From the mind of a spode

[Senior KX Rider]

I have been in that same position a few times myself Ivan. Luckily there were no cameras around ;)

 

[nephron]

Those symptoms are too diffuse to be secondary to Wellbutrin. About 1% of people starting that drug can have a seizure within the first week. Otherwise, it's well tolerated.

It's not an SSRI (serotonin reuptake inhibitor), and associated with this, it is not a good anxiety drug. In fact, it is very activating, and can initiate panic attacks and sometimes, manic episodes. This is less likely than:

Coxsackie and Echovirus have been going around here. This is an enterovirus, that causes CNS (brain disturbance/headaches), herpangina (blisters @ the posterior oropharyx/pharyngitis--which you could have had), gastroenteritis (diarrhea, nausea, GERD--gastroesophageal reflux--vomiting, sometimes rash, polyarthritis, and certainly myositis (inflammation of muscles )--particularly backpain and spasms. As regards the latter, these viruses can affect the myocardium (heart), cause heart failure (sometimes resulting in transplant), and affect conduction, causing rthythm disturbances, such as your sinus bradycardia or heartblock.

All that said, I wasn't there. Yet I am certain it was not a drug reaction, based on diffuse symptoms plus, most importantly, the length of time that the illness had occured. 1) Wellbutrin would wash out in 4-5 halflifes, which at most would be 3 days 2) Drug reactions are either anaphylactic or arthus (TypeIII), occur very early in the course of taking the medicine (former within 30 minutes, latter within 3 days).

 

[Senior KX Rider]

Originally posted by nephron


Coxsackie and Echovirus have been going around here. This is an enterovirus, that causes CNS (brain disturbance/headaches), herpangina (blisters @ the posterior oropharyx/pharyngitis--which you could have had), gastroenteritis (diarrhea, nausea, GERD--gastroesophageal reflux--vomiting, sometimes rash, polyarthritis, and certainly myositis (inflammation of muscles )--particularly backpain and spasms. As regards the latter, these viruses can affect the myocardium (heart), cause heart failure (sometimes resulting in transplant), and affect conduction, causing rthythm disturbances, such as your sinus bradycardia or heartblock.

Thats easy for you to say. :laugh:

 

[nephron]

If ANY of you think that drugs will make you feel better talk to your FAMILY doc first and make sure your family doc is one you can TRUST

That is not good advice, and would be similar to a patient preferring to go to their family doctor for renal failure, instead of a nephrologist. A totally ridiculous idea.

That said, I can understand how patients get frustrated by MULTIPLE and disparate medical opinions. It's really quite a shame, but the bottom line is a family practitioner has less than 1/2 the training time of a specialist. That's why they're called 'specialists'.

I guess a lot of people these days just 'dislike' and 'distrust' doctors, for whatever reason. Pill pushers, huh?................

 

[crash_42]

Interesting point of view.. :)

 

[Senior KX Rider]

yup :)

 

[jaction125]

I have personally seen some of the bad things that can happen with these "miracle drugs", especially Xanax. Scary stuff brother-

My mom was diagnosed as a manic depressive in the early ninties. The first thing they did was throw either Prozac or Xanax at her, I'm not sure which was first. I believe she truly was diagnosed correctly, but she would start to feel better and then quit taking the meds because she felt she didn't need them anymore--talk about a super-duper freak out. :scream:

Glad your feelin better TS, keep it up!


I also think all the chiropractors and phsychiatrists should be sent to the ocean floor. I had a counselor of some variety accuse me at 13 of being on drugs. I didn't even know what the hell he was talking about. I was from a small town and had never heard of most of the stuff he was asking if I had experimented with. :think: Silly bucket of s$%t.

 

[truespode]

Originally posted by nephron
Yet I am certain it was not a drug reaction, based on diffuse symptoms plus, most importantly, the length of time that the illness had occured.

The diffuse symptons were based on a domino effect. I may not be explaining things well but basically from the point where I had the first onset of symptons to the end things got worse. It's like I was too sick to eat and that caused the gastro problems. I didn't drink so that got me dehydrated which caused a bunch of other problems.

1) Wellbutrin would wash out in 4-5 halflifes, which at most would be 3 days

Within 20 hours of stopping the Wellbutrin the worst of what I was going through stopped. Within 3 or 4 days I could breath through my nose again.

2) Drug reactions are either anaphylactic or arthus (TypeIII), occur very early in the course of taking the medicine (former within 30 minutes, latter within 3 days).

