![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 126 to 150 of 164. Go back in thread:
Posted by christophrejmc on February 3, 2002, at 17:18:09
In reply to Re: opioids » christophrejmc, posted by Elizabeth on February 1, 2002, at 15:47:02
> Do you think you'd be able to get by taking an opioid on an as-needed basis, rather than continuously, and continuing with the Nardil? That might be better than taking the opioid full-time. I think there is some risk of tolerance to opioids for people taking them as ADs (although there definitely are people who don't become tolerant), and it's also a challenge to manage some of the side effects on a day-to-day basis.
I never even thought about that; I think I'll try that first.
> My residual symptoms are similar, and buprenorphine definitely helps a lot. Have you tried psychostimulants?
Yeah. They help, but not much. I'm currently thinking about adding a direct dopamine agonist, it seems to help some people with residual anhedonia/apathy.
> I have often thought it would be cool if buprenorphine were available in a metered-dose nasal inhaler (a la Stadol NS); that would make it very easy to take it that way.
Have you thought about filling an OTC nasal spray with buprenorphine (the good ones that control the amount of fluid sprayed)? I wonder if certain pharmacies can do this for you.
> I'm not sure how my pdoc would react if I asked if I could do this. I also think there might be problems with getting IM injections three times a day, every day (you could alternate which muscle you used, of course, but even then you'd be hitting the same site pretty often).
Yeah, I can see the problem there.
-chris
Posted by Elizabeth on February 3, 2002, at 21:45:24
In reply to Re: opioids, posted by christophrejmc on February 3, 2002, at 17:18:09
> > Have you tried psychostimulants?
>
> Yeah. They help, but not much. I'm currently thinking about adding a direct dopamine agonist, it seems to help some people with residual anhedonia/apathy.My pdoc did some clinical research with one of those a few years ago and wasn't impressed. Then again he's generally not impressed by *anything*. < g > Mirapex seems to have a good (though brief) record as an antidepressant, and it would be my first choice if I were going to try a direct DA agonist.
> Have you thought about filling an OTC nasal spray with buprenorphine (the good ones that control the amount of fluid sprayed)?
It'd have to be *very* precise. Are there any OTC ones like that? (Yes, I've thought about it.)
> I wonder if certain pharmacies can do this for you.
A compounding pharmacy could do it, but there aren't many of those. I'm not sure if a regular pharmacy could do it. Does anybody know?
-elizabeth
Posted by IsoM on February 3, 2002, at 23:26:18
In reply to Re: opioids, and a pharmacy question (Cam?) » christophrejmc, posted by Elizabeth on February 3, 2002, at 21:45:24
> > "...Have you thought about filling an OTC nasal spray with buprenorphine (the good ones that control the amount of fluid sprayed)?
>
> It'd have to be *very* precise. Are there any OTC ones like that?"*****************************
Just stepping in for a minute with a comment, if you don't mind ---I use a nasal prescription spray called Atrovent (for something entirely different). The 15 ml bottle gives 165 measured sprays. If you know stereochemistry, you can work out the dilution of the medication you're discussing to get an exact amount each time. Each spray gives the same amount of medication. The small plastic container can be rinsed out & reused. I reuse mine to make my own saline nasal spray.
If you don't trust yourself to do the calculations, I'm sure a high school chemistry teacher would be more than willing to help.
Posted by Elizabeth on February 4, 2002, at 15:14:48
In reply to Exact Amounts and Nasal Sprays » Elizabeth, posted by IsoM on February 3, 2002, at 23:26:18
> Just stepping in for a minute with a comment, if you don't mind ---
Of course not. I very much appreciate it.
> I use a nasal prescription spray called Atrovent (for something entirely different).
I don't use Atrovent or anything like it; how would I go about getting a metered-dose inhaler? Do you think a pharmacist would be willing to give or sell me one? Or do I have to seek out the shady underground trade in empty medication containers?
> If you don't trust yourself to do the calculations, I'm sure a high school chemistry teacher would be more than willing to help.
