![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 76. This is the beginning of the thread.
Posted by jealibeanz on March 25, 2007, at 15:50:12
If I called and left a message, asking if it would be OK for me to stop taking my 3mg Xanax XR, since it isn't helping.
I'm [i]hoping[/i] that I won't get a call back from the nurse saying it is fine.
I've been taking Xanax daily for almost a year now, so quitting without a taper would put me at risk for seizure. I wonder if all doctors know that.
This drug has very little efficacy for anxiety relief in my experience. I think my best bet would be to return to regular Xanax, 4 mg, for the time being. However, I don't want to suggest this. I want to leave this open ended for my doc.
I suppose the worst that could happen is that he'd say yes, stop taking it. And if I do horribly I can call back and ask for a refill.
This an odd approach, I know. I'm not trying to play games with him, although this is basically doing just that, in an indirect way. I'm letting him know that the medication is not providing anxiety relief. I should, as a responsible patient, update him on any problems I'm having with treatment, and ask before making a change.
I can just picture him when he gets the message. He'll have this puzzled look on his face, because he's pretty sure Xanax XR is a good drug, in fact, it's much much better than regular Xanax, because you only have to take it once a day, there are no peaks are valleys, it's a wonderful idea for me!
If he's not yet frazzled by his busy schedule, he may also be thinking:
Oh no! What did I do! I must help my favorite patient! I wil do whatever she needs! She is obviously is distress! (haha, I'm serious)
No prob, we'll just print out a script for Xanax 1 mg, q.i.d. Put in an envelope with the others I'm printing and tell her to pick it up at the desk. And tell her I said hi and ask if she has any updates on her grad school applications. Is she in? Is she in? Is she in?
How about trying Cymbalta! You've never tried that one before. It's just been approved by the FDA for GAD! Oh you will lovvvve it!
OK, nobody else will think this is funny, but I think it's hilarious. I have a very eccentric, friendly, and hyperactive doctor. He's fun to watch.
Posted by Racer on March 25, 2007, at 16:45:21
In reply to If you were my doc, what would you do?, posted by jealibeanz on March 25, 2007, at 15:50:12
> This an odd approach, I know. I'm not trying to play games with him, although this is basically doing just that, in an indirect way. I'm letting him know that the medication is not providing anxiety relief.
I guess I wonder why you don't just leave a message saying something more direct: "Gee, Doc, the XR was a good idea, but I'm not getting any relief from it. Can we go back to the IR?"
I guess I'm confused about why you are doing this. It sounds as though you want him to read your mind, and figure out that you're hoping for the IR, rather than just telling him that.
{shrug}
Good luck, whatever happens.
Posted by jealibeanz on March 25, 2007, at 17:21:01
In reply to Re: If you were my doc, what would you do? » jealibeanz, posted by Racer on March 25, 2007, at 16:45:21
I guess I'm taking an indirect approach because I want him to tell me it's OK to take Xanax.
Right now I'm just feeling very confused about what his current intentions for me are. Does he think that taking Xanax is a "wrong" idea?
I'm beginning to feel badly about taking the medication, due to the general attitude I know is held by medical practitioners, the benzo's should be avoided. Plus, I don't know what my doctor now thinks. I know he isn't totally against them, since he allowed me to use them daily for so long.
I guess I'm just looking for some validation, that taking a medication that helps my condition is not a horrible choice, if that's what I choose to do.
If I were speaking directly to him in person I would be OK bringing up this concern of mine. But I'm just leaving a message with a nurse. He may personally call me, or not, but even if he did, I'm not about to have a conversation about a touchy subject over the phone.
Soo.... I don't know what will come of this...
Posted by notfred on March 25, 2007, at 18:25:52
In reply to Re: If you were my doc, what would you do? » Racer, posted by jealibeanz on March 25, 2007, at 17:21:01
> I want him to tell me it's OK to take Xanax.
But you are Blanche, you are on Xanax.I think he is sending clear signals that he is OK
with it as he is the one who prescribed it for you.If you have questions about your docs treatment of you, ask them directly. Setting up these "tests"
where the other party does not know it is a test
is not effective in getting answers. Your doc will
be more effective in treating you when you are direct and honest.
