Dr Hive - wwyd?

[Night Elf]

My dd20 is having a really rough time. For years, she's suffered with insomnia and heavy fatigue. She had a blood panel done and her iron was only a little low. Her doctor put her on an iron supplement and it didn't effect her at all. Fast forward 4 years. She's been put on several different meds over the past year and has gained a huge amount of weight. She's tired all of the time. She has a hard time finding the energy to do anything and she's in college. She said most days she's just dragging herself to classes. She's actually skipped some because she couldn't get up and dressed and out the door. She has a hard time doing homework because it requires effort and energy and she's low on those things. I told her she should probably go to the doctor but she feels hopeless that they won't do anything differently than they did 4 years ago. She's gained about 75 lbs. with meds. She doesn't eat crazy. In fact, she has a hard time eating. She eats small amounts. She does eat junk food sometimes because it's the easiest thing to do. She can't get up the energy to go to the dining hall so she uses Uber Eats to bring her dinner. She's not motivated to change anything because she's feeling totally helpless. I know if I start butting in with suggestions, she'll likely get mad at me. I don't know what to do.

[Tanaqui]

Sounds like depression, right down to being reluctant to see another doctor about this. Has she seen a therapist?

[ktgrok]

Or insulin resistance, or diabetes, or low thyroid, or a lot of things including chronic fatigue, etc. Obesity is in itself a metabolic disease, not just a number on a scale, and can be tied in to depression, insulin resistance, etc. If she's insulin resistant the food she eats goes to her fat cells rather than being available for energy. BTDT. And depression can mean a loss of interest in life, low energy, etc 

Also, is it at all seasonal? A therapy light helped my energy tremendously. 

[Ellie]

45 minutes ago, Night Elf said:

My dd20 is having a really rough time. For years, she's suffered with insomnia and heavy fatigue. She had a blood panel done and her iron was only a little low. Her doctor put her on an iron supplement and it didn't effect her at all. Fast forward 4 years. She's been put on several different meds over the past year and has gained a huge amount of weight. She's tired all of the time. She has a hard time finding the energy to do anything and she's in college. She said most days she's just dragging herself to classes. She's actually skipped some because she couldn't get up and dressed and out the door. She has a hard time doing homework because it requires effort and energy and she's low on those things. I told her she should probably go to the doctor but she feels hopeless that they won't do anything differently than they did 4 years ago. She's gained about 75 lbs. with meds. She doesn't eat crazy. In fact, she has a hard time eating. She eats small amounts. She does eat junk food sometimes because it's the easiest thing to do. She can't get up the energy to go to the dining hall so she uses Uber Eats to bring her dinner. She's not motivated to change anything because she's feeling totally helpless. I know if I start butting in with suggestions, she'll likely get mad at me. I don't know what to do.

It could be any number of things, including thyroid. And it's easy to rule out thyroid issues: she needs Free T3, Free T4, and Reverse T3; the doctor will order TSH no matter what, but TSH alone does not really tell anyone what the thyroid is doing, as it is made by the pituitary gland. Write this down: Free T3, Free T4, Reverse T3. Not Total T4, not anything else. She will have to insist on it. When she gets the results, do not let the doctor tell her that her numbers are "normal" or "in range." TSH should be below 1.5. Free T3 should be in the upper fourth of the lab's ranges; Free T4 should be in the upper half. And while she's at it, she should have antibodies tested to see if there is any autoimmune thing going on.

[Laurie]

Does she snore?  Has she ever had a sleep study?  I would want to talk to a doctor about the possibility of sleep apnea, especially given the weight gain.  

 

 

 

[Ellie]

30 minutes ago, Laurie said:

Does she snore?  Has she ever had a sleep study?  I would want to talk to a doctor about the possibility of sleep apnea, especially given the weight gain.  

 

 

 

Sleep apnea is one of the undiagnosed symptoms of being hypothyroid.