If it isn't the Wellbutrin I don't know what else could have caused such sudden physical symptons. However, the research I have done point to the Wellbutrin as being a factor or catalyst if not the root cause. Something happened that I don't ever want to happen again.

 

[truespode]

Originally posted by nephron

That is not good advice, and would be similar to a patient preferring to go to their family doctor for renal failure, instead of a nephrologist. A totally ridiculous idea.

No. You are misunderstanding what I'm saying.

If it is an emergency go to the ER but if you are having problems and do not know what is going on and talk to your family doctor and let him/her help you get the best course of treatment.

I'm not suggesting the Family Doctor can cure all ills. I'm saying that whatever is going on you are best to start out with someone you trust than just go and see someone cold (like I did). You are more than likely to get a better referral to a specialist if one is needed by going through your family doc first than by flipping through the yellow pages.

The basis is TRUST and talking to the person you trust first so you can get more than a cursory lookover.

I believe that beyond a shadow of a doubt that if I could have seen my Family Doc the day after the onset of symptons that we would have a better idea of what was the root cause.

In both ER visits no blood tests were done. I was just looked at both times for less than 5 minutes by the doc and given a shot each time. They were just assuming and guessing. I'm not advocating a lot of tests should have been done but I am saying that they made and assumption (and I can see their train of thought) that for me turned out not to be accurate.

The problem now is that I had very limited care for the 4 days I was in the worst shape and after that I was having all sorts of other problems.

I am interested in information on Coxsackie and Echovirus... do you have any links b/c the information I got on Wellbutrin (from quite a few sources from a man with a doctorate in pharmacology, to other physicians to a few pharmacists as well as a few online resources) clearly have stated that they have seen similar reactions as I described from people allergic to Wellbutrin. They clearly explained how Wellbutrin is cumulative and takes time to build up in the body. Two of these individuals actually witnessed reactions like I described and it was not just information they read in a pharmaceutical salespersons pamphlet.

As for pill pushers... yes I believe MANY physicians and most psychiatrists are just pill pushers. IMO, pills will not help a person with no major illness as well as good exercise and keeping active will.

I have respect for physicians (I have known and dealt with hundreds of them in social interaction for years) but I do believe that the patient has to research and ask questions b/c physicians make mistakes if you don't keep them on your toes.

Ivan
PS... you know the difference between God and Doctors are don't you? God doesn't think he's a doctor.

 

[nephron]

Although drugs, like Wellbutrin, can magnify symptoms already present from other etiologies Ivan, I'm not sure catalyst is the appropriate term. As regards etiol. in this specific case (caveat: I wasn't there and it's virtually impossible to diagnose anything over the phone/internet without a thorough history and physical), I'd best guess it to be the virus(es) above, and you may have a little IBS underlying it all (Irritable Bowel Syndrome).

Please understand I'm not trying to bust your balls here. I'm sure there was something seriously wrong--just a little unusual, and probably VERY difficult to figure out. Many doctors will not take the time to truely sort these things out.

You could get 'convalescent' Echo & Coxsackie virus serologies (also termed enterovirus panel). IgG should be showing up by now.

Did you have fever? Don't have to, but would more likely support infection than an odd sort of drug reaction.

 

[truespode]

Originally posted by jaction125

I also think all the chiropractors and phsychiatrists should be sent to the ocean floor.

I think both have their use. I know my chiropractor has been great for my migraines.

Same with psychiatrists even though I believe most are not worth a damn! However, I do think those that do the med mgmt as well as psychotherapy/cognitive therapy are better b/c they get to know the patient.

In my case a 15 minute meeting was not enough to prescribe something like Wellbutrin which is as Nephron pointed out can be very activating for a person with anxiety already (and I'm an anxious person as is).

Wellbutrin is also not recommended for someone who has suffered a head injury. However, nobody has told me if concussions fall into that category.

In 15 minutes the doc did not have time to discern my level of current anxiety or past medical history or do anything but assume.

Ivan

 

[nephron]

Ivan, I TOTALLY agree with you on the ER thing, but someone here has a wife that's an ER physician...I'll say no more about that. There are the occasional good ones, but there's a lot of controversy out there as to whether or not it should be a residency/specialty. In the old days, ER physicians were the Internists and Surgeons on call for the ER that night. If you had a Surgical problem, you saw the surgeon. etc. These days, there's an ER residency program and specialty that's 2 or 3 years beyond internship. There's a lot of mental 'inbreeding' that goes on in that field, and the docs are basically trained to rapidly triage the patients out of there, instead of making clear cut diagnoses.