I'm not *that* out of practice! :-)
-elizabeth
Posted by IsoM on February 4, 2002, at 17:00:19
In reply to Re: Exact Amounts and Nasal Sprays - thanks! » IsoM, posted by Elizabeth on February 4, 2002, at 15:14:48
Sorry, Elizabeth, I don't know your background & the forum users encompass a wide range. Someone who might not be familiar with chemistry would just gasp at the thought. What is your background and/or career anyway, if you don't mind me asking?
Posted by IsoM on February 4, 2002, at 18:43:16
In reply to Not That Out of Practice » Elizabeth, posted by IsoM on February 4, 2002, at 17:00:19
Elizabeth, both you & sid write in a lucid wmanner & I enjoy reading your posts simply to learn more. Seeing that these posts are public on the forum, I didn't feel like I was sneaking about when I read your's & sid's postings regarding depression (& earlier CBT). Reading them over, I see that you're a mathematician by training. I apologise whether you could do the calculations - a breeze for you, I'd imagine.
Like you & sid, I love math, and if I could do nothing but math, I'd be happy & good at it. Trouble is, I have to set my mind in gear for math, I can't just switch focus & work on a different subject, & vice versa. To do math well, I need to work at it for hours. Friends couldn't understand how I'd find hours of math homework enjoyable, but I did.
An example of how I do math is --
One time in my calculus class as the prof was explaining & writing out some new thoughts on the board, filling up one board after another, I put up my hand & said "then it follows that...etc" & I went on to ask if it would tie in with some of the other things just learned & what the graph would be like. He was so pleased & happy to see someone grasp it so quickly & see the applications (he thought he had a star student, poor guy). Then he erased everything from the board, wrote up some problems & told us to try them with what we just learned. I couldn't even begin.After grasping the concept so beautifully (I see math as very beautiful), I couldn't even remember what the first step was! I hate the way my brain operates. I need to have the steps written down in front of me to guide me. Then I have to do it over & over & over to wear a pathway in my memory, else the next day, my mind is as empty as before. I explainmy mind as a huge hard-drive, but very little working RAM, & the 'search' feature doesn't work most times. I'm so, so hoping adrafinil will help my memory. Long-term memory is excellent, comprehension is excellent, but short-term & midshort-term (working memory) is absolutely crappy, which means not much happens. :-(
I respect your views. So if you've got any idea on how to improve shor-term & working memory - meds wise too, let me know. I tried all the study guides offered at university. It helps somewhat.
P.S. about driving & getting a licence. I lived on the prairies for 14 years & one could drive for an hour & only pass the occasional car. When I moved back to the Vancouver area, I figured I'd never be able to drive. The traffic was incredible. There was just too much to pay attention to & still react in time. I finally screwed up my courage & bid my sons good-bye. I told the older ones in all seriousness, I hoped I wouldn't get in an accident. Driving's a snap now. I never really relax when I drive - I always consider it a challenge - me against them so I'm always superalert. But it comes to you.
Start with small drives to someone's house close by, etc & work your way up. The nice thing about driving is that it becomes kinetic memory & you're not consciously aware of your movements - like riding a bike. You just need to watch your surroundings & all other things will be automatic.
Posted by Elizabeth on February 7, 2002, at 10:57:32
In reply to Career and Interests » IsoM, posted by IsoM on February 4, 2002, at 18:43:16
> ...I see that you're a mathematician by training. I apologise whether you could do the calculations - a breeze for you, I'd imagine.
Actually, I meant I'm not that out of practice in chemistry! I'm 25 and I've been struggling with depression since I was 14 (possibly younger, but that was the first time I was seriously impaired by it and sought treatment). So I don't have a career. After I graduated from college, I went to grad school (in math) briefly, but I got very depressed again while I was there. (This was while I was taking Nardil, an AD that seemed to be working pretty well for several months but then pooped out in a disastrous way. I tried it twice and this happened both times.) While I was recovering, I decided I wanted to be a doctor. I still need to take a couple of classes and the MCAT before I can apply, though, and it could be a while before I do that (right now what I need is some money, so getting a job is higher on my agenda).
> Trouble is, I have to set my mind in gear for math, I can't just switch focus & work on a different subject, & vice versa. To do math well, I need to work at it for hours.