[catz]

I do think the mind/body connection is not talked about enough.    I would get her screened for anxiety/depression by a psychiatrist ASAP and look into therapy as well.   And I say this as someone who had pretty severe PPD with physical symptoms.   I was actually diagnosed with IBS at the same time.  Treating BOTH is what got me through.  

This does not mean don’t follow up with additional blood work, an endocrinologist, etc.   I would follow BOTH roads.  Even if something physically is off, gaining 75 lbs and being exhausted for that length of time is grounds to be depressed.  If she is not wanting to follow up, that is also a sign of depression.   Emotionally healthy adults want to get to the bottom of problems.   Especially if there is a family history of mental illness at play.   Thyroid issuesand depression can be tightly related.   

Are you financing college?   Is she coming home for the summer?   I’d be concerned she needs a leave to deal with this if she’s not even getting to the dining Hall and skipping classes.  What kind of meds is she taking?

https://www.nimh.nih.gov/health/publications/depression-and-college-students/index.shtml

[fralala]

That's really rough. Those meds sound like they need adjustment, at the very least.

While I agree with all the information about possible causes and the encouragement to see a doctor again, since you stated that she doesn't want you butting in with suggestions, I'm wondering what you can do to help motivate her without making her stop talking to you. In truth, whether she's depressed or has another medical condition, I'd say it's probably best with a young adult to follow your instincts and keep finding ways to show you care about her and are there for her without nagging-- sending care packages, writing letters, calling her just to say hi and ask how she's doing, etc. IOW, all the things you are obviously already doing since she is willing to talk to you about this. All the I want to help/how can I help? stuff that a mother does when we can't control the rest. (And my opinion is that even when everything else is horrible, there is a light in having a mother who loves you and is always there; and there is a light as a parent in keeping the lines of communication open.)

[marbel]

12 hours ago, Night Elf said:

My dd20 is having a really rough time. For years, she's suffered with insomnia and heavy fatigue. She had a blood panel done and her iron was only a little low. Her doctor put her on an iron supplement and it didn't effect her at all. Fast forward 4 years. She's been put on several different meds over the past year and has gained a huge amount of weight. She's tired all of the time. She has a hard time finding the energy to do anything and she's in college. She said most days she's just dragging herself to classes. She's actually skipped some because she couldn't get up and dressed and out the door. She has a hard time doing homework because it requires effort and energy and she's low on those things. I told her she should probably go to the doctor but she feels hopeless that they won't do anything differently than they did 4 years ago. She's gained about 75 lbs. with meds. She doesn't eat crazy. In fact, she has a hard time eating. She eats small amounts. She does eat junk food sometimes because it's the easiest thing to do. She can't get up the energy to go to the dining hall so she uses Uber Eats to bring her dinner. She's not motivated to change anything because she's feeling totally helpless. I know if I start butting in with suggestions, she'll likely get mad at me. I don't know what to do.

You say she doesn't want to go to the doctor, yet she's also been given different meds over the past year.  So she is seeing a doctor.  It seems that they are not monitoring her properly?

I understand being worried about seen to be meddling.  I would approach it as being concerned about her health but also about school. If she is skipping classes, her grades may suffer. If  she has any financial aid or scholarship that is dependent on a certain GPA, she could lose funding.  We've also told our kids that as long as they are financially dependent on us, and covered by our health insurance (and we are paying the bills), we reserve the right to meddle a bit.  (A minor example, one of my kids was putting off calling the dentist; I said if they didn't have an appointment by x date, the would have to pay their own bill, including any extra work that needed to be done due to neglect.)

Of course I don't know the best way for you to talk to your own kid, so YMMV on my suggestions.  

Hugs to you!

[Ravin]

Weight gain is usually a red flag that will get meds switched in a big hurry. She needs to get back to her doctor.

[Night Elf]

She has already been diagnosed with depression and a couple of other things I'd rather not state here. She's on medication and is being monitored by a psychiatrist. She also has a counselor she sees every 1 - 2 weeks. She said she plans to get a physical in summer. She doesn't want to do anything here at the end of the semester.

