[Research] Oh no -- here comes the sun

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I decided to take a page from Rae, and start an online seizure diary for my partner. Although he has yet to be officially diagnosed, we're certain that what he experiences are seizures. With it being online, I can update it and access it from anywhere, and I won't have to worry if my computer pooches out that I've lost all the info. I asked him if he was okay with it, and he said he was, so I'm going to do it.

History Part 1 (I tried to make it brief, but it's not to be):

He's had signs of seizures all his life. When he was little they were mostly at night -- he'd wake up on his knees sometimes, with one arm outstretched and the other curved behind his head in a fencing posture. He had terrible moods, which started and stopped suddenly, normally without any reason. He would also have small space-outs. He would refuse to go outside on sunny days, because the sun made him feel "icky". At age 6 he had a severe head injury from holding his breath in stubborness, then passing out and knocking himself out on the toilet bowl. His parents never took him to the hospital.

At around age 9 the space-outs became so bad he would sit down to watch his favourite show, then suddenly it would be over, and he realized he missed everything. His education was affected as well, and for months he's be placed in an advanced class, then switched to a remdial class, on and on for a few years. He began to twitch more when he went to bed and when he woke up. He had episodes of squiggling colours, flashes of light or shadow which made him duck, bad smells, nausea, dizziness, vomiting and pain that would travel through his body (eg it would start in his leg, then disappear, then reappear in his abdomen, then disappear and reappear in his arm). He continued to have severe moods which started and stopped for no reason. He sometimes just fell over without being dizzy or losing balance -- he says it feels almost like he's being pushed. He also began having extremely graphic and violent nightmares about the Vietnam war. Nobody in his family fought in the war, and his dreams never had people he knew in them. All of these things would happen several times a week. Everybody told him these were normal and to stop over-reacting.

At around age 12, these symptoms became daily experiences, affecting every aspect of his life. This is about the time the epigastric rising began, and serious bouts of depression where he felt as if he was floating over his body, and no matter how much he willed himself to move, his body wouldn't respond. He also began running away. He would always be caught and brought back and asked why he ran away, but he never knew. Had moments where his space-outs lasted much longer, and friends began to notice. Sometimes he would just sink to the ground slowly during these. He developed sporadic time loss and confusion. Teachers, students, doctors, and his family began assuming he was either stupid, making things up, or on drugs.

A few years later he began drinking, and experienced a night where he popped some tylenol for a headache before going out to drink with friends. The next thing he knew, he was waking up in a parking lot and couldn't move his body for at least an hour. When he was able to move again, he basically crawled all the way home. This was the age he began smoking cannabis and his addiction was instant, because, for the first time in his life, he was able to concentrate, the worst of his symptoms subsided. He stopped running away, he was able to focus enough to finish high-school and to work.
 
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History Part 2:

At around 20, his nightmares continued, and he often woke up bruised and with scratches all over his body. His girlfriend at the time refused to sleep with him, because she was afraid of being kicked or punched while he slept. He began to experience the out-of-body depression more frequently and for longer periods of time. He went to the doctor and was diagnosed with depression and prescribed AD’s. A few years later, he developed anxiety issues and the Doctor began experimenting with different AD’s to help him. What happened instead is he developed severe panic attacks that occurred several times a day every day – sweating, screaming, vomiting, abdominal pain, running away and intense fear. For the next two years, the doctor prescribed a variety of AD’s, and during this time my partner had these attacks daily, plus a six month period where he was unable to eat solid food without vomiting and drank Ensure for every meal. Despite extensive testing, the doctors were unable to find a reason why this was.

He “stabilized” on Effexor and daily clonazepam. I met him several years later when he only took Effexor. He told me that all it seemed to do was keep him from the out-of-body depression he experienced, but otherwise it didn’t seem to help him much. As far as I knew at the time, he had depression and anxiety issues and spaciness, nausea, and occasional mystery pain and was severely sensitive to sunlight. At night he still had nightmares most nights, abdominal spasms, and episodes of scratching and moaning and chomping – all of which we attributed to his nightmares.

A year later he was diagnosed Bipolar II (because of his moods), and agoraphobic (because he doesn’t like being in environments where there is no easy escape from) and placed on lamotrigine. Most of his symptoms disappeared. He still spaced out, but he was better able to tolerate sunlight, his moods improved, his nausea lessened, his energy skyrocketed. He went to see his GP to see about lowering the Effexor dose, but the GP upped it instead. All the symptoms, except the nightmares, came back.