I get clearly angry with them frequently. I'm sorry to the person who's wife is an ER doc...she's probably one of the good ones if she's with YOU. :) (How's that for a copout)

 

[truespode]

Originally posted by nephron

I guess a lot of people these days just 'dislike' and 'distrust' doctors, for whatever reason. Pill pushers, huh?................

I love my family doc and when he told me that everything was good with the EKG and my neurological reactions were normal I trusted him. I then followed every recommendation he gave me to the letter.

I am not trying to bash physicians here (even though I do have a poor view of many physicians - I worked in a teaching hospital for 5 years and could go on and on about how pre-madona many are) but I'm trying to point out that it is VERY IMPORTANT for the patient to educate themself and talk to their family physician (if you have a good level of trust) first before going about something blindly.

Keep in mind I have a friend whose mother in law was on heart medicine for 10+ years and only when she started having episodes of passing out did she get admitted and it was found out she never had the heart issue they originally diagnosed her for!! 10 years on medicine she never needed. Mistakes happen and doctors assume. The patient needs to educate themself and be as proactive as possible with their health.

Ivan

 

[truespode]

Originally posted by nephron
(How's that for a copout)

Pretty good but my wife is an accountant (however, she's taking an EMT course after my last get off b/c she wants to be prepared for my next accident).

I think the words on the screen seem harsher than they are meant to be from me. I'm not trying to belitte the profession (even though I am making jokes and slamming some physicians).

I absolutely trust my Family Doc. This guy called me at home twice after I he saw me b/c he thought I was borderline for being admitted b/c he didn't know exactly what happened.

BTW, I am enjoying this conversation b/c I'm learning from you with your posts just like I learned from the others I talked to about this. It was a very traumatic weekend and then very traumatic the following week trying to find out what exactly happened. The only thing in the timeline that seemed consistent with research was the Wellbutrin but if you can point to other things I'm willing to listen.

I still stand by talking to a trusted family physician and DO NOT READ SPAM:)

Ivan

 

[nephron]

I do a lot of Cardiology out here, because I have to. My program at UCSD was heavily Cardiology (we'd admit 30 a night). But,...anything I get into over my head or that needs a cath, I ship.

However, Cardiology is a pretty plain and clearcut field, (either you HAVE coronary artery disease or not...either you HAVE CHF by echo or swan or chest film, or NOT...either you HAVE a rhythm disturbance or NOT)--yep, I'm calling out the dumbass that treated your friend's mother...(so long as you didn't misunderstand the situation--many patients and families get pissed because of misunderstanding(s)--which is why it's important to explain everything thoroughly to them, particularly to a guy like you who WANTS to know. (some don't). I can usually sense that as soon as I go into the room.

I bet you could find the virus information on cdc.gov?

Yeah, bupropion is a weird drug...did you know no one knows how it works? :laugh: I'm about as cynical as you are, and always REQUIRE excellent data before I'll use a drug.

 

[nephron]

Oh, and right after the show 'ER' came out, all the ER docs (@UCSD--Rosin is the author of THE textbook on ER medicine--and a drunk-- used to call me down to belittle his own residents :laugh: )...were wearing those cheesy colored scrubs and weird, big clear goggles like the actors. ;)

Man, I've got to shut the hell up.

 

[truespode]

Originally posted by nephron
Although drugs, like Wellbutrin, can magnify symptoms already present from other etiologies Ivan, I'm not sure catalyst is the appropriate term.

I agree with that. I also agree that catalyst may not be an appropriate term as well.

As regards etiol. in this specific case (caveat: I wasn't there and it's virtually impossible to diagnose anything over the phone/internet without a thorough history and physical),

I totally understand and please don't take my typed words as being defensive. I trully appreciate your input. Like I said... I shared this so it can help someone and if this is educational to me than I"m sure it is educational to others as well.

I'd best guess it to be the virus(es) above, and you may have a little IBS underlying it all (Irritable Bowel Syndrome).

Hmmm... my Family Doc said he wanted to investigate IBS in our next meeting.

Please understand I'm not trying to bust your balls here.

No. I'm glad you are jumping in and taking the time. Even though I've been making jokes and some disparaging remarks (like pill pusher) but I do realize the benefit of medical care. I'm not advocating natural care... I'm just trying to be funny and give info on my case at the same time. On the computer screen after re-reading I can see how some of that may seem defensive but honestly I'm not defensive at all!

I'm sure there was something seriously wrong--just a little unusual, and probably VERY difficult to figure out. Many doctors will not take the time to truely sort these things out.