She also saw her former psychiatrist when she was home with me last summer and again this past Spring break. She was the one who told her it was the meds she was on that was causing the weight gain. She gained weight just over the summer, in 8 weeks (about 12 lbs). She went to her regular psychiatrist when she got back to school. I think he changed one of her meds but it didn't stop the weight gain. She gained even more weight. Then her med as of January 2018 went through the roof price wise so he had to change her again. We don't know if she'll continue gaining weight. She just feels it's a losing battle.

We have Kaiser and I'm not confident with them ordering tests they don't order on a normal basis. I wish there was a specialist I could recommend that would do all of this. I don't know her GP because I don't go to that facility. I do know mine, however, and I don't know if she'd do those tests. I'll have to ask. I bet dd will be afraid to ask though. She hates going to see a doctor with a diagnosis in mind or specific things to look for because when she's done that in the past, she gets a pat on the head and told it could never be that. It's discouraging. I wonder if seeing a doctor not employed by an insurance company would help. It would cost an arm and a leg to seek medical assistance outside of Kaiser. Our plan doesn't cover out of network doctors.

[Night Elf]

1 hour ago, marbel said:

You say she doesn't want to go to the doctor, yet she's also been given different meds over the past year.  So she is seeing a doctor.  It seems that they are not monitoring her properly?

I understand being worried about seen to be meddling.  I would approach it as being concerned about her health but also about school. If she is skipping classes, her grades may suffer. If  she has any financial aid or scholarship that is dependent on a certain GPA, she could lose funding.  We've also told our kids that as long as they are financially dependent on us, and covered by our health insurance (and we are paying the bills), we reserve the right to meddle a bit.  (A minor example, one of my kids was putting off calling the dentist; I said if they didn't have an appointment by x date, the would have to pay their own bill, including any extra work that needed to be done due to neglect.)

Of course I don't know the best way for you to talk to your own kid, so YMMV on my suggestions.  

Hugs to you!

Her psychiatrist is monitoring her meds as he is the prescribing doctor. She doesn't want to go to see her GP for regular medical stuff like the fatigue and weight gain. Her psychiatirst just said the weight gain was due to the meds and didn't offer any information beyond that. I don't think he gives advice on weight. 

The combination of meds is helping her other diagnoses fairly well. It's just her depression she can't seem to get a handle on. I don't know if she discussed it with him during her last visit. She sees him again at the end of this month. I'll ask her to have him explain why her depression is still prevalent.

[Carol in Cal.]

I am really impressed that she is seeing a counselor so frequently through Kaiser.  Around here they tend to shuffle kids into group sessions, and the groups are not just one thing, so depressed kids are put in with the heavy substance abusers, which is not a great combination (although there IS some overlap).  When my DD was depressed, we paid OOP for an outside counselor.  She did not want to take meds, though.  If we had pushed that issue, we would have gone back to Kaiser for a psychiatrist.

[ktgrok]

Once you are that overweight the fat causes metabolic changes that make it harder to lose weight. And the depression makes it harder to eat right. And the obesity makes you more depressed. Ugh, it's a cycle. A doctor may be able to put her on medication to help with the weight gain, or have other resources.

[Night Elf]

7 minutes ago, Carol in Cal. said:

I am really impressed that she is seeing a counselor so frequently through Kaiser.  Around here they tend to shuffle kids into group sessions, and the groups are not just one thing, so depressed kids are put in with the heavy substance abusers, which is not a great combination (although there IS some overlap).  When my DD was depressed, we paid OOP for an outside counselor.  She did not want to take meds, though.  If we had pushed that issue, we would have gone back to Kaiser for a psychiatrist.

Oh we had a hard time with a counselor at Kaiser. There was only one at our facility so dd could only be seen every 5-6 weeks. When she moved to her college town, there is no Behavioral Health department at that Kaiser so they have affiliated counselors, really only one practice. They also have one psychiatrist too. They're not Kaiser doctors but we only pay the Kaiser copay so it works out well.

