February 12, 2002

Calling the Sleep Clinic was the first thing on my agenda this morning.  I was pleasantly surprised.  The lady I talked to was very helpful and accommodating.  In fact she faxed Bighead’s 5 page report to me while I was talking to her!

I must admit that Bighead was very thorough and wrote a very detailed report.  I have to give the man credit where credit is due.

Here are his opinions in brief:

Restless limb syndrome:  He says it remains unclear whether this is related to my thyroid abnormalities or any other metabolic derangement.  He also states the RLS timing is slightly unusual in peaking around 01:30-02:30 rather than in the evening however the other features are typical. The “jolting awake” episodes do not appear to be respiratory.  They are however accompanied by generalized restlessness and inability to lie still, however, without crawling sensations in the legs.  These “jolts” do not suggest events from any respiratory disorder or other clear sleep disorder. He states that I have mild REM predominant sleep disordered breathing. However, I apparently do not have clinical features suggesting right-sided heart failure or pulmonary hypertension at this time.  He is not optimistic that therapy of my REM predominant hypo apneas will alter my symptoms much.  He does say that I have sufficient events to merit a trial of therapy. He states that I have severe alpha intrusion during sleep which is a non specific marker but is commonly associated with chronic pain and anxiety symptoms, non-restorative sleep and fatigue.  He states that this is usually resistant to therapy.   Because of recent episode of hypokalemia (low potassium) he feels that I need to be carefully assessed to ensure that I don’t have hyperaldosteronism.  He also states that because I was hypokaemic I am at a markedly increased risk of recurrent hypokalemia on the currant furosemide (Lasix) without potassium supplement.

He states that with my bone pain and history of hyperthyroidism I am at increased risk of osteoporosis.  He says that it would be prudent to have bone density screening done. He mentioned that I have myxedema skin changes on the dorsum of both hands.  He then suggested that I have the following blood work done: Hemoglobin, Ferritin, Ca, Mg, Cr, TSH, Folate and a WBC.

He did mention that he did not notice peripheral edema which I find rather strange.  I can push down on the front of my legs at any time and it will leave an indent of my finger for quite some time.  All in all I think Bighead was very observant and came to many right conclusions.  Now if only the endocrinologist I am going to see in the west can put this all together.

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