My problem is mainly with shifting focus, I think. If I can focus on something, I can *really* focus on it. This doesn't help if you're trying to do something that requires frequently shifting your attention from one thing to another (like, say, driving).
> He was so pleased & happy to see someone grasp it so quickly & see the applications (he thought he had a star student, poor guy).
He probably was thrilled to find someone who was interested in the material, too! (speaking as someone who's taught math)
> After grasping the concept so beautifully (I see math as very beautiful), I couldn't even remember what the first step was! I hate the way my brain operates.
I know the feeling. Although it sounds like my attention problems and yours aren't exactly the same, it's really frustrating to enjoy something and be good at it and want to do it but not be able to.
> Then I have to do it over & over & over to wear a pathway in my memory, else the next day, my mind is as empty as before.
"Wear a pathway in your memory" is a pretty good analogy, actually. Hmm...I wonder if there could be a connection between your memory-attention problems and your sleep architecture?
> I respect your views. So if you've got any idea on how to improve shor-term & working memory - meds wise too, let me know.
I think that we need to look more closely at different types of attentional problems. The category of "ADD" is too broad and doesn't capture anything of what's going on when a person tries to focus (and none of the diagnostic categories goes into more detail about attention *symptoms*, which may or may not be associated with ADD). A lot of the problem is that it's considered a disorder of childhood, so the diagnostic criteria are pretty much entirely behavioral. This is understandable since it's often hard for children to explain what's going on in their heads, but I think we need to try to understand ADD and other attention problems better. A good way to start would be to listen to adults who have attention or concentration problems describe their problems in detail.
Anyway...it sounds to me like, in your case, it's a matter of being able to maintain focus, though, so adrafinil seems like a good idea. Have you ever tried piracetam (or one of the other *racetams)?
> Start with small drives to someone's house close by, etc & work your way up. The nice thing about driving is that it becomes kinetic memory & you're not consciously aware of your movements - like riding a bike. You just need to watch your surroundings & all other things will be automatic.
I'm not there yet, but I've gotten to be pretty good at it, and a lot of things do come naturally. But I still can't pass the ****ing test! (I'm embarrassed to say how many times I've tried.)
-elizabeth
Posted by IsoM on February 7, 2002, at 13:43:27
In reply to Re: careers, attention/memory, etc. » IsoM, posted by Elizabeth on February 7, 2002, at 10:57:32
> > "...Have you ever tried piracetam (or one of the other *racetams)?"
I'll look into that, do lots of reading & see if it may be applicable for me.
I've seen PET scans of people with ADD trying to concentrate vs ordinary brains. What I've never seen is a PET scan of an ADD individual who's hyperfocusing. I'm curious to what part of the brain is activated there. I know that when I do hyperfocus (not something one forces but just happens with some subjects one is intensely interested in), everything comes together so smoothly & quickly. Though it doesn't necessarily stay in my memory!
About your driver's test, have you considered (I'm sure you have) taking a tranquiliser & a stimulant together? They don't counter each other but will complement each under what I know can be very stressful conditions. Where do most driving examiners come from - the depths of Hell & then some? I've never met such a scowling, unfriendly bunch before - designed to make a professional driver quake in his boots.
Posted by reese1 on February 7, 2002, at 17:31:03
In reply to Re: Ultram » therese desqueroux, posted by Elizabeth on February 1, 2002, at 15:22:50
dear elizabeth and everyone else,
my pdoc put me on ultram instead of buprenex because she thinks it is not legal yet. so she gave me ultram. does ultram have any effect? has anyone had expierence with it?
i am taking 50mg pills only one pill split in half a day, for the first week then i will eventually take one pill twice a day
if this does not work she said methodone possibility my hairs stood up and i said no way i want to take buprenex and she said she would have to find someone who uses it.
strange. she has the licensce to prescribe methadone but not buprenex.
does anyone have any information, current, that says it is legal for pdoc to prescribe buprenex
thank you
reese
Posted by Elizabeth on February 7, 2002, at 23:48:12
In reply to pdoc put me on ultram instead of buprenex?, posted by reese1 on February 7, 2002, at 17:31:03
> does anyone have any information, current, that says it is legal for pdoc to prescribe buprenex
It is. Buprenorphine is Schedule V. Perfectly legal. Why didn't you just tell your doctor it's legal?