Posted by jealibeanz on March 25, 2007, at 19:11:22
In reply to Re: If you were my doc, what would you do?, posted by notfred on March 25, 2007, at 18:25:52
> > I want him to tell me it's OK to take Xanax.
>
>
> But you are Blanche, you are on Xanax.
>
> I think he is sending clear signals that he is OK
> with it as he is the one who prescribed it for you.
>
> If you have questions about your docs treatment of you, ask them directly. Setting up these "tests"
> where the other party does not know it is a test
> is not effective in getting answers. Your doc will
> be more effective in treating you when you are direct and honest.
>
>Right, of course that's true. This would be easier for me to be direct if he scheduled a recheck, but I have none. (Which is a bit strange. Even if he didn't think he needed to see me in a month, there should have been a 3 or 6 month appt. He just checked PRN. Haha, as if he doesn't expect me to need to be back. I've been there about 15 times in the past year.)
My actual reason for calling tomorrow is for a refill for a different medication. I was just going to throw the Xanax XR info in with it. I suppose I could just tell the nurse that it's not helping and ask what he would like me to do.
I know that stopping cold turkey is not physically healthy and there are risks, so proposing a dangerous idea doesn't add any credibility or intelligence to my character. I'll just ask for advice.
Posted by FredPotter on March 25, 2007, at 22:55:29
In reply to If you were my doc, what would you do?, posted by jealibeanz on March 25, 2007, at 15:50:12
> If I called and left a message, asking if it would be OK for me to stop taking my 3mg Xanax XR, since it isn't helping.
>
> I'm [i]hoping[/i] that I won't get a call back from the nurse saying it is fine.
>
> I've been taking Xanax daily for almost a year now, so quitting without a taper would put me at risk for seizure. I wonder if all doctors know that.
>
No. I know at least 3 that don't. My GP said Xanax increased the risk of seizures but I hadn't the strength to argue. I suppose Xanax XR is easier to come off though. So I'd say cut down by 0.5mg a week
> This drug has very little efficacy for anxiety relief in my experience. I think my best bet would be to return to regular Xanax, 4 mg, for the time being. However, I don't want to suggest this. I want to leave this open ended for my doc.
That's what I take, sometimes more, sometimes less. Incidentally Effexor made me need more, but after quitting Eff cold turkey I find the effect of regular X lasts all day
> I suppose the worst that could happen is that he'd say yes, stop taking it. And if I do horribly I can call back and ask for a refill.
>
> This an odd approach, I know. I'm not trying to play games with him, although this is basically doing just that, in an indirect way. I'm letting him know that the medication is not providing anxiety relief. I should, as a responsible patient, update him on any problems I'm having with treatment, and ask before making a change.
>
> I can just picture him when he gets the message. He'll have this puzzled look on his face, because he's pretty sure Xanax XR is a good drug, in fact, it's much much better than regular Xanax, because you only have to take it once a day, there are no peaks are valleys, it's a wonderful idea for me!
>
> If he's not yet frazzled by his busy schedule, he may also be thinking:
>
> Oh no! What did I do! I must help my favorite patient! I wil do whatever she needs! She is obviously is distress! (haha, I'm serious)
>
> No prob, we'll just print out a script for Xanax 1 mg, q.i.d. Put in an envelope with the others I'm printing and tell her to pick it up at the desk. And tell her I said hi and ask if she has any updates on her grad school applications. Is she in? Is she in? Is she in?
>
> How about trying Cymbalta! You've never tried that one before. It's just been approved by the FDA for GAD! Oh you will lovvvve it!
>
> OK, nobody else will think this is funny, but I think it's hilarious. I have a very eccentric, friendly, and hyperactive doctor. He's fun to watch.Sorry I don't understand. You're on a drug for anxiety that doesn't work. So ask for one that does! Although I think Cymbalta's a bit like Effexor - bad withdrawals. I would tell him that benzos are wysiwyg. The only side effect for me being yawning 4 hours later, whereas drugs like Effexor and (Cymbalta FAIK) have a weird pot-pourri of side- (and withdrawal-) effects.
