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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by PeterMartin on October 7, 2015, at 19:20:06
My doctor has sent me to get bloodwork for lithium levels. I was put on Lithium about 10months ago when I was in the hospital for a manic episode. When I came out of the hospital I was on 900mg w/ a level of .05 which my doctor and I decided to stay w/ at the time.
After adding a few other meds for my depression (Marplan/Lamictal) I began to get really bad abdominal pain. In order to cope w/ that I reduced the lithium to only 300 which is really all I'd like to take anyway (small dose for neuroprotective probs). All has been well for 8months or so.
But now my pdoc has asked to get another Li level. I haven't told him about the reduction in Li as I'm concerned he may remove/alter the meds I care about that handle my depression vs. having no prob w/ the Li reduction.
My question:
If I was taking 900mg for a month and my blood level was .05 but I've only been taking 300mg for the past while if I just take 900mg the day before a blood test will the levels come back _around_ .05? Or would tend to be higher or lower? I'm sure the blood levels of Li even out over time but do they spike at first and then get lower or do they start low and get higher maybe?
Basically what would be the best way to kinda fake it to make it seem I've been taking around 900mg and not 1/3 of that dose. I'm dreading taking any more than 300mg cause it really causes upper right quadrant abdominal pain. I wish I could do 600mg Li but I've tried and it's intolerable (physically).
Thanks for any suggestions on what to take for how many days prior to make it seem like I've been on 900mg w/o getting levels that are way out of wack.
Posted by Toph on October 8, 2015, at 9:05:25
In reply to Lithium levels: Really need advice please...., posted by PeterMartin on October 7, 2015, at 19:20:06
Hi Peter. I assume it is believed that you are BP1. I am, and have been taking Lithium for over 30 years. For me it has prevented both psychotic manic episodes and chronic depression effectively except for one manic episode I experienced when my mother died several years ago. I had allowed my LI level to go low at that time. Otherwise, I have kept my serum LI at about 0.7 with 750mg/day (below the suggested therapeutic range 0.8 - 1.2). Before LI, in my 20s, I would have to be hospitalized about every year with a manic or depressed episode. My only annoying side effects have been slight dry mouth and occasional diarrhea. At age 60, I developed a slight hand tremor that probably is medication related though unnoticeable except by me. I have always had normal thyroid and renal panels. This medication is not for everyone although it is the most common and arguably the most effective drug for treatment of BP1 disorder. I hope that you find an effective medication that will significantly reduce the risk of another manic episode.
Posted by baseball55 on October 8, 2015, at 20:02:00
In reply to Lithium levels: Really need advice please...., posted by PeterMartin on October 7, 2015, at 19:20:06
Let me get this straight. You cut back from 900 to 300mg of lithium and have been lying to your doctor about this. S/he wants to check blood levels and you're asking how you can play with the dosage to get your levels up so as to continue to deceive your doctor. Is that about it? Why not just tell your doctor that you had abdominal pain you believed was due to lithium and cut back the lithium and were fine.
There are doctors who would tell you to take a hike because they don't want to deal with patients who lie to them. But many are understanding and may get annoyed but will continue to try to work with you. I truly don't understand lying to your doctor. Why not tell him/her about the side effects? If you feel so uncomfortable with the doctor that you can't share this information, you should find another doctor with whom you are comfortable.
> My doctor has sent me to get bloodwork for lithium levels. I was put on Lithium about 10months ago when I was in the hospital for a manic episode. When I came out of the hospital I was on 900mg w/ a level of .05 which my doctor and I decided to stay w/ at the time.
>
> After adding a few other meds for my depression (Marplan/Lamictal) I began to get really bad abdominal pain. In order to cope w/ that I reduced the lithium to only 300 which is really all I'd like to take anyway (small dose for neuroprotective probs). All has been well for 8months or so.
>
> But now my pdoc has asked to get another Li level. I haven't told him about the reduction in Li as I'm concerned he may remove/alter the meds I care about that handle my depression vs. having no prob w/ the Li reduction.
>
> My question:
>
> If I was taking 900mg for a month and my blood level was .05 but I've only been taking 300mg for the past while if I just take 900mg the day before a blood test will the levels come back _around_ .05? Or would tend to be higher or lower? I'm sure the blood levels of Li even out over time but do they spike at first and then get lower or do they start low and get higher maybe?
>
> Basically what would be the best way to kinda fake it to make it seem I've been taking around 900mg and not 1/3 of that dose. I'm dreading taking any more than 300mg cause it really causes upper right quadrant abdominal pain. I wish I could do 600mg Li but I've tried and it's intolerable (physically).
>
> Thanks for any suggestions on what to take for how many days prior to make it seem like I've been on 900mg w/o getting levels that are way out of wack.
