Could acne medication have caused my fatigue and other symptoms?

Dr. Teitelbaum, I love your book so far!! I have only just begun ordering supplements and implementing your protocol, so I haven’t improved yet. But I feel as though you have read my mind, it’s a blessing. I'd always gotten the impression that these syndromes were likely psychosomatic. All summer and fall I've been trying to pull myself out of this overwhelming exhaustion. I crashed pretty hard a couple weeks before I was scheduled to take my USMLE Step 1 board exam in August. I was bedridden for 5 days and could not get my brain to understand any of the problems or review books I'd been doing earlier in the summer. I’ve had “symptoms” for the last several years with a tendency to “crash.” Prior to this year, however, my crashes only lasted a day or 2. But throughout 2nd year of medical school, each time I recovered from the crash (after a block of exams), it took me more days to recover than the previous time and my “recovered” brain efficacy was lower (like a gradual stair step down). To make matters worse, I’m from a medical family (husband a resident; dad, family practice; mom a P.A.; a brother and sister-in-law in anesthesia; and 1 brother in psychiatry/internal medicine). The medical people in my family seem to think I’m a hypochondriac. The most supportive person, my mom, still just says, “I think it’s the stress,” “you need more confidence.” They don’t seem to understand, this is obviously a physical thing. I have no history of inability to “push through the pain,” as they say (stop working because I’m tired of it and afraid of the obstacle in front of me). Finally, I found information on adrenal fatigue (when I mentioned this theory to family, they seemed even more skeptical), which led me to a holistic doctor, and he told me to buy your book. (He ordered a lot of labs, I’m waiting for results).

You explained EVERY one of my medical issues (even a couple of seemingly unconnected ones I’ve had for years) within the first chapter!! I’ve had IBS for 12 years straight. I’ve had myofascial leg/hip pain every day for about 4 years. I’ve thought for a few years, “I’m always thirsty, drink more water than most people, but then I pee it all out.” (I’m a runner, so the need for fluids and the leg/hip pain seemed explained. But I did not realize their connection to my fatigue episodes.) I can almost never go to bed at a reasonable hour. What you said is exactly right: I’m the most awake from 11pm to 4 am. That worked in my PhD program and the first 2 years of med school b/c I can make my own schedule. But what will I do in 3rd and 4th year? I had to get up early for the 1st semester of med school (anatomy lab). But I was still never able to go to bed; therefore, I only got 5 hours of sleep/night for an entire semester. There are very few foods I can eat without my belly turning into a giant beach ball of air. I’ve gained 15-20 pounds in 1 year even though I don’t eat much and run 6 days/week. And now, since this fatigue syndrome has set in “full time” for me (a few months straight), I’ve been worried about my rapid heart rate (my doctor said, “Why do you think your pulse is 114?”) and my ever-increasing blood pressure (up to 137 last check) – as a runner who eats healthy, this doesn’t make sense. You explained every single one of these things in the first chapter of the book (except the increasing blood pressure part – which I’m guessing may be due to hypothyroid, and H.R. – Adderall and stress? Adrenals?)!! It’s so amazing that you’ve pieced this all together. So many random symptoms occurring together in people – how can anyone say these syndromes are psychosomatic?

Sorry for the long stories. What I’m trying to say is, your book is like a life-saver for me. I’m just imagining how many people need to read it! You are doing the type of medicine I came to medical school to do – to help those people who have diseases not well understood, to always be fighting to solve the mystery for them. I did a PhD program in neuroscience before, and was planning to do psychiatry with the MD. But perhaps I need to go into neuroendocrinology so I can help you search for answers to these pain and fatigue syndromes? I’ve been wondering how many patients with depression characterized by fatigue are being treated by psychiatrists (and simply given an antidepressant). Or how many people with hormone imbalances are just being put on antidepressants. A psychiatrist put me on Adderall 10 years ago without checking my hormones or anything medical – I’ve been on it ever since.

I have a question – hoping to get at the root of my problem, if that’s okay. When I was in high school I took erythromycin for possibly a year straight (for minor acne which I later figured out was just from my cat pushing her head against my face). I can trace back to all my IBS symptoms starting just after that – and I was diagnosed 1st year of college. (I’m going to request anti-candida treatment!). On top of that, I was tired all the time (but I didn’t get much sleep – too many activities). In college I was diagnosed with a cognitive disability NOS and put on Adderall. My issue has always been “timed test taking.” I’ve always been able to solve problems, I can memorize information, etc., but I have a block in the speed with which I can read test questions and figure out what they are asking. For the past 10 years I’ve been taking Adderall and I’ve been given “extra time” on my exams. Now the NBME has refused to give me extra time. They said a “cognitive disorder NOS” is usually due to an underlying medical condition. With my prior interests in research, neuroscience, and psychiatry, I thought their assumption is wrong – the purpose of NOS (not otherwise specified) is to include the cognitive disorders not understood. If it’s not understood, they can’t assume an underlying medical condition is required. However, I noticed a box in your book mentioning neutrally mediated hypotension in the young. Prior to Adderall, I recall being very tired probably 90% of the time (starting in junior high). Do you think it’s possible I’ve had this problem for 16 years (I’m 30 now) and it was masked for the past 10 years by taking Adderall?

I apologize for the long message and appreciate any help you can provide. Thanks again for your wonderful book. I’m eagerly awaiting my D-Ribose – based on the timing of my fatigue with exercise and foods eaten, your theory makes the most sense! (I ordered your supplements as well, excited to try it all!).

Thanks for your help!

Celine

Answer

Dear Celine

Certainly suggests that there may well be a dysautonomia/orthostatic intolerance as part if your condition. With this, the Adderall may have been helpfully masking that a bit. Certainly a good idea to make sure your hormones are optimized (not simply in the "normal" range of 2 SD), and the Candida is treated, along with getting 8 hours of restorative sleep a night. If your physician would like (sounds like you have a good one), I do phone consultations with patients and offer a thorough review of your case and put together a comprehensive treatment protocol.

I had CFS in med school myself, so understand what you are going through. What I don't understand, is why they would not offer an accommodation to a physical disability just as for other causes of cognitive dysfunction for the test.

Love and Blessings,

Dr. T