Bog standard Xanax at 4 mg per day sounds like a good start.
All the best
Fred
Posted by UGottaHaveHope on March 26, 2007, at 1:01:52
In reply to Re: If you were my doc, what would you do? » jealibeanz, posted by FredPotter on March 25, 2007, at 22:55:29
My first pdoc was this lady who in all honesty was one of the top five most beautiful women I had ever seen in my life. And still is.
I was so intimidated that I couldnt really tell her the whole story. I would make things out to be a little better, as if to impress her. Where did it get me? Nowehere, years wasted.
JB: I know you have a big heart and love you for it. But if you cannot be totally honest with your doc, even though you adore your doc, then you should consider changing docs. We all need to find someone we can be brutally honest with and have no fear on what they think.
I wish you well. Michael
Posted by med_empowered on March 26, 2007, at 3:01:03
In reply to The cold, hard truth is ...., posted by UGottaHaveHope on March 26, 2007, at 1:01:52
I dont mean to sound harsh, but I think you're reading too much into all this and you're wasting (or at least not optimizing) the time you and your doc spend together. I think if you want to go back to IR, ask your doc about it. If he doesn't want you on IR or on BZD's, he'll let you know somehow. If you still want to stay on the IR or BZDs in general, you can talk about it. Unless he's a total a$$hole, which it certainly doesn't sound like he is, he should be willing to communicate with you pretty openly, especially over something so minor (even with all the bad press, xanax is rx'd a whole, whole lot, so its not a big deal unless your doc is some benzo-phobic DEA agent-in-training. Then you're screwed).
You don't sound like a drug seeker and you're not looking for a crazy combo or super-high doses and you don't seem to have anything (axis II, history of RX drug abuse/alcoholism, etc.) that would make any controlled substances contraindicated so...I think you should take a deep breath, and tell your doc what you think the best thing for you is, instead of freaking out and (mis)communicating through these oddball tactics that might prove ineffective, if not counterproductive.
Good luck.
Posted by jealibeanz on March 26, 2007, at 4:23:08
In reply to Re: If you were my doc, what would you do? » jealibeanz, posted by FredPotter on March 25, 2007, at 22:55:29
> No. I know at least 3 that don't. My GP said Xanax increased the risk of seizures but I hadn't the strength to argue. I suppose Xanax XR is easier to come off though. So I'd say cut down by 0.5mg a week
> >
Did you mean that you don't feel that quitting Xanax poses a risk for seizures or your doctors didn't? I was under the impression that it did.
>> >
>
> Sorry I don't understand. You're on a drug for anxiety that doesn't work. So ask for one that does! Although I think Cymbalta's a bit like Effexor - bad withdrawals. I would tell him that benzos are wysiwyg. The only side effect for me being yawning 4 hours later, whereas drugs like Effexor and (Cymbalta FAIK) have a weird pot-pourri of side- (and withdrawal-) effects.
>Oh I understand that I took Effexor XR for a while. It certainly does have some strange side effects. I don't want to go through that again.
Posted by jealibeanz on March 26, 2007, at 4:40:32
In reply to The cold, hard truth is ...., posted by UGottaHaveHope on March 26, 2007, at 1:01:52
> My first pdoc was this lady who in all honesty was one of the top five most beautiful women I had ever seen in my life. And still is.
>
> I was so intimidated that I couldnt really tell her the whole story. I would make things out to be a little better, as if to impress her. Where did it get me? Nowehere, years wasted.
>
> JB: I know you have a big heart and love you for it. But if you cannot be totally honest with your doc, even though you adore your doc, then you should consider changing docs. We all need to find someone we can be brutally honest with and have no fear on what they think.
>
> I wish you well. Michael
I guess I never considered what I was doing as being less than honest with my doc, since I definitely don't deny that I have and have always had a lot of anxiety. But I see your point. Pretending that I'm OK with the way things are, even if I admit to anxiety, isn't helping me much at all.
