Sebastien St-Laurent's (AKA Sebby) WebLog : Health

Moving my Main Blog From MSDN to WWW.SebbyLive.Com

sebby1234 — Fri, 05 Oct 2007 06:06:00 GMT

The time has come to finally move away from hosting my blog on MSDN. There are a few reasons for this transition but the two main deciding factors were that posting personal posts on a MSDN blog seemed odd (at least to me) and that I already had my own website to document my various side-projects so it would make more sense to have everything in a single place.

My blog now resides with my homepage at www.SebbyLive.com. In the future I may cross-post relevant technical posts onto MSDN but you should update your feeds to point to the new "main" blog...

The syndication link which can be used to subscribe to my blog directly is: http://www.sebbylive.com/syndication.axd

Which Pole am I on These Days?

sebby1234 — Sun, 16 Sep 2007 21:59:00 GMT

I have to say I have made significant progress since I was initially diagnosed with Bipolar 2 earlier this year.

Just having a better understanding of myself sure makes a great difference to start. Knowing my body and mind better, knowing what my limits are and therefore knowing when I need to slow down...

Of course, the medication does also play an important role. Currently I am on Depakote ER, which is technically an anti-convulsant but also have great mood stabalizing properties. Unfortunately, all medication has its risks and side-effects and with Depakote, there is not a "one dose fits all" solution. But after several months, I think me and my doctor finally achieved a good balance between the benefits and side effects.

There are still some side-effects I have to deal with on a daily basis. The major ones that affect me from Depakote are hair loss, weight gain and sleepiness/grogginess. The only other thing to be warry of with such medication is its potential impact on the liver. They can be somewhat harsh on the liver and therefore your blood levels and liver function has to be monitored periodically.

The hairloss isn't a huge problem yet as I have really thick hair and I generally lose alot of hair anyways due to that, it just seems worse with the medication.

In regards to the waight gain, it is not well understood wether it is the medication itself that causes it or it simply increases one's appetite. In my case, my "carb cravings" have definetly gone up. Since I started taking the medication, I have gained about 40 pounds. More recently I've started to watch my food intake and have lost about 10 pounds so far. So I think that with a proper diet, my weight should return to a more normal level...

The biggest annoyance is the grogginess. How hard is it to focus on activities such as work when you constantly feel like you're on a constant turkey dinner coma. The godsend here is Provigil. It is somewhat of a new medication, which is aimed at people with sleep deprevation disorders such as Narcolepsy. Although not technically approved by the FDA for use as a counter grogginess from other medications such as Depakote, several doctors have recognized its effectiveness and have started prescribing it.

Provigil is a fairly new medication and the exact mechanisms of how it works are not fully understood yet. The main plus of Provigil is that it is not a stimulant such as the various forms of Emphetamines that are generally prescribed in these situations. Scientists think that it acts as a GABA inhibitor, which essentially inhibits the mechanisms that make you feel sleepy. And since it does not have a direct effect on the CNS (Centran Nervous System), it does not produce any form of high and shows no signs of addition or withdrawl. Somewhat interesting as apparently, from my Internet research, Provigil is now the new study drug of choice by students for cram sessions. And its effects are long lasting 12-16 hours meaning that a single dose should keep you going all day without having a significant effect on your ability to sleep.

Well, so far so good. I have been so much more optiistic and energetic over the past few months despite all that would have normally dragged me down. Now, we just need to get the Flight Simulator Service Pack and Expansion Pack out the door so I can finally get some real rest :)

Wow, Time Sure Flies By! 08/12 Update...

sebby1234 — Sun, 12 Aug 2007 11:31:00 GMT

It's amazing how time ch some dosage anan fly by some times. It's been one month since my last post. Summer is already comming to an end. I have to admit that this year somehow flew by despite everything that has happened.

What's up with Flight Simulator?

We are hard at work on the release of Service Pack 2 and an Expansion Pack. The bulk of my work focuses around the service pack which fixes some of the bigger bugs, but mostly focuses on improving Vista support and provide native DirectX 10 support. Can't discuss specifics just yet on exactly what I have been working on but expect more details to come in the next few weeks.