-elizabeth
Posted by Elizabeth on February 7, 2002, at 23:52:17
In reply to Passing the Driver's test » Elizabeth, posted by IsoM on February 7, 2002, at 13:43:27
> I'll look into that, do lots of reading & see if it may be applicable for me.
Tell me what you find out. I haven't got any material on those.
> About your driver's test, have you considered (I'm sure you have) taking a tranquiliser & a stimulant together?
Um, not particularly. But buprenorphine, which I take three times a day, is a stimulant for me, and I think I probably took Xanax before taking the driving test.
> They don't counter each other but will complement each under what I know can be very stressful conditions.
Yup, they can. (But which is yin and which is yang?)
> Where do most driving examiners come from - the depths of Hell & then some?
That sounds about right!
> I've never met such a scowling, unfriendly bunch before - designed to make a professional driver quake in his boots.
Yeah, they're pretty vicious bastards.
-elizabeth
Posted by reese1 on February 8, 2002, at 1:07:56
In reply to Re: pdoc put me on ultram instead of buprenex? » reese1, posted by Elizabeth on February 7, 2002, at 23:48:12
i tried over and over and over again and she said she was at the last meeting and it was not yet allowed
i'm going to bring in a shit load of information i found on the web under pain managment which proves it's legal and schedule v
thank you
Posted by IsoM on February 8, 2002, at 14:43:49
In reply to Re: Passing the Driver's test » IsoM, posted by Elizabeth on February 7, 2002, at 23:52:17
> > "...Tell me what you find out (about piracetam or any other *racetams). I haven't got any material on those."
I'm doing some reading on piracetam. Not enough solid information to make any decision right now. I may just let the adrafinil do what I want - enhanced memory - but I'd still like to learn more about piracetam, find if there's any interaction between it & adrafinil. If I could get my memory working well, how knows what I may do? What an on-top-of-the-world feeling that would be!
With the absessed tooth I had, I was taking lots of codeine painkillers & Ativan to dull it. I felt so thick - couldn't think, let alone remember. I felt so mentally dull - nothing seemed to interest me in reading, TV or computer. I'm sure you've read the story "Flowers For Algenon". I don't mean to be arrogant about my intelligence, but the difference I felt was horrible. I enjoy my intelligence (it makes life so much more interesting) & would hate to imagine what it would be like to lose it. If I can incorporate a good memory into it too, well...!!
> > "...Um, not particularly. But buprenorphine, which I take three times a day, is a stimulant for me, and I think I probably took Xanax before taking the driving test."So do you think it helped you with being more relaxed during the test? I found with myself, mistakes I made were due to "the evil one" watching every move I made to such an extent I felt so shakey. I wonder if they figure you can drive well under such adverse conditions, you can handle anything. :-)
Where you're living now (at family home, I think), can you still continue some sort of studies or such on-line? I know with computer science, there's so many excellent on-line courses that can be used towards a bachelor's degree. Elizabeth, can you tell me if there's any practical applications of knot theory? As one math prof told me, most of the time, theories are developed & years later some application is found that applies to them. Also another question, if I wanted to learn more about fractal math (geometry), do you know what areas of math leads to it? I would dearly love to pursue more on fractals, but have no idea of what fields one needs to study to work my way there.
Posted by Elizabeth on February 8, 2002, at 23:26:04
In reply to Re: pdoc put me on ultram instead of buprenex?, posted by reese1 on February 8, 2002, at 1:07:56
> i tried over and over and over again and she said she was at the last meeting and it was not yet allowed
"Meeting?"
Any doctor can prescribe any drug that's legal. Buprenorphine is legal; it's been approved by the FDA. The only situation in which it would possibly be illegal would be if she were prescribing it for the maintenance of an opioid addiction.
It really sounds like your doctor doesn't understand the laws that affect her practice.
