A Difficult Patent Asks Who Am I? Part 2

By | July 24, 2011

I suggested that we first obtain an MRI of the brain and neurological consultation to rule out Multiple Sclerosis or partial complex seizures.

By the time of her return all of the symptoms with the exception of weight gain had abated. Neurological exam was completely within normal limits. I explained that these were all probably side effects of the medication and that we should probably try a different tricyclic compound or an SNRI to treat her pain, but suggested that we first obtain an MRI of the brain and neurological consultation to rule out Multiple Sclerosis or partial complex seizures. The MRI of the brain was normal as was the examination by the neurologist. However the patient became frightened after her discussion with the neurologist and declined to complete the work up for loss of consciousness and partial complex seizures. I asked her to return to the office to discuss how best to proceed.

This time when Joan returned to the office she expressed intense frustration with the whole medical process. She stated that she was not really herself as she had still been unable to return to her previously active life style and had not yet been able to lose the 10 pounds that she said she had gained from the nortriptyline. Joan also told me that she had searched the Internet and found that similar side effects had been reported with all of the medications that I had mentioned to her. I told her that while less potent than nortriptyline, side effects were much more uncommon and suggested at trial of Silenor at the lowest dose of 3mg once a day progressing to 3mg 3 times a day over a three week period. At this point Joan flatly refused for two reasons, firstly because she was unwilling to take the chances of any more medication side effects and secondly because she did not want to take any medication that affected her brain.


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