Psycho-Babble Medication Thread 3230

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Re: Medical Records

Posted by Elizabeth on March 20, 1999, at 11:41:29

In reply to Re: Medical Records, posted by Susie on March 19, 1999, at 9:05:23

> Elizabeth, did you read the previous post in this thread (EMDR on 3/12/99 by Toby)? The answer he gave re. medical records was very helpful to me and made perfect sense.

Yes, I understand the reasons that are usually given for this sort of policy, but they do not seem to me like good, ethical reasons; they seem like paternalistic ones.

 

Re: Muscle Tension-Jaw

Posted by PL on March 21, 1999, at 21:07:19

In reply to Muscle Tension-Jaw, posted by DL on March 16, 1999, at 20:33:19

I started on remeron to control the TMJ side effect of effexor in me. Please see my posting titled "Remeron Side Effects" to see what happened next.

 

Re: Medical Records

Posted by Toby on March 23, 1999, at 15:39:44

In reply to Re: Medical Records, posted by Elizabeth on March 20, 1999, at 11:41:29

Paternalism and ethics are not mutually exclusive concepts. Paternalism is defined as doing something for someone's benefit without that person's consent. This is the concept that governs guardianship, parenting, and involuntary commitments. Ethics involves a set of principles guiding a person in deciding what is right or wrong. While everything a physician does should be governed by ethics, not every decision is paternalistic; hence the informed consent idea. There have been examples of unethical paternalism such as the involuntary sterilization of mentally retarded persons back in the 50's and currently there is the great debate about euthanasia and Dr. Kervorkian's actions. With regard to allowing a patient free and unsupervised access to their psychiatric record, there is obviously a paternalistic aspect since the therapist is presumed to have knowledge that the patient may be incapable of understanding or, in the therapist's judgement, may be better off not knowing, but as Dr. Bob said, ethics would dictate that if the record is opened to the patient, the therapist should be present to discuss those issues with the patient. The previous statement may offend many who read it here, since most folks who can operate the internet are fairly well educated and believe that they know just as much as any therapist or psychiatrist when it comes to their own mental illness. However, if that were true, there would be no need for anyone here to be seeing a therapist or psychiatrist, much less dialoging here about various forms of treatment experiences. On the other hand, many folks understand the need for experts, but want to be privy to all the juicy details that the therapist may write down. IMHO that is tantamount to gossip about yourself; it's like wanting to read true-crime best sellers where the experts' reports are laid out for all to see about how some killer became that way; it's like wanting to see all the fluids and fat from your liposuction (i.e., you don't need to see it to know that it's gone). When you are reading about "Sybyl," it's fascinating to see what the psychiatrist thought about her behaviour and how dysfunctional it was; when it's about you, it isn't the same, no matter how intelligent you are, no matter how mentally healthy you've become, no matter how technically unemotional the report is. At any rate, I've rambled, but my point is that psychiatrists do many things that patients do not understand and may not like; that's the nature of the treatment of the mind but that does not make those actions unethical or unreasonable.

 

Re: Medical Records and Toby

Posted by DL on March 23, 1999, at 22:33:30

In reply to Re: Medical Records, posted by Toby on March 23, 1999, at 15:39:44

Hey Toby,--are you still having problems with this site? I have really missed your input. Am still hangin in there waiting for that appt in April.. Any comments on Q's below?

>>when it's about you, it isn't the same, no matter how intelligent you are, no matter how mentally healthy you've become, no matter how technically unemotional the report is.

This is true. We all create our own life story--by selectively attending to some things and ignoring or repressing others. At times this is a protective instinct and allows us to survive overwhelming times. I can imagine that if I were to read records from 2 years ago (when I was not sleeping at all and in an abusive situation)--written by someone who could see objectively all that was there----I don't know if my self esteem could survive it.

But, I am still curious to see somethings:
--I never saw a treatment plan--yet I saw a therapist for a few years. I know now that insurance co's require them. I would like to see if there are some in my records.

--I saw a psychiatrist every few months during the same time. He usually wasn't sure who I was when Icame in after 8 wks or so. I know once he forgot to write down a prescription and it caused all sorts of problems for me when he was away...Ususally he just asked me what script I needed. .I wonder if he put anything in his records? There was always another pt. immediately after me. I'm curious just to see if there are records!