-elizabeth
Posted by Elizabeth on February 8, 2002, at 23:52:42
In reply to Piracetam and Other Bits » Elizabeth, posted by IsoM on February 8, 2002, at 14:43:49
> I'm doing some reading on piracetam. Not enough solid information to make any decision right now.
I was interested because Keppra, an anticonvulsant labeled for adjunctive therapy (surprise) of partial seizures, is levetiracetam. I was thinking of asking for it when I see a neurologist.
> I may just let the adrafinil do what I want - enhanced memory - but I'd still like to learn more about piracetam, find if there's any interaction between it & adrafinil.
I don't know of any, but it's a good idea to check into that stuff.
> If I could get my memory working well, how knows what I may do? What an on-top-of-the-world feeling that would be!
Feeling grandiose today? :-)
> With the absessed tooth I had, I was taking lots of codeine painkillers & Ativan to dull it. I felt so thick - couldn't think, let alone remember.
Heh -- just shows how different we all are. Opioids (not just buprenorphine, but also morphine and hydrocodone, and presumably the rest too) help me think more clearly. And benzos at least don't make me tired at normal doses (even normal doses for me, which is already quite a bit higher than the usual normal doses).
Why were you taking Ativan for a tooth abscess, BTW??? Benzos don't generally help with pain, AFAIK.
[re taking Xanax before the driving test]
> So do you think it helped you with being more relaxed during the test?*shrug* It certainly didn't hurt.
> I found with myself, mistakes I made were due to "the evil one" watching every move I made to such an extent I felt so shakey. I wonder if they figure you can drive well under such adverse conditions, you can handle anything. :-)
No, I think Satan probably sent them up here for some other purpose. :-}
> Where you're living now (at family home, I think), can you still continue some sort of studies or such on-line?
You can't really do that with the stuff I need to learn -- virtual chemistry and biology labs just aren't the same as the real thing!
> Elizabeth, can you tell me if there's any practical applications of knot theory?
Sure there are, I think it has applications in chemistry, even.
> Also another question, if I wanted to learn more about fractal math (geometry), do you know what areas of math leads to it?
Actually understanding that sort of thing takes a lot of background. I'm not sure what it is ("fad math" never excited me < g >), but I think at the very least you'd need a good understanding of abstract algebra and real and complex analysis. Knots are more up my alley (I did a lot of topology and then branched out into differential geometry). But honestly, I haven't done much of this stuff in years. I sort of burned out when I tried to go to grad school. A life lesson: if you really love doing something, don't go to school in it. < g >
-elizabeth
Posted by IsoM on February 9, 2002, at 0:43:59
In reply to Re: Piracetam and Other Bits » IsoM, posted by Elizabeth on February 8, 2002, at 23:52:42
> >"...I was interested because Keppra, an anticonvulsant labeled for adjunctive therapy (surprise) of partial seizures, is levetiracetam. I was thinking of asking for it when I see a neurologist."
Let us know what happens. It does sound interesting alright. If I could get better info than just what 'smart drug' sites put out, I might put more credence in it.
> >"...Feeling grandiose today? :-)"
Sounds like it, huh? No, not grandiose but so good compared to my 2 1/2 weeks of pain & headaches.
> > "...Heh -- just shows how different we all are. Opioids (not just buprenorphine, but also morphine and hydrocodone, and presumably the rest too) help me think more clearly. And benzos at least don't make me tired at normal doses (even normal doses for me, which is already quite a bit higher than the usual normal doses).
>
> Why were you taking Ativan for a tooth abscess, BTW??? Benzos don't generally help with pain, AFAIK."Actually, if I have to take a painkiller (codeine) I generally feel clearer too, but I think it was the combination of infection, *severe* pain, & Ativan that made me dopey. Your're right benzos don't help pain but I didn't know what else to do to fight the pain. All my muscles were so tight & tense & I wanted to be numb temporarily. It helped a little, enough till the absess was drained. No way I'll go to the hospital for painkillers. I went once for a migraine & vowed to never go again unless I needed to seriously be admitted.
> > "...You can't really do that with the stuff I need to learn -- virtual chemistry and biology labs just aren't the same as the real thing!"
No, they certainly aren't! I was somehow thinking on-line math.
