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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by ace on November 3, 2007, at 0:19:58
Girls and guys!
first of all i am really sorry if i missed any messages someone posted at me last time...I think sorry to Ron is in order...I just have so much workload, but I don't want to ignotre anyone. Unlike on myspace where it is common practice!
Now, I am in a tad of a jam.....!!:)I have to get wisdom teeth out, and YES- i have to stop Nardil, due to absolute contraindications...Otherwise Ace will be digging up daisy'....(I am too young and handsome to die now:))
One good thing is it my 'refresh' my biochemistry, but nardil has been working great as of late.....at times really brilliant.
HELP!!!!!!!!!!!!!!!!!
Ace:)
Posted by Cecilia on November 3, 2007, at 0:56:52
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
I suggest getting another opinion. There are lots of different types of anesthesia and some are ok with MAO's. If you were hit by a car and needed emergency surgery, they wouldn't operate on you without anesthesia, they would find an experienced anesthesiologist who knew what types are ok. I bet your dentist is just too lazy to look into alternatives to his usual practice. Cecilia
Posted by Justherself54 on November 3, 2007, at 11:11:25
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
I had to stop parnate when I had my surgery..both my pdoc and the doctor administering the anesthetic advised me to stop. Personally, as it was elective surgery, I felt more secure having the surgery without parnate..it was a scary enough experience in itself, without knowing there could be complications from it being in my system..that's just me..
The washout period wasn't as bad as I expected..I didn't relapse into depression although I had to take more clonazapam for post surgery anxiety (just about cancelled it a few times)then for over a week I was pretty happy on morphine and then T3's..
We're still not sure if it was restarting Parnate that caused me to have severe chills or just a slower recovery from the type of major surgery I had..
In any event, if I have to have any elective surgeries in the future I will still go through the washout period..as the doctor explained to me..he wanted the surgery to be as safe as they could make it. I did ask him what would happen if I was in a car accident or something where I had to have urgent surgery and was on a MAOI..he told me they would have no choice but to do surgery but the risks of complications would be far greater..
My surgery was in a major hospital and I got the distinct impression from the doctor they would have refused to do the surgery if I had insisted on staying on the MAOI..
Hope your surgery goes well Ace..keep us posted!
Posted by Phillipa on November 3, 2007, at 11:38:54
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
Ace I agree with Cecelia but could you have it done in a hospital and maybe not have to go off it as I know you had problems when you stopped before I think you said cause of being really busy????I mean we need our Nardil Champ!!!!!Love Phillipa
Posted by cumulative on November 3, 2007, at 15:52:04
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
I don't know. I think there are numerous opioids that you could get that are NOT contraindicated with MAOIs. I think you need to research, and tell your dentist this, because they are misleading you if they tell you otherwise.
I know a number of people who went without pain meds after surgery, or only did it for a few days. It's not as big a deal as it's hyped up to be.
Posted by bleauberry on November 3, 2007, at 18:43:47
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
You know as well as I do how many times people get screwed up by messing with their meds that are working. You might stop nardil, return to it, and be fine. Or not fine. Maybe it never works as well again, ever. You know how this stuff is. I think the risk is way way way too high.
I'm not knowledgeable on anesthesia, but I know there has to be something on this planet you can take with nardil. It is in your best interest to do some serious google searching, calling other dentists, digging deep into the psychiatrist, etc.
Can you take tylenol or advil? My dentist hardly ever prescribes opiates or heavy pain relievers because he says the combination of tylenol plus advil at the same time works almost as well.
People have had their teeth pulled out without anesthesia. I had it done once. But not a wisdom tooth. I know someone else who did it. The trick is how my dentist did it. He would hook his tool around the tooth and then gently slowly rotate it in a circle, ever so slowly widening the circle, until it was fairly loose. About half a minute. Then he would let it rest for about 15 mintues, come back and do it again. After another rest he came and with the same circular motion got it out in one yank. The circular stuff has really loosened up the ligiments to let the tooth go easily.
He is not an ordinary insurance company sponsored ADA dentist. He is one who specializes in bio-dentistry...the safe removal of amalgams, etc. Believe me, those guys are multitudes more skilled than ADA dentists. Get one of them, and I'm sure you will have options that do not require stopping nardil.