Posted by PeterMartin on October 8, 2015, at 20:23:22
In reply to Re: Lithium levels: Really need advice please.... » PeterMartin, posted by baseball55 on October 8, 2015, at 20:02:00
> Let me get this straight. You cut back from 900 to 300mg of lithium and have been lying to your doctor about this. S/he wants to check blood levels and you're asking how you can play with the dosage to get your levels up so as to continue to deceive your doctor. Is that about it? Why not just tell your doctor that you had abdominal pain you believed was due to lithium and cut back the lithium and were fine.
>
> There are doctors who would tell you to take a hike because they don't want to deal with patients who lie to them. But many are understanding and may get annoyed but will continue to try to work with you. I truly don't understand lying to your doctor. Why not tell him/her about the side effects? If you feel so uncomfortable with the doctor that you can't share this information, you should find another doctor with whom you are comfortable.
>Don't appreciate being scolded. I'm a big boy. Next time I'll ask it specifically about levels.
I'm in a bind for the moment so I asked for help. Some of us here have issues w/ anxiety (including speaking up. I'm not looking for my doctor to tell me to take a hike so that is sort of the issue here.
God your response made me feel like sh*t. Thanks.
Posted by PeterMartin on October 8, 2015, at 20:46:53
In reply to Re: Lithium levels: Really need advice please...., posted by PeterMartin on October 8, 2015, at 20:23:22
" have been lying to your doctor about this. S/he wants to check blood levels and you're asking how you can play with the dosage to get your levels up so as to continue to deceive your doctor. Is that about it?"
No. I don't want to deceive anyone. I want to get passed this without pain.
" Why not just tell your doctor that you had abdominal pain you believed was due to lithium and cut back the lithium and were fine. "
That is the right thing to do. There was no way to do that last session after being asked to get a lithium level.
My issue is one of being unable to tell my doctor of the decrease and now we're months beyond. He has not specifically asked me so I don't know if that's lying to him. (and PLEASE don't go off that it is the same don't reply if that's what you are looking to do).
Blah whatever.
I wish there was a way to delete messages here. I'm done using this acct and will be host blocking this site for a while to avoid reading any responses to this - too much anxiety.
It was the words. I am not trying to be a liar nor am I trying to be deceitful. I just can't always speak up.
Thanks to SLS and the people who have helped me in the past.
It'll hurt but I'll take 900 until I see my doctor again (if anyone cares).
-PM
Posted by Christ_empowered on October 8, 2015, at 20:48:32
In reply to Re: Lithium levels: Really need advice please...., posted by PeterMartin on October 8, 2015, at 20:23:22
Hey man...I know where you're coming from.
I had a doc at a hospital put me on depakote. Too much depakote. When I got blood levels, they were too high. New outpatient doc said reduce and use XR. Still felt terrible. Had to blood levels, so...
I took 2x the depakote for a couple days before the test. I don't think you can do that w/ lithium, though.
You may just have to find a way to tell your doc about your probs with lithium. Lithium isn't exactly the safest medication over the long haul, so...listen to your body first, your doc second (my advice).
Good luck!
Posted by SLS on October 9, 2015, at 4:40:14
In reply to Re: Lithium levels: Really need advice please...., posted by PeterMartin on October 8, 2015, at 20:46:53
> It'll hurt but I'll take 900 until I see my doctor again (if anyone cares).
I totally get that.
I almost walked away from a NIH investigational drug trial when I learned they had me taking high dosages of lithium, too. The investigational drug was actually helping, but the lithium was making me feel worse overall. I was extremely pissed because I told them in advance that lithium makes me feel worse. I worked hard to get the chance at being treated by the NIH, and remained an inpatient for 9 months before they told me about the lithium.
I felt like I was being forced to take poison.
Interestingly, 300 mg/day of lithium is helpful for depression, and I don't get depressive side effects.
Hang in there. It is very hard to do what you are doing. At least you can tell the doctor how bad you are feeling and know that you gave the Li+ a full trial. You will be able to synchronize with your doctor again and have no secrets.
Are you able to communicate with your doctor's office? Even if your doctor doesn't call you back directly, maybe the staff can forward to him your message describing how you feel and what you can do about it. Perhaps the staff will call you back with instructions. I don't know.
I have lied to doctors on a few occasions. It only complicated matters. It will be nice to be able to have a fresh start with your doctor when you see him next.
What is your current diagnosis, and what symptoms is the lithium meant to address? Is mania the main concern? I'm sure you have alternatives.
I see you are thinking about leaving Psycho-Babble for awhile. Perhaps this is for the best, but you might want to think about it for a day or so if your anxiety level will allow it. You can always change your posting name if you like, but then you lose continuity.
Good luck.
- Scott
Posted by baseball55 on October 9, 2015, at 18:03:29
In reply to Re: Lithium levels: Really need advice please...., posted by PeterMartin on October 8, 2015, at 20:23:22
I didn't mean to scold, but it's a serious problem when, for whatever reason, anxiety, fear, distrust, you can't be upfront with your doctor about what you're taking and, when directly asked, you lie (yes, answering a direct question falsely is lying). I mean, maybe you need another doctor whom you trust more. Or maybe you need a therapist who can help mediate things with your doctor. (I had a therapist do this twice).
