Polly, And All - What About The Risk Of Vitamin D3 Overdose?

[tex]

Luce,

Hey, no fair ganging up on me. And changing eating habits, as we all know, is a sensitive subject. LOL. Tuna fish? What's that? I agree, though, one of these days, I've got to start working on that.

I just checked the symptoms for an overdose of Triamcinolone acetonide, (specifically).

Rarely, it is possible this medication will be absorbed from the skin into the bloodstream. This can lead to side effects of too much corticosteroid. These side effects are more likely in children and people who use this medication for a long time or over large areas of the skin. Tell your doctor immediately if any of the following side effects occur: unusual/extreme tiredness, weight loss, headache, swelling ankles/feet, increased thirst/urination, vision problems.

All the symptoms that I emphasized with the red color, were prominent, except for the vision problems, and I only noticed that symptom while I was using both corticosteroids at the same time. A pretty good fit, isn't it. The weight loss really caught my eye. I don't lose weight easily, but I noticed that between sometime Saturday, and Monday morning, I lost 5 or 6 pounds. That's remarkable, to say the least, because the only meal I skipped, was breakfast, on Sunday morning. That's usually about a 300 to 400 calorie meal, for me. You have to cut out roughly 18,000 to 20,000 calories, (or more), in order to lose that much weight, (without additional exercise), and I didn't do anything but take it easy, all day Sunday. My lips are badly chapped, (from the drymouth that I experienced on Sunday morning, I suppose). I haven't had chapped lips in a long time.

I'm currently thinking that maybe a migraine, during the night, (possibly induced by, and in conjunction with, the corticosteroid issues), resulted in a combination that caused the one-sided numbness. If the numbness were caused by a TIA, it should have ended at least by early yesterday, if not within a few hours. How's that for a far-fetched theory?

Tex

[Polly]

Hiya Tex,

It is possible to have a TIA or stroke without headache. (for example, if only a very small area of brain is damaged). Oh, I forgot to ask you : did you have any confusion or problem speaking or understanding words? Since your symptoms have lasted beyond 24 hours, it would be more likely that you have suffered an actual stroke. Although TIA symptoms usually last only a few minutes, they can occasionally last up to 24 hours, but no longer.

I don't understand why they didn't do a CT scan by now. It is used to diagnose both the bleeding kind of stoke as well as the clot kind. I can see (perhaps) deferring it in the ER, but when you saw your doc after 24 hours plus of symptoms, I would have thought it would be ordered. You may want to insist on this - not only is it good medicine, it may help to prevent another, more serious event and lead to an optimal treatment plan. I don't mean to scare you, but this is what I would recommend for one of my own family (which of course, I feel that you are!).

Re the cholesterol and HDL/LDL, I'll tell you a story. Hubby Scott had his yearly blood tests on1/22/09 and had a cholesterol of 207 with an HDL of 42 and an LDL of 144. His cardiologist simply told him to work harder on his diet and exercise program. Scott was discouraged because he is really doing just about all he can in those 2 areas and has been for years. Well, I had to call the cardiologist myself and insist that he be put on a statin drug......she had never suggested it. He had retests on 7/8/09. The results were: cholesterol of 133 with and HDL of 37 and an LDL of 77. The LDL, which is probably THE major risk factor for a cardiac event, has almost been halved!!! If your doc is lukewarm on statins, I'd insist on one, if I were you! They are most impressive drugs - miracle drugs, almost.

Don't worry about the elevated blood sugar. It is common on tests done in the E.R. Whenever you have a major adrenalin rush from being in a stressful situation, it raises the blood sugar. Makes sense - it is preparing the body for "fight or flight". And 110 is actually quite low given the situation you were in. It will take a while for your BP to get back to normal.

