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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by jealibeanz on March 15, 2007, at 5:09:14
I see my doctor today for a med recheck.
I started Xanax XR, 3mg, about 3 weeks ago. It does not do much at all for my GAD. At first I thought it was subtle, weak, but mildly effective and lasts all day. It seems to have less effect everyday, to point where I end up in a near panic attack at night, which isn't normal for me.
I was taking 4 mg of regular brand name Xanax for quite a while. This does help with anxiety. I can feel it working and it calms me down. I definitely like brand name. I do feel very up and down though, even when I break it up into 4-8 doses per day.
It was my doc's idea to switch to XR, for no reason at all (I wasn't complaining.), except that he thought I'd like the consistency. I had slight hope for it at first, but I'm not liking it right now.
So, I'll have to make a decision/suggestion about what we will do. I definitely would like a script for the immediate release so I can keep it on hand for excessive anxiety/panic moments. I was thinking of suggesting to him that I may do better on the brand, since that was the case with the IR, and that another factor (obviously) may be that I was on 4mg and jumped down to 3mg.
If I could get a script for 2mg Xanax XR, twice daily, plus a script for 120 mg Xanax IR, I'd be happy. That would allow me to try out the Xanax XR again, but if it doesn't work, I can go back to what I'd been taking before.
My doc (family GP) is very trusting and liberal with me. However, I don't know how to ask for 240mg Xanax from him! It's pretty excessive. Haha, I don't think he will think I'm abusing it, or selling it, or trying to take 8 mg a day (I have fatigue problems, plus he knows I'm intelligent and logical.), but it's still A LOT at once.
I am perfectly comfortable asking for 4mg of brand Xanax XR. I am perfectly comfortable asking to go back to 4mg of immediate release Xanax. I'm not, however, comfortable with asking for both. I just don't know how to word it without having his jaw hit the floor (never would happen anyway, he's a super nice and fatherly guy). I'm very grateful that he's willing to give me a daily benzo script and don't want to do anything to begin to wonder if I'm becoming a drug seeker.
Also, I'm on 400 mg Provigil and 60 mg Ritalin LA for fatigue and ADHD. The Provigil is helping with fatigue. I've always thought the Ritalin was ineffective, which he knew, and the same with Concerta.
I may tell him that the addition of Provigil has helped with the fatigue, but I don't think the Ritalin has ever helped with studying, like Adderall did. I hated the Adderall side effects, don't want to go there. I can manage right now because I'm not taking a huge load of courses, but this will be changing in either June or August, so eventually I'll need to find something else.
I don't even know if I want to change the stims right now. They're keeping me awake and functional. My light courseload allows me to study very infrequently and whenever I feel the need to. If I had to study for hours a day, I couldn't do it, but I don't have to right now.
I may just tell him this, since I'm there and he should know what's going on, but also tell him that I'm OK with leaving them as is for this month and working on just the anxiety meds instead. The stims can be next month's project.
Posted by Phillipa on March 15, 2007, at 11:59:23
In reply to Med switches today! Help!, posted by jealibeanz on March 15, 2007, at 5:09:14
Well my new pdoc switched me from the valium to long acting xanax but the pharmacy told me the highest is 2mg of the long acting. But my pdoc ordered it for twice a day and he said if it doesn't hold you call me for the immediated release to add. So I don't think he will think you are med seeking. I'm withdrawing from luvox at the same time as the pdoc dosen't think ad's are for me and says he thinks my thyroid is the culprit. I have some wierd auto antigen for both Graves and hasimotos. Love Phillipa
Posted by jealibeanz on March 15, 2007, at 12:04:53
In reply to Re: Med switches today! Help! » jealibeanz, posted by Phillipa on March 15, 2007, at 11:59:23
I don't think it's a horrible idea, just don't want to be the one to suggest it.
Posted by UGottaHaveHope on March 15, 2007, at 12:11:33
In reply to Med switches today! Help!, posted by jealibeanz on March 15, 2007, at 5:09:14
Do you think the Provigil and Ritalin is working against the Xanax, or maybe causing anxiety?
Posted by jealibeanz on March 15, 2007, at 12:56:04
In reply to Re: Med switches today! Help! » jealibeanz, posted by UGottaHaveHope on March 15, 2007, at 12:11:33
Provigil did cause anxiety the last time I went on it. That's when I had to increase the Xanax to 3mg a day. After a while, I adjusted to the Provigil, plus the extra Xanax helped.
I do have to factor in the Provigil and the Xanax XR, which is very different from Xanax, into my cause for increased anxiety.
Ritalin LA doesn't cause anxiety with me. I'm not sure it does much of anything (besides make me crash after 2-3 hours, which I no longer feel because of the Provigil).
It's hard to find a balance when you have comorbidities. Polypharmacy sometimes does seem counter productive, but to be functional is necessary for some people.
If I didn't take the Provigil I wouldn't be able to stay awake during the day. I'd struggle to get anything done or have a life. That would add to anxiety.
I have ADHD. If I didn't have the meds (which aren't great at the moment, but better than nothing), I wouldn't be able to do well in school and have a semi-organized life. That also would cause anxiety.
