Hi Rob. I have a background in Critical Care Medicine. What exactly is your question here about Clare?
Just use reply to expert to respond Rob
brain scan MRI revealed no abnormalities considering age (little white spots on front cortex – impacts memory but result seen as a normal ageing process) and whilst the EEG showed a slight slowing down of brain signals this was not seen as a concern.
Although Clare’s blood tests revealed an Epstein-Barr blood virus (recorded at 173 when normal level would be 20 or less) and could result in fatigue it was considered that this infection (virus) was contracted some time ago and little can be done to remedy that situation in the blood stream.
Also Clare’s blood test revealed a recording of 2.07 on a normal band of 1.1 on VZV (Varicella Zoster Virus) which infects nerves and other symptoms can arise but this was not felt to be of concern.
Clare also recorded a slightly lower level on her thyroid than normal - this was not seen to be a major issue although an ultra-sound test on the thyroid gland was recommended (we will do this locally).
The severe head pains Clare suffers was diagnosed as probably a recurring migraine issue.
The cognitive full test results were not available as thought although Dr Vanda Freitas gave a short summary - showed some signs of an issue (especially figures) but once again not thought to be too bad.
Dr Vanda Freitas discussed Clare’s behavioural issues (confusion, short term memory loss etc) with me and concluded that Clare may be depressed – I was not surprised as I think I would feel quite low/depressed with such symptoms.
So the recommendation on medication for the severe head pain is to take the prescription given in Cape Town (Rizatriptano) which had a better effect than those previously prescribed by Dr Isabel Pavao Martins and for Clare’s major issue re feelings of confusion, short term memory loss and lack of focus etc then to take an increasing doseage of anti-depressant/brain stimulant medication - Venlafaxine.
We also discussed the possibility of Clare undergoing “re-training of the brain” at times in the day when she did not feel fatigued.
So, to me, it appears unclear re what, if any, physiological or mental health issue Clare has been diagnosed with – migraine and depression appear to be the symptoms but the cause is not quite clear?
Hi Dr Chip, this is Clare. Yes, the major concern at the moment is memory loss, confusion - not so much memory fog more so not seeing or registering things. i.e buying items from the supermarket, getting home, forgotting that the items have been bought and going out to buy them again the next day. Or looking at a table and only registering a couple of items on that table and not seeing the other items at all. Arguing with my partner about having mentioned something to him which he says I clearly didn't.
This has been going on for about 18 months now. I feel total shattered all the time apart from early morning and between 5 and 7 o'clock in the eveing.
Hi Clare. Let's explore this a bit.
How's your sleeping?
Overall do you feel unusually fatigued?
Any problems with weight gain or weight loss?
I sleep well at night. I have to rest during the day as I get so tired during the day doing the smallest tasks. Exhausted actually. Showering, sweeping cooking leave me feeling exhausted and I need to sit down and just stare out the window with no sound, I don't want to speak etc.
I am average weight for my height although recently put on a couple of kilos around my thighs which was quite strange as I was exercising then and eating a healthy diet.
OK. You mentioned your thyroid--do you know what your TSH level is?
And have you had cortisol levels checked as well as vitamin B12 levels?
My TSH was normal 2.40
I am not aware I had Cortisol levels checked - what would the chemical name be for that?
And no, definitely not B12
The term is cortisol level Clare.
What did your doctor mean by a slightly low thyroid level?
my T3 level was: 0.79
OK--and we can still continue after this if you'd like Clare
First off, while depression could be a factor here, I think this is mostly a medical problem
From what you've told me so far I would consider you hypothyroid and your TSH level should be closer to 1.0 so I would start you on a thyroid replacement medication like Synthroid to get it to that level
This also could be a low cortisol problem so I would check that
I also would check you for a low B12 level
I think once one or more of those is corrected the fatigue and the memory problems will be resolved
Should I ask my GP for additional Vit B12 and Cortisol tests? Also can I come back to you on the thyroid ultrasound test I am having today?
Would you recommend doing this before embarking on the anti depressants listed above?
Your GP can run those tests but I think you should see an endocrinologist after that.
Sure--let me know what the ultrasound shows
And yes, if I were your doctor I would first make sure this isn't totally a medical problem before I started you on antidepressants. If you are depressed I think it's because of the symptoms you have and not a chemical--neurotransmitter--depression
Thank you for the information. How can I ensure I get back to you for further advice?
Fine. Thank you very much.
I will do.
Do you perhaps have recommendations for an Endocrinologist in the UK?
I live in the Algarve Portugal
Yes. They do have good practitioners here but I don't know of any Endocrinologists here.
OK Here's the facility you should contact then
Great I will look into it.