Anyway, FWIW, if I were your doc, I would order a CT scan. Headache is not as important a symptom in the scheme of things as are the one-sided weaknesses/disturbances which have persisted, IMHO. I am also concerned about the length of time that you haven't felt "quite right" - doesn't seem typical for TIA or even migraine. I saw your theory about the corticosteroids - again, like the vitamin D, they would not be causing one-sided symptoms. One sided symptoms are extremely significant and should be fully evaluated to R/O stroke before any "lesser" diagnosis can be assumed IMHO. It is best to think "horses" and not "zebras" right now.

PLEASE take care of yourself!!! If anyone is indispensable, it is you, dear friend!!! I think all of us mother hens (as Maggie called us) will rest easier knowing that you are having further evaluation.

Love,

Polly

[Lucy]

What about R.I.N.D.? Luce

[tex]

Polly,

Hmmmmmm. Well, you're the doctor, (and a dear friend to boot), so I obviously can't help but pay attention to what you are saying.

I didn't have any problem speaking or understanding words, (or doing math, or remembering things), during the event. At least, I didn't think so. From the ER report:

NURSING ASSESSMENT: NIH STROKE SCALE (09:49 VW2)
NIH STROKE SCALE: 0=LEVEL OF
CONSCIOUSNESS:Alert,keenly,responsive 0=LOC QUESTIONS:Answers both
questions correctly, 0=LOC COMMANDS:Performs both tasks correctly,
0=BEST GAZE:Normal, 0=VISUAL:No visual loss, 0=FACIAL PALSY:Normal
symmetrical movement, 0=SENSORY:No drift, arm stays 90/45 for full 10
seconds, 1=SENSORY:Drift, arm drifts down but does not hit bed or
other support, 0=BEST LANGUAGE:No drift, leg stays at 30 degrees
for full five seconds, 0=BEST LANGUAGE:No drift, leg stays at 30
degrees for full five seconds, 0=LIMB ATAXIA:Absent, 0=SENSORY:Normal,
no sensory loss, 0=BEST LANGUAGE:No aphasia;normal,
1=DYSARTHRIA:Mild to moderate:patient slurs at least some words
and, at worst, can be understood with some difficulty, PT REPORTS
FEELING LIKE HIS "LIPS FEEL FAT", 0=EXTINCTION AND INATTENTION:Normal,
Total points is 2.

In defense of myself, though, I'd like to point out that I always slur some words, (I was born and raised in Texas, you know), and I'm probably always difficult to understand. (Maybe I had a light stroke some time ago). (Also, the right side of my mouth was numb, including the right half of my tongue).

I thought that statins were considered "bad stuff" for us. I may not have been paying proper attention, on that issue. If you don't see a problem with them, I'll have to give them a try, I reckon. Do you have a preference?

That explains the blood sugar level - that never dawned on me. You're right about the BP. Five hours ago it was 125/71. Now it's 145/90, again, and I haven't been doing anything but sitting around. Are you right sure that the corticosteroids couldn't be causing the erratic blood pressure excursions? I've even figured out why I absorbed the Triamcinolone so readily. I was using it on the spots where I had worn androderm patches. Those spots itch like mad, sometimes, for a day or three after the patch is removed, because the patches contain a chemical to enhance the absorption of the active ingredient. I never thought about it before, because that's a recommended remedy, but that probably sucked the corticosteroid right into the blood stream.

Okay, I'll ask my doc about lining up a CT scan. It's been slightly over 60 hours, now, and I can still feel a slight numbness on the right half of my lower lip, and my right nostril.

Thanks for your thoughtful insight, (and the kind words), dear friend.

Love,
Tex

[Polly]

Hi Tex,

Thanks for sharing the NIH stroke screening test, which is performed by nurses. I don't see where they noted which side they were testing. Hopefully it was the right! LOL! Although your score was low, I'm not sure that all of your symptoms were covered by that test - especially the mouth/nose ones.