Posted by jealibeanz on March 26, 2007, at 4:58:01
In reply to just say what you need, posted by med_empowered on March 26, 2007, at 3:01:03
> I dont mean to sound harsh, but I think you're reading too much into all this and you're wasting (or at least not optimizing) the time you and your doc spend together. I think if you want to go back to IR, ask your doc about it. If he doesn't want you on IR or on BZD's, he'll let you know somehow. If you still want to stay on the IR or BZDs in general, you can talk about it. Unless he's a total a$$hole, which it certainly doesn't sound like he is, he should be willing to communicate with you pretty openly, especially over something so minor (even with all the bad press, xanax is rx'd a whole, whole lot, so its not a big deal unless your doc is some benzo-phobic DEA agent-in-training. Then you're screwed).
>You're right. It is prescribed a lot and I've had it prescribed to me. My doctor is a 40ish D.O. in a very busy family practice. I was always a bit surprised that he'd be so willing to give me Klonopin or Xanax without a second thought (after AD's) since D.O.'s usually are a but less likely to think that drugs should be heavily prescribed. Apparently he isn't someone who's afraid of drugs.
> You don't sound like a drug seeker and you're not looking for a crazy combo or super-high doses and you don't seem to have anything (axis II, history of RX drug abuse/alcoholism, etc.) that would make any controlled substances contraindicated so...I think you should take a deep breath, and tell your doc what you think the best thing for you is, instead of freaking out and (mis)communicating through these oddball tactics that might prove ineffective, if not counterproductive.
>
> Good luck.Nope, no drug/alcohol abuse. I'm about as clean and straight and narrow as they come. It's practically written on my forehead. I don't know what it is about the way I look or act, but it's somehow very evident, whether you know me well or not.
A few weeks ago my doctor asked if I smoked because it popped up as a question on his computer screen for some reason. (He actually barely asked. Quickly said you don't smoke do you?) I just laughed and said NO! (no offense to those that do, although it's not healthy, I don't think it's something that defines a person's morals). I meant that I just don't do anything risky or questionable, legal or not.
Thanks to all who are responding. I need a little slap back in to reality. I know what I was thinking of doing was not direct enough to get what I need. I may wait til tomorrow so I can think some more and not do anything stupid.
Posted by Honore on March 26, 2007, at 10:47:55
In reply to Re: just say what you need » med_empowered, posted by jealibeanz on March 26, 2007, at 4:58:01
hey, jealibean. I'm really in agreement with others here. It really would take a lot of pressure off your future dealing with your GP if you could just tell him the facts, without trying to get him to offer you things that you want, but are uncomfortable asking for. You have the right to ask-- he's not going to think worse of you. You have a long=-term solid trusting relationship with him-- and are a very reliable patient. I'm sure he wouldn't take it the wrong way.
Where I become concerned (and I do hope you realize it's concern, not blank negativity about long-term xanax; I use it myself longterm, at varying doses) is when you think about adding more than the 4 mg/day. The combination of 4 mg/day xanax plus at-need xanax xr strikes me as possibly placing you in that zone where you may, entirely innocently, start becoming more dependent on more then 4 mg/day than you realize.
It's important, I think personally (and this is me, I guess) that if you take drugs with some addictive potential, like xanax-- which you can fall prey to for entirely good reasons, ie dealing with anxiety-- that you monitor the dose level, and promise yourself never to go above a certain level. Also, that, if possible, you use less when it isn't absolutely necessary on certain days or at certain times. That alone can help to keep the dosage level down a bit.
I asked my pdoc , when he gave me xanax, about when you get into the danger zone for addiction. He said it's a problem when you take 4 mg a day, and that he wouldn't want to see me taking that much. That's why I'm concerned about you. I realize that you're using it for pervasive anxiety and really need it. But that doesn't mean it might not pose a threat long-term.
I know this isn't something you feel comfortable about, but I'm going to say it anyway. I do think you might want to begin to reconsider an AD, because you do suffer from depression along with the anxiety. That mix is hard to differentiate.
Cymbalta works a lot more on the noradrenergic system than Effexor at small doses, so it might help. I think it's a pretty good drug and it seems to be catching on a lot, too.