> > "...Actually understanding that sort of thing takes a lot of background. I'm not sure what it is ("fad math" never excited me < g >), but I think at the very least you'd need a good understanding of abstract algebra and real and complex analysis. Knots are more up my alley (I did a lot of topology and then branched out into differential geometry). But honestly, I haven't done much of this stuff in years. I sort of burned out when I tried to go to grad school. A life lesson: if you really love doing something, don't go to school in it. < g >"
I don't pretend I'd understand fractals but they've interested me for almost 2 decades now but I never had much chance to learn about it before. It's the relationship fractals have with biology & nature that I love so much.
I agree about not going to school for what you really love. Plants & nature is my big, BIG love & I can't get enough of it.
Posted by Elizabeth on February 10, 2002, at 11:53:53
In reply to Other Bits » Elizabeth, posted by IsoM on February 9, 2002, at 0:43:59
> Let us know what happens. It does sound interesting alright. If I could get better info than just what 'smart drug' sites put out, I might put more credence in it.
It's going to be a while until I see a neurologist -- I have to see a GP and then get a referral and who knows how long I'll wait after that and then they might not want to add anything to the Trileptal. I know what you mean about the credibility problems with smart drug websites (or any websites, for that matter).
> Your're right benzos don't help pain but I didn't know what else to do to fight the pain. All my muscles were so tight & tense & I wanted to be numb temporarily.
That's a good point: benzos can help with muscle tension, which often results from pain even if the pain isn't musculoskeletal. They're also sedating, which is always rather helpful if you're in pain.
> No way I'll go to the hospital for painkillers. I went once for a migraine & vowed to never go again unless I needed to seriously be admitted.
Oh jeez -- I bet they gave you a hard time when you went for the migraine. Can I ask what happened? (I'll understand if you don't want to discuss it!)
> No, they certainly aren't! I was somehow thinking on-line math.
I haven't investigated it, but I don't think there are any online math courses at the level that I'd need. Anyway, I'm not studying math anymore.
> I agree about not going to school for what you really love. Plants & nature is my big, BIG love & I can't get enough of it.
For some reason I want to go to med school anyway, though! I should probably practice what I preach. :-}
-e
Posted by IsoM on February 10, 2002, at 13:40:36
In reply to Re: Other Bits » IsoM, posted by Elizabeth on February 10, 2002, at 11:53:53
> > "...Oh jeez -- I bet they gave you a hard time when you went for the migraine. Can I ask what happened? (I'll understand if you don't want to discuss it!)"
I've no problem saying why. Emergency rooms are generally the worse spot to be in anyway - with a migraine, the noise & lights make it much worse. Plus the whining patients get treated first around here, regardless of how serious it is. I'm not a noisy whining type. I laid on the bed for a couple of hours before I was even looked at. They were so afraid of even giving me anything. I got a Gravol shot for the nausea by insisting they treat that too. The final thing they gave me was Demerol which I didn't particularily want. Fine, if you don't move but when I was driven home after the farce, I fought not to vomit in my friend's car. As soon as I got home, I threw up repeatedly & the pain wasn't even diminished. It lasted another 3 days! As you can understand I'd rather treat pain (unless broken limbs) at home. I can do better myself.
Talk to you later - I've a number of things to do today.
Posted by Elizabeth on February 13, 2002, at 17:16:15
In reply to Hospital Emergency Rooms » Elizabeth, posted by IsoM on February 10, 2002, at 13:40:36
> I've no problem saying why. Emergency rooms are generally the worse spot to be in anyway - with a migraine, the noise & lights make it much worse.
I don't get migraines, but I'm generally sensitive to noise, light, and cold. ERs can be pretty unpleasant places. Plus they're full of people who are mostly in a bad mood for one reason or another.
> Plus the whining patients get treated first around here, regardless of how serious it is.
I'm not sure if that's true here. It is true that (here at least) if you're a psychiatric patient and you whine too much (or otherwise piss off the doctor/nurse/psychologist/whatever), you risk being pathologized for your whining ("hysterical," "hypochondriac," etc.).
> They were so afraid of even giving me anything.