I am now thinking that the best next step may be an evaluation by a neurologist. The E.R. docs do only a very cursory neuro history and exam. A neurologist would be able to do a thorough, comprehensive exam which may give us more clues. The neuro. would be looking into any and all causes for the symptoms you had, including migraines and "zebras". The neuro. could then order the CT scan if appropriate. See if your PMD would agree to this kind of consultation - hopefully it could be done without delay. The sooner the better to be able to evaluate any lingering symptoms.
I hope you are keeping a running log (with time intervals) of your symptoms.

I believe your acute weight loss was due to significant dehydration. As Gayle correctly noted above, those catecholamines (stress chemicals) suppress the body's antidiruetic hormone (ADH), thus allowing for major diuresis (loss of water), which you experienced as lots of peeing and dry mouth. If you divide the weight loss by your normal weight and multiply by 100, that will tell you the percent of dehydration you had.

I guess it's possible that your erratic BP could be related to the topical steroids. More likely, I would guess, would be the continued adrenalin surges that you must be having from the anxiety of not knowing what is wrong, imagining various scenarios, etc. It's only human - we are all the same. Even when we are not consciously worrying, our MIND is obsessing at some level, and that sets off those stress chemicals every time. Try to remember that what the mind conjures up is almost never as bad as the actual outcome.

Re the statins......do you remember why they may have caused problems for MCers? Do they contain wheat or dairy? I really can't remember. Scott takes Zocor, the generic form, and has had no problems with it. I believe it is one of the safest statins to date.

Love,

Polly

P.S. Luce, I have been using the term TIA, which I thought was interchangeable with R.I.N.D. Is your understanding different?

[Lucy]

Polly,
I was thinking I read that R.I.N.D. was when the symptoms went on a little longer than 24 hours, but were like TIA, but this is way above my pay grade. Another place, I read seemed to be using these interchangeably, so I thought perhaps there was a difference from the earlier thing I read. I had heard of TIA, but RIND only recently. Now I know.
Thanks!
Luce

[JLH]

Tex, jmho (NOT medical) NO Crestor or Lipitor. YMMV

[Jan]

Tex,

FWIW I have been going through lots of problems with statins for a number of years. I know I posted about muscle and joint problems some time in the past. When I went off statins for several weeks (under Dr. supervision) all of my problems went away. There are non-statins (such as Zetia) that also lower cholesterol. My Dr. and I are just starting to explore options other than statins. I took Zetia in the past and it didn't lower the LDL fast enough to satisfy my Dr. then. I may be back on it.

Please take care of yourself. You provide a valuable service to soooooo many.

Jan

[MaggieRedwings]

Morning Joan,

Lipitor - No???? It is the only one they could prescribe for me that works. Let me know the problem and I would bet it is hidden gluten.

Thanks, Maggie

[Dee]

Maggie,
Lipitor is on the gluten free drug list.



Dee~~

[tex]

Polly,

The doc did give me a complete ROM, (Range Of Motion), assessment, including all limbs, facial muscles, (smile, stick out your tongue, look up, down, left, right), etc. I don't recall any nose tests.

My log is in my posts, PMs, e-mails - I may have to reorganize it a little better. BP now is 139/84, HR 75.

I lost 3%, a pretty substantial "shrink", (as it's called in the livestock industry. ) My weight now is slightly less than it was on Monday morning, when I weighed for the first time following the event, (roughly a pound less). Obviously those chemicals are still in control, even though I consider myself to be a pretty laid-back kind of guy. In all honesty, I don't feel that I'm consciously concerned about my future. My attitude is that it was just a minor "catostrophic" event, over which I had no control, so why worry about it? I don't feel as though I'm in some sort of dire risk situation. What my subconscious mind is thinking, I haven't the foggiest idea.