But also, an MAOI might really make a huge difference for you. I know you don't like the idea of ADs. But there' s no weight gain with Parnate or Emsam-- and they might make your need for xanax much more secondary and within what you would feel completely comfortable asking for.
I know it's a big jump, but why not at least give it some thought over the next period of time, as you try to figure out what's best?
Honore
Posted by Phillipa on March 26, 2007, at 12:06:31
In reply to Re: just say what you need » jealibeanz, posted by Honore on March 26, 2007, at 10:47:55
No benzos are working for me right now. Love Phillipa I quit
Posted by jealibeanz on March 26, 2007, at 16:51:43
In reply to Re: just say what you need » jealibeanz, posted by Honore on March 26, 2007, at 10:47:55
Oh I definitely do not want to combine Xanax XR and Xanax to exceed 4mg, take only Xanax and exceed 4mg, or take Xanax XR and exceed 4mg. I know that going over is considered "a point of no return", and addiction may occur and tapering and withdrawing becomes difficult.
I think the whole 4mg thing is taken a bit too literally, since all bodies are different. We all have varying metabolic and excretion rates in relation to medications and we all have different levels of tolerance and therapeutic response. However, I do use it as a benchmark, because I know it's what medical professionals so, so I'll respect that.
I never took more than prescribed and had many instances where I took less. I always tried to take the lowest dose possible, without my anxiety getting too high. This came in handy several times when I was unable to get my prescription sent to me on time.
I think that nobody should be terrrribly concerned about the difference between someone taking 3mg or 4 mg. My highest daily was 4mg. Right now I'm taking 3mg XR, so I have been able to decrease, and it's with the version that I feel is much less therapeutic. I don't feel withdrawal or cravings. Just anxiety, because I have GAD. I'd probably be very satisfied with 2 or 3 mg of regular Xanax right now, divided througout the day, since it would be an improvement from what I have now.
Haha! Yes, you're right, I do not want to try another AD right now! Ughh... so many side effects!I thought that Effexor worked more on NE than Cymbalta. I may be wrong, but I believe that's correct.
I hated Effexor, Paxil, Wellbutrin, Buspar. They all have their negatives. I seem to be particularly sensitive to them. All caused nausea, weight gain, total apathy. Effexor caused night sweats and dizzyness. So I'm not particularly keen on an SSRI or SNRI.
Both my doctor and PA have told me that I could try another, but it's likely that I'll have similar side effects based on my history. When I told my PA last year I wanted to stop Effexor, since I was having a hard time with the side effects, and was feeling better, he didn't want me to try another AD. My doctor briefly mentioned Celexa last September, but when I reminded him of the other meds, he quickly dismissed that idea.
Hmm... Parnate or EMSAM? Do you think they'd help with anxiety? Or are you saying that lessening any depression will make anxiety easier to control?
I'm not saying I don't want to take an AD, just because I'm being stubborn. I've just experienced too many negative side effects to be overly anxious to go for another one. Haha, I don't think my GP would go for an MAOI anyway, and I'm afraid of whatever new and unexplored side effects I'd have, because they just seem likely to occur with me. Every time I've gone off one, it's with the thought that I'd nevvvver do it again, so I have tried again, despite my vows. And after the discontinuation of each one, I want to run from all meds!
I appreciate your lengthy response very much. I'm not trying to argue with you at all. You've given me quite a bit to think about. I'm still a little afraid of asking for Xanax straight out, but am considering it. Hopefully a good night's sleep will help.
Posted by Honore on March 26, 2007, at 18:33:32
In reply to Re: just say what you need » Honore, posted by jealibeanz on March 26, 2007, at 16:51:43
At several points, you wrote things similar to this:
"I was thinking about possible solutions to my medication problems. I wonder if anyone ever takes both Xanax XR and Xanax daily. Although I don't feel like Xanax XR does anything for me, it probably does. Maybe I could take 1-2 mg Xanax XR daily plus 2-3mg Xanax daily. That way, I have a stable baseline, with the addition of a medication that I believe helps with my anixety."