Posted by tecknohed on November 4, 2007, at 15:57:38
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
I don't understand why you need to come off the Nardil. What other drug(s) is your dentist wanting to administer?
I'm currently taking an MAOI (Marplan) & have had recent dental treatment. I had a filling extracted and a root extracted. Local anesthetic was all I needed. I know extracting wisdome teeth is a bigger deal (probably more painfull?) but I dont see why local anesthetic wouldn't suffice.
Apart from local anesthetics, the only other meds administered for the surgery seem to be anti-anxiety meds: http://www.animated-teeth.com/wisdom_teeth/t4_impacted_wisdom_tooth.htm
If it is anti-anxiety meds that they are administering (hence the so-called contraindications) then say that you dont want them and just take extra Xanax. Thats what I did with my Klonopin.And like others have said, get a second opinion.
IMO, sacrificing your mental health for dental surgery is 'insane' if it doesn't REALLY have to be that way, which I doubt it does.
Best of luck!
teck
Posted by tecknohed on November 4, 2007, at 16:02:05
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
Also, I took OTC painkillers (paracetamol + ibuprofen) PRIOR to my appointment, so by the time the surgery was taking place the painkillers had already kicked in.
Posted by Phillipa on November 4, 2007, at 18:17:38
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Ma » ace, posted by tecknohed on November 4, 2007, at 16:02:05
Laughing gas was given to me. Also novacaine can give you a rapid heartrate so hence not only lidocaine. Phillipa
Posted by Iansf on November 6, 2007, at 23:42:18
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Ma » ace, posted by tecknohed on November 4, 2007, at 15:57:38
I also had two wisdom teeth, as well as one non-wisdom tooth, pulled with local anaesthetic. It was unpleasant but painless.
In addition, I know people who have had teeth pulled under hypnosis. There are certified medical hypnotists who specialize in putting people in trance for surgery. You might check into that option.
Posted by Ron Hill on November 7, 2007, at 21:15:15
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
Ace,
> first of all i am really sorry if i missed any messages someone posted at me last time...I think sorry to Ron is in order...I just have so much workload, but I don't want to ignotre anyone.
No problem, Ace. At the time, I fully understood that you were (and probably still are) overloaded with your studies.
> I have to get wisdom teeth out, and YES- i have to stop Nardil ...I agree with other posters; do some research and find a way that it can be done without temporarily taking yourself off of Nardil.
You may be different, but if I try to even slightly reduce my Nardil dosage, I quickly fall into depression. Realistically, I think it would take six months to a year to wean myself off of 90 mg of Nardil. However, you have increased and decreased your Nardil dosage in the past, so you might have a pretty good idea of what it would take.
If you do end up deciding to wean yourself off of Nardil for the surgery, maybe you could wait until summer break?
> ....(I am too young and handsome to die now:))
And humble too, aye Mate? ;-)
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
7.5 mg/day Deplin
Posted by kaleidoscope on November 9, 2007, at 12:09:45
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Man! » ace, posted by Ron Hill on November 7, 2007, at 21:15:15
Hi Ron
What benefit do you get from Keppra? I guess I'm suspicious because there's virtually no evidence to support its use in psychiatry, although it's clearly useful in epilepsy.
Ed
Posted by Ron Hill on November 12, 2007, at 3:42:29
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Man! » Ron Hill, posted by kaleidoscope on November 9, 2007, at 12:09:45
> What benefit do you get from Keppra? I guess I'm suspicious because there's virtually no evidence to support its use in psychiatry, although it's clearly useful in epilepsy.
Ed, so sorry to be so slow to answer. I've been swamped with projects for the past few days and, therefore, I have not been on PB. Again, sorry to leave ya hanging.
Keppra does an astonishing job in the tx of my bipolar rapid cycling. Actually, there is quite a bit of open trial results and case study reports. I'll send you some links and discuss my personal experience with Keppra in detail within the next couple of days. Hopefully tomorrow, but it might be a couple of days.
I gotta hit the hay right now. Talk to you soon.
It's great to see you again, Ed. How is your anxiety disorder doing? Are you still using Paxil? What else? What does a benzo do to you? If you are on an antidepressant, there is something I’d like to mention.
Talk to you in a day or two.
