The Medical Thread

[barcode120x]

Originally Posted by GDB

So, I'd like some opinions on this. Lately, I've noticed my left eye's had this weird twitching/pulsing feeling under the eye. Closing the eye usually makes the feeling go away, as does putting my finger under the eye (as if I were to wipe a tear from the inner duct without touching the eye itself).

For a while, while it worried me, I thought it was just a feeling and not something actually happening. Then a week or two ago, it started happening while I was in the bathroom, so I decided to check the mirror and noticed there was actually a visible pulse going on under the eye (think those cliche anime pulsing veins). This sort of freaked me out.

I checked online and it looked like the three main causes are inadequate sleep (I do have some degree of insomnia, usually takes 30-60 minutes to fall asleep and the past couple of weeks I'd only gotten about 6 hours a night on average at best), stress (definitely been getting that at work), and eye strain. The last one is the one that I'm most curious about, as I do work with computers all day, but I also got new lenses in my glasses in May. I cannot recall when this twitch started happening, but I at least know it wasn't happening before January.

Anyone ever have something like this happen? It's getting more frequent, so not sure if I should consult an optometrist, check to make sure they didn't screw up my left lens, or if this is an issue for a general practitioner.

I actually had this EXACT issue mid last year when I started working graveyard shift (11:30pm-8am). I too didn't know what it was, but I did notice I was getting bags under my eyes and my eyes were always drying out and blood shot (I wear both glasses and contacts). I worked gy shift on the weekends then during the weekdays I would be back to regular sleeping schedule + school. I don't think it was stress (but I do think that it could be a contributing factor) since school wasn't too bad for me. This all lead me to believe that it was the lack of sleep that was causing these eye twitches.

I don't know exactly when it went away, but I just stopped having it. Most likely since I got used to working gy shifts and I do tend to take a lot of naps a week + I always make sure I get at least 6 hours of sleep a day. I'd say get as much sleep as you can and find things to de-stress, exercise, gaming, anime, etc x)

[SummeryDreams]

Originally Posted by GenjiChan

That's my opinion but based on what a doctor said to me... Besides... I never heard a case of malignancy on earlobes or eyelids....

Oh! I almost forgot, eye related cancers are rare.. So that explains it.. xD

[oompa loompa]

So, as I had posted earlier I had some problems with chronic pelvic pain. My urologist has run every test he can think of, and I mean EVERY test including an MRI for nerve compression, to uroflowmetry, with absolutely nothing coming up. In the end, the conclusion drawn was that it was probably all in my mind, or that I had an injury a while ago that hadn't completely healed. In any case, I was prescribed Fludac (Prozac in other places, I actually had no idea Fludac = Prozac till yesterday, the drug didn't have any effect on me mood wise as far as I could tell), and Flotral. It helped a LOT. I was told that the problem would come and go, and slowly get better over a few years, which it has, albeit very very slowly. Now its spiked again, and my urologist gave me the same prescription again.

My question is: Should I be worried about the use of Prozac? The dose is pretty high; the prescription is for 20mg, once in the morning for a month. What I'm especially concerned about is insomnia, as I haven't been getting the best sleep lately ( I've had sleeping problems for about 5-6 years now) : I can sleep for around 4 hours at a stretch max, but then can go to sleep for another 4, in the last month there have been 3 days where I've gotten 0 hours of sleep laying in bed. I don't understand brain chemistry at all, but could the prozac exacerbate this beyond the 1 month period? As to the obvious question, am I stressed and anxious? Yes. But I don't think the raw stress or anxiety is something that I can't deal with myself. I've got no reason to be so stressed, and if its a 'structural' thing (don't know a better word), I should learn to deal with it because I can't use meds as a crutch forever, I'm only 23 for gods sake.

I ask because now that I think back on it, when I was on the medication, I had trouble falling asleep; it would take a solid 2 hours to sleep but I was also taking the pill late at night. I'm specifically worried about this side effect because I really didn't notice anything else. Hell, I thought it was a variation of another medication I had been prescribed a few years ago called Urimax.

EDIT:
Obviously I asked my doctor this. He replied smugly "If I thought so I wouldn't have prescribed it" , along with the obvious " If you aren't able to get sleep once it starts, stop" . The thing is, in the years that I've had this problem (almost 5 now), this combination of medicine is the ONLY thing that has helped. Well, Urimax did too.. but it had very very unpleasant side effects, the details of which I won't get into here.

tl;dr
I just want to know what your experiences and opinions are on the short and long term effects of prozac are, specifically with respect to insomnia.