You also said that although the xanax 4/day helped, you were up and down, and often had more anxiety than could be entirely dealt with, even if you dosed it at 4/8 times a day.
So you have expressed a desire for more than 4 mg/day.
I'm saying this out of concern for you, not criticism. I"m sure there are reasons why you trust xanax and not other meds. But I still am concerned. I hope it works out for you and you can get the medications you need, that are stable and help you to accomplish the things you want to do.
Honore
Posted by FredPotter on March 26, 2007, at 18:39:42
In reply to Re: If you were my doc, what would you do? » FredPotter, posted by jealibeanz on March 26, 2007, at 4:23:08
No I mean some Drs don't know the seizure danger of coming off Xanax too quickly. I do. In hospital they just took me off it suddenly and sure enough I had a seizure
Posted by jealibeanz on March 26, 2007, at 19:19:38
In reply to Re: just say what you need » jealibeanz, posted by Honore on March 26, 2007, at 18:33:32
> At several points, you wrote things similar to this:
>
> "I was thinking about possible solutions to my medication problems. I wonder if anyone ever takes both Xanax XR and Xanax daily. Although I don't feel like Xanax XR does anything for me, it probably does. Maybe I could take 1-2 mg Xanax XR daily plus 2-3mg Xanax daily. That way, I have a stable baseline, with the addition of a medication that I believe helps with my anixety."
>
> You also said that although the xanax 4/day helped, you were up and down, and often had more anxiety than could be entirely dealt with, even if you dosed it at 4/8 times a day.
>
> So you have expressed a desire for more than 4 mg/day.
>
> I'm saying this out of concern for you, not criticism. I"m sure there are reasons why you trust xanax and not other meds. But I still am concerned. I hope it works out for you and you can get the medications you need, that are stable and help you to accomplish the things you want to do.
>
> HonoreYeah, that was what I wrote in a different thread. I knew what I meant, but it probably wasn't clear to readers.
I was just suggesting the possibility of combining both XR and IR. I'm not sure if it's a good idea for me or anyone else, merely a thought.
My doses that I wrote were all supposed to total no more than 4 mg, taking both medications into consideration. (1. Xanax XR 1 mg + Xanax IR 3mg or 2. Xanax XR 2mg + Xanax IR 2mg) I didn't clearly write that out before, plus I had in mind the IR dose would be written as a maximum of either 2 mg or 3 mg, but with the idea that I'd take less if possible.
Does this makes sense? I hope so.
Did I write somewhere that I dosed the Xanax 8 times a day? If I ever wrote that I spaced my medication out that way, I certainly don't remember actually doing so! I know at one point I had my 1 mg tabs all cut in half when I was trying to take less than the 4 mg/day. So, yes, I've taken it more than 4 times a day at some point, but that would have been me trying to find the level I needed in small increments, and trying to keep it as low as I could. Haha, I don't know, maybe it's the old age and my memory is going...
Yeah, my anxiety does go up and down, based on medication changes and life stressors. When I was on 4 mg a day consistently, if felt that it helped. I never want to go above the dosing, whether or not I'm feeling anxious, because I do want to avoid having my body get used to a large dose of medication.
I'm not writing any of this out of defense. I'm trying to explain the situation a little more. There may be some confusion on both sides. I don't know. Or maybe my brain is fried from studying A+P all weekend!
I appreciate the concern. I do have reasons for not trying other meds, unfortunately, because I wish I could just take an SSRI or SNRI without feeling lifeless and numb, plus rid my anxiety. It just doesn't seem to be the logical choice.
If this were only my opinion, I'd say it's skewed, since it's difficult to be objective when assessing your own situation, but I would pretty much have to beg my PA or doctor to give me an SSRI right now. Even then, it would come with an, "OK, but it's your choice and we warned you. You probably won't be happy with it, just like the other times."
Does this clarify things?