--Is it ok to ask the new therapist to discuss the records being sent to her--with me?

QUESTION:
--Still have that extra weight. Not good for self-image. Doesn't want to leave me. You gave me suggestions before, but MD was not interested. I have 2 names from the new therapist-to-be for MD's and may call and switch. Knowing my sensitive system, any ideas for me to take to a new psychiatrist?

QUESTION:
--Any guidelines on how long to take Remeron? It's been almost 6 mos now. Do you have experience with people who stopped it and continued to sleep well?--and continued with the lower levels of anxiety?

QUESTION:
--My jaw has become very painful. One side only opens enough to talk without pain. Eating can be quite a chore since Ican't open far enough for a sandwich etc. unless I squish it. If I force it to open more it is so painful--including right into my ear, and just locks up. Always had some off and on "hitching" there but not painful until a few wks ago. Is this just stress? The REmeron seems to help with mental stress but not physical stress.--Not sure who you go to for this if it continues.

>> my point is that psychiatrists do many things that patients do not understand and may not like; that's the nature of the treatment of the mind but that does not make those actions unethical or unreasonable.

If you use the perspective that all psychiatrists are as caring, knowledgeable, up-to -date, and attentive as you, then this applies. however I suspect there are some psychiatrists out there (like the one I have seen for the past few years?) who don't fit that description and for one reason or another are not able to be ethical or reasonable or helpful????

Is there some form of peer review for psychiatrists and therapists?

 

Re: Medical Records and Toby

Posted by Ruth on March 24, 1999, at 20:28:13

In reply to Re: Medical Records and Toby, posted by DL on March 23, 1999, at 22:33:30

A few thoughts. It is reasonable to ask your psychiatrist what information he/she is sending to the new therapist. I'd probably put it in terms of wanting a perspective on where he sees things in your treatment at this point. Thats probably much more important than seeing the written word.
As for peer review, private practitioners don't have a peer review mechanism, although some of them, especially when they are beginning have regular consultaltion.

> Hey Toby,--are you still having problems with this site? I have really missed your input. Am still hangin in there waiting for that appt in April.. Any comments on Q's below?
>
> >>when it's about you, it isn't the same, no matter how intelligent you are, no matter how mentally healthy you've become, no matter how technically unemotional the report is.
>
> This is true. We all create our own life story--by selectively attending to some things and ignoring or repressing others. At times this is a protective instinct and allows us to survive overwhelming times. I can imagine that if I were to read records from 2 years ago (when I was not sleeping at all and in an abusive situation)--written by someone who could see objectively all that was there----I don't know if my self esteem could survive it.
>
> But, I am still curious to see somethings:
> --I never saw a treatment plan--yet I saw a therapist for a few years. I know now that insurance co's require them. I would like to see if there are some in my records.
>
> --I saw a psychiatrist every few months during the same time. He usually wasn't sure who I was when Icame in after 8 wks or so. I know once he forgot to write down a prescription and it caused all sorts of problems for me when he was away...Ususally he just asked me what script I needed. .I wonder if he put anything in his records? There was always another pt. immediately after me. I'm curious just to see if there are records!
>
> --Is it ok to ask the new therapist to discuss the records being sent to her--with me?
>
> QUESTION:
> --Still have that extra weight. Not good for self-image. Doesn't want to leave me. You gave me suggestions before, but MD was not interested. I have 2 names from the new therapist-to-be for MD's and may call and switch. Knowing my sensitive system, any ideas for me to take to a new psychiatrist?
>
> QUESTION:
> --Any guidelines on how long to take Remeron? It's been almost 6 mos now. Do you have experience with people who stopped it and continued to sleep well?--and continued with the lower levels of anxiety?
>
> QUESTION:
> --My jaw has become very painful. One side only opens enough to talk without pain. Eating can be quite a chore since Ican't open far enough for a sandwich etc. unless I squish it. If I force it to open more it is so painful--including right into my ear, and just locks up. Always had some off and on "hitching" there but not painful until a few wks ago. Is this just stress? The REmeron seems to help with mental stress but not physical stress.--Not sure who you go to for this if it continues.
>
>
>
> >> my point is that psychiatrists do many things that patients do not understand and may not like; that's the nature of the treatment of the mind but that does not make those actions unethical or unreasonable.
>
> If you use the perspective that all psychiatrists are as caring, knowledgeable, up-to -date, and attentive as you, then this applies. however I suspect there are some psychiatrists out there (like the one I have seen for the past few years?) who don't fit that description and for one reason or another are not able to be ethical or reasonable or helpful????
>
> Is there some form of peer review for psychiatrists and therapists?