-- Ron
dx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
15 mg/day Deplin
Posted by tecknohed on November 12, 2007, at 6:00:55
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
Posted by kaleidoscope on November 12, 2007, at 15:34:36
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Man! » kaleidoscope, posted by Ron Hill on November 12, 2007, at 3:42:29
Hi Ron
> Ed, so sorry to be so slow to answer. I've been swamped with projects for the past few days and, therefore, I have not been on PB. Again, sorry to leave ya hanging.
No problem!
> Keppra does an astonishing job in the tx of my bipolar rapid cycling. Actually, there is quite a bit of open trial results and case study reports.
I've see some open trials. I meant randomised-controlled trials really. Open trials can be misleading. It's fantastic that it's working so well for you though.
>How is your anxiety disorder doing? Are you still using Paxil? What else? What does a benzo do to you? If you are on an antidepressant, there is something I’d like to mention.
I'm on citalopram but I'm tapering off it at the moment, I'm not sure I need it anymore. Benzos tend not to be very effective for me. Low doses don't work and high doses make me aggressive and depressive.
Take care
Posted by sdb on November 13, 2007, at 18:35:44
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Man! » Ron Hill, posted by kaleidoscope on November 12, 2007, at 15:34:36
> Hi Ron
>
> > Ed, so sorry to be so slow to answer. I've been swamped with projects for the past few days and, therefore, I have not been on PB. Again, sorry to leave ya hanging.
>
> No problem!
>
> > Keppra does an astonishing job in the tx of my bipolar rapid cycling. Actually, there is quite a bit of open trial results and case study reports.
>
> I've see some open trials. I meant randomised-controlled trials really. Open trials can be misleading. It's fantastic that it's working so well for you though.
>
> >How is your anxiety disorder doing? Are you still using Paxil? What else? What does a benzo do to you? If you are on an antidepressant, there is something I’d like to mention.
>
> I'm on citalopram but I'm tapering off it at the moment, I'm not sure I need it anymore. Benzos tend not to be very effective for me. Low doses don't work and high doses make me aggressive and depressive.
>
> Take care
>hi k!
Take care, good if it will probably work without drugs for you.
warm regards
sdb
Posted by Ron Hill on November 14, 2007, at 12:42:40
In reply to Re: Oh no!!!!!!! I am in big trouble!!!!Nardil Man! » Ron Hill, posted by kaleidoscope on November 9, 2007, at 12:09:45
> Hi Ron
> What benefit do you get from Keppra? I guess I'm suspicious because there's virtually no evidence to support its use in psychiatry, although it's clearly useful in epilepsy.
Keppra works great to tx my bipolar II ultra rapid cycling. I always go through one complete cycle every 15 days. Let me tell my background before discussing Keppra.My ultra rapid cycling was induced in 1996 by a p-doc who, without any testing, misdiagnosed me as ADHD, and started feeding me Ritalin. Initially, the Ritalin caused me to hyper-focus, with good energy, and motivation.
This was the first time that I ever visited a pdoc. Unfortunately, I knew nothing about p-dx's and nothing about p-meds. I went to see the p-doc because I was having trouble staying motivated to work hard at my job as an engineer.
Like you, Ed, I believe that a full day's pay deserves a full day's effort. Therefore, I was trying to find out why I lacked the motivation and energy that I had always had for my job prior to then.
Well, long story short, within a couple of weeks of taking 20 mg/day of IR Ritalin, I became VERY IRRITABLE with severe mood swings. I went in and told the pdoc that I needed to stop taking Ritalin because of the severe mood swings. His response was; "Stick with me, we can add Paxil to the Ritalin and it will take away the moodiness".
As a bipolar patient, the SSRI without any moodstabilizer on-board pushed me into a full blown mania. Further, I began to rapid cycle. I was not yet married, so I did not have anyone to tell the pdoc that I was all screwed up. The pdoc was apparently oblivious to my condition.
For example, while in mania one time I bought the pdoc a $350 fly fishing rod. He accepted it with a smile and a thank you, but no mention of mania. Hell-oh, pdoc; his lights were on, but apparently nobody was home.
My workplace put up with my completely inappropriate manic behavior for as long as they could, but eventually they had to show me the door. A couple of months later I fell into a debilitating atypical depression that I could not pull out of.