Why?
> I got a Gravol shot for the nausea by insisting they treat that too.
Gravol? Isn't that just diphenhydramine (or something similar)? Promethazine or prochlorperazine would be my drug of choice for nausea.
> The final thing they gave me was Demerol which I didn't particularily want.
What did you want -- one of the *tripans? (It's cool that there's actually a specific tx for migraine, even if no one knows why it works. < g > Most people with chronic or recurring pain syndromes have to beg for medication.)
> As you can understand I'd rather treat pain (unless broken limbs) at home. I can do better myself.
In general, if I have pain that I can treat myself with OTC meds, then it's not bad enough that I would bother taking any medication for it. I only get headaches *very* rarely, I use a prescription NSAID for menstrual cramps, and the buprenorphine has virtually eliminated the chronic (musculoskeletal) back-neck-shoulder pain that I've been suffering for the last 6+ years. (Not the reason I wanted to try it in the first place, but certainly a nice benefit.)
-elizabeth
Posted by IsoM on February 13, 2002, at 19:45:06
In reply to Re: Hospital Emergency Rooms » IsoM, posted by Elizabeth on February 13, 2002, at 17:16:15
> I don't get migraines, but I'm generally sensitive to noise, light, and cold. ERs can be pretty unpleasant places. Plus they're full of people who are mostly in a bad mood for one reason or another.
There was one woman who whined. I heard the nurses muttering about her under their breath because the doctor on duty was picking the noisiest patients to treat first. There was also a 13 yr old girl who'd cry every time someone came near her but was giggling when nurses & the doctor was engaged elsewhere. It made my "someone needs a damn good slap" mode start up. One nurse came to me & apologised.
> I'm not sure if that's true here. It is true that (here at least) if you're a psychiatric patient and you whine too much (or otherwise piss off the doctor/nurse/psychologist/whatever), you risk being pathologized for your whining ("hysterical," "hypochondriac," etc.).
As I said, it was more due to that doctor on call, I think, than other reasons.
> > They were so afraid of even giving me anything.
I have no idea. While I've had tests at the hospital's lab before, I've never been a patient there. There's no reason & I felt too sick to argue.
> Gravol? Isn't that just diphenhydramine (or something similar)? Promethazine or prochlorperazine would be my drug of choice for nausea.
Seems like they don't dish meds out easily there. I know from previous experience that Gravol (yes, it's what you think it is) works fairly well for the nausea if given intramuscularly & they were willing to give me that. It helps with a touch of sedation too. Hardly noticable, but anything would help.
> What did you want -- one of the *tripans? (It's cool that there's actually a specific tx for migraine, even if no one knows why it works. < g > Most people with chronic or recurring pain syndromes have to beg for medication.)
Yeah, I was hoping for one of the new drugs specifically for migraines. But they told me they won't give it out unless their doctor says too. What crap! They're just to cheap to pay for it as it's expensive.
> In general, if I have pain that I can treat myself with OTC meds, then it's not bad enough that I would bother taking any medication for it. I only get headaches *very* rarely, I use a prescription NSAID for menstrual cramps, and the buprenorphine has virtually eliminated the chronic (musculoskeletal) back-neck-shoulder pain that I've been suffering for the last 6+ years. (Not the reason I wanted to try it in the first place, but certainly a nice benefit.)
Demerol isn't a good med to give for headaches as it doesn't work that well for whatever reason. This was one migraine that had me lying on the floor, I was so sick. Someone was concerned about me & took me to the hospital for help. They thought it was a good idea & I didn't know better at the time. Nothing I had done for it diminished it & the pain & nausea was getting worse.
Glad to hear your combo works good for you. I'm not even a wuss but long bouts of pain really saps so much from a person. I honestly don't know how some people manage, like those with cancer (esp bone cancer).
Posted by kpo2002 on May 29, 2002, at 10:04:25
In reply to Re: chronic pain » BarbaraCat, posted by Elizabeth on January 30, 2002, at 6:37:35
I have many other detailed informative postings about my experiences with severe chronic neuropathic pain. They can be found at:
www.dr-bob.org/babble/20020402/msgs/101474.html
www.dr-bob.org/babble/20020517/msgs/106848.html
www.dr-bob.org/babble/20020525/msgs/107931.html
www.dr-bob.org/babble/20020510/msgs/106225.html
and a few others.