 

Re: Medical Records

Posted by Elizabeth on March 24, 1999, at 21:46:49

In reply to Re: Medical Records, posted by Toby on March 23, 1999, at 15:39:44

It seems people are getting the idea that it's generally okay for a therapist, without any particular justification, to deny a patient access to his or her medical records. It's not, and it may even be illegal, depending on where you are.

The law in Massachusetts on this depends on the practitioner involved. A private hospital must provide a copy of the record to the patient or the patient's representative (legal guardian, etc.) (although they may charge a *reasonable* fee for it). A state hospital is only required to make the record available to a patient under certain specific circumstances (e.g., the patient is suing the hospital). A private therapist must give the record to the patient unless the therapist has made an honest and specific judgment that it would be harmful to do so (for some particular reason). In this case, the therapist still must provide a copy to the patient's attorney or a psychotherapist of the patient's choosing, and also give the patient a "summary" of the record.

Toby says:

>Paternalism and ethics are not mutually
>exclusive concepts. Paternalism is
>defined as doing something for someone's
>benefit without that person's consent.
>This is the concept that governs
>guardianship, parenting, and involuntary
>commitments.

More precisely, paternalism means doing soimething that you believe is for someone's benefit that is *contrary to their wishes*, not simply without their consent. It should be regarded as a necessary evil, not something to be practiced on a whim.

The examples you give are acceptable only because the people who are having decisions made for them are considered incompetent to make the decisons themselves, by virtue of age or mental status. You cannot simply assume that any person who has at some point been a psychiatric patient is therefore mentally incompetent.

>With regard to allowing a patient free
>and unsupervised access to their
>psychiatric record, there is obviously
>a paternalistic aspect since the therapist
>is presumed to have knowledge that the
>patient may be incapable of understanding
>or, in the therapist's judgement, may be
>better off not knowing, but as Dr. Bob
>said, ethics would dictate that if the
>record is opened to the patient, the
>therapist should be present to discuss
>those issues with the patient.

Umm. Certainly a therapist (or a medical doctor) ought to *offer* to go over the record with the patient. This is a different question than whether it is justifiable to withhold the record from the patient altogether or to *insist* on reading it with the patient.

>The previous statement may offend
>many who read it here, since most
>folks who can operate the internet
>are fairly well educated and believe
>that they know just as much as any
>therapist or psychiatrist when it
>comes to their own mental illness.

Most of us know what we don't know, actually.

In any case, a psychiatrist (or "therapist") ought to be held to the same ethical standards as any other health care practitioner. If anything, psych records are easier to read than other medical records, so I really do not believe this argument holds water.

Since you seem to need a reason why anyone would want to see their records, here's an obvious one: for many people with chronic illnesses, understanding the illness intellectually is a coping mechanism. (A healthy one, at that, as long as it doesn't grow into an obsession - wanting to read one's own medical records is not, IMHO, an obsession.) Nothing to do with juicy details.

Insurance companies often ask to see patients' medical records. I find it hard to believe that, in general, you think it's perfectly fine to show something to an insurance company that you can't show to the patient. Many therapists don't even keep detailed records (much less records containing what might appear to be "malicious gossip"), out of respect for confidentiality, for the patient's privacy (they don't want the HMO to be reading all about a patient's personal life, and maybe they also don't want to have a document that can be subpoenaed by a court of law). They note a diagnosis, treatment plan, and their justifications for same, but little more than that beyond keeping track of progress and changes.

There's something I don't get: if something is too embarrassing for you to tell a patient, why put it in the record, a legal document, and not, say, your personal diary? (If embarrassment is not what you hope to avoid by withholding a record from a patient, you may wish to provide an example of something that would be harmful for a mentally competent patient to read and that you would put in his or her medical record.)

