PW Health Clinic

[nasirjavaid]

[ATTACH=CONFIG]1588455[/ATTACH]

[Farhansa]

Seems like signs of major depression. Can you tell the pt. age. Signs of major depression or minor depression(dysthymia):

S- sleep disturbance(usually loss of sleep insomnia)
I- loss of Interest in daily activities
G- Guilt/worthlesness
E- Decrease energy
M- Depressed mood
C- decrease concentration
A- appetite/weight loss
P- psychomotor retardation
S- suicidal ideation

Any four of these symptoms present for at least 2 weeks is mostly major depression. If severity of these symptoms is less and present for at least 2 years is minor depression or dysthymia. If sleep increased and weight and appetite increased along with some above mentioned symptoms atypical depression is likely. If pt. older than 65 then major depression can present as loss of memory.

Neurologists seems to be better but good GP can be good as well Dr. Mahmud majeed, Dr. mazhar ali mufti or dr. shahzad khan siddiqui seem to be good general physicians try them. But when treating for depression always remember takes at least 2-3weeks for meds to work.

@ Glioblastoma
JazakAllah. Thank you so much for the detailed reply. Even some doctors cant investigate like this.
Patient age is 39-40. The following conditions are present.

I- loss of Interest in daily activities
G- Guilt/worthlesness
E- Decrease energy
M- Depressed mood
C- decrease concentration
P- psychomotor retardation

went to GP few months ago. He advised ALP for a week and cironex for 3 months. While taking medicines, felt a bit better (about 10-20%). but when course is completed and medicines stopped, again same symptoms.

[ahmed2396]

@ Glioblastoma
JazakAllah. Thank you so much for the detailed reply. Even some doctors cant investigate like this.
Patient age is 39-40. The following conditions are present.

I- loss of Interest in daily activities
G- Guilt/worthlesness
E- Decrease energy
M- Depressed mood
C- decrease concentration
P- psychomotor retardation

went to GP few months ago. He advised ALP for a week and cironex for 3 months. While taking medicines, felt a bit better (about 10-20%). but when course is completed and medicines stopped, again same symptoms.

Symptoms you are facing are because of alprazolam and escitalopram withdrawal

[asjdsm]

how much will 3mg GNC Melatonin cost?

I forgot but you can call gnc islamabad and confirm from them
Prices are same as they are in America etc
F7 markaz jinnah super branch office 051_2608061 or 2608062

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[capsat]

doctor saheb i prepare lemonade at home as:

2 litres of water, 4 lemons squeezed, 200 gms of sugar, 1/8th of tea spoon table salt, i churn in blender & keep adding ice cubes, to make it 3 litres top. am sure its very balanced nothing hard on the kidneys, & when lemon is not fresh i simply make ORS n freeze it 60 minutes before ifftar.

3 liters of lemonade brother have some mercy on your kidneys they are already overburdened. Please no acidic drinks more than 500ml per day. Thats the best advice. Remaining for thirst issue nothing can be done just be patient that is the main exam and test as all of us know. Harder the test better the reward. If you feel dizzy or in extreme conditions IV lines are allowed and don't break your fast.

[capsat]

sir respectfully this is what Our religion is about start our day at sun rise & finish by sundown, The Complete way of life is in our wonderful religion. - Fajr ki namaz sai din ka aghaz, maghrib par kamkaj pora, ghar jayey family time at esha have dinner offer namaz and hit the bed,

subhan ALLAH

[nasirjavaid]

sir respectfully this is what Our religion is about start our day at sun rise & finish by sundown, The Complete way of life is in our wonderful religion. - Fajr ki namaz sai din ka aghaz, maghrib par kamkaj pora, ghar jayey family time at esha have dinner offer namaz and hit the bed,

subhan ALLAH

You are right bro, but sorry to say we don't follow our religion as we should. Rise up early, work hard during daytime and go to bed after isha prayer and there will be 90% less diseases and depression. But we do opposite and hence are forced to take medicines which have more side affects than benefits

[Farhansa]

Symptoms you are facing are because of alprazolam and escitalopram withdrawal

These terms r new to me. Plz explain.

[ahmed2396]

These terms r new to me. Plz explain.

these are chemical names of tablets you were using

[Glioblastoma]

Thanks sir, Can you please mention the most important tests that we should get done on yearly basis like

CBC
Cholesterol
LFT or HbSAg (If LFT is fine then can we omit Hepatitus tests asuming liver is fine or there could be hepatitus even if LFT is fine)

Thanks.

Test that can be done yearly Fasting blood sugar and always do fasting lipid profile never cholesterol alone.

CBC can be done but if no problems present no need.

LFT or HBsAg done only if problems present never routine.

[Glioblastoma]

@ Glioblastoma
JazakAllah. Thank you so much for the detailed reply. Even some doctors cant investigate like this.
Patient age is 39-40. The following conditions are present.

I- loss of Interest in daily activities
G- Guilt/worthlesness
E- Decrease energy
M- Depressed mood
C- decrease concentration
P- psychomotor retardation

went to GP few months ago. He advised ALP for a week and cironex for 3 months. While taking medicines, felt a bit better (about 10-20%). but when course is completed and medicines stopped, again same symptoms.

As I suggested condition looks like depression. But to be safe do get thyroid hormones dones(TSH, free T3, free T4) and a CBC for anemia.

Never leave medications without doctors advice because there is high chance of suicide then in such patients. Immediately go to psychiatrist and start pt. on medications, these medications take at least 2-4 weeks to work and then improvement is seen. But along with medicines a very important thing is psychotherapy if not done most pt develop depression again.

Medicines that were given were fine but as I said they take time to work. Walk or exercise daily for 1 hour and also take a glass of warm milk before going to bed.

