INFLAMMATION AS THE CAUSE OF SARCOIDOSIS

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I recently went to see a pain management doctor, because I am in pain. DUH! His recommendation was that I change my antidepressant medication and take a muscle relaxant.

I called my psychiatrist and asked her what she thought. I take 20 mg of Lexapro per day for depression. I haven't experienced a single side effect from it. I also take Xanax for anxiety and panic attacks. My psychiatrist still does not feel that my depression is under control. She said she was thinking of adding another medication to help me to cope but was certainly not going to put me on a completely different course of antidepressants for pain control, as she treats my mental and emotional health and does not believe antidepressant medications control pain.

I am constantly shocked at the number of doctors who feel that by relieving depression, the pain of your disease will just float away.

I had major lung surgery which was junk surgery. I have a hideous 8-10 inch scar down the right side of my back. The thoracic surgeon cut through nerves, muscle, entered my chest cavity through the 4th intercostal (rib) space with a rib spreader. He then proceeded to remove the right middle lobe of my right lung, supposedly while he was waiting for my tissue samples to come back from the lab. It has never been explained to me why the lobe of my lung was removed. Was this doctor a psychic who could see into the future that one day that lobe would become cancerous? As I've said before, ad nauseam, this surgery was not necessary. Every lymph node, tissue sample, the mass in center of my chest and right middle lobe of lung were all Sarcoidosis.

The resulting pain from the surgery may be with me for the rest of my life. I was also diagnosed with Fibromyalgia back in January. Perfect. Two autoimmune diseases for the price of one.

My pain circles around both sides of my rib cage and then wham, it shoots up my spine. This is, I feel, the result of my surgery and sarcoid.

Fibromyalgia pain is all over, shoulders, down the side of my body and I never walk anywhere without being in pain- legs, lower spine and hips. "Yeah, let's change her antidepressants and with the aid of a muscle relaxant, she'll be all better." Horsesh*t !

The problem with this type of thinking is that it's bass ackwards. If your physicians under treat your pain or depression, the resulting stress on your immune system becomes totally out of control. This sets the stage for inflammation, the reason you got sick in the first place.

There is also a prevailing attitude amongst doctors that I call the "possibility of drug addiction." Are they afraid of losing their medical license for writing too many prescriptions for controlled substances or are they genuinely concerned that a person in moderate to severe pain will become an addict? Let me add here that the possibility of them losing their license is practically nil and once you've made your co-pay and your insurance picks up the rest, I doubt your doc will be up all night worrying that you'll become a junkie.


Pain must be treated as what it is - PAIN. Ask a good doctor and he or she will tell you that a person who is in constant pain does not get better.


Depression must be treated separately as a chemical imbalance in the brain. Pain and depression are not the same thing and treating one but not the other could be as bad as no treatment at all.

Since my diagnosis, I've come to the conclusion that sarcoidosis and some, perhaps all, autoimmune diseases start as the result of some type of stress which creates an imbalance in the body's chemicals. This then leads to a severe type of inflammation in the body and this process combined with your genetics throws your entire immune system into a frenzy, attacking and counter attacking what it perceives is an absolute threat.

Until we find a Doctor of Sarcoidosis, I feel that it is wise for each and every one of us to see the type of Doctor we need at any given time.

If you have pulmonary sarcoidosis, you need a pulmonologist, bladder problems - urologist, etc.,etc. If you are in pain, there must be communication between your Primary Care Physician and your pulmonologist, neurologist or whoever is caring for your sarcoidosis. If they don't believe your pain is real enough to warrant the proper pain medications, fire their a*ses.

Finally, if you even think you're a little bit depressed, get help. I hate to keep harping on this but Sarcoidosis and other autoimmune diseases carry depression in their toxic little damaged cells.

We must make every attempt to cool down the inflammation in our bodies, and by doing so, restoring the chemical balance to our body and thereby regaining our good health.

Be Well and God Bless... JanetG

18 replies

Janet -

Well put! Wonderful summary of the stuff we deal with daily.

Just as importantly, a great statement of the need to advocate for yourself and fire a doctor who does not respect you.

Hang in there -

Thanks Nan,

You are always so upbeat and encourage me to write. I so appreciate you. xxoo... JanetG

I tell my family I am going to buy a t shirt that says " I'm not fat I'm inflamed". Every time I go to the doctor they always tell all we see is inflammation. Duh! Hang in there Janet things will get better. God Bless you

Hi Janet,

Have you tried Plaquenil? My rheumotologist prescribed it when I was diagnosed with fibromyalgia. It worked for me to control the pain. I stopped it because of anxiety, but I'd try it again and take a sedative along with it.