A few months later, he was prescribed gabapentin for his back injury. All of his signs intensified, and he began to experience racing thoughts and repeated phrases as well. He also drank more than 2 litres of water a day, and urinated often, but the urine was always dark yellow as if he were dehydrated. His body bloated, and he had dark circles under his eyes. One of his space-outs was so obvious that I recognized it as a seizure and began to research the other symptoms. All of them fit into types of partial seizures, and he told me then that he’d experienced these things all his life, and had been told they were normal. We went to the GP, who set up a neuro appointment, but told us to continue the gabapentin. We weaned him off it instead. He’s never really fully recovered from the round of gabapentin. His signs remain more frequent than before, and his energy levels are very low.

So, we saw the neuro, he ordered an EEG which showed nothing even though partner came out of the EEG feeling like he was floating, and he lost time. His GP decided there’s nothing wrong with him. We decided to go to the Epilepsy association to seek help.

And that's as brief as I could make it. I know I've missed stuff -- like a number of seizure types, so I'll continue updating the list as I go along.
 
GOOD ON YOU!
both of you for that matter. i'm glad your taking this step too. it will help. its already opening my eyes to my bad habits and things i need to work on.
 
Thank you Rae! You're an awesome support. Okay -- I'm going to try to piece what I can remember from the last few days. Partner's participation varies -- some days he's on board, and other days he's too tired to pay attention.

Friday, February 26, 2010

Lamotrigine 200 mg
Effexor XR 225 mg
Both taken 9 am

3 cups coffe at 8 am.

Did not eat all day, and was sleeping when I came home (have to get day experiences from him if he remembers). Cheerful when he woke up at 5:30 pm, and went out for dinner -- bacon, eggs and pancakes and coffee.

During dinner, he looked down at the table and spaced out for aprroximately 3 seconds. Momentary loss of awareness because he did not know that I had spoken to him during that time. Happened two more times, the last one lasting a slightly longer time -- approximately 5 seconds. He said the last stare felt different, felt deeper than the other two. He then began to feel dizzy, nauseous and exhausted.

Was tired the rest of the evening, and went to bed at 11 pm. Didn't notice any activity during the night.

Saturday, February 28, 2010

Lamotrigine 200 mg
Effexor XR 225 mg
Both taken 9:20 am

Drank 3 cups coffee at 9:30. Began wearing yellow-tinted sunglasses at 10:30 am when the sun became too bright in our apartment. Mood cheerful.

Went to the mall at 12:30, ate burger and fries, and went to the barber. Had two small space-outs in the chair. Got a top gun haircut -- no idea whose fault that is, since I sent him in with a picture.

Mood still good, but got burning/chemical smell - really intense for 5-10 seconds, then slowly fades over 10 minutes. affects taste as well.

Ate dinner approximately 6:30 hot dogs. Yes, we ate poorly this weekend. Went to bed at midnight. Didin't notice any activity during the night.

Sunday, February 29, 2010

Lamotrigine 200 mg
Effexor XR 225 mg
Both taken 9:30 am

3 cups coffee at 9:30. Breakfast @ 11 am -- scrambled eggs, fried onion and toast. Wore sunglasses from 10:30 to 11:30. Took them off and had many staring spells due to sun on the boldly patterned curtains (if I had known about him and patterns, I'd never have bought them). By 1 pm he was exhausted and moody. Snacked on twizzlers (yes, bad! but ohsogood) Ate dinner at 7 pm -- whole wheat pasta, with olive oil, coconut oil, onions, garlic, peas, salt and pepper. 10 pm began to feel antsy and frustrated. Says everything hurts (back injury related maybe).

No twitches on falling asleep, but I woke up suddenly at 5 am under the impression that he had spoken loudly at me. He was sweaty and cold and seemed deeply asleep.

Monday, March 1, 2010

Lamotrigine 200 mg
Effexor XR 225 mg
Both taken 9:30

Was okay this morning -- cheerful, but spacing out at morning news on TV. Had a 1 minute sudden sharp headache around left eye, that stopped abruptly. Made him put on sunglasses (poor guy). Don't know if he kept them on. Called him at 10:30 to remind him to eat. Called him at 2 pm to ask a question about psychiatric assessment appointment -- no answer, usually means he's sleeping. Sleeping usually means he's having a bad day.

He tells me he had a lot of episodes of the squiggly colours (each lasting around 10-15 s), and the pain by his right eye came and went all day too (each bout lasting around 1 minute). Nausea and dizziness on and off as well. One of the worst days for back pain. He was so exhausted he had to lie down and fell alseep instantly. Slept until I cam home @ 5:30. Woke up with the pain by his eye which faded by bedtime. I fed him leftover pasta, and he felt a little better. Mood seems okay. A little bitter maybe, but so am I, since we're discussing doctors.

