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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by stickywicket on May 16, 2006, at 15:07:16
My Dad (age 79) has IBS (irritable bowel syndrome). He admitted to me he's depressed and nervous because of his condition. He showed me an article from '04 that claimed Paxil can effectively treat IBS pain. But he considers using an AD his last choice because he's afraid of *addiction*. He's seen a gastroenterologist who didn't even suggest medications for the pain. Everyone else in the family thinks he's seriously depressed and needs to see a pdoc to address that problem. He's lost alot of weight because he's eating very little. He's scared of food now.
I'm the oldest sibling near Dad so basically this is falling on me. I'm walking that fine line between acting as Dad's child or Dad's parent. This is stressing me out and exacerbating my own illness. I'm at my wits end.
Any suggestions?
Posted by Larry Hoover on May 16, 2006, at 16:48:56
In reply to What to do about Dad, posted by stickywicket on May 16, 2006, at 15:07:16
> My Dad (age 79) has IBS (irritable bowel syndrome). He admitted to me he's depressed and nervous because of his condition. He showed me an article from '04 that claimed Paxil can effectively treat IBS pain. But he considers using an AD his last choice because he's afraid of *addiction*. He's seen a gastroenterologist who didn't even suggest medications for the pain. Everyone else in the family thinks he's seriously depressed and needs to see a pdoc to address that problem. He's lost alot of weight because he's eating very little. He's scared of food now.
>
> I'm the oldest sibling near Dad so basically this is falling on me. I'm walking that fine line between acting as Dad's child or Dad's parent. This is stressing me out and exacerbating my own illness. I'm at my wits end.
>
> Any suggestions?Do you know which form he has? IBS has three variants: a) crampy diarrhea; b) crampy constipation; c) alternating.
If he will take Paxil for the IBS, the antidepressant effect would be a bonus, non?
Would it help for him to read up on the difference between the definitions for dependency vs. addiction? Sometimes the mere use of a particular word is enough to trigger the stigma. It is quite possible to become physiologically dependent upon e.g. an SSRI, but there is no addiction.
Lar
Posted by Jost on May 16, 2006, at 20:43:14
In reply to Re: What to do about Dad » stickywicket, posted by Larry Hoover on May 16, 2006, at 16:48:56
I wouldn't even use the word "dependent," because it also has many negative connotations, ie everyone thinks it very important to maintain independence, etc.
It doesn't really fit the meaning, either, for me. To me, using a drug that you need, in order to improve your health (mental or physical), if it's being used carefully and responsibly, and with a doctor's sponsorship, doesn't create "dependence."
It's true that there are "withdrawal" syndromes, with ADs, which implies an analogy. But there are important differences, and if it harms the process of getting help, why push the analogy any further than it goes. There are significant distinctions.
It may be the ADs could help your father to feel better, and to live a more productive, or fulfilling life. Period.
If someone I loved were having a hard time, I might at any point step in somewhat paternalistically (or maternalistcally) to take up the space left by their having to cope with the pressures or pain of the situation.
I'm so sorry to hear that your father's having such a hard time, and hope you find something that helps.
Jost
Posted by Phillipa on May 16, 2006, at 22:33:52
In reply to Re: What to do about Dad, posted by Jost on May 16, 2006, at 20:43:14
Has he seen a pdoc? Maybe he can suggest something appropriate for his age and condition. I've seen wonders in the elderly with an ad. Love PHillipa
Posted by yxibow on May 17, 2006, at 0:56:35
In reply to What to do about Dad, posted by stickywicket on May 16, 2006, at 15:07:16
> My Dad (age 79) has IBS (irritable bowel syndrome). He admitted to me he's depressed and nervous because of his condition. He showed me an article from '04 that claimed Paxil can effectively treat IBS pain. But he considers using an AD his last choice because he's afraid of *addiction*. He's seen a gastroenterologist who didn't even suggest medications for the pain. Everyone else in the family thinks he's seriously depressed and needs to see a pdoc to address that problem. He's lost alot of weight because he's eating very little. He's scared of food now.
>
> I'm the oldest sibling near Dad so basically this is falling on me. I'm walking that fine line between acting as Dad's child or Dad's parent. This is stressing me out and exacerbating my own illness. I'm at my wits end.
>
> Any suggestions?IBS is a serious condition and affects a non negligible part of the population. Its very uncomfortable. I've had bowel upsets that mimic it but I've never actually had it.
