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I saw my p-doc yesterday. It was a difficult visit for me. I have ambivalent feelings towards him. He is a kind of older brother figure, rather than a father figure, but in his authority as a psychiatrist he will be a father figure. I respect him as an older brother, but I also feel like fooling him and ignoring his authority in as far as he's a father figure.
I had taken 5mg of dextroamphetamine before the appointment. When I saw him coming towards me with an enthusiastic smile, I had a bad conscience. Although I had stuck to the core of his proposed regimen, I had been experimenting away with other drugs and also already started taking bethanechol, while I was supposed to wait for his consent.
He didn't have the blood values yet. He made a phone call to the lab right away. The blood levels were weird. Clomipramine, which had been 96µg/ml, was now 91µg/ml - so it had lowered while I've upped the dose! Desmethylclomipramine, which had been 20µg/ml, had been raised to 96µg/ml - higher than the clomipramine! At this point, I confessed to having taken Ritalin 'a couple of times'. Methylphenidate is a 2D6 inhibitor, but only a weak one. He couldn't imagine that Ritalin was the cause. Anyway, the overall blood level is still subtherapeutic, so we're raising the clomipramine to 150mg and the Luvox to 50mg.
I already thought I had much more desmethylclomipramine in my blood, since I'd noticed its pronounced antidepressant and pro-social effects.
After having given the myserious blood values some thought, I began to wonder wether the bethanechol might be the cause. It's a diuretic - could it make me piss out the Luvox faster? A tiny part of Luvox is being pissed out unchanged. Might this tiny bit become a lot when on a diuretic? I googled this idea, but only found out that combining fluvoxamine with a diuretic can cause hyponatremia, a condition of not having enough salt in your body, which can have dangerous consequences, like seizures. I'd better eat more salty potatoe crisps..
P-doc came to the subject of bethanechol and suggested I would only start taking it when the dry mouth becomes really too much. I agreed. Damn, but I'm already taking it. I didn't dare to say it. After the appointment I felt so horribly guilty that I popped 5mg of Valium. Oh shit. Together with upping the clomi and Luvox, I feel like a zombie today. I slept almost five hours this afternoon. The Valium will keep me sedated for at least four days, its break-down being inhibited by the Luvox.
eat more
I had taken 5mg of dextroamphetamine before the appointment. When I saw him coming towards me with an enthusiastic smile, I had a bad conscience. Although I had stuck to the core of his proposed regimen, I had been experimenting away with other drugs and also already started taking bethanechol, while I was supposed to wait for his consent.
He didn't have the blood values yet. He made a phone call to the lab right away. The blood levels were weird. Clomipramine, which had been 96µg/ml, was now 91µg/ml - so it had lowered while I've upped the dose! Desmethylclomipramine, which had been 20µg/ml, had been raised to 96µg/ml - higher than the clomipramine! At this point, I confessed to having taken Ritalin 'a couple of times'. Methylphenidate is a 2D6 inhibitor, but only a weak one. He couldn't imagine that Ritalin was the cause. Anyway, the overall blood level is still subtherapeutic, so we're raising the clomipramine to 150mg and the Luvox to 50mg.
I already thought I had much more desmethylclomipramine in my blood, since I'd noticed its pronounced antidepressant and pro-social effects.
After having given the myserious blood values some thought, I began to wonder wether the bethanechol might be the cause. It's a diuretic - could it make me piss out the Luvox faster? A tiny part of Luvox is being pissed out unchanged. Might this tiny bit become a lot when on a diuretic? I googled this idea, but only found out that combining fluvoxamine with a diuretic can cause hyponatremia, a condition of not having enough salt in your body, which can have dangerous consequences, like seizures. I'd better eat more salty potatoe crisps..