Posted by jealibeanz on March 26, 2007, at 19:23:05
In reply to Re: If you were my doc, what would you do? » jealibeanz, posted by FredPotter on March 26, 2007, at 18:39:42
> No I mean some Drs don't know the seizure danger of coming off Xanax too quickly. I do. In hospital they just took me off it suddenly and sure enough I had a seizure
Ohhhh... that is not a situation I want to get in to. Thanks for the reminder that it does actually happen in real life.Were these doctors in the hospital aware that you'd been on Xanax for a while? And did your doctor know they were D/C'ing it?
How much were you taking and how long had you been taking it for, if you don't mind me asking?
Posted by Honore on March 26, 2007, at 21:33:30
In reply to Re: just say what you need, posted by jealibeanz on March 26, 2007, at 19:19:38
Hi, jealibeanz. That does clarify a lot.
I do hope you can get what you need. I certainly think you shouldn't have to deal with so much anxiety. My only concern is the problem I mentioned, but if that's not an issue, and you can maintain the dose without going up, then my concerns are answered.
Maybe you can just ask your GP for what you want; why not just go back to the prior situation? You seemed to think originally that he was looking for a stable solution; maybe what's best is what he was already doing. Can't see why he wouldn't be open to that, really.
Honore
Posted by jealibeanz on March 26, 2007, at 21:45:30
In reply to Re: just say what you need » jealibeanz, posted by Honore on March 26, 2007, at 21:33:30
> Hi, jealibeanz. That does clarify a lot.
>
> I do hope you can get what you need. I certainly think you shouldn't have to deal with so much anxiety. My only concern is the problem I mentioned, but if that's not an issue, and you can maintain the dose without going up, then my concerns are answered.
>
> Maybe you can just ask your GP for what you want; why not just go back to the prior situation? You seemed to think originally that he was looking for a stable solution; maybe what's best is what he was already doing. Can't see why he wouldn't be open to that, really.
>
> HonoreStability is definitely what I'm looking for. Aren't we all?! I'm trying to get there!
Going back to the regular Xanax for right now is most likely my best solution. It'll help me get to a better state, and then I can make reasonable decisions about my future regarding medications and such.
Posted by jealibeanz on March 27, 2007, at 5:30:21
In reply to Re: just say what you need » jealibeanz, posted by Honore on March 26, 2007, at 21:33:30
This is just a random thought/analogy that ran through my head this morning, not entirely related to the topic...
Flonase:
I'm dependent on Flonase. I've taken it for allergies every day (almost) for the last 8 years. It's the only thing that truly relieves my symptoms. I went through years of allergy shots and have been on all the prescription antihistamines, neither helped.
I go on and off Allegra, Claritin, Zyrtec, and Clarinex every few years. Sometimes I don't take them because I don't feel I need them because my allergies aren't bad. Or, my allergies are bad, but I know they make no difference with me. Right now I'm taking Clarinex, since I've had more symptoms over the last year and decided to try taking an oral med again. It doesn't help!
My Flonase is the only thing that keeps me breathing, keeps my throat from being itchy and inflammed, and prevents complications. If I don't take it as soon as I wake up, it set me up for a bad day, because I start to have allergic reactions. If I go a day or so without it, I'll get a sinus infection. I've tried to "quit" my Flonase before, because I thought I was addicted, haha, and lasted only 3 days.
I asked my PA about what he thought about me taking it for such a long time and told him I wanted to stop, even though it's the only med that works, because I thought I'd been on it too long. He looked at me like I was crazy. There's no reason to stop it, but many to keep taking it. (He was probably thinking... Flonase?! You're concerned about Flonase?! That is not your biggest problem!)
I asked one of my professors, a D.O., about this a few months ago when she was lecturing about allergic rhinitis. She was saying that she likes to avoid the steroids, and was very clear about it. So, I told her my story and asked what she thought. She told me to stick with what is working! It goes completely against what she holds as her "rule of thumb" for practice and treatment, yet she said that without hesistation. And she said that if I try stopping, I'd have some "rebound" reactions, because my body is used to having the steroids to fight allergens, so it's a bit weakened so to speak.
Anyway...
