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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by jealibeanz on October 16, 2006, at 9:03:28
The anxiety disorder:
My anxiety is sky-high, depsite the 1 mg Xanax t.i.d. Actually, I experience *minor* panic episodes now, where I can barely breath, with extreme muscle tension, unable to move with ease, and horrible feeling of doom/despair. I never considered myself someone with panic attacks, although I'm thinking I'm falling closer to that category rather than plain old GAD.
I'd like to increase the Xanax, maybe switch to XR since my current dose gives me cover for 9 hours total max. This is not enough for a person who has about 16 hours daily of high level stress induced anxiety. I tolerate Xanax better than any psych med I've tried. It reduces anxiety when at proper levels. It's no longer too sedating, doesn't make me foggy or clumsy, and is a mild antidepressant.
I'm miserable without it(w/regard to anxiety and depression). But I don't want to look like an addict/abuser who's always looking for more, since most docs now think of daily Xanax users as the equivalent to the person on the street shooting up crack to get high. :(
My doc is sympathetic to my needs though. After I left a message about anxiety/panic problems, he called me at night from home when I couldn't be reached during the day. He immediately doubled my dose.
It makes me feel sad and weak that I'm taking this controversial med. Who knows when I'll be able to find a better option.
Posted by jealibeanz on October 16, 2006, at 9:15:54
In reply to Several disorders... need a better cocktail!, posted by jealibeanz on October 16, 2006, at 9:03:28
The excessive daytime sleepiness disorder:
I'm taking 400 mg Provigil each morning. It increased my anxiety, one of the reasons I needed to up my Xanax dose. However, it does work fairly well. It subtly allows my to be fairly awake and coherant during the day. I don't feel spectacular, always tired, but this is to be expected as a PA student, but I'm no longer sleeping 18 hours/day. I'm OK with continuing this as prescribed.
The Sleep Disorder- Chronic Insomnia:
We increased my Lunesta to 3mg a couple of months ago. It works OK, but not great, too bad they don't make a 4mg. On my days where I have 12 hours of classes + studying, I'm out like a light. On lighter 8-10 hours days and my lazy, I'm not getting out of bed weekends, I don't always sleep til 1-2AM, then sleep way too late and waste my day. I could continue with this, don't want to make too make complaints and requests at once. If need be, I'll supplement/self-medicate with OTC meds (yuck... that's when I oversleep, but it's better than never sleeping).
Posted by jealibeanz on October 16, 2006, at 10:00:05
In reply to Re: Several disorders... need a better cocktail!, posted by jealibeanz on October 16, 2006, at 9:15:54
Inattentive ADHD:
I tend to ignore and deny this one. Sometimes my doc, my PA, and I write concentration problems off as anxiety. While this is partly true, it's not the whole story.
I have all the classic risks/symtoms of inattentive ADHD:
-I'm female... girls are most likely to be inattentive and undiagnosed because we're not hyperactive, loud, or impulsive.
-I'm verrry unorganized (despite being a perfectionist in my mind, I can't follow through in real life)
-I lose/misplace everything I own (keys,purse,car!,phone,books,assignments,notes,pens,pencils,clothes,shoes,lunch... haha, on and on), many times a day, every day.
-I daydream and CAN'T pay attention to oral instructions or lectures. I fidget, swirl around in my chair, and draw during class (I still don't consider this truely hyperactive, although it's a modest manifestation). I have no ability to just sit still, be calm, and listen and absorb material.
-I consider myself an academic underachiever. I still can make A's or B's for the most part, but I know I'm just not even close to doing my best or comprehending information.
-I more or less don't study, not because I'm lazy, but because it's almost painful. My brain turns off and makes me sleepy. I constantly try to multitask and wander around. When I do sit down with notes or a book, my methods are completely illogical.
I skip around from page to page. I would never read a book starting from the beginning to the end. I often start at the end, read paragraphs on a page in reverse order (very difficult to comprehend!), or just decide to read chapters that I'm not assigned instead of what I'm supposed to due because of boredom.
I don't have a learning disorder. I'm very very good at reading comprehension and language skills, if forced to sit in a chair a take a test. But on my own, I just have completely random styles.
-There's no documented history of ADHD in my family that I know of (my sister is probably inattentive and hyperactive though). I actually have trauma-induced brain dysfunction. My lungs collapsed at birth and I suffered from hypoxia for several minutes. My frontal cortex functioning was measured a few years ago- verrrrry little activity. I was able to partially correct this through new capillary growth from intense biofeedback therapy. I'm much improved, but still need help.