> Don't appreciate being scolded. I'm a big boy. Next time I'll ask it specifically about levels.
>
> I'm in a bind for the moment so I asked for help. Some of us here have issues w/ anxiety (including speaking up. I'm not looking for my doctor to tell me to take a hike so that is sort of the issue here.
>
> God your response made me feel like sh*t. Thanks.
Posted by linkadge on October 15, 2015, at 15:54:52
In reply to Re: Lithium levels: Really need advice please...., posted by baseball55 on October 9, 2015, at 18:03:29
I thought I would chime in on this topic as I am now taking lithium myself. Also, I am not always completely honest with my doctor - for a variety of reasons, that I feel are justified.
For starters, if you want the lithium level to appear higher than it is, you need to take the medication 2h-4h before the test (this will maximize blood level). Also, you need to tell them that you last took it longer ago, than you actually did. For example, if you get the test done at 2 pm, you could tell them you last took it the night before.
I completely understand not being completely honest with your doctor. There are several reasons why I have done this (and continue to do this).
Example 1: I may stop a medication which is clearly making me feel worse. However, I will tell the doctor I gave it a fair trial. I have found with previous doctors, that I lose credibility if I jump ship on too many meds too early - even though many make me significantly worse.
Another instance would be with my methylphenidate prescription (Ritalin). I take it occasionally (i.e. as needed). Many doctors don't like this with a stimulant, and would yank me off it, if I told them I was only taking it as a booster (as needed) med. However, doing this keeps me well.
There have been times I tell the doctor I am taking my meds when I am not. I do this because I want to continue seeing a psychiatrist and trying options. Because there are times that I feel normal off meds, the doctor may assess me as being well (in Canada, psychiatrist are hard to get and there is some push out the door, once you are stable)
Another example might be fore diagnostic purposes. For example. I might consider my self bipolar, yet be able to stabilize my moods with say 300mg of lithium and perhaps omega-3 and other supplements. However, most doctors would not call you bipolar, if you only need 300mg of lithium. So, I might want a higher blood level, to ensure a "diagnosis" is in place, yet not want to take 900mg every single day.
At the end of the day, I have found that, when I am completely honest, and take my medications exactly as instructed, I usually end up much worse, and more impaired. So I can fully understand why somebody might want a higher blood level (for a test) yet not have to take that dose long term.
Linkadge
Posted by Lamdage22 on October 16, 2015, at 11:55:12
In reply to Reasons I am *not* always honest with my doctor, posted by linkadge on October 15, 2015, at 15:54:52
My doctor wanted to take me off Nardil which i didnt want.
The results where disastrous.
Posted by elanor roosevelt on November 5, 2015, at 19:36:35
In reply to Reasons I am *not* always honest with my doctor, posted by linkadge on October 15, 2015, at 15:54:52
Thanks for this. You are not alone. when i really start to go into the darkness i have meds that i import. nothing i would take all the time but enough to hold on to the faith that there is light at the end of the tunnel.
I thought I would chime in on this topic as I am now taking lithium myself. Also, I am not always completely honest with my doctor - for a variety of reasons, that I feel are justified.
>
> For starters, if you want the lithium level to appear higher than it is, you need to take the medication 2h-4h before the test (this will maximize blood level). Also, you need to tell them that you last took it longer ago, than you actually did. For example, if you get the test done at 2 pm, you could tell them you last took it the night before.
>
> I completely understand not being completely honest with your doctor. There are several reasons why I have done this (and continue to do this).
>
> Example 1: I may stop a medication which is clearly making me feel worse. However, I will tell the doctor I gave it a fair trial. I have found with previous doctors, that I lose credibility if I jump ship on too many meds too early - even though many make me significantly worse.
>
> Another instance would be with my methylphenidate prescription (Ritalin). I take it occasionally (i.e. as needed). Many doctors don't like this with a stimulant, and would yank me off it, if I told them I was only taking it as a booster (as needed) med. However, doing this keeps me well.
>
> There have been times I tell the doctor I am taking my meds when I am not. I do this because I want to continue seeing a psychiatrist and trying options. Because there are times that I feel normal off meds, the doctor may assess me as being well (in Canada, psychiatrist are hard to get and there is some push out the door, once you are stable)
>
> Another example might be fore diagnostic purposes. For example. I might consider my self bipolar, yet be able to stabilize my moods with say 300mg of lithium and perhaps omega-3 and other supplements. However, most doctors would not call you bipolar, if you only need 300mg of lithium. So, I might want a higher blood level, to ensure a "diagnosis" is in place, yet not want to take 900mg every single day.
>
> At the end of the day, I have found that, when I am completely honest, and take my medications exactly as instructed, I usually end up much worse, and more impaired. So I can fully understand why somebody might want a higher blood level (for a test) yet not have to take that dose long term.
>
> Linkadge
>
>
>
>
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This is the end of the thread.
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