As a side note, I've read some of my own records. I've never come across anything that looked remotely like "gossip" (and no, this is not just because my life is boring!). I can't think of any circumstance in which it would be necessary to write a psych record in a way that would sound like malicious gossip. If you can, feel free to provide an example of this also.

 

Re: Medical Records

Posted by Dr. Bob on March 24, 1999, at 22:03:51

In reply to Re: Medical Records, posted by Toby on March 23, 1999, at 15:39:44

> Paternalism and ethics are not mutually exclusive concepts.

This is important and not always appreciated. Paternalism has a bad name, but there's a place for it.

> many folks understand the need for experts, but want to be privy to all the juicy details that the therapist may write down...

Sorry if I'm repeating myself, but IMO therapists should think twice before writing down anything "juicy". This being one reason.

Also, feelings about the therapist or the therapy often underlie the wish to see the record, and those should of course be discussed and not just given in to.

> it's like wanting to see all the fluids and fat from your liposuction

Toby, thanks *so* much for such a vivid image. :-)

Also

 

Re: Medical Records

Posted by Elizabeth on March 28, 1999, at 2:04:48

In reply to Re: Medical Records, posted by Dr. Bob on March 24, 1999, at 22:03:51

> Paternalism has a bad name, but there's a place for it.

This is surely true, but there's something wrong when it's considered to be generally okay rather than an occasionally necessary evil. It should be the exception, not the rule. If anything, this is especially true of psychiatry - a "doctor knows best" attitude tends to foster dependency, which ought to be avoided.

> Sorry if I'm repeating myself, but IMO therapists should think twice before writing down anything "juicy". This being one reason.

Also for simple privacy concerns. It's perfectly fine to put this stuff in your diary or something, but a medical record is no place for it. I'm not sure exactly what sort of salacious details Toby was thinking of, but to write them in someone's medical record, a legal document (!), seems unprofessional to say the least.

 

Re: Medical Records

Posted by Elaine on March 28, 1999, at 17:51:18

In reply to Re: Medical Records, posted by Elizabeth on March 28, 1999, at 2:04:48

> a "doctor knows best" attitude tends to foster dependency, which ought to be avoided.
>
>> How does a professional having private records foster dependency? Sometimes it's for your own good. ESPECIALLY in psychiatry - someone with emotional problems can more easily misinterpret something than anybody else. Sometimes there are things that can be shared, sometimes it is best that it not be.

>
> It's perfectly fine to put this stuff in your diary or something, but a medical record is no place for it. ..to write them in someone's medical record, a legal document (!), seems unprofessional to say the least.

A doctor can't be expected to remember everything. If something particular about a patient needs to be remembered, the medical record is the appropriate place. A professional can't keep a secret diary. Perhaps only sketchy notes could be made, just enough to remind him/her without being explicit. A doctor or therapist must be allowed to do his/her job, not have his/her primary concern be what may be discoverable. As an insurance adjuster and as an individual, I believe the current trend of "everyone has every right" and "let's sue if something goes wrong" has gone far overboard. Everybody has their hands tied behind their backs these days because they're afraid of being sued. Personally, I prefer that my doctor be reasonably allowed to do his/her job, even if it means making notes relevant to me, rather than getting me mixed up with another patient because nothing can be written down! As a patient, I am going to a doctor or therapist because I need help - I cannot do it myself - THEY ARE THE EXPERTS even though therapy is a joint effort. They DO have training and experience that I do not. Just because a lot of their notes are in a language I can understand, rather than technical language like a scientist or computer programmer, doesn't mean I have a greater right to access and *try* to correctly interpret them. As I have stated before, a good doctor or therapist would discuss their impressions, your progress, etc. - as long as they are willing to talk with you, why do you need to see exactly what they write? I think they need to be cautious, but do their job considering the majority rather than the occasional record that is subpoenaed, as long as they are ethical in their practice.