Having coffee now at 7:20 *grrrr*

Had rhythmic shoulder/arm spasms, then abdominal spasms, then leg spasms as he was falling asleep. A few second of rest and repeat the pattern two more times.
 
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Is it possible that some of the things your partner is experiencing are side effects of the Effexor? My sister was very briefly on it, and hated it. Here are some of the listed, common side effects:

• Nausea
• Headache
• Drowsiness
• Dry mouth
• Dizziness
• Insomnia
• Nervousness
• Loss of appetite
• Body weakness
• Sweating
• Constipation
• High blood pressure
• Anxiety
• Shakiness (tremors)
• Diarrhea
• Yawning
• Chills
• Vomiting
• Indigestion (dyspepsia)
 
The sweating is definitely related to the Effexor and the Lamictal. The loss of appetite may be related, and the anxiety he has could also be related, since he developed anxiety/panic issues after he began treatment with ADs.

Sudden onset of nausea, dizziness, and vomiting he's had since childhood, which worsened dramatically when he hit age 12 or 13. He began Effexor in his mid-twenties, and he continues to have bouts of nausea, dizziness and vomiting -- just now he sometimes has them all day instead of for a few minutes here and there several times a day. So, yeah, it's often hard to tell what's caused by the Effexor, what's aggravated by it, and what's independent of it.

The sudden 1 minute headache was something he doesn't remember having before -- he's been on Effexor for 9 years now, so my guess is it's not specifically related to the AD. I don't know though. That's why we're keeping a record. Maybe a doctor can figure this stuff out.
 
I get those sharp painful headaches after a complex partial. providing i didnt go to sleep. they hurt. like when you get those sudden owie heart/chest pains *that might just be me*

I think the first thing you should try is to wean him off the coffee and see how that goes. The caffeine could be something that his body doesnt like. Just because he has been drinking or taking something for years doesnt mean his body likes it. He's probably used to feeling like crap. *no offense* so try that. I'm sure that most of the stomach and intestinal problems may subside at least a small amount.

also, if possible and if he feels ready. Slowly wean him from the Effexor. SLOWLY. try just by taking the pill at 200mg or 175mg *cut it in half or arrange it to be able to do it slow* then when you get to the end. start by taking the 50 or 25mg dose every second day, then every third day. going in weekly or biweekly incriments. what ever he will feel comfortable with.
then just do it every sunday, and then nothing at all.

If he can make it that far without them, then you know that this is nothing to do with depression and alot to do with his meds. then see if the symptoms "disapear" this will be your clue to how much lamictal is working for him.
 
We've definitely discussed weaning off the coffee. We figured perhaps we'd switch to green tea, which is a slower release caffeine, and then to rooibos. We just need to decide when we'd like to start. I'm thinking this weekend is a good time. That way I can sleep through the headaches too. I have to show my support.

He's decided to reduce the Effexor when he gets his next refill on Xanax -- just in case the change induces panic attacks. That should be some time next week, I think. He's going to stay on it, but is reducing back to the level he was at originally (before doctor decided a higher level would be better, and everything went haywire again). He won't wean off completely unless he's under a doctor's (psych or neuro) supervision. He's been on it too long, and he does have depression issues, which is why he was put on in the first place.

EDIT: I get those weirdo chest pains too!
 
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With any of the anti-depressants (as with the AEDs) it's important to go very slow with the weaning process. I would recommend going as slow as possible so he can adjust and take stock at each increment.
 
He's been through it many times before, so he knows how to do it. Right now we're discussing if he should do it, since he has a psych assessment coming up, and it could mean problems for him if he appears non-compliant on his meds by taking a lower dose, regardless of whether compliance is best for him or not. We're weighing possible benefits with possible negatives *sigh* It's hard to figure out what the right thing to do is.

All of this is complicated by his severe back pain from his injury. Since he's been given no pain meds after the gabapentin failed to work, he has to deal with it every day without a break, and it's wearing him down.
 
Anti-depressants can help with chronic back pain (they can prevent a sort of pain feedback loop from getting established in the brain), so you're probably right not to mess with anything right now. Though maybe a different AD med might be worth considering in the future, one with potentially fewer side effects. Has he tried any of the alternative/complementary back treatments like gentle massage, or acupuncture? My father, who had terrible chronic back pain, was helped by massage (and also by cortisone shots).
 
That's something we haven't considered, good point Nak. Also, the may be preventing him from dipping into deeper depression from his pain. I've tried to convince him to try acupuncture, but he has concerns that it'll worsen his pain. He's had some bad experiences with massage, so he's resistant to that too.

