Disabling symptoms since distal bicep repair surgery. Any suggestions?

@stevetaylor721 Hello and welcome to Connect. My first thought on reading your story is about prescription medications. Have your doctors looked at everything you are taking to see if there are conflicting drugs or a possible allergy to a drug? I was presuming that you may be taking a pain medication since your surgery, so please correct me if that is not the case. I wonder if prescription pain meds can also slow down heart rate. Pharmacists are a great source of information about any drug reaction or interaction, and beyond their normal advice, they can look up more detailed information. Some pain meds are very addicting, and I wonder if your symptoms may be related to that. I don't feel well on pain meds that I was given after surgeries, so I managed without or took minimal amounts and weaned off of them.

Here is some information about Trazodone which is listed as an anti-depressant. https://www.drugs.com/trazodone.html
Here are the overdose symptoms that include vomiting, so this is something to consider. I found more and here are the side effects of Trazodone which does have dangerous interactions with alcohol. It's possible you could be sensitive to this drug.

This is a quote from the link above.

"Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
slow heartbeats;
unusual thoughts or behavior;
easy bruising, unusual bleeding; or
low levels of sodium in the body - headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady.

Seek medical attention right away if you have symptoms of serotonin syndrome, such as: agitation, hallucinations, fever, sweating, shivering, fast heart rate, muscle stiffness, twitching, loss of coordination, nausea, vomiting, or diarrhea.

Common trazodone side effects may include:
drowsiness, dizziness, tiredness;
swelling;
weight loss;
blurred vision;
diarrhea, constipation; or
stuffy nose."

This list of side effects mentioned serotonin syndrome. Here is Mayo's information on that with details about the side effects and risks.
https://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758
Have you consulted a cardiologist? They may be able to figure out why your heart rate has been lowered or if there is another reason for that. I know all of this and thinking about it and not knowing what is wrong is worrisome. It can kind of create a vicious cycle of symptoms that lead to worry, and worry that leads to symptoms. I have been through a full cardiac workup myself because I had chest pains that were caused by stress. They found nothing wrong, so I could take that worry off my plate. My dad was a heart patient, and I always worried that I had inherited that, so I made changes in my life that were heart healthy. The cardiologist confirmed that what I was doing was working because most people have some slight amount of artery blockage at the age I was then (early 50's) and he could find none at all.

I also went through 4 months of panic attacks because I was afraid of surgery and I needed surgery to decompress my spinal cord. I did a lot of things to work through those fears and it worked. I overcame them and I am not paralyzed by fear anymore. That comes with understanding what the problem is, and how to address it. Ask lots of questions. Pay attention to when during the day your symptoms are worse or better, and how does that relate to your medication schedule. Have you had exposure to anyone with Covid? On reading this information I shared, the symptoms you have seem to match the side effects for this drug, so that would be something to ask about if your physician thinks the drug is causing your symptoms. They may not be thinking about that and looking for disease instead.

We also have a new discussion about ways to face fear. You are welcome to join us.
https://connect.mayoclinic.org/discussion/how-can-i-defeat-my-anxiety-about-medical-tests-and-surgery/
Do you think your medication may be responsible for your symptoms?

Thank you so much for your response! To answer your questions as best as I can: I only started trazodone 7 days ago after more than a month of not getting more than a couple hours of sleep almost every night. At one point I went 4 straight nights of zero sleep due to the symptoms waking me as soon as I would start to doze off (within one or two minutes). I was an absolute mess and was seriously delirious during that time. After than I settled into a pretty terrible cycle where I could get a couple of hours in a row but no more. Sometimes after I was awake for a few hours I would be able to lay down and get another hour or two but I was completely non-functional for a month. I was vomiting with those symptoms prior to the trazodone and I am taking a very low dose of trazodone (I cut a 50mg pill in half). As for other meds I only took ibuprofen for a few days after surgery and haven’t touched it since. I also take low dose allipurinol for well controlled gout, but that is it as far as meds go. My arm just hasn’t hurt very much. I do not take meds if I can help it. Prior to the surgery I was very socially active and only drank alcohol in social settings, typically one day a week. I haven’t had any alcohol since the surgery and just haven’t felt good enough to do anything other than go for walks to calm my symptoms. I have been completely unable to relax since the surgery and can’t sit still or even watch TV because I begin to feel worse. It’s a catch 22- I desperately want to relax and sleep and can’t do either. I was a very happy and positive person prior to the surgery and was very active. I exercised, coached my kids teams, was very successful at work and had a bunch of great friends and an extremely active social life. Then out of nowhere it was like a switch flipped and I am a different person. I want to get back to my hobbies and work and enjoy all my kids activities again, but right now I am just struggling to get through each minute of each day. One thing I did forget to mention above is since the surgery I have had intense middle/upper back pain that comes and goes. Yep hanks again and sorry for the long reply- I have a good doctor trying to help me but nothing is turning up yet.

