Brief Answer:
Please specify a question

Detailed Answer:
Good morning. Happy 4th of July to you. I would be very happy to opine on a specific question you may have regarding your health condition. Can you help narrow things to a particular problem?

I'm sure you are already under treatment for many if not all of these conditions by another physician(s) since you've got diagnoses.

Is there something specifically about one of those conditions that you'd like to ask about? If so, please supply some history and other data as in lab reports, imaging studies, results of any physical, occupational, or speech/cognitive therapy, that you've had, etc. so that I have something I can look at and perhaps offer some suggestions for improvement or alternatives.

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Brief Answer:
Multifactorial etiology is possible

Detailed Answer:
Thank you for your clarifying questions.

Based upon the rather limited information presented and the apparent complexity of your case I'm sure you can appreciate that being able to definitively diagnose the cause to each of your problems without an examination or advantage of seeing reports and diagnostic information will be challenging to say the least.

However, if one is in a high impact accident as you've described and then, suffers these many consequences the most likely cause to something such as insomnia, hypersomnia, or other sleep disorders is likely multifactorial (multiple causes). The chief one is probably the accident itself. I'm going to make the assumption that there was a closed head injury resulting in concussion. That in and of itself is usually sufficient to cause what is known as a post-concussion syndrome which can include a variety of problems such as headaches, dizziness, nausea, and SLEEP DISTURBANCES. Other possibilities for the sleep disturbances could be due to whatever medications and their interactions or side effects are causing. If you were never evaluated for the possibility of a concussion after this accident then, my suggestion would be to see a neurologist with experience and interest in this topic for an evaluation and possible treatment. Post-concussion syndrome effects typically last weeks to months but in some cases, depending upon severity can last up to several years but almost never longer.

Dry mouth is most likely the consequence of being on multiple medications and most notably occurs in people who are on tricyclic antidepressants such as AMITRIPTYLINE which you mention. If you would like to reduce your dry mouth symptoms you should speak with your doctors about reducing medications or at least trying nortriptyline instead of amitriptyline which has a much less aggressive side effect profile. Incidentally, in many people AMITRIPTYLINE can cause a number of sleep disturbances and I have ended up switching those folks who complain of BOTH hyper as well as insomnia either to nortriptyline or taking them off that class of medication altogether and placing them on something else if it is necessary.

Again, GERD could be reflective of either anxiety/stress following the psychological aftermath of the accident and surgery or it could again be a result of medications that cause reflux. Most medications due possess some GI side effects and reflux, indigestion, abdominal pains, etc. Amitriptyline and hydrocodone are both well known for their negative impact on the GI system.

The tongue movements may be a phenomenon known as dyskinesias and again these generally go back to medications or they can occur as a result of incidents of head trauma if that is a possible factor. But I would look at the medication lists for side effects involving DYSKINESIAS (most commonly tongue, face, and torso). Medications that commonly cause this type of problem are antipsychotics used for depression, anxiety, AND commonly a drug called RANITIDINE or REGLAN which is used for IBS, GERD, and other GI problems. When offensive medications are stopped symptoms generally subside slowly over the course of several weeks.

I don't think your back or hip pain is a consequence of Nuvigil and if you and your doctor will consider other possible causes to your sleep issues as I've mentioned and if your doctor has already gone through the task of FULLY testing you for thyroid problems, parathyroid problems, and other potential chemical/hormonal imbalances (especially since you say you are also suffering from HYPERALDOSTERONISM) then, perhaps you could even suspend the Nuvigil.

If I've satisfactorily addressed your question(s) and/or concern(s) could you do me the kindest of favors by CLOSING THIS QUERY including some fine words of feedback regarding our interaction?

Again, many thanks for posing your questions on this network and do not forget to recontact me in the future at: www.bit.ly/drdariushsaghafi for additional questions, comments, or concerns having to do with this topic or others.

This query has utilized a total of 43 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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