 

Re: Medical Records

Posted by Elaine on March 28, 1999, at 17:59:00

In reply to Re: Medical Records, posted by Elaine on March 28, 1999, at 17:51:18

An addendum to my prior message: In case you misinterpret, I really do not believe in being an ignorant patient or consumer. I believe you need to know enough about your doctor to develop the trust you need to. And, in my profession, I have learned not to put doctors or lawyers on a pedestal and think everything they say is right. I do believe in being an informed consumer, but I also believe in allowing a professional room enough to work.

 

Re: Medical Records

Posted by Seedwoman on March 29, 1999, at 14:38:42

In reply to Re: Medical Records, posted by Elaine on March 28, 1999, at 17:59:00

Speaking from my perspective as a patient: I have thought about requesting to see my records, but I don't think I will. I've read enough of the psychiatric literature to know something about the language and format in which clinical information is presented. Being a scientist myself, I understand why this is so and it doesn't bother me...however, I have a strong, warm relationship with my psychiatrist and I *know* that seeing my deepest fears & most distorted perceptions translated into jargon would hurt my feelings because it would seem so impersonal. I would rather have him tell me about treatment plans, diagnoses, therapeutic strategies, etc. We have done it this way so far and it works for me. If I have technical questions, I just ask.

Trust is essential and with the right therapist it's an important lesson learned. Then again, one has to be informed and if one feels left in the dark, this is a threat to the therapeutic relationship.

why not simply offer to answer a patient's questions, in detail if requested, and then explain in a straightforward way why you think it's a bad idea for the patient to actually read the chart? if the patient insists and is "competent" to make the decision (I'm not sure how that would be determined), I'm not sure it would be appropriate to resist further, even if it's permitted by law.

my personal view, perhaps because I have a therapist/Dr. whom I trust completely (after roughly four years of working at it), is that all therapeutic decisions should be made on the basis of what will help the patient to grow in the direction of improved health, whatever that entails at the moment. I trust my therapist's advice because I know he adheres to this principle. so what if he's wrong sometimes; he's human. we make decisions together for the most part. there are things I don't want to know because they would at present be possibly harmful, but this may change in the future. Psychotherapy, like Tai Chi, is about change.

Seedwoman

 

Re: Medical Records-legal

Posted by jane on March 30, 1999, at 15:37:03

In reply to Re: Medical Records, posted by Elaine on March 28, 1999, at 17:51:18

Elaine - you mention subpoenas - I would like to know from anyone out there if my info is correct. I think if you ask your own doctor to testify about your case in court (re divorce,etc) THAT opens your doctor's file on you to anyone, ie. the opposing lawyers. Am I right? In my case years of all my medical records were opened to court, now I am very careful about what my psycharist puts in writing. And yes, it does affect the working relationship. - jane
Also,consumers may want to know that some major insurance companies cooperate and submit medical info to an organization called 'MIB' "medical informatioon bureau". There,your medical info is shared by insurance companies. (diagnosis,not doctor's notes)

 

Re: Muscle Tension-Jaw

Posted by Matt on April 1, 1999, at 0:36:52

In reply to Muscle Tension-Jaw, posted by DL on March 16, 1999, at 20:33:19

> Remeron has reduced anxiety and "mental tension", but I am noticing more and more that it does not affect physical-muscular tension from stress or whatever. Back last Fall when I was still taking the tiny dose of klonopin it was less noticable to me. Over the last few months the tension in my jaw that I talked about a few months ago has gotten worse. One side of my jaw at this point seems to have become sort of "disjointed". I have to make sure I don't open my mouth too far. Very painful and it seems to come undone at the joint and not go back where it belongs. Is this from tension/stress? I have always had some trouble with my jaw but nothing like this. Any ideas?

Are you on any sort of antipsychotic or amoxapine?

Matt

 

Re: Muscle Tension-Jaw

Posted by DL on April 1, 1999, at 20:06:26

In reply to Re: Muscle Tension-Jaw, posted by Matt on April 1, 1999, at 0:36:52

> >
> Are you on any sort of antipsychotic or amoxapine?
>
> Matt

No--only Remeron, calcium and vitamins. Saw dentist today. He said I had muscles that had gone into spasm. Suggested hot packs. Showed me how to try to relax the jaw (pretty hard when it hurts) and gave me a quick and thorough dissolving calcium and mag. supplement. We'll see if it works. His assistant told me she goes to a chiropractor/massage therapist pair for TMJ and that it helps. Anyone have experience with this? I've never been to one.