@stevetaylor721 The intense back pain sounds troubling. That can be a symptom of a heart problem, so please talk to your doctor about that. Do you have a cardiologist? I'm not trying to make you anxious by mentioning this, but my brother in law died of an aortic dissection which is a life threatening problem that is easily missed at the emergency room. It was in his case as he was not feeling well for a couple of days and was seen at 2 emergency rooms. They finally figured it out, but he died before they could get a surgical team in place. It is where the layers of the wall of the aorta start to separate which is the big artery that comes right out of the heart to send blood to the entire body. When it goes far enough, the aortic wall ruptures and very few people survive this because doctors don't catch it in time to do surgery to fix it. Please don't ignore that pain. There must be a reason for it. You will need to advocate for yourself if your doctor is dismissing this.

Here is Mayo Clinic information for heart disease.
https://www.mayoclinic.org/diseases-conditions/heart-disease/symptoms-causes/syc-20353118
and for Aortic dissection. https://www.mayoclinic.org/diseases-conditions/aortic-dissection/symptoms-causes/syc-20369496

Has anyone checked your thyroid functions? If your thyroid is kicking out too much hormones, it does speed things up and cause anxiety type issues, and probably trouble sleeping too. I take thyroid meds and once mine were too high because my thyroid function changed, so my dose became an overdose.

I sure hope that I am not increasing your anxiety by talking about this. If there is a serious problem, catching it early is a good thing. My cousin's wife also recently died of a ruptured aneurysm on the aorta with similar symptoms of upper back pain. Please keep searching for answers and take care of yourself.

Have you been seen by a cardiologist before?

Thanks again for the reply and information. I have been to the cardiologist who ran an EKG but blew it off as anxiety. The problem is I don’t think I am not having anxiety at all, although the symptoms are similar. Although the doc blew it off as that (including my primary who I have since replaced) I was suspicious because I had no previous anxiety/panic disorders and it was never triggered by thoughts. My heart rate dropped from consistently being in the mid-70s to being consistently in the mid 50s or lower about 3 weeks ago and has stayed low. Based on this and his examination, the psychiatrist I was referred to by my first primary was pretty clear with me that my problem is not anxiety but a medical issue that they need to figure out. It is a complex one apparently…. I have had my thyroid checked and it is normal. CBC and metabolic panel all looked good as well. My blood pressure has been way up since the surgery but that can be from being sick and not sleeping, I guess. My new primary also did a full autoimmune panel since I have an autoimmune disorder and have had past previous positive ANA tests. Oddly, I no longer have any markers for autoimmunity. I can totally understand why the docs are perplexed and it has been a frustrating 6 weeks.

Thanks for the tip about the heart. I’ll ask my primary about it as soon as he is in the office this week. I do have some sort of sinus rhythm issue that they have never been able to figure out the cause of, so I am also very concerned about it being an issue with my heart. I really appreciate the advice and info and thanks again!

@stevetaylor721 I am surprised that a cardiologist would only do an EKG. It sounds to me like he did not take this seriously. Did you tell him about the intense upper back pain or is that new? Was there a reason they did not do imaging? If you don't feel like they are listening to you and being dismissive, you can get other opinions. You can also try Cleveland Clinic which is similar to Mayo. To get doctors to listen, you might start asking questions about aortic dissections and aneurysms and how they are diagnosed. Sometimes you have to direct the conversation. I am still suspicious of the Trazadone because your symptoms match the side effects. There can be more than one thing going on and maybe the drug is only part of it. You may want to ask if it interacts with the drug you take for gout. Was there a reason they put you on Trazadone and is this a doctor that you are still seeing? Did this drug seem to help? Are you drinking enough water? That can cause heart arrhythmias if you are dehydrated and affect blood pressure. My mom did that once and they put her in the hospital.

The other thing you may want to look at is a consult with a functional medicine doctor who looks at the biochemistry of the body. I have had doctors who were in AAEM, the American Academy of Environmental Medicine. They are not heart doctors, but may have insight into the gout or autoimmune issues because they look at processes that cause inflammation. Here is the website and there is a button in the top right for a provider search.
https://www.aaemonline.org/
How is your arm functioning now? Is there anything in moving it that may be causing the back pain or scapular pain? Has anyone tried to do a sleep study? Have you been seen by a neurologist? (they order sleep studies) You said that walking helps, are you doing that every day? Does it cause shortness of breath? Exercise can lower blood pressure. You have me baffled too. Do you need to keep taking the Trazadone? Do you know why it was prescribed?