[Night Elf]

3 minutes ago, Ktgrok said:

Once you are that overweight the fat causes metabolic changes that make it harder to lose weight. And the depression makes it harder to eat right. And the obesity makes you more depressed. Ugh, it's a cycle. A doctor may be able to put her on medication to help with the weight gain, or have other resources.

Yes, that's what has me worried. I'm going to buy her a few things for her summer residence. She wants a magic bullet blender so she can have smoothies. I'm also trying to decide between a slow cooker and an instant pot. She doesn't want to spend 30+ minutes making a meal. She needs something she can throw together within minutes. I figure she can toss ingredients into a slow cooker and it be ready to eat at dinner time. I found a couple of college cookbooks too that might work. They are supposedly healthy cookbooks with few ingredients. I need her to look at what I've found and let her decide what she wants to try. She's just too busy to want to do that right now.

[unsinkable]

2 minutes ago, Night Elf said:

Yes, that's what has me worried. I'm going to buy her a few things for her summer residence. She wants a magic bullet blender so she can have smoothies. I'm also trying to decide between a slow cooker and an instant pot. She doesn't want to spend 30+ minutes making a meal. She needs something she can throw together within minutes. I figure she can toss ingredients into a slow cooker and it be ready to eat at dinner time. I found a couple of college cookbooks too that might work. They are supposedly healthy cookbooks with few ingredients. I need her to look at what I've found and let her decide what she wants to try. She's just too busy to want to do that right now.

How about a George foreman type grill, a salad spinner and a set of storage containers? 

She could batch prep a few days worth of lean protein ( steak and chicken), lettuce and veggies then pull out a meal's worth for lunch or dinner.

[Night Elf]

17 minutes ago, unsinkable said:

How about a George foreman type grill, a salad spinner and a set of storage containers? 

She could batch prep a few days worth of lean protein ( steak and chicken), lettuce and veggies then pull out a meal's worth for lunch or dinner.

That's a good idea. I'll add those to my list.

[Ellie]

1 hour ago, Night Elf said:

She has already been diagnosed with depression and a couple of other things I'd rather not state here. She's on medication and is being monitored by a psychiatrist. She also has a counselor she sees every 1 - 2 weeks. She said she plans to get a physical in summer. She doesn't want to do anything here at the end of the semester.

She also saw her former psychiatrist when she was home with me last summer and again this past Spring break. She was the one who told her it was the meds she was on that was causing the weight gain. She gained weight just over the summer, in 8 weeks (about 12 lbs). She went to her regular psychiatrist when she got back to school. I think he changed one of her meds but it didn't stop the weight gain. She gained even more weight. Then her med as of January 2018 went through the roof price wise so he had to change her again. We don't know if she'll continue gaining weight. She just feels it's a losing battle.

We have Kaiser and I'm not confident with them ordering tests they don't order on a normal basis. I wish there was a specialist I could recommend that would do all of this. I don't know her GP because I don't go to that facility. I do know mine, however, and I don't know if she'd do those tests. I'll have to ask. I bet dd will be afraid to ask though. She hates going to see a doctor with a diagnosis in mind or specific things to look for because when she's done that in the past, she gets a pat on the head and told it could never be that. It's discouraging. I wonder if seeing a doctor not employed by an insurance company would help. It would cost an arm and a leg to seek medical assistance outside of Kaiser. Our plan doesn't cover out of network doctors.

FTR, Kaiser is pretty pathetic when it comes to treating thyroid issues. I was first diagnosed, and then way undermedicated, by a Kaiser in San Jose. I cannot emphasize enough the importance of doing a complete thyroid lab panel. A hypothyroid condition can cause every.single.one of her symptoms, including the depression, and no amount of counseling will counteract a physical condition. And it's a physical condition that can be easily treated once it is diagnosed, although I'm sorry to say that even if she gets the labs, Kaiser will not medicate properly. :-(

Check out Stop the Thyroid Madness (stopthethryoidmadness.com). There are recommendations there for getting your labs done, and for a non-prescription "supplement" that some have been happy with.