 

Re: Muscle Tension-Jaw

Posted by Matt on April 1, 1999, at 21:52:33

In reply to Re: Muscle Tension-Jaw, posted by DL on April 1, 1999, at 20:06:26

What's the cause of this? Is it localized to the jaw, or is it caused by brain abnormalities?

(The reason why I asked about the antipsychotics is that people who take them (esp the typical ap's) sometimes develop dystonic reactions in the face and neck. This comes about from blockade of the dopamine (D2) receptors in the basal ganglia and a subsequent imbalance of the serotonin-dopamine ratio there (well, people think--no one actually is sure.) But Remeron doesn't (directly) act on dopamine. It does hit the same serotonin receptor that the atypical antipsychotics hit, but it's though that this feature of the atypicals helps to prevent dystonia and other side effects that the typical ap's cause.

I'd be quite interested if someone could proffer a psychopharmacological explanation of Remeron's action in all this.

Matt

 

Re: Muscle Tension-Jaw

Posted by saintjames on April 2, 1999, at 3:13:40

In reply to Re: Muscle Tension-Jaw, posted by Matt on April 1, 1999, at 21:52:33

> What's the cause of this? Is it localized to the jaw, or is it caused by brain abnormalities?
>

James here....

being a classical singer I have had some problems with TMJ. If at all possible avoid letting someone grind your teeth to balance your bite. (ballanced occlusion) A mouth guard worn at nite helps....you can use the kind of guard a football player uses though some feel only a costly appliance will do. The best muscle relaxant I found to use is Soma (there is a cheap generic) Just make sure your Pdoc knows you are using it as it effects the CNS. I use non seroidals as first line and Soma as needed. It is best to try everything and get a 2 nd opinion b4 you allow someone to grind away tooth....in some this works but as you get older the lost tooth materal can leave you with considerable problems.

I have always ground my teeth...on and off the psyco meds.

j

 

Re: Muscle Tension-Jaw

Posted by saintjames on April 2, 1999, at 3:23:54

In reply to Muscle Tension-Jaw, posted by DL on March 16, 1999, at 20:33:19

> Remeron has reduced anxiety and "mental tension", but I am noticing more and more that it does not affect physical-muscular tension from stress or whatever. Back last Fall when I was still taking the tiny dose of klonopin it was less noticable to me. Over the last few months the tension in my jaw that I talked about a few months ago has gotten worse. One side of my jaw at this point seems to have become sort of "disjointed". I have to make sure I don't open my mouth too far. Very painful and it seems to come undone at the joint and not go back where it belongs. Is this from tension/stress? I have always had some trouble with my jaw but nothing like this. Any ideas?

James again....

Finally I found the start of this thread. Like I said I am a classical singer and I have several friends with jaw problems. It can be caused by bite problems, misformed jaw, problems with the hinge (TMJ), some people just grind and this causes the problem. Get a consult with an oral surgeon...there are some imaging studies that he/she can do to rule out jaw/TMJ problems. Like I said it is best to exaust all other possibilities b4 someone grinds down your teeth to refit your bite.

j

 

Re: Muscle Tension-Jaw

Posted by Susie on April 2, 1999, at 5:32:47

In reply to Re: Muscle Tension-Jaw, posted by saintjames on April 2, 1999, at 3:23:54

I have found that eliminating caffeine and supplementing my AD with 1/4-1/2 mg Xanax at bedtime significantly reduces the jaw/neck tension. Also, after a year on Effexor XR, reducing the dose recently has reduced the muscular tension. At first I was scared about reducing the dosage but at the same time I went on a spiritual retreat and through prayer, searching my heart, confession, dealing with traumatic memories, abuse, etc. I feel better than I have in years. The retreat (which included many hours of counseling) gave the significant response that Toby has been suggesting could come from the use of EMDR.
Also, in the two months before the retreat I had received 3 treatments of massage therapy and I must say that it also helped but was temporary relief.
If the Klonopin worked before is there some reason that you are not using it now? Isn't it similar to Xanax? My Dr. has no problem with prn use of Xanax. Hope this helps.

