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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Sjogrens Syndrome, Depression, Fatigue And Pain. Oxygen Diffusion Capacity Is Low. Using Apo-quetiapine Tab. Advice?

hi, I have sjogrens syndrome (extra glandular) fibromyalgia, depression that has been continually treated but is not responsive to many types of antidepressants. Lately I have had terrible mood swings causing lots of irritablility and agitation. My dr. prescribed 50mg of apo - quetiapine for 3 nights then 150 mg on the fourth. On the fourth night, I could not sleep until I passed out many hours later after having severe pain and muscle problems and circulation problems in both legs (mostly my right) as well as headache, fatigue and dizziness. I am going back to the 50 mg tonight because of that. Today my legs have been hurting (joints, muscles)... I have positive ANA 1:320 speckled pattern, positive RF, high esr, and positive panel for sjogrens syndrome, but not the positive dna. I regulary have muscle fatigue, short of breath, and muscle pain after exherstion, I have low diffusive oxygen lung capacity of 69%. Total lung capacity of 80%, I have mild copd. I am 46, female, 5' 7 and 140 lbs. I have gained weight this year, my usual weight is between 132 and 135. I am supposed to see a pulmonary dr but it takes time to get in. I wish I knew how to fix this fatigue, depression and pain. I get walking excersising but lately not much because the humidity is killing me. My doctor is not hugely concerned about the low oxygen diffusion capacity because it says I only have mild copd, however breathing seems to be an issue especially in the heat . It is the shortage of breath on exherstion which is tough. I definitely have to stay out of the sun. Do you have any ideas about all this condition that could help me. Or any ideas that I should look at and point out to my dr. Oh yes, I also have gall stones and have had kidney stones ( they didn't find any, three times that I went to the hospital, and just treated the terrible pain) ..any ideas of what I could do to make this better?... I think I did have a reaction to the 150 mg..of apo-quetiapine so I am going to take less 50mg tonight...I am afraid to just cut it out. I will call dr. tomorrow...not sure
Sat, 27 Jul 2013
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General & Family Physician 's  Response
Hi and thanks for the query,

I do believe you are followed up by a rheumatologist. The ANA levels indicate that an intense therapy be instituted. Hydroxychloroquine, Gold salts could be attempted. Well monitored steroid therapy in association to these drugs is useful.

You need not change the drugs prescribed by your physician without his consent. Collaboration between an internist and a rheumatologist could be very useful. Tricyclic anti depressants and Selective Serotonine Reuptake inhibitors could help for depression. Ultrasound measures to characterize the stones could help in proposing appropriate treatment measures. It is however necessary to run tests for renal function.

Thanks and kind regards,

Bain LE, MD.
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Sjogrens Syndrome, Depression, Fatigue And Pain. Oxygen Diffusion Capacity Is Low. Using Apo-quetiapine Tab. Advice?

Hi and thanks for the query, I do believe you are followed up by a rheumatologist. The ANA levels indicate that an intense therapy be instituted. Hydroxychloroquine, Gold salts could be attempted. Well monitored steroid therapy in association to these drugs is useful. You need not change the drugs prescribed by your physician without his consent. Collaboration between an internist and a rheumatologist could be very useful. Tricyclic anti depressants and Selective Serotonine Reuptake inhibitors could help for depression. Ultrasound measures to characterize the stones could help in proposing appropriate treatment measures. It is however necessary to run tests for renal function. Thanks and kind regards, Bain LE, MD.