How's My Health?

Much better so far. The problem with being bipolar is that there is no "one size fits all" treatment. So it is essentially a game of trial and error with different medications and dosage. The main problem I had with my current medication was that it caused me constant sleepiness. With some dosage adjustment and the addition of Provigil (a medication uses to treat sleep dissorders such as narcolepsy) I have been much more efficient and energetic over the last month or so.

Any Progress on Your Projects?

No, not really. With the exception of working on the next titles for Paradoxal Press, my finances simply do not allow my to make any progress right now. This year has been really bad financially with having to take dissability leave and a few other unexpected events, I just have to catch up and therefore my "fun money" budget is nill at the moment. Actually struggling to find the funds to get my current books in production out the door. Hopefully, I can make a sense of everything over the next few months.

My Medication and Constant Sleepiness. How Annoying!

sebby1234 — Mon, 18 Jun 2007 09:41:00 GMT

This has been such an odd weekend sleep wise. Actually spent more time sleeping than awake. Here is roughly how much I slept (as far as I can remember)...

Friday:
6pm - 7:30pm (pizza came in)
9pm - 11pm (food coma nap)
1am - 7am (stupid phone rang)

Saterday:
9:30am - 12:30pm (just couldn't stay awake after that phone call)
2:30pm - 7 pm (lunch killed me)
1:30am - 10 am

Sunday:
12:30pm - 5pm (lunch killed me again)
Well been awake since.. Probably will go to bet around 12:30-1am...

So that's about 31 hours of sleep in roughly 48 hours! No wonder I can't get anything done at home. From what I read, lots of people taking Depakote are having similar problems. It essentially feels like a almost constant "post thanksgiving dinner food drowsiness". And this makes it real hard to focus at times.

My doctor's oppinion is that it might be related to poor sleep due to me comming off of my other medication (Lexapro). But considering I am not down to less than 1mg/day (compared to 20mg/day initially). I think this medication should be mostly out of my system by now. Sometimes, with some online research, I feel like I know more about my condition and the medication I am taking than my doctor knows. I can understand this from a general practitioner since they can't know everything on every topic. But with a specialist, you'd think they would keep up on those things and not only take that the pharmaceutical companies feed them for granted.

So what to do? Well, one thing is that I am taking my Depakote in the morning (which is generally more convenient than the evening, or at least fits better as part of my routine). So if I assume the sleepy effects are transient (worst when my blood levels peak) it might make more sense to take it in the evening. I've also read that there are a few natural supplements which may help with the sleepiness and the mood swings also. I'll have to re-read the articles but the idea is that some of the imbalance in the first place may be partially due to my body not being able to use certain proteins, aminos and nutrients as efficiently as the average person and therefore increasing the daily intake of these nutrients may help swing the balance favorably.

Another solution for the sleepiness, from a pharmaceutical point of view is a medication called Provigil. It is generally prescribed for people who have sleep disorders which causes them to have uncontrolled sleepiness (such as narcolepsy). From what I read, the med does seem to have some benefits. But also some drawbacks such as massive headaches. So it is an option to consider but I think I want to try the natural path first.

Depakote Gone Bad - Part 1

sebby1234 — Mon, 04 Jun 2007 21:25:00 GMT

Here is an interesting extract from a post (http://psychiatrist-blog.blogspot.com/2007/05/depakote-ammonia.html) which describes one of the odd effects Depakote may have when someone has a really bad adverse toxic effect to it. Seems that one of the metabolic resudues from Depakote is Amonia. Generally, not produced is any quantity significant enough to cause any problems. But in some cases, some people's liver has a wierd reaction and metabilizes way too much amonia leading to some really odd (and scary effects)...