 

Re: Medical Records

Posted by Nancy on April 5, 1999, at 10:16:54

In reply to Re: Medical Records, posted by Toby on March 23, 1999, at 15:39:44

most folks who can operate the internet are fairly well educated and believe that they know just as much as any therapist or psychiatrist when it comes to their own mental illness. However, if that were true, there would be no need for anyone here to be seeing a therapist or psychiatrist

:) How would I be able to get medication or ECT referal, if I didn't see a pdoc???

 

Re: Muscle Tension-Jaw

Posted by Jeanette on April 5, 1999, at 20:11:06

In reply to Re: Muscle Tension-Jaw, posted by Susie on April 2, 1999, at 5:32:47

I have had TMJ for many yrs. with night bite guard, meds including Inderol, Klonopin, tricyclics, etc. At present, I am taking Kava Kava in amt. suggested on label. It seems to have a calming effect, and is helping the TMJ. Anyone else having a similar experience?

 

Re: Muscle Tension-Jaw

Posted by Toby on April 6, 1999, at 11:28:08

In reply to Re: Muscle Tension-Jaw, posted by Jeanette on April 5, 1999, at 20:11:06

Dottie,
The suggestions offered above regarding massage, Klonopin, Kava, consultation with an oral surgeon, bite guard and the EMDR are all good. I know the jaw pain was present before the Remeron, so I don't think it's contributing to it. You may indeed have to go back to the Klonopin or try the Kava from the health food store (just be sure never to use those two together because the effects add up and can lead to coma). I have been also hearing about very good results with TMJ from EMDR specialists, so you should ask the therapist you are seeing if she can target the jaw pain at some point. I believe you are seeing her tomorrow or the next day, right? I look forward to hearing about it.

As for the weight gain: I asked the drug rep if there has been any new information about that. Besides the suggestion of trying the Zantac or Pepcid, increasing the mount of exercise you get and cutting calories, there has been nothing new. You would really need to talk with your doctor before thinking about stopping an antidepressant, especially since you've had the depression for so long it would be a big risk to come off the one thing that has really worked. Maybe one of the posters here has some advice from their own experience.

 

Re: Muscle Tension-Jaw

Posted by DL on April 6, 1999, at 22:42:59

In reply to Re: Muscle Tension-Jaw, posted by Toby on April 6, 1999, at 11:28:08

Toby,
Thanks for remembering.....Thought you had disappeared.....Been marking time waiting to see the therapist, now I'm getting a little nervous. I had to make appt in the middle of my work day and work things around it. Appt is on Thursday at 10:30AM.......I continue to sleep well almost all the time and anx level is still lower than I can remember it. But, it's rare that I feel happy, excited. I'm not sad, tearful a lot but life continues to be fairly flat. I put a lot of myself into what I do and I think I do well with the families I work with and their babies/toddlers, but it feels sort of like a "fake" me. I think "me" got lost over the last 2 decades[or more] and I have to find a way to rebuild it. I mostly like to come home to my place where I can relax. I think peeling away some of the fear and anx and need to constantly protect myself, has unmasked a person who needs a lot of work to find a way to enjoy life (the way I see others doing--but I can't seem to get there). I slip into that "social phobia" perspective a lot..


> The suggestions offered above regarding massage, Klonopin, Kava, consultation with an oral surgeon, bite guard and the EMDR are all good.

Update on jaw pain:
The dentist gave me something called "Cal Max" it's an instant dissolving, quickly absorbed Ca and Mg supplement with Vitamin C. Each teaspoon supplies 400mg Ca, 200mg MG, and 500mg Vit C. You add one teaspoon to 1/2 cup boiling water and it foams, fizzes and ends up looking like water-with a very mild lemon taste. He said the Ca is necessary for muscle fibers to relax and that it should feel very calming to me and also help me sleep. He had me take it 3 times a day for 3 days and now I'm doing 2x day and then will just take it at bedtime. It does really relax me. Works better than the Ca pills I was taking. He also showed me how to open and close my jaw inline (I was moving it out of alignment to avoid the pain of the spasmed muscle.) It hurts to stretch it that way but I am noticing it is a little better. I have a bite guard and now use it whenever I'm home instead of just at night.

