate doses/frequency, as recommended by me. Fond regards

---

Brief Answer: Follow my advice as given below Detailed Answer: Thanks for the clarification, Mr. XXXXXXX In any case, I had taken BOTH possibilities into active consideration while expressing my opinion. To summarize once again: 1. Your psychological problems are attributable to Serotonin syndrome. 2. Numbness in legs and coordination problems can be attributable to both : side effects of Zyvox, as well as, Serotonin syndrome. 3. Other physical symptoms are most likely due to side effects of Zyvox. I can assure you that your physical problems will improve with the advised treatment; while, the symptoms of Serotonin syndrome will be taken care of by your Psychiatrist. Take care

---