P-doc came to the subject of bethanechol and suggested I would only start taking it when the dry mouth becomes really too much. I agreed. Damn, but I'm already taking it. I didn't dare to say it. After the appointment I felt so horribly guilty that I popped 5mg of Valium. Oh shit. Together with upping the clomi and Luvox, I feel like a zombie today. I slept almost five hours this afternoon. The Valium will keep me sedated for at least four days, its break-down being inhibited by the Luvox.
eat more
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raggedemt
30 July 2010 - 02:54 PM
damm luvox inhibited the breakdown of valium... is there anything u can do to further that process like drinking water or something? milk thistle?
missy
31 July 2010 - 08:44 AM
Brainbeard, this is just me, but I've been dealing with pdocs for a long time, and for my own conscience I've found if I can find someone I can be honest with and work with I do a lot better.
If I feel like I want to do something that he and I haven't discussed, I will call him on the phone between appointments to propose to him what I would like to do and to get his okay.
There must be some reason he wants these blood values from you.
I'm not in a position right now to need blood values; I guess you are on different meds, and it is clear you know a lot more about this stuff than I do.
But it would be hard for your pdoc to get the real blood values if you are taking other meds and not telling him, and he really is just trying to help you.
He actually sounds pretty cool: I mean, he didn't freak when you mentioned Ritalin ... who knows? Maybe you will find you will be able to actually have a real conversation with him about it at some point.
Just saying you may be having a guilty conscience for nothing when you may have found a doc you can actually talk to.
I fully admit you know a lot more about these meds and you sound like you are into experimenting with combinations and drugs and their effects on the fly, and who knows? Maybe this pdoc would be totally cool with that and actually see merit in it. I mean, not a new drug every day, but maybe give him a chance? He might prescribe you some "take as needed" drugs (sorry, can't remember what they are called -- ah, P.R.N.). Anyway, good luck!
If I feel like I want to do something that he and I haven't discussed, I will call him on the phone between appointments to propose to him what I would like to do and to get his okay.
There must be some reason he wants these blood values from you.
I'm not in a position right now to need blood values; I guess you are on different meds, and it is clear you know a lot more about this stuff than I do.
But it would be hard for your pdoc to get the real blood values if you are taking other meds and not telling him, and he really is just trying to help you.
He actually sounds pretty cool: I mean, he didn't freak when you mentioned Ritalin ... who knows? Maybe you will find you will be able to actually have a real conversation with him about it at some point.
Just saying you may be having a guilty conscience for nothing when you may have found a doc you can actually talk to.
I fully admit you know a lot more about these meds and you sound like you are into experimenting with combinations and drugs and their effects on the fly, and who knows? Maybe this pdoc would be totally cool with that and actually see merit in it. I mean, not a new drug every day, but maybe give him a chance? He might prescribe you some "take as needed" drugs (sorry, can't remember what they are called -- ah, P.R.N.). Anyway, good luck!
Brainbeard
31 July 2010 - 10:51 AM
Hi Missy,
You are right, of course. But erm, my p-doc is erm, perhaps a little too friendly, you know? He had said that he could be 'a little stern' when devoted to a certain pharmacotherapeutical course for me. He said it in a tone so friendly that it annulled the credibility of the statement.
The deal is that I have to stabilize on the clomipramine before we start adding other stuff. Yeah. The urge to be my own doctor is a little too strong. Maybe I should indeed tell him. Problem is, if I'd phone him and say 'Doc, I have this great idea of popping some Ritalin and some dextroamphetamine alternatively to see what good they are', I know in advance that he'd be against it. But in my mind, I need to know which of the two drugs is best before I ask for a prescription.
Complete honesty.. I'll contemplate it.
-Beard
You are right, of course. But erm, my p-doc is erm, perhaps a little too friendly, you know? He had said that he could be 'a little stern' when devoted to a certain pharmacotherapeutical course for me. He said it in a tone so friendly that it annulled the credibility of the statement.
The deal is that I have to stabilize on the clomipramine before we start adding other stuff. Yeah. The urge to be my own doctor is a little too strong. Maybe I should indeed tell him. Problem is, if I'd phone him and say 'Doc, I have this great idea of popping some Ritalin and some dextroamphetamine alternatively to see what good they are', I know in advance that he'd be against it. But in my mind, I need to know which of the two drugs is best before I ask for a prescription.