[MrTerrorist]

A sad day.

Toddler with bioengineered windpipe dies three months after surgery

[SummeryDreams]

Originally Posted by oompa loompa

So, as I had posted earlier I had some problems with chronic pelvic pain. My urologist has run every test he can think of, and I mean EVERY test including an MRI for nerve compression, to uroflowmetry, with absolutely nothing coming up. In the end, the conclusion drawn was that it was probably all in my mind, or that I had an injury a while ago that hadn't completely healed. In any case, I was prescribed Fludac (Prozac in other places, I actually had no idea Fludac = Prozac till yesterday, the drug didn't have any effect on me mood wise as far as I could tell), and Flotral. It helped a LOT. I was told that the problem would come and go, and slowly get better over a few years, which it has, albeit very very slowly. Now its spiked again, and my urologist gave me the same prescription again.

My question is: Should I be worried about the use of Prozac? The dose is pretty high; the prescription is for 20mg, once in the morning for a month. What I'm especially concerned about is insomnia, as I haven't been getting the best sleep lately ( I've had sleeping problems for about 5-6 years now) : I can sleep for around 4 hours at a stretch max, but then can go to sleep for another 4, in the last month there have been 3 days where I've gotten 0 hours of sleep laying in bed. I don't understand brain chemistry at all, but could the prozac exacerbate this beyond the 1 month period? As to the obvious question, am I stressed and anxious? Yes. But I don't think the raw stress or anxiety is something that I can't deal with myself. I've got no reason to be so stressed, and if its a 'structural' thing (don't know a better word), I should learn to deal with it because I can't use meds as a crutch forever, I'm only 23 for gods sake.

I ask because now that I think back on it, when I was on the medication, I had trouble falling asleep; it would take a solid 2 hours to sleep but I was also taking the pill late at night. I'm specifically worried about this side effect because I really didn't notice anything else. Hell, I thought it was a variation of another medication I had been prescribed a few years ago called Urimax.

EDIT:
Obviously I asked my doctor this. He replied smugly "If I thought so I wouldn't have prescribed it" , along with the obvious " If you aren't able to get sleep once it starts, stop" . The thing is, in the years that I've had this problem (almost 5 now), this combination of medicine is the ONLY thing that has helped. Well, Urimax did too.. but it had very very unpleasant side effects, the details of which I won't get into here.

tl;dr
I just want to know what your experiences and opinions are on the short and long term effects of prozac are, specifically with respect to insomnia.

I guess you've developed psychosomatic disorders.. And yes Prozac is very much prescribe... This is most of the time being develop if you've had stress for a very long time.. Have you been depressed for a long time? Prozac is an antidepressant..

[barcode120x]

Originally Posted by SummeryDreams

I guess you've developed psychosomatic disorders.. And yes Prozac is very much prescribe... This is most of the time being develop if you've had stress for a very long time.. Have you been depressed for a long time? Prozac is an antidepressant..

Antidepressants and anxiolytic are sometimes used to treat chronic pain indirectly. These in a sense help the person relax (mentally), so to speak, so that the pain level is reduced. Usually used to complement actual pain medication. Of course one could look to non-pharmacological methods such as hot/cold applications to treat the pain but I'm pretty sure he's already done these considering it's still persisting.

[SummeryDreams]

Originally Posted by barcode120x

Antidepressants and anxiolytic are sometimes used to treat chronic pain indirectly. These in a sense help the person relax (mentally), so to speak, so that the pain level is reduced. Usually used to complement actual pain medication. Of course one could look to non-pharmacological methods such as hot/cold applications to treat the pain but I'm pretty sure he's already done these considering it's still persisting.

That is not the case here in the Phils. We don't give antidepressants or anxiolytics for chronic pain, we give them narcotics.. BUT! when patient is in severe pain that even morphine wont take effect, then doctors would prefer to use placebo instead of Prozac I believe.. I haven't encountered a patient in chronic pain being given with antidepressants or anxiolytics.. BUT! Somatoform disorders are quite different, they don't have the immediate disease causing pain but is in feeling of a pain (psychological), so at this rate, Morphine wont give you any good, that is why Prozac has been given.. So here is the catch; for Physical pain with an organic costs - we give narcotics, but with physical pain with no organic cause - we'll give them drugs such as Prozac.. I hope I've made it clear here..