My family doc is still bewildered and although he agrees the Wellbutrin could have been a part of it... he isn't as confident as I am that it was the root. But he is still exploring everything else and 1 of 3 things we are sure of...

1) I have gotten over it and we'll never know what the root cause trully was.
2) I have gotten stronger and now the symptoms of being dehydrated and having severe acid reflux will not cover up the symptoms of what really was going on.
3) I may have a panic disorder. However, I find that very unlikely but I'm not going to throw that out as a possibility.

You could get 'convalescent' Echo & Coxsackie virus serologies (also termed enterovirus panel). IgG should be showing up by now.

So at my next doctor visit should I mention the enterovirus panel? What does that involve? He did a few blood tests and one thing he thought was odd was that my white blood count was down but not by a serious amount.

Did you have fever? Don't have to, but would more likely support infection than an odd sort of drug reaction.

Nope. Actually, my temp was lower than normal. It was in the 97's and my normal is usually around 98.4 o4 98.5. But I was laying around a lot too.

Another interesting point... when I had the weird feelings in my head my pulse rate would be in the 60's and my bp would drop (my Mom was a phlebotomist and does know how to do basic vitals). This would come and go.

During it all my HR never got above 90 at resting and my bp never went above 160/90 at the highest point (normal is usually 140/80 range for me).

Like I said, it is odd. While I know I'm blaming Wellbutrin that is not the point of me sharing. The point mostly is to remind everyone that they need to talk to doctors they feel they can trust and to research the information to educate yourself. Also, the INTERNET is a BAD resource for information overall b/c you will hear all the horror stories more than the truth. Read actual journals and talk to true professionals when you want to educate yourself.

What is odd is that when my wife had surgery we researched all the surgeons in the area for what she needed but for me I didn't do the same for my issues.

Ivan

 

[Farmer John]

Originally posted by nephron
someone here has a wife that's an ER physician...I'll say no more about that. I get clearly angry with them frequently. I'm sorry to the person who's wife is an ER doc...she's probably one of the good ones if she's with YOU. :) (How's that for a copout)

That would be me.
Your comments would only bother me if they were false.
I also work in a Hospital. I no longer deal w/the medical side of operations.
I agree with you 100%. Most ER docks are the equivalent to Lube Techs @ Jiffy Lube. They know enough to cause some good, but not enough for everything that gets thrown their way.
My wife is a burn specialist & that is most of what she deals with. The hospital she works at, Valley Medical Center in San Jose, has a very busy burn unit. It is the one of the few that I know that employee a burn spec. in the ER. She constantly tells me about patients with burns that she sees from other facilities that have been incorectly diagnosed &/or improperly treated.

Wanna be scared some time? Get injured in Mexico. ;)

 

[truespode]

Originally posted by nephron
I'm about as cynical as you are, and always REQUIRE excellent data before I'll use a drug.

Under normal circumstances I do. Once I started feeling better I demanded to get off XANAX but my family doc explained why he wanted me to take it and move off of it slowly.

He felt the anxiety I had when I finally got to see him (5 days after all of this started) was causing me to be unable to communicate with him in a way that could help him so he told me to go ahead and take what the specialist prescribed (the XANAX).

I learned a valuable lesson this month for sure.

You know... this almost looks like a chat room between you and I :) Either way I hope the information here is as helpful to others as it has been to me.

Thank you.

I'm off to cdc.gov for a little while but I'll be back :)

Ivan

 

[nephron]

We used to get transfers from Mexico. 'Senio'r, this man is having a GI bleed.' 'Did you heme check his stool or put an NGT down?' 'No.' :silly:

Ivan, since you're getting better, you probably should just let him decide on the serologies. He'll figure it out, if he works hard enough on it and keeps chasing things down.

I've seen Coxsackie and Echo virus cause SEVERE CNS disturbances, to the point where the patient will have seizures associated with encephalitis or severe headaches due to meningoencephalitis, associated with myocarditis, gastroenteritis

You probably should have had a fever, though.... :think:

There ARE a few oddball things that can cause hypothermia and bradycardia, like hypothyroidism (with myxedema) and Salmonella Typhimurium. Have they checked a TSH (thyroid stimulating hormone--high means hypOthyroidism, low typically means hypEr)--some of these viruses can cause an acute granulomatous or lymphocytic thyroiditis that's referred to as DeQuervan's disease. My mom had it once, and her FP wanted to take her thyroid out because he thought it was Graves. :scream: Thankfully, she ignored him and recovered fully, which is typical. ;)

 

[d.u.g.]