Jan's post highlights the basic problem with statins. (Thanks Jan, for posting that information again). Here's part of an abstract of a research report called Drug Consumption and the Risk of Microscopic Colitis:

RESULTS: Drug consumption was more frequent in lymphocytic colitis than in the control group (92.3%vs 76.3%, P < 0.05). The mean daily number of drugs by person was also higher in lymphocytic colitis (3.79 ± 0.44 vs 2.13 ± 0.22, P= 0.04). The following associations as compared with the control group were observed: Group 1—Consumption of NSAIDs (46.2%vs 23%, OR 2.9, 1.3–6.4), selective serotonin reuptake inhibitors (SSRIs) (18%vs 1%, OR 21, 2.5–177), specifically, sertraline (15.4%vs 0%, P < 0.0005); Group 2—SSRIs (28%vs 1%, OR 37.7, 4.7–304), beta-blockers (13 vs 3%, OR 4.79, 1.04–20), statins (13%vs 3%, OR 4.6, 1.04–20), biphosphonates (8%vs 0%, P= 0.022); Group 3—SSRIs (15%vs 1%, OR 16.2, 2–135), statins (11.5%vs 3%, OR 5.4, 1.2–24). As compared with the chronic diarrhea group, a significant association with the usage of sertraline in LC (P= 0.005) and a trend for NSAIDs in CC (P= 0.057) were found.

http://www3.interscience.wiley.com/jour ... 1&SRETRY=0

Thanks. I'll look into the chances of lining up a neuro appointment.

Love,
Tex

[tex]

Joan,

Why are you concerned about Crestor and/or Lipitor?

Tex

[MaggieRedwings]

Thanks Dee. I know any gluten bothers me and thought I had verified it was GF. The only thing I have noticed strange - and bear in mind that I tend to be (LOL) - is that I always seem to dream the entire night when I take my Lipitor before bed. I take it every other night. Doc wanted every night but I am not in to overdoing it on meds.

Love, Maggie

[Gayle]

Tex,

RE: No, this is the biggest hospital in the area, with satellites in many cities in Texas, and they have plenty of CT machines.

I wondered about that question when I wrote it, as it would indeed seem rather improbable for a hospital to have a large enough ER to have an ER Doc in house, but not have CT equipment in their imaging department. But one never knows.

You are correct to say, CT does not diagnose a TIA. CT is used in this case to ascertain whether or not there is evidence of an intra-cranial bleed. It would not considered good practice to give clot buster type medication without knowing this status first. YIKES!!!

I agree with Polly here … begin thinking a Neuro consult and CT scan. Because your story tells of symptoms that are not global, but rather limited to one side – thinking about an infection, or a response to ingested or environmental agents, is not likely – so those ideas go toward the bottom of the possibility scale.

Continue to consider Migraine as a possibility. HOWEVER, there are other causes to be RULED OUT FIRST. Only after eliminating other potentials would Migraine become the diagnosis (by default).

As you seem to continue feeling after effects, they need to also be considering possible seizure activity. People do tend to feel “damped out” for long periods of time following a seizure. That entailes encepholography of course, but still -- I believe, the beginning point would be a CT scan.

Yep, we’re back to that almighty CT scan! Drats HUH?



Best thoughts,

Gayle

[tex]

Hi Gayle,

Well, shouldn't a seizure have been more dramatic? Unless it occurred during sleep, of course - I don't even know if that is possible or not, but I would assume that it might be.

Here's something that I consider to be interesting: If I ever had an aura before, I didn't notice it at the time, (which could be possible with a minor one, especially if I had never experienced one before). On May 17th, I had two of them, separated by about half an hour, each about a half hour long. 36 days later, on June 22, I had another, not as dramatic, (black and white). The "TIA" event, (no aura, though), occurred on July 19th, (27 days after the last aura). If they are all connected, and this is a linear relationship, then 18 days is the indicated next interval, (approximately). That would be August 6th. Hmmmmm.

The dehydration issue seems to still be in effect, because my BMs have consistently been on the dry side, (and still are). My BP, about 45 minutes ago, was 143/86, HR 77, and I haven't been doing anything but researching a question that Jill asked, so that's high, for the situation. I still feel sort of "damped out", as you put it.

I reckon I'll see what I can arrange with my doc, in the morning.

Thanks for your thoughts,
Tex