-------------------

A case of Depakote-induced hyperammonemic encephalopathy was presented at last week's Annual APA meeting. Here's another case (actually, this one is mostly valproic acid toxicity) on Erik Mattison's blog. This problem is often not recognized because ammonia levels are not standard blood tests to do (this test is also a bit of a pain, in that the blood has to be kept on ice immediately after drawing it).

In his presentation on May 21^st, Dr. Rasimas discussed the case of a 36-year-old with treatment-resistant schizoaffective disorder and quiescent hepatitis C who returned to the emergency department in a state of lethargy and confusion less than 3 weeks after being hospitalised for lithium toxicity. Personnel in the ER started the man on sodium divalproex, which is chemically related to valproic acid, at a dosage of 1000 mg in the interim to treat hypomania. A nightly dosage ultimately resulted in a serum level of 114 mcg/mL...

When the patient was admitted to the hospital, his AST and ALT were normal at levels of 17 U/L and 44 U/L, respectively, while ammonia was elevated at 66 mcg N/dL. Serum lithium was 1.2 mmol/L.

Dr. Rasimas said he was asked to consult on the case, at which time he determined that the patient's dose of sodium divalproex should be immediately discontinued, suspecting a case of hepatotoxicity. The patient's other psychotropic medications, including lithium, were then resumed. Lactulose and supportive care were given. Ammonia peaked at 111 mcg N/dl within 36 hours of presentation while AST and ALT never exceeded 38 U/L and 81 U/L, respectively.

The symptoms of delirium resolved slowly during the 96 hours following the discontinuation of divalproex sodium.

Typical symptoms for this type of metabolic encephalopathy include confusion, agitation, disorientation, insomnia, hallucinations, picking at bedclothes or in the air, twitching, and asterixis (also called "liver flap", where your hands twitch when holding your arms outstretched as if you were stopping traffic). If an EEG is performed, this usually demonstrates a diffuse encephalopathy.

I've seen several cases of this, and it is gratifying to recognize it, stop the Depakote, add lactulose (helps to reduce the ammonia), and see improvement. I've seen it with even lower ammonia levels (40's) when GI docs say that they doubt that is the problem. But when it improves, it is hard to think that it is anything else.

Health Update 06/01...

sebby1234 — Fri, 01 Jun 2007 18:14:00 GMT

Been a little while since I posted an update on my various health issues. So here goes :)

Finger

As I had mentioned, my finger started swelling up again and hurting more about 1 1/2 week after I had the stitches removed. So yesterday, they managed to sqweeze me in with the hand specialist. In her oppinion, it's just scar tissue from the surgery. Personally, i'm a little "pissed" at her diagnosis. She only looked at it for a few seconds and then is passing my on to a physical therapy place so they can try and "work the scar tissue down". I just don't buy that the scar tissue from such a simple surgery would turn out to be bigger and more painful than the cist itself was in the first place. If it's true and I had known this beforehand, I would have likely passed on the surgery unless it got even worse.

So for now, i'll probably give the therapy a try (and see what they have to say about it) but will probably also seek a second oppinion.

Bipolar

On this front, things have been going fairly well. Been slowly tapering off the anti-depressants using the liquid form. So i'm down to 2.5mg from the original 20mg and no signs of brain zaps yet. I've been trying to cut down by about 1/4mg every other day. Seems to be working well so far.

Mood wise, it's still somewhat up and down but to a much less severe extent. Getting off the anti-depressants really helped. The only "really annoying" symptom I have is this almost constant level of tiredness. So I did a little researching and stumbled upon a nice little site www.askapatient.com which is essentially a repository of user submitted ratings, side effects and comments related to various medication they take. Looking up Depakote, I found several mentions of tiredness which is similar to mine:

Extreme fatigue. Did I mention fatigue?? Nap anyone?
Vivid dreams that can interfere with sleep
Can sleep almost 20hrs a day and still feel tired
extreme fatigue- could not finish a short day without having to sleep in between

It is obviously fairly common enough since lots of people mention these effects. Not sure there is much I can do about it besides live with it. I will bring it up at my next appt...