Posted by reese1 on October 23, 2002, at 14:17:59
hello everyone or anyone,
this is reese, i've written before about my situation, and i finally have gotten in contact with Dr. Stoll. I have an appointment with him on the first of november.
i was told he will work with opiates. my problem is i have a high tolerance for opiates and everything else. be it regular medication , to mood stabalizer, add meds, whatever
my concern then is how do i explain this to him so i don't wast months trying opiate oriented medication of a low level. if i were to try oxycontin it would be ridulous if i was to stary at 10mg. i would have to start higher probably at 20mg. doess this sound like a bad situation? or do you think he will understand and not have to much of a problem with it?
thank you everyone, anyone, elizabeth ,
reeese
Posted by reese1 on October 23, 2002, at 15:37:18
In reply to doctors » reese scott, posted by Elizabeth on January 18, 2002, at 10:08:12
> Reese,
>
> Dr. Stoll has used opioids to treat depression, although I'm not sure if he's used bupe. He has used full agonists like oxycodone (he wrote a letter to the American Journal of Psychiatry reporting on some cases where he did this successfully), so he would probably not have a problem with bupe. I'm not sure if he's still seeing patients, though (he's very into his research on omega-3 fatty acids), and he's pretty hard to reach.
>
> Best of luck to you! You seem very persistent so I think that you will find a way to get the help you need.I have an appointment with Dr. Stoll this Nov 1 what doses does he prescribe for oxycontin. how flexible is he. i ask this because i have always had a high tolerance for all meds including opiate oriented meds. would he be willing to prescribe 20mg 3x a day or more as time went on or start at a much smaller dose which i know i will have no response to
thanks
>
> -elizabeth
Posted by BrittPark on October 23, 2002, at 16:53:36
In reply to i have an appt w/ Dr. Stoll please help anyone, posted by reese1 on October 23, 2002, at 14:17:59
Just tell Dr. Stoll that in the past you have usually required larger doses of medication than average. It's quite probable that you're a hyper-metabolizer. I am. I need to take 300mg imipramine a day to get a blood level in the middle of the therapeutic range.
Now, Dr. Stoll may still wish to start you on a low dose but if he's really used to working with opiates he'll be willing to increase dosages as needed.
If you get a chance ask him if he's heard of the combination of an opioid agonist, like oxycontin, in combination with a super low dose of naltrexone (perhaps 100 micrograms). There has been research done that shows that such a combination potentiates the action of the opioid and inhibits the development of tolerance which is of course the chief difficulty with opioid therapy. There's a company called Pain Therapeutics which is developing just such combination drugs. I think they are in stage III trials.
I think opioids are the great undiscovered country for the treatment of depression.
My apologies for ranting.
The most important thing is that you get effective treatment. Best of luck, though you shouldn't need it because you will find something that works.
Feel Better,
Britt
Posted by reese1 on October 23, 2002, at 17:07:33
In reply to Re: i have an appt w/ Dr. Stoll please help anyone » reese1, posted by BrittPark on October 23, 2002, at 16:53:36
thank you so fucking much for writing back so fast. i'm starting to feel really nervous about the whole thing.
in your expierence what are the average doses given out for oxycontin? 10mg 3x a day or is it unheard of to recieve 20mg 3x a day it i have a strange tolerance to all drugs.
i just don't want to sit around running around in my mind 24 hours a day without finding a place to sit still
it's so hard and it's been going on for over ten years
so the appt with dr. stoll is pretty important
thre's also the concern that he resides in boston and i reside in new york and i don't know how that would work for getting prescription.
what other information you have about what the typical dose is for starting someone out on oxycontin
to me starting out at 10mg seems okay. 20 would be most apporpriate.
i have taken adderall for years and i have never abused it one bit. i know how much i can take and usually i don't take my whole dose unless i feel it necessary. i am very responsible with my meedication.
thanks again
reese (doug)
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