Michele

There is one anti-depressant designed to reduce physical pain. It is suppose to work with the pain receptors. I know some people who take it who have chronic headaches and /or fibromyalgia and at least half of them claim it has reduced pain. It is called Cymbalta. In order for it to be successful in treating chronic pain the dose needs to be pretty high 90-120mg. It is considered an atypical anti-depressant since it works with 2 of the neuro-transmitters including seratonin. It cannot be taken in combination with an SSRI as that will cause an overdose effect of seratonin . Lyrica is also a medication similar to neurontin that is suppose to help fibromyalgia as well. Good luck.

Hi Janet,

My primary doctor put me on Cymbalta and it caused extreme anxiety so I stopped it. When I told my psychiatrist about this he said that Cymbalta is one of the most anxiety-causing drugs out there. I thought you might like that info with your anxiety history.

Best wishes,
Michele

Interesting as I have several clients that physicians have put on Cymbalta and rarely have any reported increased anxiety. Some report a decrease of pain and others did not notice a difference. But everyone responds to medications differently. The only client I had that did poorly on Cymbalta was also taking an SSRI (Zoloft)and had a toxic reaction due to an overdose of seratonin. Of course all these medications need to be used with caution as they all can cause side effects. Prednisone can cause an increase in anxiety as well as other serious side effects. If someone is taking an anti-depressant that is working they probably not change it. If it works don't fix it.

When it comes to meds, doctors have to realize one size does not fit all. They would like it to because it makes their job a lot easier. This is an excellent post which hits the nail square on the head.

We have to be out own medical advocates in self-defense.

I used to be on Cymbalta. (I am considering going back on it). For me, I found it to be the only one that didn't make me sleepy. It also tooklk away the edge on some shoulder pain I was having (still have) chronically.

Gail

Hi Janet.
I had that debate about anti-depressants with a neurologist at the end of last year. I think about that appointment and all that comes out is aaarrrggghhh! Firstly, I said I had facial pain and then had to listen to a monologue for half an hour about how most people in neurologists' surgeries are women in their 30s, 40s and 50s with facial pain or migraine. I have facial nerve damage from a car accident and now something else going on as well and a malfunctioning voice, too. From what I understood, anti-tricyclic anti-depressants actually alter how the pain recepters (or something like that) work so that your experience of pain is reduced. This neurologist just got my shackles up because he had me dubbed as depressed and twisted everything I said to fit that. Of course I get down about my lack of control over my health and aches and pains and I'm sure we all do but they make it sound like depression caused all the aches and pains and that's just wrong, wrong, wrong!!! I'm currently trying Tegretol (anti-convulsant) for the facial stuff and taking more non-prescription pain killers than usual for the chest/back aches. I'm frustrated right out of my tree with the whole thing right now. I recently had a gallium scan which showed nothing. I asked my specialist the other day would a scan of some sort show something if I actually had one on a day where I was in agony instead of having them on days between flares as always happens and he said no. Ahhh, so much more but I'll be ranting and raving like a lunatic if I continue writing the conversation we had.
Back to your issue about the anti-depressants, yes, from what I've been told, anti-tricyclics work on pain in a way that other anti-depressants don't. I don't know whether they work for only neuralgia type pain or all pain. Maybe someone else here knows that.
All the best, Janet. Always read your posts and think what a generous person you are with your sharing and your kind words.

What a great post!! I hear you my question is how did you get your doctor to actually give you a diagnosis for you fibro. ? I am struggling in this small town to get my 13 doctors that I have seen to listen to me regarding my pain. I agree that pain should be managed and no one should suffer everday. They think that since I haven't went to school for 10 years or whatever I don't know what is going on with my own body. Media tells us to listen to our body but the doctors won't listen to us. Hang in there, I just try to do as much as I can that good day that way my bad days are as bad. Do you have any advice for those of us that suffer in silence?

Nurse1,

I thank you for your compliment about my post. I was diagnosed with Fibromyalgia at Mayo Clinic in FL and still do not believe that the diagnosis was accurate.

Perhaps it is correct, but since then, I have deteriorated health wise and have bigger fish to fry. I have always blamed my accelerating pain issues on the thoracotomy and lobectomy that was performed on me in 2004. As of late, I'm being tested for yet another disorder, results not yet known.