[catz]

Has she ever been tested for Vitamin D level?  I'd really encourage her to get out at least for a short walk every day.  She could start with 10 minutes of shuffling.  I think fatigue and depression and eating comfort food can be a very hard cycle to break out of.   To me it sounds like her meds are really not working for her and if she hasn't had a full blood panel, she should definitely get that done.   I totally get it can be a hard road to intervene with a young adult though. I'm sorry!  :(

[Night Elf]

She had some bloodwork done last summer. All numbers looked good. They did a Vitamin D test, A1C, fasting blood glucose, and a Lipid Panel. 

What we need to see is how her current meds are working together. I don't know everything she is on but I do know her most recent change was Latuda to Abilify. Starting in 2018, a 30-day supply of Latuda costs us $270. We paid it for one month but made her go to her doctor to find an alternative. He put her on Abilify and that med is free under our plan. I hope it does the trick. I can't remember what she was on before the Latuda that they blamed the weight gain on and took her off of it and put her on the Latuda. She's tried so many meds. She has a few different mental health diagnoses and it's hard to pick only one to be sure to fix. Naturally we want them all under control. I wish I could talk with her psychiatrist but she doesn't want me interfering. All I can do is tell her what I think and suggest she tell her doctor. Then she tells me some of what was said during the appointment but holds some back. It's quite frustrating.

[Supertechmom]

Going to a functional medicine doctor can help tremendously.  IT is the only thing that stopped the tide and turned it around for me regarding tiredness, fatigue, weight gain, and depression.  For one, all my levels were normal by regular medicine.  By the functional medicine md, they were all trash and low and pathetic.  She brought them up drastically and I can't tell you how much better I feel.  She also adjusted hormones and I'm amazed by that difference as well.  The better ones can also recommend supplements to help with side effects of some drugs and counter the bad.

 

For the drugs, there is one drug (restoril (sp?) or remeron, can't remember which) that causes huge weight gains practically overnight.  A coworker went on it and then quit it after about 25 pound weight gain in a month.  Then she said it was so hard to lose any of it.  

 

Do hope she can find the right help.  It is hard sometimes.

 

[Night Elf]

10 minutes ago, Supertechmom said:

Going to a functional medicine doctor can help tremendously.  IT is the only thing that stopped the tide and turned it around for me regarding tiredness, fatigue, weight gain, and depression.  For one, all my levels were normal by regular medicine.  By the functional medicine md, they were all trash and low and pathetic.  She brought them up drastically and I can't tell you how much better I feel.  She also adjusted hormones and I'm amazed by that difference as well.  The better ones can also recommend supplements to help with side effects of some drugs and counter the bad.

 

For the drugs, there is one drug (restoril (sp?) or remeron, can't remember which) that causes huge weight gains practically overnight.  A coworker went on it and then quit it after about 25 pound weight gain in a month.  Then she said it was so hard to lose any of it.  

 

Do hope she can find the right help.  It is hard sometimes.

 

Thanks. I've never heard of functional medicine before. I found a practitioner in my dd's college town. I know my insurance won't cover it. They do mention labs but we'll have to see if her Kaiser doctor will order them where they won't cost us any money. The last time an outside lab was used was when she went to the college health center and it cost us $450. I've emailed the practice and asked about their fees which aren't on their website.

[Supertechmom]

It can be a shocking price.  But it was worth it.

[Lizzie in Ma]

I could have written this post.  Oldest has had many physical issues over the years and is on meds as well for depression and anxiety.  Her weight gain is continuous and it is getting worse.  She goes to the gym, eats pretty well, thyroid numbers are fine which someone finally checked, she had been on thyroid medicine for several years because her numbers were off when she was in the middle of her lyme battle. She is off those meds now.  She recently had a sleep test done and she does not have apnea.  We are at a loss.  I desperately want her to see an endocrinologist.  She has mast cell issues for sure but I don't know what else.  She wants to go off Zoloft and her beta blocker as they could both be culprits in this scenario.

I hate that she is an adult now and I can't battle for her like I always have.  I can only suggest.  I hope you find some answers. <3

[Splash1]

Abilify is known to cause weight gain