Dr. Rauch's Appointment

I met with Dr. Rauch yesterday. He was very intelligent and also a good listener. He was quite certain that I have MAV. I don’t think I have too much info to add from my appt, other than what Dr. Rauch wrote for the MAV site. I apologize that I wasn’t able to ask a few questions that others wanted me to. I even forgot some of my own questions, although I did ask him many questions. For me, there isn’t anything much i could do right now. He won’t prescribe any meds during pregnancy, which of course makes sense. He did say that pregnancy usually makes symptoms worse. I was told by my OB/GYN that Zoloft is safe. However, Dr. Rauch does not think SSRIs are helpful for migraine. This confuses me a bit, as I know that people do get better with SSRIs. His drug of choice is Nortriptyline. He highly recommended reading “The migraine Brain,” by Carolyn Bernstein (Scott I think you mentioned this in the past).
P.S thanks for those who told me about valet parking. it worked out very well

Lisa, I am happy that you made it to the appointment and that it went as well as it could. It isnt great that you will not be able to get perscription relief for a while but maybe some of the other alternative treatments (B2, COQ10, magnesium, and the like) could give you some relief. I dont know how well they actullly work as I have only tried sporadically and havnet given them a fair shot. I actually did start reading that book. It is pretty good. Again, not directed at our MAV issues but a good overall migraine book about how the migraine brain is sensitive to almost everything. I wish you the best and keep your spirits up! Ben

Thanks, Ben. I actually did try the supplements for several months with no success. So, I stopped them. How are you tolerating the side effects of med?

Hi Lisa,
Thanks for sharing about your appointment. Here’s my thought, though. Would you consider giving Dr. Newman another shot? My reasoning is that:

  1. He believes women get better during pregnancy–might be nice to have a doc that is more optimistic about the next few months for you.

  2. He absolutely feels Zoloft is a good drug for MAV.

It may be more beneficial to you both physically and mentally to be supported by a doc with the above attributes.

I 100% respect Dr. Rauch as a great physician, but sometimes it is better to be with someone who is on the same page as you, can offer you positive support, and has a treatment that is possible for you while pregnant.

Good luck.
Lisa

Hi Lisa,

I appreciate your insights. I’m not sure if it would be the best decision for me to return to Dr. Newman. However, I do want to understand better why he prescribes Zoloft - clearly, he has found success with it. I’m just baffled about how Dr. Rauch and Dr. Buchholtz went so far as to say that Zoloft is ineffective, while Dr. Newman states that it is one of his first choice drugs. Those are HUGE contradictions. Maybe I can just send him an inquiry. I’m not sure how to go about that, though. have you prescribed Zoloft to your pregnant pts? As far as migraines getting better when pregnant, I would love the optimism of Dr. Newman; however, I do not know how realistic it is. I am certainly evidence that things can get worse. But, of course, there is still time in the pregnancy for fluctuations. Do you know if Dr. Newmam ever gives zoloft on its own? I believe he does, and doesn’t always prescribe it in combo with Verapamil or something else.

Thanks again for writing. Maybe we can chat sometime soon.

Lisa

Hi Lisa,
Yes, these are huge contradictions and I suppose it is solely based on the doctor’s own experiences and comfort level with drugs. I did speak at length to Dr. Rauch and he is really into nortriptyline… I also remember reading a number of posts by some of the forum members about some doctor in NJ who claims to have cured a lot of patients with Zoloft. I also spoke with Dr. Furman who is a “big wig” at the Univ. of Pittsburgh who also uses Zoloft and suggested it to me as first line treatment when I told him of my chronic dizziness. There is a research paper I can try to find again and email you about a study on zoloft and dizziness that Dr. Furman told me to look at. I had Scott post it on the forum not too long ago so if you can’t find it, let me know. I am fairly confident that Dr. Newman does use zoloft on it’s own. And yes, I have prescribed zoloft to pregnant patients, although I have to admit, my main experience is with patients who get pregnant while taking zoloft. The latest psychiatric recommendations are to continue patients on their SSRI’s while pregnant as it is more harmful to the fetus for the mother to suffer from the stress hormones related to her not having her depression or anxiety controlled. I think speaking to a neurologist who deals with MAV and uses zoloft would be the best way to get this question answered. I also think it might be worth a shot to email Dr. Newman. I don’t see why he wouldn’t respond. (he is away until Aug. 17th just so you know).
Keep us posted. Yes, we should chat soon.
warmest,
lisa

Thanks again, Lisa, for that info. I probably read Furman’s paper, but can’t remember. Will look for it. You definitely raise excellent points. It is so darn hard to know what to believe. I guess there is no “right” answer at this time.