God bless you Ivan,
Please don't feel embarrased.You have been through the ringer,big time.While reading your letter when you got to the Xanax part I was thinking I'd better make sure he knows that has to be weaned,not stopped all of a sudden.Hey,you already know.
I've been in health care a long time now,and I agree totally that having a great relationship with a Family Practice doc is VERY important.
I'm sure not slamming docs.I work with some great ones every day.A lot of times though,I see specialists that are so darn busy that they practically act like robots,don't make eye contact with the patients,and pretty much will have their diagnosis made after 30 seconds of speaking with the patient.This is not always,but I do see it a lot.
I like having a family doc eho listens,cares,and will take his/her recommendations for specialists to see.
Hang in there bud! dOUG

 

[truespode]

Originally posted by nephron
You probably should have had a fever, though.... :think:

Well, we would check my temp 3 times a day. It was consistent. But...

The odd thing was that I sleep with a fan on me. During all this I would wake up with my pillow covered in sweat but only from my neck up. The rest of my body felt normal temp wise. That is why we were checking my temp so often b/c we thought I would have a fever indicating infection.

Until about day 3 when the dehydration and not eating started taking its toll all of my physical symptoms were in my head. No pain, just vertigo and waves of weirdness. The diarhea and vomitting was there too but there was not pain in the abdomin or chest until after day 3 when the acid and everything else started to go south.

like hypothyroidism (with myxedema) and Salmonella Typhimurium. Have they checked a TSH (thyroid stimulating hormone--high means hypOthyroidism, low typically means hypEr)--some of these viruses can cause an acute granulomatous or lymphocytic thyroiditis that's referred to as DeQuervan's disease.

He did a TSH on me yes. My wife has thyroid issues and takes Synthroid to battle it out. Now that was a scary time when her and I got married. She was depressed for a year before being diagnosed. Then she got on Synthroid and was doing great as things balanced out. Then when we got married she went on the pill and became and evil biotch!! I wanted to throw her off the roof. She stopped taking the pill and went back to normal.

One funny thing with my Family doc was that when Jen was first diagnosed he did diagnose her with thyroid issues and put her on synthroid. We asked for a second opinion with a specialist and named the specialist (very well respected in the area for thyroid disease). He looked at her and everything and said we are getting great care as is so we went back to the Family Doc for the rest of her treatment.

Like I said, the guy is pretty good. He doesn't mind second opinions and he does go out of his way. At my last visit he schedule me to be his last patient so he could take an extended period of time b/c of what I had gone through.

Ivan

 

[truespode]

Originally posted by nephron
Those symptoms are too diffuse to be secondary to Wellbutrin. About 1% of people starting that drug can have a seizure within the first week. Otherwise, it's well tolerated.

I was thinking about that last night and remembered that stat however, that is usually with those using 300mg or more a day.

I was on 100mg a day for 6 days then went up to two doses of 100mg a day for less than a week before I had my problem. From day one I started noticing some differences (my back pain didn't start until I began Wellbutrin but I have not found any correlation between backpain and the drug so it is probably just a coincidence).

The biggest difference I noticed was more agitation. When I went up to two doses a day my agitation got worse. One time I even just ripped off my favorite shirt b/c I got some bad news (and it wasn't really that bad of news).

One reason during my research I have listed Wellbutrin as a contributor of sorts is b/c of how it builds in the system. Also, with many allergic reactions reactions do not always occur the first time of exposure to an allergen. Reactions can get worse with each exposure. The first reaction may be mild. The next reaction may be moderate or life-threatening.

Looking over my time line the issues I was having did not lesson until I stopped taking the Wellbutrin. However, b/c of how sick I was I kept forgetting my dose and was only taking one a day for two days after I went to the ER before stopping cold.

I wonder if there are blood tests that can be done to determine if I'm allergic to Wellbutrin (which a rare amount of people are)?

I understand I may never know exactly what happened for those 4 days and I blame myself mostly b/c while I was sick I completely forgot that my physician network has an Urgent Care that is open on Holidays and weekends. I could have went there instead of the ER. As a matter of fact I found out this week that my doc covered that holiday weekend too :(

Ivan

 

[Green Horn]

Wow Ivan. I didn't realize the extent of what you had going on in your life. Take it easy man, the forums and the rest of the world need people around like you. :thumb:

 

[nephron]

One time I even just ripped off my favorite shirt b/c I got some bad news (and it wasn't really that bad of news).

lol, I thought I was the only guy around these parts with a temper like that. ;)

You're a good dude. Keep the chin up.