If nothing else, my disorder was solidified when my classmate (who has hyperactive ADHD, so only she would actually understand and pick up on my problems) turned to me after a psych lecture of ADHD, and said "So, you have ADHD." I just looked at her, laughed, and said, "Yeah, I really do."
It was very ironic that it happened that day. We were both slightly out of control during the lecture, playing with anything we could get our hands on and completely disregarding the rest of the class.
She later was trying to explain the different subtypes to classmates who were confused. She knows her stuff and has been diagnosed since 1st grade, so she *knew* she's right about me.
Anyway, I went off Straterra in August. It helped a little at first. Maybe I could try again, maybe even try to titrate past 60 mg. Or try a different med, but something needs to be done. I can't just let myself, my doc, and others just shrug off the problem and assume I'm doing OK because I still am fairly successful in school. I could be much better. And I could definitely benefit from wasting less time being unproductive.
Posted by jealibeanz on October 16, 2006, at 10:21:18
In reply to Re: Several disorders... need a better cocktail!, posted by jealibeanz on October 16, 2006, at 10:00:05
I'm obviously depressed. I've completely lost interest in my future goals. I'm sad, hopeless, overwhelmed, desperate and cry all the time. I have no motivation to do anything. I don't feel like hanging out much with friends.
I know it's very common for people in my situation. All of my classmates are unhappy, and I'm sure some are depressed. Many think about or have tried to drop out. So, I'm not alone, but it doesn't make it OK. Everyday I consider leaving and don't care what it will do for my future.
So, due to my horrible mood, I don't want to go to my appointment. I don't want to force myself to be friendly and polite to the office staff who know me well and will of course want to know how I'm doing at school.
Obviously going to the doctor isn't a fashion show, but this is my field, and I feel the need to look semi-professional. They're used to seeing me dressed to the 9's, happy, energetic, and enthusiastic, which I was last year when interning there.
I look horrible right now. I'd have to actually shower for the first time in a couple of days (I have a long weekend), probably should cut my hair since I haven't in many months, put on makeup and not look like a loser. I should buy a half-way decent looking outfit that fits. I have nothing but hoodies and jeans that I wear now because I've put on weight due to the depression, less exercise more junk food because it helps relieve anxiety and sometime I like to lie in bed all day instead of moving.
I refuse to take an antidepressant. They all make me gain a lot of weight and feel apathetic. I'm already at that point, we don't want to add to it.
I don't want to go in and tell my doctor how horrible school is, how I think the whole education process and stressful workplace is insane, and that they must all be insane for choosing this career (although I'm sure they either felt this way or knew many many friends who did at school). I fed up with healthcare/medicine right now, it's all I do. The last place I want to go right now is a doctor's office:(
Posted by Squiggles on October 16, 2006, at 10:29:23
In reply to Several disorders... need a better cocktail!, posted by jealibeanz on October 16, 2006, at 9:03:28
The problem is not with the Xanax. The
problem is with the lack of monitoring tolerance
to the Xanax. Tolerance and withdrawal to benzos is very dangerous. Maybe some of these people that go nuts-- e.g. car rage have reached tolerance, and then withdrawal.Psychopharmacology is a course that should be
a prerequisite to a degree/license to practice psychiatry, imho.I made a fuss about it at benzo.org because i got addicted to it without an adjustment, so i know i have "BENZO ADDICT/ACTIVIST" stamped on my forehead and have to be discreet about asking for it, less i appear as if i don't know what i want.
My sympathy.I hope your dr. understands. It's becoming au courrant now to examine psychoactive drugs with a microscope in the medical field. Lots of conferences and it's not all blamed on Scientology.
Squiggles
Posted by Squiggles on October 16, 2006, at 10:47:31
In reply to But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 10:21:18
Would it help if you got a friend to
come with you and wait for you while
you speak to your therapist/doctor/psychiatrist?That mind lend some support.
Squiggles
Posted by jealibeanz on October 16, 2006, at 11:24:46
In reply to Re: But I don't feel like going... » jealibeanz, posted by Squiggles on October 16, 2006, at 10:47:31
No, I don't have anyone to go with me right now.
It's just tough because obviously I don't even feel like dragging myself there for one thing. I don't feel like fighting for myself and getting all my concerns properly addressed.
It's hard to go through trials and failures of meds, as everyone here knows. Finding a balance between managing anxiety and insomnia, which require sedatives, along with the fatigue and ADHD, which require stimulants is so hard.