Thanks for the great tip about the functional medicine doctors. I was prescribed trazodone because I was not sleeping and could not stay asleep for more than an hour or two a night. I’ve only been on the trazodone for the past week. It is a very small dose and it has helped me get some sleep (4-5 hours a night). I haven’t noticed any side effects from it yet. All of the symptoms were unfortunately present before I started taking it. My arm is healing well and on that front I am well ahead of schedule, per my physical therapist. I’ve actually not had much of an issue with the arm. I drink quite a bit of water every day and have always taken care to ensure I am hydrated. I do walk every day and have been averaging about 23,000 steps a day which is a ton. I’ve always walked a lot, but mostly at work and on the golf course prior to this, lol. I haven’t noticed much of any shortness of breath while walking, so that is a good sign. It is truly baffling. For what it is worth the psychiatrist I saw thought it may have been an extreme sensitivity to a drug I was given under general anesthesia, and that it will eventually get better. It’s been 6 weeks so I am not so sure but I will say I’ve always been extremely sensitive to medications, which is why I try to avoid them whenever possible. Thanks for your insight and help!

@stevetaylor721 Another suggestion I could make is to soak in an Epson salt bath. Most people are deficient in magnesium, and you will absorb that through your skin in the bath. Magnesium also helps you relax and it is needed for detoxification. If you are not able to sit in a bath, I have seen a lotion that contains epsom salts, and there are magnesium supplements. It takes about 20 minutes to absorb enough in the bath. This was a recommendation from my functional medicine doctor. I like doing this myself as I feel so much better afterward.

@stevetaylor721 Steve, I was also thinking about melatonin. That is the substance your body makes that induces sleep. I was wondering if this could be an alternative to the antidepressant you are taking, and you may want to ask your doctor about this. It is an over the counter supplement. With all the serious side effects of the Trazodone, it might be a safer alternative if it works for you. It looks like melatonin helps with anxiety and blood pressure too. I pulled up this information about it. https://www.webmd.com/vitamins/ai/ingredientmono-940/melatonin

Also, light, and blue light from cell phones and computer screens interferes with our bodies making melatonin. I always try to turn off the computer at least 2 hours before I go to bed, otherwise, I lay awake for 2 hours. I did take an epsom salt bath last night after mentioning it to you, and it did make me sleepy. I am not tempted to look at a cell phone if I can't sleep. Actually my cell phone is a boring flip phone anyway, but I will put on my headphones and listen to relaxing music and hope that my cats will settle down. Speaking of cats, last night one of my kitties jumped into the tub with me to discover that the water was a bit deeper than he thought it was, so I helped him out and then there was a wet cat loose in my room and on the bed licking off the water.

Hi CoachT, I thought I would jump in here for a minute too. You've been getting great support and coaching from @jenniferhunter so I don't have much to add. But you're used to being the coach, not needing coaching, right? I sure hope you can get answers soon so you can get back to golf and coaching your kids teams and the things that bring you joy.

Good for you for pursuing the recommendation of seeing a psychiatrist even though you were quite sure it wasn't an anxiety-related issue. It's good to have it ruled out for the record and for future physician consults to not dismiss the issue as a mental health issue. Mental health is just as important as physical health. Reading the complexity of the situation, I'm sorry to hear that you weren't able to get an appointment at Mayo Clinic. Currently we are experiencing high volumes of requests and seeing record numbers of patients. It may just be a situation of volume and capacity. You could try again at a different location. Or, as Jennifer suggested, consider another larger learning medical institution that treat patients with a multidisciplinary team.

My mom is also extremely sensitive to drugs. General anesthesia is really tough on her. She has relatively simple bilateral bunion surgery a few years ago and the recovery from the anesthesia was more challenging that the surgery itself.

Are you still averaging 23,000 steps a day now? That is a ton!

50mg of Trazadone helps my sleep tremendously. It a very low dose no where’s near it to be a sufficient antidepressant. A lot of doctor’s prefer Trazadone to sleeping pills. It’s non-narcotic, it supposedly not addictive and it’s a low dose so no hangover effect the next day. I am no means an expert and this is my perspective. You need to do you and decide what medication is a fit for you.
I will say I had surgery on June 29th and I am still not fully recovered. I am trying to think positively but I have had a rough ride and I am hoping I can past this hurdle.