No job, no income, and so debilitated with depression that I could not even go out to apply for jobs. Further, Paxil caused me to gain so much weight that none of my business clothes fit.
As a result, Ed, I lost everything except my house, and I darn near lost it as well. I even cashed in my retirement account. All because a pdoc did not take time to give me a simply screening test.
A screening test plainly shows that I have bipolar disorder and NOT ADHD. Can you say malpractice? However, I was so bad off that I was not able to contact a malpractice attorney before the two-year Statute of Limitations ran out. In fact, I've only recently gotten well enough that I would be able to contact the proper attorneys and follow through with the malpractice process.
Geeze, my long-story-short turned out to be more long than short. Sorry. But, I gave all this history to say this: Before starting Keppra, my cycle consisted of ten days of deep debilitating depression, one day of dysphoric mixed state, and four days of normal mood. The process repeated over and over and over and ... over ..., never ending. I can set my watch by my cycling frequency. The timing is that predictable.
The most useful thing I've ever began, was to start tracking my mood states daily using a scale of 0 to 5 in an Excel spreadsheet format. Excel then presents these data graphically. The depression verses time graph is absolutely eye opening, because it so clearly shows the ultra rapid cycling frequency, severity, and pattern.
Each day I enter numerical values (0 = no symptoms, to 5 = dead from ..., well you know). I track the severity of the following mood states; 1) Depression, 2) Hypomania, 3) Irritability, and 4) Obsessive Compulsive Personality Disorder symptoms. Each of these four major categories is displayed on four respective graphs.
My OCPD symptoms are usually very mild. In fact, with the addition of Deplin, I no longer have OCPD symptoms, nor do I become irritable.
I suspect that my OCPD symptoms may be what you deal with, although you have it much worse than I do. Keep it in the back of your mind that Deplin took away all of my OCPD symptoms via what feels to me like a serotoninergic action, but without the SSRI-induced apathy thingy. But, of course, Nardil is playing into all this as well in a very beneficial manner.
My irritability and OCPD symptoms are always zero since I added 15 mg/day of Deplin. My wife says the Deplin has changed me from "growly-boy", to "lovey-dovey boy". And my mood tracking data support her observation.Getting back to your question, Keppra greatly reduces the severity of my rapid cycling. I still complete one full cycle every 15 days, but since the addition of Keppra, my cycle consists of two or three days of depression, and twelve or thirteen days of a normal mood state.
Paradoxically, if I take any more than 1000 mg/day, Keppra makes me depressed. The PB archives show that this happens to a lot of pts taking Keppra.
My med cocktail is currently working very well. The addition of Deplin has brought back my belly laughter, enjoyment of a sunset, the smell of a fresh rain, etc. As I previously mentioned, Deplin has completely taken away my irritability and my OCPD symptoms. However, I have only been taking it for a little more than three weeks. Time will tell with regard to long-term efficacy.
However, despite the fact that the severity and duration of my depressive phases have been lessened tremendously, I still cycle into an atypical mini-depressive phase (i.e.; low energy, lack of motivation, sleepy-tired, etc), for two or three days out of every 15 day cycle. But, with one very recent exception.
During my most recent depressive phase a few days ago, I got to thinking that perhaps my 15 day cycling is somewhat akin to other types of cycling that are hormonal in their cause. So, as I was entering depression this time, for one day on a PRN basis, I applied four pumps of Androgel, exogenous testosterone applied dermal. And, by golly, I instantly snapped out of the depressive and I did not return to depression after the one day of testosterone tx. Way too early to tell if it will continue to work, but it worked this time. As always, time will tell.
Ed, read my post regarding Deplin that I posted earlier today:
http://www.dr-bob.org/babble/20071104/msgs/795014.html
Also, here are some links to abstracts of a few small open studies and case histories. And, your are right, I've not seen a good double blind study on Keppra tx of bipolar disorder or bipolar rapid cycling. None the less, many researchers and pdocs are very intrigued by a tx that might reduce the hard to treat rapid cycling:
http://jop.sagepub.com/cgi/content/abstract/17/2/239
The follow are for the tx of p-disorder other than bipolar disorder:
-- Rondx: Bipolar II, with ultra rapid cycling (15 days for one complete cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil
15 mg/day Deplin
4 pumps of Androgel on a prn basis.
