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Re: Chronic benzos, mood + memory. Hoover + exper mattdds

Posted by Larry Hoover on April 19, 2009, at 8:15:07

In reply to Re: Chronic benzos, mood + memory. Hoover + exper, posted by mattdds on April 17, 2009, at 19:50:45

> The mil p-docs even sent me off with a bucket of Klonopin (the only time they were liberal with benzos). Insane who they'll send these days.

I suspect your skill set might have been one variable they considered.

> I am very fortunate to be back in one piece. Better people than me have not been so fortunate. I did come back with a life experience that few get (or want). I'm not a true believer in the war by any means, but it did build character. I complain a lot less about things back home now.

I'm glad for that. Character building is a good thing. War is often random, and better and lesser men are equals, methinks.

> Yeah, I got out of the quacksilber business and am heading into my second year in OMFS. I don't know why I do this to myself. I do enjoy the work though - it can be very gratifying, and I'm learning tons.

Well, again, I think you're answered your own question. What were you saying about better men? I think I perceive cream rising to the top.

> > I got news for you. You're aging. No faster and no slower than the rest of us, though. I'm more concerned that a high stress lifestyle might be cumulatively burdensome. I'm big on coping strategies such as regular sleep, exercise, good nutrition, social supports, indulging in hobbies.
> Yeah, you ain't kidding. I feel it big time too. You're absolutely right about the multifaceted approach. With my life choices (i.e. the OMFS residency), all those luxuries like eating food that isn't out of a vending machine and sleeping are not often options.

I think many people downplay lifestyle factors, thinking a pill is somehow going to fix them. Not that I was suggesting that to you, but stress is inherent in all that you've described. Stress management is my mainstay for mental stability.

> I seriously considered dropping out during my general / vascular surgery rotation - rounds at 5:30 am, 18-20 very ill vascular patients on the ward, an attending with an ego bigger than...I can't think of anything that big at the moment. Getting out at 10 pm. I truly feel sorry for general surgeons.

You could have gone into dermatology. I'm sure that has better hours. ;-)

> Life is good for now, I'm on anesthesia for 2 more months and getting out early and even eating well and exercising. People are happier in that line of work that gets passed on to me. I met my wife and daughter again too! Turns out they're fascinating people!

Heh! heh! I'm glad they'd have you back. :-)

> > So, why is it you're cutting back on the clonazepam? Not enough risk in your life? <teasing, but seriously teasing>
> Probably the same reason I chose to take on the residency - overestimating myself and my capacity to cope and continuing to neglect myself (it will pay off eventually... right?).

Everybody tests the boundaries, even the ones forged by their own experience. They forget the importance of the factors that led to their creation. I eat at MacDonald's once every couple of years, and only then do I recall with clarity why it's only once every couple of years.

Somehow, Matt, I suspect that you have not over-estimated yourself at all. Residency is boot camp for doctors. Boot camp teaches the grunts not to under-estimate themselves, right?

> I'm tapering because my oh-so-caring doc reminded me that I'm a resident surgeon who takes a benzo and that I should take an SSRI and propranolol like all the rest of the good little surgeons do. I was frustrated and baffled, but I took that chance to do a trial taper and it hasn't been as bad as I thought. I'm taking it SLOW, and refuse to feel any withdrawal.

I get a sense that you are being asked to fix what ain't broke? Were you having adverse reactions to the clonazepam?

> Clonazepam has been a lifesaver over these difficult years, but I love the idea of not being dependent on psychiatrists - I really have gotten fed up with the federal health care system. The good patient-oriented psychiatrists are the exception rather than the rule in my experience. There is far too much cover your a$$ mentality at the expense of the patient. Probably due to the high demand for mental health care in the military, very little thought appears to go into their treatment plans. For anxiety, It's pretty much SSRI or suffering.

It may be that my exposure to data is biased, but I am of the belief that adverse events are far more likely to accrue to users of SSRIs than to those using benzos. There always seems to be a lag between when a "new and better" treatment comes to the marketplace, and when "sober reflection" is brought to bear on the actual effects of the treatment. Those are two distinct statements, by the way. Next in line, time-wise, behind the SSRIs, would be the atypical antipsychotics. Anyway, getting tangential here.

> > I would describe medication for mental illness as generally being an incomplete treatment.
> Couldn't agree more here. As I have gotten older, I've lost a lot of my initial enthusiasm in meds and conventional psych treatments. I could go on about how modern psychiatry hinders a more thorough approach, but that's for another forum. The bottom line is that if you want to get better, you really need to be very proactive with your health, because nobody else will.

Precisely. And I might add, the doctors can't do it all.

> > Well, you got me looking. Phase III clinical trials (one for GAD, one for depression) have wound up for Pexacerfont, a CRF-1 antagonist drug. They only recruited females, though. Nothing published yet.
> > And there is another one called antalarmin. Doesn't work well as a standalone drug, apparently. If they could come up with a CRF-2g antagonist, that might be great, as those receptors are only in the amygdala.
> The name is a bit smarmy - antalarmin?

I was totally amazed by that name. I thought it more suited to the Internet snake oil school.

> However, I like that these are still being investigated. I hate my amygdala, by the way.


I think we're getting closer to understanding how to regulate it. I think cannabinoids may be a useful route of inquiry.

> > Good to see you, Matt.
> Likewise, Lar. You're a huge intellectual asset here. People who post here, including me, are very fortunate to "have" you.

That's so very kind of you to say. Thank you.

> So now that I vented to you, what have you been up to these days?
> Matt

Well, my recent years have been occupied by a novel medical stressor.

I fell and broke my arm in 2004. X-rays indicated a non-displaced radial head fracture, so treatment was conservative (sling and physio). Unfortunately, I had a malunion (step deformity), and it seemed the edge was catching on a ligament. After a lengthy delay to see an elbow specialist, I had an osteotomy and fixation. Unfortunately, I experienced a re-injury of my ulnar nerve during that surgery (first injured during my fall), and came out of the anaesthetic screaming. Since that point in time, I have endured severe and unremitting pain. Thankfully, I was quickly referred to a pain clinic, where I was diagnosed with Type 1 Complex Regional Pain Syndrome (used to be called Reflex Sympathetic Dystrophy, or causalgia).

I could not tolerate opiates after about a year, and since then I've relied on periodic stellate ganglion nerve blockade, and mindfulness meditation. I've only recently been able to post again. I was quite incapacitated by it, for a good long time. I still have hyperalgesia and allodynia, but my symptom baseline is in steady decline since the nerve blocks were initiated.

Apart from the period during which I withdrew from the opiates, my mood has been stable. I attribute that to my collection of coping strategies, mostly acquired from prior experience.





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