Complete honesty.. I'll contemplate it.
-Beard
missy
31 July 2010 - 05:52 PMBrainbeard, on 31 July 2010 - 01:51 PM, said:
Hi Missy,
You are right, of course. But erm, my p-doc is erm, perhaps a little too friendly, you know? He had said that he could be 'a little stern' when devoted to a certain pharmacotherapeutical course for me. He said it in a tone so friendly that it annulled the credibility of the statement.
The deal is that I have to stabilize on the clomipramine before we start adding other stuff. Yeah. The urge to be my own doctor is a little too strong. Maybe I should indeed tell him. Problem is, if I'd phone him and say 'Doc, I have this great idea of popping some Ritalin and some dextroamphetamine alternatively to see what good they are', I know in advance that he'd be against it. But in my mind, I need to know which of the two drugs is best before I ask for a prescription.
Complete honesty.. I'll contemplate it.
-Beard
You are right, of course. But erm, my p-doc is erm, perhaps a little too friendly, you know? He had said that he could be 'a little stern' when devoted to a certain pharmacotherapeutical course for me. He said it in a tone so friendly that it annulled the credibility of the statement.
The deal is that I have to stabilize on the clomipramine before we start adding other stuff. Yeah. The urge to be my own doctor is a little too strong. Maybe I should indeed tell him. Problem is, if I'd phone him and say 'Doc, I have this great idea of popping some Ritalin and some dextroamphetamine alternatively to see what good they are', I know in advance that he'd be against it. But in my mind, I need to know which of the two drugs is best before I ask for a prescription.
Complete honesty.. I'll contemplate it.
-Beard
A little too friendly, you say? Yeah ... if I get your meaning, I would be wondering about his intentions myself.
And I can see your point of view about wanting to know about which is going to work for you before asking for a prescription.
If they are both short-acting drugs, and honestly this is the thing ... I do not know. Because (a) I am not an expert and (
I don't take either one. So I don't know how long they stay in your system, or if one is still around while the other one goes into your bloodstream. Or how they interact with each other. Maybe you could ask to try one for a month, then the other for a month, and then decide.
Medication choices are fluid. Or so I hope. I try Med A, then Med B. I decide to go for Med B. But later I may decide I want to go back and try Med A. I don't know your doctor so I don't know if he's the kind to leave this sort of thing up to you. My doc would; but all of them are different.
You definitely know a lot more about how these drugs work than I do. I am impressed by your knowledge -- I don't know much at all about how these drugs work. Even moreso, I can't even pretend to know how they interact with each other. My body feels like one giant chemistry lab.
Good luck with whatever you decide to do!
Brainbeard
01 August 2010 - 04:18 AM
Thanks, Missy.
I don't really know as much as I seem to do. I know a lot about a tiny part of pharmacotherapy. There certainly are lay p-doc colleagues who have a broader knowledge than I do. And real p-docs have a much broader knowledge. Hence they can sometimes miss important details that an Aspie-like guy such as myself has discovered on his endless sailing through cyber-seas of information.
I'm afraid that if I start out with med A, and it doesn't do that bad, my p-doc will be satisfied and disinclined to try and see wether med B might be superior.
Oh, if you have a point b), you need to turn smilies off, otherwise you get the guy with the sunglasses................. ;)
(You can turn them off after hitting 'Use full editor'. If it matters to you. I am a detail freak.)
I don't really know as much as I seem to do. I know a lot about a tiny part of pharmacotherapy. There certainly are lay p-doc colleagues who have a broader knowledge than I do. And real p-docs have a much broader knowledge. Hence they can sometimes miss important details that an Aspie-like guy such as myself has discovered on his endless sailing through cyber-seas of information.
I'm afraid that if I start out with med A, and it doesn't do that bad, my p-doc will be satisfied and disinclined to try and see wether med B might be superior.
Oh, if you have a point b), you need to turn smilies off, otherwise you get the guy with the sunglasses................. ;)
(You can turn them off after hitting 'Use full editor'. If it matters to you. I am a detail freak.)
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