I know I can't place all these as priorities because we not going to make 3 or 4 med changes at once. So I have to decide what's most important to me.
And I either have to admit to depression and refuse meds or pretend I'm happy. This would be really hard to deny due to my current situation and emotions. I'm usually a very positive person when speaking to my doctor, but that's certainly not going to happen right now. It actually would seem a bit odd if I were happy right now if you were to ask me about my frustrations with medications, along with the stress and pressure of school.
Oh well, I guess I have to decide whether not to go. And then what I'm going to focus on.
Posted by Squiggles on October 16, 2006, at 11:33:03
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 11:24:46
You say your anxiety is sky high; that
would prevent you from making any decision
with ease.When I am in a tight situation like that,
I call my doctor, and ask for (say an increase
in Xanax) right away -- if only for a short
term, until you are calm enough to decide
to go or not.I think drs. generally can give something
on a short-term basis for need-now basis.Squiggles
Posted by Phillipa on October 16, 2006, at 11:52:58
In reply to Re: But I don't feel like going... » jealibeanz, posted by Squiggles on October 16, 2006, at 11:33:03
What is happening? I've gotten three e-mails today from people who all of a sudden their anxiety is out of control including me. Then I worry and this wears me out. A viscous cycle. Love phillipa
Posted by Squiggles on October 16, 2006, at 12:04:50
In reply to Re: But I don't feel like going..., posted by Phillipa on October 16, 2006, at 11:52:58
We live in interesting times.
And i fear, they are going to get
even more interesting.Squiggles
Posted by jealibeanz on October 16, 2006, at 12:58:24
In reply to Re: But I don't feel like going... » jealibeanz, posted by Squiggles on October 16, 2006, at 11:33:03
He actually refilled my prescription by phone for Xanax last week. I have taken a bit more than prescribed. Most days up to 4 mg. I know most people consider this a big no-no in terms of getting your doc to trust you with abuse and obtaining further scripts.
However, last time when I was having problems I told him due to the panic attacks (OK, I know realize this is what is happening), I explained how I had experimented over a few days, increasing the Xanax, descreasing the Provigil, at various levels. I told him what worked. He prescribed exactly what I wanted.
He trusts me. He knows I'm very intelligent, sensible, rational, and incredibly acutely aware of changes in my body. At my last visit I actually told him I was taking less than prescribed because obviously pushing it too high just leads to fatigue and lack of productivity.
I have more than enough since I just filled this script, than I can take extra for the appointment. I just will have to be careful so that I don't use up too much before the month is done, in case decides to keep it at my current level.
Posted by Squiggles on October 16, 2006, at 13:02:01
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 12:58:24
God bless him, or whoever the deities responsible
for doctors are! :-)But do check the cause of the problem when
you are better.Squiggles
Posted by jealibeanz on October 16, 2006, at 13:02:59
In reply to Re: But I don't feel like going..., posted by Phillipa on October 16, 2006, at 11:52:58
Phillipa, why does this have an impact on you? I didn't email you, and certainly never would do so because I don't want you hearing any more negative comments.
We are all different. I am going through life situations and medication adjustments that are causing my anxiety. We all have different situations. The world is not coming to an end. Anxiety isn't contagious.
Please disregarding any posts that cause you distress. I am one who tends to gravitate and remember the positive responses from members. You should do the same. I let the negatives go in one ear and out the other. You should as well.
Posted by jealibeanz on October 16, 2006, at 13:06:07
In reply to Re: But I don't feel like going... » jealibeanz, posted by Squiggles on October 16, 2006, at 13:02:01
Hahaha... the cause of the problem? Not hidden at all! First of all, I've always had chronic GAD. This is greatly exacerbated by the fact that I'm in PA school! While not a horrible place, I like my friends, classmates, professors, and the entire atmosphere of the place. There's no avoiding that fact that these programs definitely trigger people who have had anxiety/depression in the past.
Posted by Squiggles on October 16, 2006, at 13:07:59
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 13:06:07
What's PA school?
Posted by jealibeanz on October 16, 2006, at 13:12:25
In reply to Re: But I don't feel like going... » jealibeanz, posted by Squiggles on October 16, 2006, at 13:07:59
physician assistant (aka the 15 months condensed, less scientific, version of med school) = overwhelming!!!!