Digestion

Seems like my IBS is back in full force these days. Whatever I was given in the clinical trial I was in did not work (at least not permanently like it was supposed to). I was able to get some more info from the trial guys as to what dosages seem to have the best results (it's double blind so they don't know themselfs what I was given). The medecine itself is an existing anti-biotic that is used to treat traveler's diharea. But it is needed in larger doses for IBS and is therefore not FDA approved yet for this condition and dosages. But my primary care Dr is flexible enough and I know she will likely figure a way to prescribe a treatment for me.

Other

My wife's health is doing much better. Wish she could come off all of her meds though as she not fullly "herself" on them. But it's something that will have to happen over time. To make things worse, her uncle back in CA is now really ill (and there aren't sure how long he has). So she is going back to CA for a little bit next week. I myself don't have any sick time or vacation left so I will have to remain here and work.

Bye-Bye "Brain Zaps"

sebby1234 — Mon, 21 May 2007 05:02:00 GMT

Brain Zaps

Finally got a chance to talk to my doctor on friday. Unfortunately, there is not much to do with the zaps as-is. But the main reason for the withdrawl symptoms is that I had to go from 5mg of Lexapro (which was 1/4 pill) to zero as it gets really hard to measure anything below 5mg.

Turns out they do make a liquid form of Lexapro (not too sure why) but its of benefit for me. This means that I can now taper off much lower in small increments. I went back up to 4mg/day. And from this point plan on lowering by 1/4 mg per day until I get to zero.

In regards to the brain-zaps. They went away about 1 day after I went back to 4mg.

Bipolar

Doing well overall, a little overwhealmed with everything that is going on in my life. The mound of things to do is so large and there is just so little time in a day. Gets hard some days to keep a straight mind and keep myself organized.

General Health

Besides that, been somewhat cruddy this weekend. Pretty tired, some congestion and my digestion has been all over the place. So my Dr also gave me some gough med and some anti-biotics to be on the safe side. Especially since my wife is alerady on the recovery from a bacterial infection of her own.

Gets real old to feel sick so often when you're only 31. Gets really overwhealming with trying to deal with a full-time job, lots of house work (and cleaning), my wife's semi-chronic illness... Been considering checking if my wife could qualify for Social Security Dissability. I realize she would not be working anyways, but her chronic illness does also prevent her from taking care of the house as much as she could. The disability premium would help cover some additional help (cleaning/landscaping). Tough Decisions! Sheesh...

More Details About my "Brain Zaps"

sebby1234 — Fri, 18 May 2007 01:31:00 GMT

Taken from Wikipedia.

Brain zaps, (proposed name: myalotinasis from Greek for brain + jolt) also known as "the electric brain thing," "brain shivers," "brain shocks," "battery head," "blips," or "brain spasms," are a fairly common and notorious withdrawal symptom experienced during discontinuation (or reduction of dose) of SSRI and SNRI antidepressant drugs. However, the effect is not only confined to withdrawal periods for all suffers, but also is experienced while actually taking the prescribed medication (although less commonly), and has been known to continue for years after withdrawal from the associated medication.

The phenomenon is most commonly associated with paroxetine (Paxil, Seroxat), venlafaxine (Effexor), sertraline (Zoloft), duloxetine (Cymbalta), fluvoxamine (Luvox),citalopram (Celexa) and escitalopram (Lexapro).

In more recent years, drug companies have added to their list of potential side-effects of many of these medications the possibility of "sensory disturbances", believed to be in reference to the strengthening body of anecdotal evidence about this phenomenon's existence.