With the fear of CA of the lung hanging over my head, I ignorantly agreed to the surgery in '04. Diagnosis was Sarcoidosis of lungs and lymph nodes. Pretty drastic surgery, even by Sarc standards.

My advice for those who suffer in silence is to stop! Get yourself a good primary care physician, one who believes in your medical complaints and is willing to treat you appropriately. He or she will treat you for your pain issues and prescribe any medications you require for what is ailing you.

Medicine seems to have changed a bit in that one doctor should prescribe all of your medications, unless you are suffering from a disease requiring specialized treatment and all of your medications should be filled at the same pharmacy, always. I suppose this came to be, due to the number of people who "doctor shopped", in order to obtain multiple prescriptions for restricted medications.

I wish you improving health and hope to hear from you again.

Take care and be well... JanetG

hello Janet,
Your posts are always so well written. I'm sorry your in so much pain. And your absolutely correct in saying our mind and bodies need to be medicated seperately but often times go hand in hand with our illnesses. One will most certainly affect the other and both need to be treated. Take care friend:)

It never ceases to amaze me how many people on this site have been told by doctors that their pain is caused by depression & are given anti-depressants to deal with the pain. Has it never occurred to any of them that BEING IN CONSTANT, CHRONIC PAIN CAN MAKE A PERSON DEPRESSED! I would have thought it was fairly obvious, myself....

Hey Janet,
I also had a thoracotemy, which I ignorantly agreed to...it was the most painful experience I've ever been through (and I had open heart surgery!). Of course they found nothing and when xrays showed something in my other lung one year later, they wanted to do another!! That's when I changed doctors and discovered I had sarcoid, which was causing the oddities in my xrays. Now I also have neurosarcoid. I've been on antidepressants for more than a decade and am currently on a combination of cymbalta and wellbutrin, which I like a lot. And my general doctor doesn't hesitate to prescribe for the pain which we all know accompanies sarcoid, particularly neurosarcoid and the accompanying headaches. I have ongoing prescriptions of motrin 800 for the days of light pain and vicodine for the stronger pain. I don't abuse either. My sarcoid doctor told me a long time ago that you can't cure sarcoid but you can treat the symptoms and that's what I've done. If your doctors won't do that, I say find new doctors.

Hi Janet,
I totally agree. I have suffered since I was 5 years old with a panic disorder, but we didn't realize it back then. I was Diagnosed with Sarcoidosis in 1990. And finally went for help with the panic disorder in 1999. I also think that medicines work different for everybody, because our chemicals are different. I have been on Zoloft since 1999, and tried to get off of it. I then tried Cymbalta and became suicidal. We stopped the Cymbalta and I went back on the zoloft on a higher dose. I am doing great now Thank God. I am very Fortunate to have great doctor's (Primary, pulmonology, Rheumatoid) They all work together to keep me feeling good.
Peace & Love
Patricia

hi Janet I would like to know how long you have had sarcoid to go through so much but I know what you are talking about because my mom suffer very bad with pain and not even murfin could help, brace your self Janet this is only the beginning your med will keep adding up my mom was on about 20 pills in the morning and gods knows how much at lunch time and dinner one thing I should let you know in never ends Oh I also have sarcoid for six years no med so far and no pain so far thank god. peace vgirl

Hi Janet,

I'm so sorry you've been through so much. I also recently had my anti-depressant upped because my doctor felt it would help with the chronic pain. I haven't had the terribly surgery you had to deal with, but have chronic pain in my knees, legs, hips, and lower back ~~ not sure why, although my doctor a few years ago suggested the possibility of fibromyalbia also. At the moment, I have less problems with the Sarc, but like you, I also have more than one autoimmune diseases I'm dealing with. I was diagnosed in 2006 with autoimmune hepatitis, which has caused stage 2 fibrosis of the lungs, with much scarring. Not cirrhosis yet, but not far off. I was also diagnosed in 2008 with Mineire's Disease, which I deal with about 5 to 6 times a year. I'm on prednisone, imuran, anti-depressants, acid reflux meds, cholesterol meds, and allergy meds because of chronic sinus issues. God knows when the day will come that doctors recognize the fact that we are in pain, and that anti-depressive meds aren't necessarily going to do the trick. Good luck to you my friend. Do you have any Sarc support in your home town? I so wish that I had a group that wasn't 100 miles away that I could get the support we all could truly use.

Hugs,

Dawn Marie

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