Posted by Jeroen on November 18, 2007, at 5:09:31
In reply to Oh no!!!!!!! I am in big trouble!!!!Nardil Man!, posted by ace on November 3, 2007, at 0:19:58
HI, i am currently taking anti biotic for the infection on my wisdom teeth
I also take Zyprexa, and Temesta
what i am reading here, is this dangerous???
Posted by Jeroen on November 18, 2007, at 5:20:08
In reply to URGENT REPLY NEEDED!!!, posted by Jeroen on November 18, 2007, at 5:11:17
they need to be removed
Posted by yxibow on November 18, 2007, at 9:51:12
In reply to URGENT REPLY NEEDED!!!, posted by Jeroen on November 18, 2007, at 5:11:17
> HI, i am currently taking anti biotic for the infection on my wisdom teeth
>
> I also take Zyprexa, and Temesta
>
>
> what i am reading here, is this dangerous???
>Neither Zyprexa nor Temesta (Ativan) would have any effect on your wisdom teeth. I have no idea what antibiotic you are taking since you didn't mention it. A few can cause psychiatric problems such as Biaxin but there are plenty of choices out there. Also plenty of choices for 100% successful anaesthesia if you choose general instead of local for removal.
Posted by Phillipa on November 18, 2007, at 10:24:39
In reply to Re: URGENT REPLY NEEDED!!! » Jeroen, posted by yxibow on November 18, 2007, at 9:51:12
Biaxin????Was on it for three years three months at a time for lyme's disease you said psychiatric what type? Jeroen I don't think you will have a problem with your teeth when they are out and the infection gone I'm sure you will feel better and what is your antibiotic? Phillipa
Posted by gardenergirl on November 18, 2007, at 11:22:16
In reply to Re: URGENT REPLY NEEDED!!! » yxibow, posted by Phillipa on November 18, 2007, at 10:24:39
Biaxin XR (XL?) made me hypomanic when I took it for a week for a bad sinus infection.
gg
Posted by yxibow on November 18, 2007, at 12:38:33
In reply to Re: URGENT REPLY NEEDED!!! » yxibow, posted by Phillipa on November 18, 2007, at 10:24:39
> Biaxin????Was on it for three years three months at a time for lyme's disease you said psychiatric what type? Jeroen I don't think you will have a problem with your teeth when they are out and the infection gone I'm sure you will feel better and what is your antibiotic? Phillipa
No, it was for some random short term infection, we switched it to something else, for a lack of a better scientific term, I really can't remember the feeling it was quite a while ago.. mm.. "nuts" (no offense to our mental illnesses)? No hallucinations or anything like that, just off kilter.
Posted by kaleidoscope on November 18, 2007, at 16:57:28
In reply to Keppra » kaleidoscope, posted by Ron Hill on November 14, 2007, at 12:42:40
Hi Ron
What a fascinating story. Thank you for telling me. Have you just started the Androgel? I don't remember you mentioning it before.
Ed
Posted by tecknohed on November 18, 2007, at 17:48:22
In reply to Keppra » kaleidoscope, posted by Ron Hill on November 14, 2007, at 12:42:40
Thanks for posting your story Ron. Sounds like you've been to hell & back - & IMO that WAS DEFINITELY malpractice! I mean if I gave my pdoc a fly rod he'd definitely suss something was up!
Anyway, I'm interested in this Keppra. My pdoc beleives I would benefit from a mood stabiliser. I do get mood swings & irritability but I've never considered myself bipolar (though I may be for all I know). I've tried lamotrigine twice but find it too sedating. I wouldn't want to try lithium...yet. Questions: does Keppra just stabilize you mood or does it have any other benificial effects? Does it enhance your other meds (esp. Nardil) or have any mood elivating effects of it's own? Any side effects?
Also, whether you get side effects or not, do you take B6 with it? I found these: http://www.aesnet.org/Visitors/AnnualMeeting/Abstracts/dsp_Abstract.cfm?id=3367 & http://www.blackwell-synergy.com/doi/abs/10.1111/j.1528-1167.2005.460801_16.x (abstract 2.163).
And do you know if Deplin is available on prescription in the UK?
Glad you're doing well! Nice to see ANY success on this board which is (unfortunitely) a pretty rare occurance!
Thanx in advance for any answers you (or anyone else) provide.
teck
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