I actually found Furman’s paper. My head is killing so I couldn’t read it thoroughly. but, does he prescribe zoloft for Migraine Anxiety RElated Dizziness or MAV. Does he believe that cases of MAV are actually MARD. Lisa- just wondering if he discussed this with you on the phone. Would Zoloft then be helping the anxiety which in turn alleviates the migraine symptoms.

Lisa, I am up to 25 mg of Topamax and tolerating it. My reactive hypoglycemia has been way out of site for the past week or so and my general dizziness and weakness is at a high point too. Not sure if it is Topamax related or I am just in a bad cycle. I read the posts between you and Lisa and think it may be worth a shot to try to email Dr Newman. I also think Zoloft is worth a shot and it was going to be my next med had I not opted to try Topamax again. Good luck and keep us posted. Ben

Hey Lisa,
We never even discussed anxiety at all. I believe that Dr. Furman believes this is helpful for chronic dizziness, and nothing to do with treating anxiety per se. I believe he suggested a pretty low dose as being efficacious.
Keep us posted.
Lisa

Lisa - thanks for the response.

Ben - so sorry that things are not well for you. Did any of your docs recommend SSRIs? I hope that you can get through the trial of Topamax so either it can help (I HOPE!!) or you can at least cross it off your list as something that you fully trialled. I know much easier said than done, though.

One of my Drs did mention Lexapro. I asked about Zoloft at that point and he said that would be similar and if I preferred that over Lexapro he would be ok with it. It really is crazy how different Drs have different views on SSRIs!

Lisa,
Will you go back to Dr. Rauch after the baby is born if you have not recovered by then? Did he suggest more testing of any kind?

I’m glad the parking worked out. Wish you got more answers.
Sal

— Begin quote from “benh”

One of my Drs did mention Lexapro. I asked about Zoloft at that point and he said that would be similar and if I preferred that over Lexapro he would be ok with it. It really is crazy how different Drs have different views on SSRIs!

— End quote

And crazier how different people respond to them. I have had no luck with them but never get past fact that they make my rocking so much worse, it’s never the side effects.
Sal

Sally - I made an appt a few week’s after baby’s due date, at which point I’ll take meds if I’m not better, which I doubt I will be. HE didn’t suggest any testing. I already had many tests. I wasn’t clear on what you wrote - sorry - did you say that SSRIs made your rocking worse?

Hi Lisa,
I’m glad you had your appointment and so sorry he didn’t give you hope, I don’t think his assessment is a very fair one. I like a couple of others wonder if you should try the Zoloft. You are under incredible pressure right now and if nothing else it may relieve some of that which may relieve some of the migraines. Talk to your doc! We are all so different, it’s amazing what works for one can make another feel worse. Your in my prayers.

Tammy

Tammy = thanks so much for your kind words and concern.

— Begin quote from “MAVLisa”

  • did you say that SSRIs made your rocking worse?

— End quote

Yes, I tried Lexapro, Zoloft, and Prozac with worsening rocking. I never really got side effects. But that is just me and what doesn’t work for one may work for others. We all just have to find our relief.

Wishing you and the baby well.

Sal

I think you should really talk to a “pregnancy-doctor” about this. If you feel extremely stressed and depressed about feeling so crap, it might be better to try and take the zoloft anyway as depression etc. isn’t “optimal” for pregnancy either (not trying to scare you though, I don’t think there will be any major problems even if you’re stressed out, just try to relax as much as you can ofc…).

As I see it, you can try zoloft and feel great, and it might outweigh any potential risk it may have on the unborn child (again, talk to expert). On the other side it might make you feel like sh*t, in which cause I don’t know how that would affect you and your pregnancy.

Wish you were feeling better :frowning:

— Begin quote from “MAVLisa”

Dr. Rauch does not think SSRIs are helpful for migraine.

— End quote

Hi Lisa – very interesting to read of your appt with Dr Rauch. I have to say that I flat out don’t agree with the above statement. This might be more accurate when dealing with classic migraine but not with MAV per se. When I have time later, I plan on amassing all of the evidence I have to show that they are in fact useful for people with MAV –– and in some cases can take people right back to feeling almost 100% normal (as I experienced on Cipramil and which I am now seriously thinking about revisiting).

I’d hate to hear that you can do nothing while this pregnancy is going on and you cannot enjoy it without this junk getting in the way. Perhaps seeing Newman is a good plan … or at least you could ask a pediatrician if Zoloft is OK to use right now. I’d probably do this if I were in your shoes.

Scott