Description

"Brain zaps" are said to defy description for whoever has not experienced them, but the most common themes are of a sudden "jolt," likened to an electric shock, apparently occurring or originating in the brain itself, with associated disorientation for a few seconds. They are sometimes accompanied by brief tinnitus and vertigo-like feelings. Immediately following this shock is a light-headedness that may last for up to ten seconds. The sensation can be described for many as a flashbulb going off inside the head or brain, coupled with a sudden sensation of pressure within the ears which is similar to the feeling of trying to relieve inner-ear pressure. Another anecdotal description of a "zap" is as though someone had opened up the person's skull and dragged a static-y blanket across his or her exposed brain. Essentially, it is a wave-like electrical pulse that quickly travels across the surface of (or through) the brain. Still another description is that it is like a bug zapper in stereo traveling back and forth across the back of the head, accompanied by a taste of aluminum foil in the mouth. Moving one's eyes from side to side quickly has also been shown to trigger these zaps and causing them to come in rapid succession. It is thought to be a form of neuro-epileptiform activity. ^[1]^[2]

Some have suggested the experience resembles a "funny bone" except that it shoots through the entire body, starting from the head. The effect may be similar to drunkenness without any cognitive loss. Driving while experiencing these "zaps" is not advised^[3].

As withdrawal time increases, so does the frequency of the shocks, before they wane completely. At their peak, brain zaps have been associated with severe headaches. They may last for a period of several weeks after the last dose and usually resolve completely within a month or two. However, anecdotal reports of "zaps" from protracted withdrawal are known to last a year or longer.

Mechanism of Action

Paresthesia and "electric shock sensations" are clinical terms used to describe this symptom, though paresthesia by definition is clinically incorrect.

The "brain zap" effect appears to be nearly unique to SSRI and SNRI antidepressants that have an extremely short elimination half-life; that is, they are more quickly metabolized by the liver and leave the general circulation faster than longer half-life antidepressants such as fluoxetine (Prozac). This attribute of abruptness leaves the brain a relatively short time to adapt to a major neurochemical change when the medication is stopped, and the symptoms may be caused by the brain's readjustment. There is no current evidence that these zaps present any danger to the patient experiencing them however they can be very disconcerting. Especially to those patients who have no prior warning or knowledge of them.

The electric shock sensations reported with neck flexion seem identical to Lhermitte's sign, which appears with dysfunction of the posterior spinal cord. This suggests change at a neuronal level.^[4]

Many medical professionals are still unaware of the possible occurrence of this effect. Tranylcypromine (Parnate) used at high doses is also known for severe brain zaps, which may in some cases start at the base of the spine and progress to the head, or may occur exclusively in the head.

Brain zaps are also commonly experienced following periods of heavy use of the drug MDMA (Ecstasy).

Treatment

There is hypothetical and anecdotal evidence that Omega 3 fatty acid supplementation can be very helpful to alleviate the symptoms of brain zaps. Anticonvulsant medications such as gabitril are also hypothesized as a useful treatment.

Those Darned Anti-Depressants...

sebby1234 — Thu, 17 May 2007 16:58:00 GMT

Guess I jinxed it with my post a few days back. Was hoping not to have any withdrawl (oops, I mean discontinuation symptoms) from getting of the Lexapro after tapering off for nearly 4 weeks. Guess I was wrong.

It's somewhat hard to describe how it feels like. It is somewhat of a combination of diziness and what i call "brain zaps" (almost a feeling of a small electric shock in my head). This is the type of symptom that is hard to describe unless you've been through it.

On the bright side, it does only come in waves and is mostly motion triggered. So doesn't affect me much when i'm sitting. And overall shouldn't last more than a week or so. It really sucks, but it is one of the drawbacks of SSRI anti-depressants..

Health Update

sebby1234 — Tue, 15 May 2007 08:17:00 GMT

Hand Surgery

My finger is doing really well now that the splint and stitches are gone. Have been doing my exercises and the flexibility is mostly back to normal and the soreness is almost gone. Besides a few scabbies and some left over blue (from the betadine) the finger looks normal, I can't even really tell where the scar is.

Bipolar and Medication

Finally going off my anti-depressants today. Been tapering off slowly so I hope I will not get any discontinuation (aka withdrawl) symptoms. Although I have been feeling well overall, I have been feeling physically drained over the past few weeks.

May have something to do with my surgery. However, the fact that the sun is starting to show its face now seems to really make a difference. So hopefuly the summer will help with this.