Zelnorm is now approved for IBS in men, but only for IBS without constipation. Why there is still this sexual divide, I'm not clear. To me a bowel is a bowel.
TCA antidepressants are also indicated in the management of irritable bowel syndrome.
Somehow you will have to approach your father and as mentioned before explain the difference between habituation and addiction, neither of which particularly would happen on Paxil or one of the TCAs typically used for IBS. And as noted before it might brighten his mood.
Now whether its Zelnorm or an antidepressant, of course, dosages are different in the elderly, but that doesn't mean they cannot be used judiciously.
-- tidings
Jay
Posted by stickywicket on May 17, 2006, at 6:55:51
In reply to Re: What to do about Dad » stickywicket, posted by Larry Hoover on May 16, 2006, at 16:48:56
> Do you know which form he has? IBS has three variants: a) crampy diarrhea; b) crampy constipation; c) alternating.
He has b) crampy constipation. And the use of an AD concerns me for this because they usually cause me constipation.
> If he will take Paxil for the IBS, the antidepressant effect would be a bonus, non?
>
Absolutely.> Would it help for him to read up on the difference between the definitions for dependency vs. addiction? Sometimes the mere use of a particular word is enough to trigger the stigma. It is quite possible to become physiologically dependent upon e.g. an SSRI, but there is no addiction.
>
Even I'm still confused about the difference. I'll have to poke around on the Net to self-educate.
>Thanks, Larry, for taking your time to reply and for the, as always, helpful advice.
Posted by stickywicket on May 17, 2006, at 7:03:14
In reply to Re: What to do about Dad, posted by Jost on May 16, 2006, at 20:43:14
> If someone I loved were having a hard time, I might at any point step in somewhat paternalistically (or maternalistcally) to take up the space left by their having to cope with the pressures or pain of the situation.
>
I wonder when is that *point*? How bad does he have to be before I step in?He has an appointment with another gastroenterologist next week and I'm pretty certain once he's talking with the doc, he won't bring up the depression. Is it inappropriate for me to call the doc ahead of time and fill him in?
Posted by stickywicket on May 17, 2006, at 7:06:32
In reply to Re: What to do about Dad, posted by Phillipa on May 16, 2006, at 22:33:52
> Has he seen a pdoc? Maybe he can suggest something appropriate for his age and condition. I've seen wonders in the elderly with an ad. Love PHillipa
Horrors! A pdoc you say? When I suggested that to Dad, he changed the subject fast. As far as he's concerned, he's only depressed when he's in pain from the IBS, but I've noticed he's depressed even when he's having a good day.
Posted by stickywicket on May 17, 2006, at 7:10:43
In reply to Re: What to do about Dad » stickywicket, posted by yxibow on May 17, 2006, at 0:56:35
> Zelnorm is now approved for IBS in men, but only for IBS without constipation. Why there is still this sexual divide, I'm not clear. To me a bowel is a bowel.
Darn - he's got IBS with constipation.
>
> TCA antidepressants are also indicated in the management of irritable bowel syndrome.When I took Elavil, it made me horribly constipated. What type of SSRI causes diarrhea?
>
Posted by Larry Hoover on May 17, 2006, at 7:24:08
In reply to Re: What to do about Dad, posted by stickywicket on May 17, 2006, at 6:55:51
> > Do you know which form he has? IBS has three variants: a) crampy diarrhea; b) crampy constipation; c) alternating.
>
> He has b) crampy constipation. And the use of an AD concerns me for this because they usually cause me constipation.That is the more likely result, I would think.
http://www.gastromd.com/education/print_irritablebowelsyndrome.html
Have you tried prunes? They contain a unique something or other that has an inductive effect on peristalsis, and the fiber is also quite high. Yes, gramma was right. Prunes *are* different.
Simply taking magnesium salts can draw moisture into the gut, and the magnesium relaxes the muscle walls of the gut. Milk of magnesia (magnesium hydroxide) is commonly used for this, but any magnesium salt will do. Gradually titrate the dose, if you go this route. Individual sensitivity differs quite a bit, especially the older one gets.
> > If he will take Paxil for the IBS, the antidepressant effect would be a bonus, non?
> >
> Absolutely.Which is really why I "went there" first.
> > Would it help for him to read up on the difference between the definitions for dependency vs. addiction? Sometimes the mere use of a particular word is enough to trigger the stigma. It is quite possible to become physiologically dependent upon e.g. an SSRI, but there is no addiction.