[MeoTwister5]

I'll probably be one of the doctors who will end up not agreeing with drugging psychiatric conditions left and right.

[barcode120x]

Originally Posted by SummeryDreams

That is not the case here in the Phils. We don't give antidepressants or anxiolytics for chronic pain, we give them narcotics.. BUT! when patient is in severe pain that even morphine wont take effect, then doctors would prefer to use placebo instead of Prozac I believe.

Opposite here in the US, placebos are not necessarily frowned upon, but to some it can be ethically wrong. Though, I am speaking from a nursing standpoint (of course not every nurse thinks it's ethically wrong but as nurses we cannot administer placebos). IMO, if a person is in SEVERE pain where morphine has no effect, I HIGHLY doubt a placebo would make the pain go away. I've actually never heard of a placebo being used in extreme medical cases...then again when one is very sick, I'm pretty sure one would try anything and in this case, placebos actually wouldn't really hurt...I would that's for sure xP

[SummeryDreams]

Originally Posted by MeoTwister5

I'll probably be one of the doctors who will end up not agreeing with drugging psychiatric conditions left and right.

If you know how things work for psychiatric patients, you'll cry because you don't have any other choice but to drug it left and right...

[SummeryDreams]

Originally Posted by barcode120x

Opposite here in the US, placebos are not necessarily frowned upon, but to some it can be ethically wrong. Though, I am speaking from a nursing standpoint (of course not every nurse thinks it's ethically wrong but as nurses we cannot administer placebos). IMO, if a person is in SEVERE pain where morphine has no effect, I HIGHLY doubt a placebo would make the pain go away. I've actually never heard of a placebo being used in extreme medical cases...then again when one is very sick, I'm pretty sure one would try anything and in this case, placebos actually wouldn't really hurt...I would that's for sure xP

Yes, what you're trying to express is the standard of practice, what is written in the book.. But here in the Phils, I mean, at least where I've worked before, it's mostly related to patient centered.. Like the obligation will always be as much as possible to give relief to the patient.. I have two cases, one is my personal experience.. First, I have a patient before who's in morphine for about months already, she has a stage 4 cancer.. Now she is in chronic pain, and we all know that the lowest interval for a full dose morphine is 4 hours, now when the patient reach morphine's half life, the patient will now demand pain medications, and we put her on a Morphine self injection.. After she injected the whole morphine dosage in her body, when she asked for more but it's not yet 4 hours, we give her NSS just to make her somewhat feel okay.. I guess somehow it works, the patient sort of stop yelling, but she says, she still has pain, but the yelling stops.. It's like from 10 of scale decreasing to 7.. Better than double dosing morphine or giving her more drug that will somehow put her more at risk of liver problems.. Now my second experience was with my girlfriend, she'd had severe 10/10 abdominal pain.. I rush her myself into the ER, but we all know that especially women, we can never give pain medications in the ER if the Chief complain is abdominal pain as there are risk that she might have conditions like apendicitis wherein if given pain medications, we can never monitor it anymore if it is about to rupture.. But you know, they all know that I'm a nurse, but I never care, I just want my girl to somewhat just looks fine.. I've asked the intern to order for a placebo, the medicine ignored my request.. Now I've explained it to my girl.. Now the OB came, you know, standard procedures for women complaining abdominal pain.. So then the check up ends with the OB gyne, my girl is still yelling in pain, now once again even if it is against any laws in nursing or ethics, I once again ask the OB intern to please just a placebo - wished granted.. I myself gave the placebo, I was informed that just in case things get messed up, my license will be in danger, and never care as I've done a lot of this stuffs before, so I gave her, and she became looks fine, and she went asleep.. Now what is in my mind for both of these happenings? It's kind of, man just a bit of their pain, there's always a risk for revocation of licenses, it's not like it will be revoked, it is just a risk so I believe if a risk could give a super relief for the patient, then I would do it.. Maybe we're more on patient's advocate rather than paternalism? I don't know, but this is the case for us..

[MeoTwister5]

Well my professional opinion won't matter until I pass the boards this August.