My point is, Flonase is not considered first line treatment for allergies. Maybe second line in conjunction with oral medication, and its extended use is discouraged, since it is a steroid. I don't think many people with allergies are prescribed this medication by itself for so long, but I am. However, my allergist/pulmonologist, GP and PA all see no problem with me taking it long-term. It helps me!
This is soo similar to my Xanax situation, in my opinion. It's not first line. It's extended use is discuraged. It's not normally taken without a 1st line drug. If you stop taking it, you may experience rebound anxiety. Hmm...
Posted by Honore on March 27, 2007, at 10:36:32
In reply to Re: just say what you need » Honore, posted by jealibeanz on March 27, 2007, at 5:30:21
I take long-term Flonase myself (with MAOIs and chronic low-level sinus infection).
The analogy isn't perfect, of course, because dependency hasn't been a problem with Flonase.
But I agree that we (in this country and elsewhere) have a bit of a fixation on dependence on certain drugs-- and not others. Of course there are reasons and distinctions-- but I do think it's overstated, and that these drugs are useful, if not overused.
My concern stems from a family situation, which was extremely tragic-- which came from needed use, that led to dependence, which led to other things-- and I would just hate to see you get into any of those things.
I don't blame my family member although it was at times agonizing to see his struggles and the problems that developed. I know you can need something like that-- and still, unawares develop more of an addiction-like relationship to it.
I think this can be avoided- but it takes vigilance and a little on-going fear of what could happen-- even when you think you have it under control.
That's why I'm saying the things to you that I am. I think it's fine to take xanax if you are very very aware of the potential for getting into that danger zone--whatever it is for you, personally. But again, I would just hate to see you move into that, and have to cope with the problems that it can cause.
I do think you should ask your GP up-front about giving you the xanax IR, and talk about it more with the PA, who seems more on the ball. You want to protect yourself-- and yet to stay on the dose you need. Both of which are worthy goals, for which there's no reason to hint, without being clear.
If either of them does have concerns, it's best to talk it over, anyway, and see if you can come to a clear agreement, yet have the xanax also. I'm sure they'll do their best to keep the anxiety at manageable levels and work with you.
Honore
Posted by jealibeanz on March 27, 2007, at 11:41:26
In reply to Re: just say what you need » jealibeanz, posted by Honore on March 27, 2007, at 10:36:32
I am very aware that Xanax can be addicting to some-- not all. I certainly do not want to get to that point and won't let myself. I'm a very disciplined person.
Haha, I think my anxiety may work in my favor when it comes to this issue, because I do worry about it! I worry that I take the medication at all, since it's a bit controversial. I worry that the time will come when I'll have to switch doctors, and nobody will continue with my treatment.
I'm young enough that I actually do believe I will benefit from the novel drugs of the future. I try to view Xanax as buying me some time.
I never see my PA anymore, since he can't prescribe all the controlled medications, so my doctor has become my primary provider. I do know however, that he isn't terribly keen on them, but I wouldn't be either if I were him. He's very young, so was taught in school that they are "bad", because that's the current belief being shared with students. He can't really say how much he thinks they help, since he doesn't prescribe them. I'll ask my doc whenever I actually can see him in person, what his future plan is for me.
Posted by jealibeanz on March 27, 2007, at 17:39:55
In reply to Re: just say what you need » Honore, posted by jealibeanz on March 27, 2007, at 11:41:26
I called today and left the message with the nurse, saying that it wasn't helping and asked he'd want me to go back to regular Xanax or try something else. I haven't heard back. Blehh... I hope he calls tomorrow because I don't want to have to call again. They're terrible at relaying messages. Sometimes they don't give them to the doc, especially if he wasn't working. I'm not sure if he was actually in the office today or not.
Posted by Phillipa on March 27, 2007, at 18:36:12
In reply to Re: just say what you need, posted by jealibeanz on March 27, 2007, at 17:39:55
Jelly right now I'm sitting here totally miserble . Cry at the drop of a hat. Dizzy. Scared. Can't sleep as I'm now on ativan. I've become tolerant to benzos it's obvious to me now. Love Phillipa ps I did better on the long lasting xanax. At least I could do things and wanted to now I'm a quivering shaking person.
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