I really do not want to go back to taking the klonopin again unless I have to. I still have some of it so I could if I wanted to. I do have the name of 2 places (chiropractors) who have massage therapists and have experience in TMJ. But I have never been to a chiropractor and wonder if this would only help for a short time.?? EMDR for jaw pain--I wonder--who knows?

I know the jaw pain was present before the Remeron, so I don't think it's contributing to it. You may indeed have to go back to the Klonopin or try the Kava from the health food store (just be sure never to use those two together because the effects add up and can lead to coma). I have been also hearing about very good results with TMJ from EMDR specialists, so you should ask the therapist you are seeing if she can target the jaw pain at some point. I believe you are seeing her tomorrow or the next day, right? I look forward to hearing about it.
>
> As for the weight gain: I asked the drug rep if there has been any new information about that. Besides the suggestion of trying the Zantac or Pepcid, increasing the mount of exercise you get and cutting calories, there has been nothing new.

I was reading a new psychotropic drug reference at the book store this week. I looked up Rememron and it was described as only good for the occasional person who has tried all the other drugs already without success--due to it's side effect of weight gain in almost all who take it. It was pretty much passed over. Also mentioned that if you have flue symptoms on it you should go have your white cell count done.

>You would really need to talk with your doctor before thinking about stopping an antidepressant, especially since you've had the depression for so long it would be a big risk to come off the one thing that has really worked.

I moved my MD appt up till after the therapy appt. The therapist said she has had good luck connecting with 2 local MD's in the area. so I may try to get an appt with one of them and switch from the only psychiatrist I have ever seen--at the health clinic. I won't do anything with the Remeron till I speak to MD. Perhaps someone new will be more open to suggestions. The Remeron is very expensive. It now costs me $25/mo. I finally dropped the natural hormone prescriptions since they were "non preferred also" I also wrote to the company that makes Remereon and have had no answer. Wrote to health ins co and they won't move it to the preferred category.

I wrote to the e-mail address on an Organon site I found. If anyone has a better way to write to them please pass it on to me.

Will post after therapy session if I am still in working order.

Dotty

 

Start new thread?

Posted by Me on April 10, 1999, at 7:41:32

In reply to I'm here, but of no help, posted by Toby on February 25, 1999, at 14:31:21

This thread has taken many turns since the original message, and it is takes up a lot of scrolling space. Might you consider starting a separate thread with any and all of the issues discussed above that don't have to do with Toby's original log in problem? Thanks.

 

Muscle Tension-Jaw/face

Posted by Kristian Heide on April 13, 1999, at 8:32:59

In reply to Re: Muscle Tension-Jaw, posted by DL on April 6, 1999, at 22:42:59

For 6 months I've been having muscle tension in my jaws and in the face. I don't feel any pain, but I can feel the tension building up after a meal and after a workout with weights. I use Sobril as a muscle relaxing medicine, and it also helps me calm down when I am tensed. First I interpreted my symptoms as pressure inside the head, and this caused a high degree of anxiety. But now I'm almost certain that my torments comes from tension in my jaws and in my facial muscles. I am also at times very dizzy, again thinking that this comes from facial muscle tension. Does anyone have any suggestions on have to get better? I have tried muscle relaxing pills, some exercises stretching the jaw muscles and sleeping with this device that stops me from grinding my teeth. Nothing of this seems to be of any help. And I don't think I am grinding my teeth anyway, it's just muscle tension. Help!

 

Re: Muscle Tension-Jaw/face

Posted by Jim on April 21, 1999, at 12:53:46

In reply to Muscle Tension-Jaw/face, posted by Kristian Heide on April 13, 1999, at 8:32:59

I would suggest trying acupuncture for TMJ and
face/jaw tension. I think it's better than
chiropractic for this (I AM biased being an
acupuncturist.
I just treated a new patient for this an hour ago, and the response was excellent. Cal/Mag
is also helpful, CalMax (mentioned above) is a
very good product.
BTW, acupuncture can also be useful for depression. I recently helped a woman who didn't
want to use meds because she was nursing and she
has done very well. Look for a practitioner with
some experience in treating depression.


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