[SummeryDreams]

Originally Posted by MeoTwister5

Well my professional opinion won't matter until I pass the boards this August.

oh！Good luck to you then! Board exams are really difficult so please do take it seriously.. If you've made it, you will feel like you are the proudest person of themselves in the whole world..

[NoemiChan]

My school is dead if it'll not get a higher rating this November.... Damn, the new dean....

[SummeryDreams]

Originally Posted by GenjiChan

My school is dead if it'll not get a higher rating this November.... Damn, the new dean....

Why? What seems so wrong about your dean? If the dean weren't taking care of students as much as she/he needs to, you can always have your schoolmates, classmates, and you to file a complain. Are you at by any chance taking NCLEX? ah, I miss my nursing stuffs.. I switched learning Japanese after a year when I passed the NLE. Our Salary here in our place as a nurse really scked you know, like just $100 per hour minimum and about $200 dollars maximum. So I didn't practiced my profession, but I've got office works related to my profession. I'm working for US, not my country. At least I'm earning dollars even if I'm here, though the salary still aren't comparable to the $40/hr of my cousin as a surgical nurse in South California.

[NoemiChan]

The Dean was half hearted in leading our college, I hope our old dean ( a strict idealist) should return back to whip the students and staffs again....

Speaking of working... I may not work abroad.... If possible I just wish to stay here to take care of my parents

[Ledgem]

Originally Posted by barcode120x

Opposite here in the US, placebos are not necessarily frowned upon, but to some it can be ethically wrong.

There is no question about this, it is considered to be ethically and legally wrong. There may be some exceptional cases where there is a very good reason to engage in it but it is not the norm. This is because of the requirement for informed consent with procedures and treatments. It is expected that the healthcare professional has given the patient sufficient explanation of the treatment such that they can decide whether or not to take the treatment. It frequently doesn't work out that way in the real world, of course. But from a practical standpoint, we don't want patients to be wondering if their doctors are faking them out. Trust is at stake.

Placebos are allowed and in most cases required when performing drug trials. Note, however, that the patient gives their consent to that scenario. They don't know if they are receiving the drug or the placebo, but they are aware that they could be receiving either one. Even then, if initial evidence indicates that the drug or treatment protocol is more efficacious than the placebo or former protocol then it is considered unethical to continue to trial. It will be terminated early, and the new drug or protocol will be considered superior.

[NoemiChan]

How do we deal with patients who are obviously faking pain or just that they are too depending on pain medications? I've given two "placebos" in my two years and they're "effective" to those kind of patients...

[Ledgem]

Originally Posted by GenjiChan

How do we deal with patients who are obviously faking pain or just that they are too depending on pain medications? I've given two "placebos" in my two years and they're "effective" to those kind of patients...

This is an area that we need to be careful with. There are some patients who have legitimate pain that requires extremely high doses of pain medication for relief. I have heard it termed "pseudoaddiction" because the patients behave similarly to an addict. The difference is that their "addict" behaviors disappear once their pain is properly controlled.

I like to think back to Sir William Blackstone, an English judge from the 1700's, who is famous for this particular quote: "it is better that ten guilty persons escape than that one innocent suffer." In other words, it is better to err on the side of caution and be merciful than to be judgmental and harsh. What good does turning away a drug seeker accomplish? Very little: it is unlikely that their behavior will change, and they will just move on to another medical professional or medical center. What is the risk of turning away someone you perceive as a drug seeker? That you're turning away someone who is truly in need of help.

A mentoring doctor of mine who I greatly respect told me that he gives everyone the benefit of the doubt at least once. It is for a similar reason as Blackstone's: at worst, he is duped into giving an addict another dose of drugs; at best, he has helped someone who would likely be cast aside by many members of the medical system. How you determine whether or not someone is faking depends on how your relationship with the patient goes, as well as your own intuition. But you need to establish that relationship, otherwise you're passing judgment based on a poor understanding of that patient as an individual. Establishing that relationship requires you to treat them honestly, and to go in expecting (and demanding) that they be honest with you, as well.

[NoemiChan]

Then if placebo did work, is it still wrong? We are preventing an obvious dependence on pain medications that's why we are sometimes informed by the physician to be sure that the patient is really in pain before giving the said medication. We do observation and using the 0-10 pain scale most of the time....