[Glioblastoma]

doctor saheb i prepare lemonade at home as:

2 litres of water, 4 lemons squeezed, 200 gms of sugar, 1/8th of tea spoon table salt, i churn in blender & keep adding ice cubes, to make it 3 litres top. am sure its very balanced nothing hard on the kidneys, & when lemon is not fresh i simply make ORS n freeze it 60 minutes before ifftar.

4 Lemons is fine then in 3 liters.

[Farhansa]

As I suggested condition looks like depression. But to be safe do get thyroid hormones dones(TSH, free T3, free T4) and a CBC for anemia.

Never leave medications without doctors advice because there is high chance of suicide then in such patients. Immediately go to psychiatrist and start pt. on medications, these medications take at least 2-4 weeks to work and then improvement is seen. But along with medicines a very important thing is psychotherapy if not done most pt develop depression again.

Medicines that were given were fine but as I said they take time to work. Walk or exercise daily for 1 hour and also take a glass of warm milk before going to bed.

Thanx for advice. will start exercise and having glass of milk at night after ramazan.
by the way can symptoms be the result of foracort inhaller???? because i am regularly taking foracort inhaller. Is there any linkage of inhaller with fatigue / powerlessness etc

[nasirjavaid]

Test that can be done yearly Fasting blood sugar and always do fasting lipid profile never cholesterol alone.

CBC can be done but if no problems present no need.

LFT or HBsAg done only if problems present never routine.

Thanks sir, yes fasting sugar and cholesterol with lipid profile. Last time about 5 months ago my fasting cholesterol was borderline so will be going again.
I have heard people saying if LFT is normal then no need to go for any hepatitis test. I wanted to know if it is true or hepatitis can be present even if LFT is normal?

[asjdsm]

@doc is low Testo also a cause of add or adhd..

I am taking jumex. 5mg half capsule for my add. Not as effective as ritalin but certainly better then ndri sndri nri class of drugs.

Last year tak jtni bhi add ki drugs registered hovi hain sari try ki hain. Nothing except ritalin works. But jumex keeps me calm and functioning all day.

I am taking half tablet daily.

Left ritalin because of unavailability. Frequent dosages. Ineffectiveness with time. And after a year on it I was like zombie.. So had to take some ssri with it..

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@doc
Any advice regarding above?

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[Glioblastoma]

Thanx for advice. will start exercise and having glass of milk at night after ramazan.
by the way can symptoms be the result of foracort inhaller???? because i am regularly taking foracort inhaller. Is there any linkage of inhaller with fatigue / powerlessness etc

Foracort inhaler contains steroids which can cause such symptoms but because you are taking it in inhaler form so its highly unlikely. Only steroids taken orally can cause such symptoms, so as I said no chance the inhaler is the cause.

By the way why are you taking this inhaler are you a diagnosed asthmatic or any other respiratory problem?

Do get those tests done which I mentioned.

[Glioblastoma]

Thanks sir, yes fasting sugar and cholesterol with lipid profile. Last time about 5 months ago my fasting cholesterol was borderline so will be going again.
I have heard people saying if LFT is normal then no need to go for any hepatitis test. I wanted to know if it is true or hepatitis can be present even if LFT is normal?

Yes hepatitis can be present with a normal LFT but there must be presence of some other symptoms otherwise its highly unlikely.

There are many things which can make LFT abnormal hepatitis is only one of the many causes, so if you are vaccinated against hep b then no need to do hepatitis b test better get hep c test done because there is no vaccine for it. But in short do not get LFT tested in routine until and unless there is a problem.

[Glioblastoma]

@doc
Any advice regarding above?

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As far as testosterone levels are concerned as a cause of ADHD or ADD no papers have been published till yet so no proof. Its written on some forums only and patient experiences. So scientifically no proof and one more thing comes into mind that women have very low testosterone if it was the cause then women will be going mad with ADHD :D.

If you want to get tested then do get your thyroid hormones checked TSH, Free T3 and Free T4. For serum Testosterone levels it's your choice I would advise against it, but you want mental peace as you read it somewhere and now cannot stop thinking about it then you can get your testosterone levels tested.

First line treatment for adhd is ritalin or dextroamphetamine(not available in pakistan). If they fail we shift to NRI like atomoxetine(attentra, strattera). But many physicians start with atomoxetine as its side effect profile is way better than ritalin.

Jumex(selegiline) or other antidepressants especially tricyclic antidepressants have been used for ADHD but are not FDA approved. And FDA is the most authentic source when looking for drug approval for particular disease treatment.

Problem I am seeing here is except ritalin and jumex you have never used any drug for a long period if I am correct. Any drug for ADHD will show no improvement until 2-3 months of use and that also will be 20-30% improvement but long term drug use with psychotherapy for about a year will show marked improvement. My advice stick to one drug and please DO NOT experiment yourself with drugs it's not childsplay.

Go to a good psychiatrist or neurologist stick to his treatment for 2-3 years emphasize on getting psychotherapy and then if no improvement change your doctor.

[nasirjavaid]

Yes hepatitis can be present with a normal LFT but there must be presence of some other symptoms otherwise its highly unlikely.

There are many things which can make LFT abnormal hepatitis is only one of the many causes, so if you are vaccinated against hep b then no need to do hepatitis b test better get hep c test done because there is no vaccine for it. But in short do not get LFT tested in routine until and unless there is a problem.

Ok thanks for clearing the misconception. I haven't been vaccinated for hepa B yet.

[Glioblastoma]

Ok thanks for clearing the misconception. I haven't been vaccinated for hepa B yet.

Get yourself tested directly for HBsAG and immediately go for a vaccine afterwards LFT is your choice.