EDIT: Scratch that last one -- he's willing to try the place by my work for massage. Huh. Now I have to find the funds for it.

He's hesitant to try other AD's because of the two years of panic attacks and not being able to eat when he was tested on a few other AD's. He's been seriously traumatized by that experience.

Sometimes I wonder how he's made it through all this intact.
 
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Tuesday, March 2, 2010

Lamotrigine 200 mg
Effexor XR 225 mg
Both taken 9:30

Had two 5s staring spells before I left for work this morning. One before coffee, one while drinking coffee. 3 cups as usual. Of course it took me a moment to realize he was staring the first time, so I looked to see what had caught his interest. Nothing of course... I can be such a doofus. Had a moment where he was unable to speak. Lasted maybe 3s. This is a common one for him, but I don't always catch it.

Otherwise felt fine, just very tired, and was in a good mood and talkative. No other incidences this morning. It's also a very grey day, with foggy frost coming down, so he doesn't need to wear his sunglasses. He had a piece of bread some time this morning. I encouraged him to eat lunch, we'll see if he does.

He ate cereal for breakfast, pasta at lunch, banana in the evening and burgers for dinner (I was exhausted after work). He had a milder version of yesterday's headache all day today. It's not directly on his right eye, but in his forhead just above it. No nap, but he felt exhausted all day, probably from battle back pain.

He doesn't recall anything else happening during the day, and I didn't notice anything in the evening.

Falling alseep was difficult. He would be asleep for a few minutes (judging by his breathing) then spasm in his shoulders, abdomen or legs, grimace, smack his lips, then spasm again, at which point he would wake up. This happened repeatedly until he got fed up and stayed up for a while. I don't know when he went to sleep, but judging by how late I finally fell asleep, it was very late.
 
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yeah thats good for him to try massage.
accupunture, from what I understood from epileric, its reallt hard for accupunture to make things worse. the point of it is to reroute "stuck" energy into the proper areas. and let energy flow naturally and freely. so dont worry about that.

as far as funds, see if the place will direct bill your insurance company. then you dont need to pay up front.
 
I hope they direct bill, but I still have to pay 20%, which isn't so bad. I'm just on a fairly tight budget at the end of the month, so the first visit will have to wait for the middle of the month.

I'm not concerned about acupuncture making it worse, he is, and he's sometimes hard to sway when he gets an idea in his head. Have you seen the ad on TV where the parents play cop trying to intimidate their kid so he eats his dinner? Think that, only adult-sized lol
 
Well here in winnipeg, accupuncture is actually really cheap. $15-$50 bucks. so you'd pay anywhere from $3.00 to $10.00 from out of pocket. just get a few price points to work with.

Cunning tip #2: Compare prices to other stores, and tell them about the competition. most times, they are willing to throw in something for free. a massage, aromatherapy, accupuncture, etc depending on what you are comparing. free is always better.
 
Phew! I had a rawkingly busy day at work today matching wits with our web developer, who I now loathe (I only dislike him before).

The sad thing is, at the end of the month, I don't have the money to spare. I do not budget well! Neither does partner *sigh*

The price comparison is a good idea. I'll definitely do that.
 
Wednesday, March 3, 2010

Lamotrigine 200 mg
Effexor XR 225 mg
Both taken 9:30

Woke up and already had at least one space-out -- a big-eyed stared at the curtain and picked at his thumb with the other fingers.

He doesn't remember any of what I described about his falling asleep last night. He just remembers the constant waking up, and eventually getting up.

Just spoke to him on the phone -- he says he's doing fine, no smells, no colours, no space-outs that he's noticed. He ate a banana for breakfast, and has been practicing guitar all morning. Cereal for lunch.

The morning was mostly cloudy, but by 11 it got sunny. Took a nap from 3:30 - 5, woke up and had repeated space-outs for the next two hours. Felt exhausted and sick after. Has been tired all evening. Ate hot dogs for dinner at 6:30. I need to clean up the kitchen and cook again, yargh!

We were up late again because we were watching a movie. So bed at 1 am again, but partner only had one round of spasms and lip-smacking with a wake-up, and then was out like a light. Early in the morning (4 or 5 am) he experienced some shudders, which start in his shoulder and travel down through his abdomen to his leg, with cold sweats.
 
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I wonder if maybe upping the Lamotrigine will help reduce some of the seizures? In general I'm not a superfan of Lamotrigine, or of upping meds, but I know that 200mg is considered to be on the low end of dosing for epilepsy.
 
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