I have insomnia. I take Lunesta. The Provigil and Ritalin LA don't effect my sleep. The Ritalin has worn off by nighttime and Provigil, for me at least, is a medication that allows me to nap or sleep at night as I please, yet keep me alert when I need to be. The insomnia is related to anxiety. If I didn't take Lunesta, I wouldn't be well rested. I would be cranky, increasing my anxiety. I'd be tired, decreasing my concentration and energy.
The funny thing is that I never had insomnia until 2 years ago when I can back from London. I've always had anxiety.
So, yeah, I agree, the polypharmacy thing can be tricky. Most GP's would do this with a patient. I'm lucky mine does.
I don't love the idea of meds, but have come to realize that they improve the quality of my life. My doc knows this too.
When I was first put on Lunesta, I was seeing my PA for the first time. I explained to him that I was only sleeping about 3 hours a night and waking constantly. It had gone on for about 3-4 months before I saw him. My life was soo difficult. I was going to school full time (taking o-chem, microbio, physics, and others), interning, and working. I was about to crash. He had no problem giving me the Lunesta.
The NP at the same office blew me off the month before, gave me an antihistamine since it can make people sleepy, and told me to make an appointment with my doctor if I wanted a real sleep med. Can you say no guts?
Posted by jealibeanz on March 15, 2007, at 15:49:58
In reply to Re: Med switches today! Help! » jealibeanz, posted by UGottaHaveHope on March 15, 2007, at 12:11:33
Well... not much happened...
He was rushed, of course, it's a busy practice.
Asked me a little bit about school, then about the meds. He was more interested in school.
So I said the Provigil was fine. Then said I wasn't happy with the Xanax XR. He asked if I was on 3mg or 3mg + 1mg (so he was aware of the option and possible need). I told him 3.
I said at first it was OK. Definitely very different, weaker, but lasted all day. Then every day it seemed to last less and less. Right now it feels like I'm taking nothing. I said I didn't know if it was the change in brands, or that I dropped down from 4mg to 3mg. He didn't seem to like the fact that I was implying that I wanted 4mg. So he wrote the 3mg script as brand name, and told me to try that.
No scheduled rechecks. Usually he does schedule one if I'm not stable on meds in about a month. If I am, the recheck should be in 3 months. A lot of times he's just neglected that (like when I was 19 and was given 6 months worth of Wellbutrin without rechecks, plus many other times). He's forgetful. My PA always schedules one. If they don't, I'm sorta left hanging not knowing what to do.
So, since the meds have to be written each month, I just call for refills. I may have to call next time and be like ummm calling for a refill... on a med that does not work. Can you ask the doc what he'd like to do? Change things? Have me come in?
Ughh... I'm just tired and in a bad mood. I really like him. I just didn't get what I wanted this time. Normally I do. But giving his idea a chance allows him to regain control, because I really have way to much. Then allows for changes to be made if it doesn't work.
I didn't even ask about the immediate release Xanax for extreme anxiety. I didn't tell him that I have only been able to get through the last few weeks because I had extra regular Xanax, and that I have mini panic attacks. I was really tired, didn't feel like being aggressive.
I'll just be patient for a month. Usually he goes above and beyond to help me. It's partly my fault for not communicating. And partly his, because honestly, he never really asks me about symptoms or how things are really going. Just asks what refills I need. He's been the best doc I've ever had though, not because he's a good doc, but because of out relationship, and he does give me meds that most GP's wouldn't think of.
Posted by jealibeanz on March 15, 2007, at 16:12:41
In reply to Re: Med switches today! Update!, posted by jealibeanz on March 15, 2007, at 15:49:58
Oh, yeah, and the pharmacy didn't want to fill the script, since it hadn't been a month. Don't give the crazies too many drugs, right?
I specifically asked my doctor before I left if the pharmacy would fill it, since it wasn't 30 days since my last script, but it was technically a change since we switched to the brand. He said yeah that is considered a change. Obviously he considered this a change which was to be in effect immediately, not two weeks, otherwise he would have figured out a different way to write it (like 2+1 mg).
I told the pharmacy that it was not the same script, this was written as DAW. There was a reason for this being done. Eventually they agreed to fill it, and made me wait a long long time, instead of putting my script next to be filled, since it was their mistake.
It's things like this that bother me. And I do understand how this all works... I was a pharm tech, I've been in med school. I know what they need to do to comply with insurance companies. I know the ways around it. Empathy people. Empathy.
OK, I'm taking a nap now. Obviously I need it.
Posted by jealibeanz on March 15, 2007, at 21:27:29
In reply to Re: Med switches today! Update!, posted by jealibeanz on March 15, 2007, at 16:12:41
Sorry... last time I'll respond to myself...
It's too bad I wouldn't just be cured with an SSRI. The doc's and pharmacists are very accepting of them.
They aren't accepting of controlled drugs... stims, benzo's, antipyschotics, hynotics, atypical psych meds...
I'm a little more critical of myself since I'm going to be practicing medicine, and feel like I need to be perfect. When in actuality, I don't need to be perfect. I need to have proper medical care.
I'm always afraid that my doctor is judging me as a possible future colleague, and juding my excessive axiety, insomnia, mild ADHD, and fatigue. But realistically, I know he's not. Right now I'm just his patient, how he's trying to help, but doesn't always know how to.
This is the end of the thread.
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