> >
> Even I'm still confused about the difference. I'll have to poke around on the Net to self-educate.The distinction I prefer is that dependency is a necessary component of addiction. Addiction is dependency, plus: cravings for the drug, a tendency to escalate both the dose and the dosing frequency, changes in behaviour to acquire the drug, diminished response to the drug, and often, changes in personality. Did I leave something out?
The distinction is far more than semantic. We routinely discuss e.g. insulin-DEPENDENT diabetics, without any social approbation. No one would call such individuals addicts, despite the fact that withdrawal from the drug would quickly be both horrible and fatal.>
> Thanks, Larry, for taking your time to reply and for the, as always, helpful advice.You're very welcome.
Lar
Posted by Larry Hoover on May 17, 2006, at 7:27:37
In reply to Re: What to do about Dad » Jost, posted by stickywicket on May 17, 2006, at 7:03:14
>
> > If someone I loved were having a hard time, I might at any point step in somewhat paternalistically (or maternalistcally) to take up the space left by their having to cope with the pressures or pain of the situation.
> >
> I wonder when is that *point*? How bad does he have to be before I step in?
>
> He has an appointment with another gastroenterologist next week and I'm pretty certain once he's talking with the doc, he won't bring up the depression. Is it inappropriate for me to call the doc ahead of time and fill him in?I should think it would be an act of kindness to offer up your greater understanding. I would be very careful to suggest that the doctor should show no evidence that he had been counselled, though. Your dad is of the era when mental illness was heavily stigmatized. He may feel very ashamed already.
Good luck. Your dad is blessed to have your support.
Lar
Posted by stickywicket on May 17, 2006, at 15:25:21
In reply to Re: What to do about Dad » stickywicket, posted by Larry Hoover on May 17, 2006, at 7:24:08
Posted by Jost on May 17, 2006, at 16:27:12
In reply to Re: What to do about Dad » stickywicket, posted by Larry Hoover on May 17, 2006, at 7:27:37
It's mostly a process of trial and error-- you don't want to overstep, but also not underestimate the help your father would accept--esp. if framed in a way that doesn't undermine his self-esteem.
. I'd call a doctor if I thought it would help. But there's an area of doctor-patient confidentiality that can complicate your working too much through his doctor. You might ask for permission to talk to the doctor, and for the doctor to talk to you. That would probably make the doctor more comfortable--esp. in letting you know where things stand.
I'd go as far, or a little further than I felt comfortable, and see if the person seemed receptive, or seemed to be closing down--not necessarily only at the moment, but in terms of thinking it over, and being able to use it later.
But if the situation was moving toward being a harmful one, I'd be more assertive-- and hope that the person could let me work for them,, even if not initially so willingly.
I'd just try things, and then step back, if it's too much, and be a little more moderate, but not give up--
It so much depends on how different people respond--sometimes you can take over a bit, sometimes, you have to chip away gradually--
Jost
Posted by stickywicket on May 18, 2006, at 7:14:52
In reply to Re: What to do about Dad, posted by Jost on May 17, 2006, at 16:27:12
Excellent advice. I was discussing this last night at my bipolar support group, and others brought up the HIPAA law (or is it HIPPA)that would not allow the dr to talk to me without my Dad's permission. So I don't think that will work. I'm also sure Dad wouldn't want me to accompany him to his appointment. I'm going to draft up some questions for Dad to ask the dr and hope Dad remembers or takes notes. I might even give him a mini tape recorder to take with him.
Thanks, Jost.
Posted by Larry Hoover on May 18, 2006, at 9:11:02
In reply to Re: What to do about Dad » Jost, posted by stickywicket on May 18, 2006, at 7:14:52
> others brought up the HIPAA law (or is it HIPPA)that would not allow the dr to talk to me without my Dad's permission.
The doctor cannot talk to you. True. But he can listen to you. He can read a letter, ethically. He can take a call, ethically.
Lar
Posted by notfred on May 18, 2006, at 16:15:44
In reply to Re: What to do about Dad » stickywicket, posted by Larry Hoover on May 18, 2006, at 9:11:02
> The doctor cannot talk to you. True. But he can listen to you. He can read a letter, ethically. He can take a call, ethically.
>
> LarThe law requires the patients consent to discuss
his/her treatment with others. Dad;s doc would not take calls from me or mom. Mom did write the doc a letter which the doc did read as the doc told dad mom sent a letter and discussed the letters content with dad.
This is the end of the thread.
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