Posted by Phillipa on October 16, 2006, at 19:07:20
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 13:02:59
No No I didn't insinuate I hope that you had e-mailed me but it seemed very strange to me that people I e-mail with and don't have anxiety seem to have it in the last few days. I try and anaylze a lot. It's my personality. You haven't said or done anything that is upsetting to me. I know we are all different. But it's as if a full moon when I worked in psych we were innundated with admissions. that's all. An observation. Love Phillipa
Posted by Phillipa on October 16, 2006, at 19:12:48
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 13:12:25
Ahhh but gratifying. And I do disagree as my RN was a two year course when it used to be three. I loved every moment of it. And didn't find it that stressful and the instructors were so kind to us and always there for us. Love Phillipa. ps if I'd graduated one year earlier I would have gone to PA school too. But that year they changed the rules so to speak and you then needed a Bachelors Degree first. Darn I would have loved it.
Posted by jealibeanz on October 16, 2006, at 19:41:04
In reply to Re: But I don't feel like going... » jealibeanz, posted by Phillipa on October 16, 2006, at 19:12:48
Yes, but we are talking about two different careers and education pathways. I'm not saying RN is easy and void of stress by any means, but it's apples to oranges. We do have very supportive faculty, nonetheless, it's still extremely overwhelming, difficult, and scary to think how much responsibility and influence we will have.
Posted by Phillipa on October 16, 2006, at 19:56:16
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 19:41:04
Not really as nurses run the codes and are responsible for orders MD's write. We have to know all meds and correct doses. And it won't be thrown at you all at once. You can do it I know you can. Please don't do what I do catastrophsize. And I do care . Love Phillipa
Posted by jealibeanz on October 16, 2006, at 20:03:36
In reply to Re: But I don't feel like going... » jealibeanz, posted by Phillipa on October 16, 2006, at 19:56:16
Oh, I realize that nurses have an enormous amount of responsibility. Yet, there seems to be a common trend to PA/med students (although MD/DO's are certainly under much more stress and have to learn much more than PA's), that many become depressed. If not depressed, many do not like that period of their life. Of course there are exceptions. Some people are happy no matter what they're doing. Many of our faculty members have admitted this to us recently as they noticed we were struggling.
Posted by Phillipa on October 16, 2006, at 20:13:48
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 20:03:36
Hummm interesting. They say pdocs have the highest rate of suicide. And Jelly you will be fine. I know you will you are billiant. Love Phillipa
Posted by Jost on October 16, 2006, at 23:10:03
In reply to Re: But I don't feel like going... » jealibeanz, posted by Phillipa on October 16, 2006, at 20:13:48
Jeali, did you ever talk to you GP about the AD-- you were interested in Emsam, but even Parnate might be worth trying.
Maybe it's time to tell him more about what you've been experiencing emotionally.
If you're terribly worried about weight gain, Parnate or Emsam seem like good choices. And if, by some chance, you do gain weight-- it won't be much.
Plus one of those might give you more energy, and reduce some of the anxiety. I've found both of them anxiolytic--
It's hard to fight against negative thinking, and the sense of futility-- and therefore to do what might help for youself, when it feels so hard-- but this might be that point when you need to take it to a more honest level with your doctor. He didn't react as you'd feared, last time around.
Plus, I worry that the dose of xanax is getting high. Maybe it's okay for you-- but my pdoc, who's worked with physicians who've become addicted to xanax, says it's a really awful struggle to get off, if that happens.
He mentioned 4 mg a day as a dividing line around which you get into the more addictive levels. Try to be careful, maybe cut down on days when you can?
Jost
Posted by jealibeanz on October 16, 2006, at 23:31:06
In reply to Re: But I don't feel like going..., posted by Jost on October 16, 2006, at 23:10:03
Yeah, the Xanax dosage worries me. It's not quite strong enough and only 9 hours or so is only half my day. I don't want to mention it because I know this is risky.
I'm tired of all this, having to worry about meds that help me not worry is ridiculous. I'd rather stop everything right now- medication, school, etc. I'm done with this game.
Posted by jealibeanz on October 17, 2006, at 11:24:15
In reply to Re: But I don't feel like going..., posted by jealibeanz on October 16, 2006, at 23:31:06
Well, my worries about my problem were solved... I was held up in traffic for 30 min extra than planned. Since I was the last appt before lunch, I could just call and say I was going to be a little late. They won't let me reschedule for the only days I can make it, Saturdays, because those are generally reserved for sick people who can't come during the week or become sick that day and make an appointment, not for rechecks. They've bent this rule for me before, since I'm in an unusual situation, apparently we didn't want to be accomodating today. So, I'm screwed. The only breaks I have are days when the office is closed. I won't be able to come for 2 months now when my semester ends. Great.
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