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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by lepus on July 2, 2011, at 13:36:16
After a horrible stay in the hospital I have to start Emsam on my own. Very nervous about it. Any encouraging words? FB?
I can't believe the state of psychiatric care. I thought I was so lucky to get a hospital bed. But no, it was like winning the lottery in a Shirley Jackson book. My meds were always late (not good with Klonopin). The way they dealt with my severe agoraphobia was to tell me that I would not get food or my meds unless I could walk to the nurse's station and cafeteria. If I had panic and had to retreat then too bad - I won't be eating that meal. I went without breakfast and lunch more than once. My meds they only threatened to not give me; it never happened, except the first morning when my Klonopin was horribly late, sending me into withdrawal symptoms. One night I had a terrible panic attack. I rang the nurse. She yelled at me for using the call button. I said I'm having a terrible panic attack, I can't walk to the nurse's station, please get me my Ativan. She did. The Ativan didn't work so I rang her again. More yelling and then she told me there was nothing she could do for me and left. She left a shaking, sobbing person there to deal with the attack completely alone. She wouldn't even get me ice water.
I checked myself out yesterday. Using the threat of no food or meds unless you can get places is just cruel. Worst of all they did nothing to help me get to these places. Didn't walk with me, nothing. Just yelled. In one day I was supposed to go from being totally agoraphobic to being able to move about anywhere with ease when nothing had changed; no new meds, no new therapy, nothing. Just threats of no food and no meds unless I magically cured myself.
I'm so despondent right now. Then the fear of taking the Emsam isn't helping. I feel like God, and even man, has completely abandoned me.
Posted by floatingbridge on July 2, 2011, at 18:16:45
In reply to Encouragement - Emsam, posted by lepus on July 2, 2011, at 13:36:16
Lepus, I have been wondering how you are. It's good to hear from you.
First, you need emsam support. Tell us if you have a script?
This is how I managed my fears about starting. I cut the patch into thirds. You can make any size you feel comfortable with. If you are very hesitant, try a forth.
There is no reason not to cut them--it does not interfere with delivery. My very cautious pdoc called the rep (!) to make sure. So it's officially unofficially acknowledged as far as I'm concerned.I found my upper arm best. The skin seemed bit tougher there, and I was worried about a rash (which I did not get).
Second, for myself, most hospitals are not great for an anxious person unless they are also in other danger. My opinion. I found this out once. I ended up with my first absolutely blown worst panic attack in the hospital for very similar reasons. There was no one to talk to, my meds became mechanically distributed. All I could think of was that I had to get out of there asap, and if I didn't calm down, 'they' would know I was 'crazy' and keep me.
I am very very sorry you had to go through your experince!
To date, my best treatment was a day hospital program. That is what I was released into. There were women there who at the drop of a hat would begin to panic, and it was o.k. Those of us who were fine offered support. The staff, like a trained rn's and psychologist and psychiatrists understood and would talk people through it. We might have to go get our own water, but a very understanding person would just quietly and reassuring walk with anyone if they needed.
Let us know about your med situation, please. Very glad to hear from you!
> After a horrible stay in the hospital I have to start Emsam on my own. Very nervous about it. Any encouraging words? FB?
>
> I can't believe the state of psychiatric care. I thought I was so lucky to get a hospital bed. But no, it was like winning the lottery in a Shirley Jackson book. My meds were always late (not good with Klonopin). The way they dealt with my severe agoraphobia was to tell me that I would not get food or my meds unless I could walk to the nurse's station and cafeteria. If I had panic and had to retreat then too bad - I won't be eating that meal. I went without breakfast and lunch more than once. My meds they only threatened to not give me; it never happened, except the first morning when my Klonopin was horribly late, sending me into withdrawal symptoms. One night I had a terrible panic attack. I rang the nurse. She yelled at me for using the call button. I said I'm having a terrible panic attack, I can't walk to the nurse's station, please get me my Ativan. She did. The Ativan didn't work so I rang her again. More yelling and then she told me there was nothing she could do for me and left. She left a shaking, sobbing person there to deal with the attack completely alone. She wouldn't even get me ice water.
>
> I checked myself out yesterday. Using the threat of no food or meds unless you can get places is just cruel. Worst of all they did nothing to help me get to these places. Didn't walk with me, nothing. Just yelled. In one day I was supposed to go from being totally agoraphobic to being able to move about anywhere with ease when nothing had changed; no new meds, no new therapy, nothing. Just threats of no food and no meds unless I magically cured myself.
>
> I'm so despondent right now. Then the fear of taking the Emsam isn't helping. I feel like God, and even man, has completely abandoned me.
Posted by lepus on July 2, 2011, at 21:15:10
In reply to Re: Encouragement - Emsam » lepus, posted by floatingbridge on July 2, 2011, at 18:16:45
Hi FB,
I have samples of Emsam right here. One is even open from when I was going to apply it this morning. I think maybe I needed a day off to recuperate after the hospital fiasco. I think my muscles were clenched for about 48 hours straight. I'm feeling it today.
Okay, so I will cut the patch. Any scissors will do or do I have to sterilize them? Wash them after I assume?
How did you feel on so little of the patch? Of course you were having the thyroid problems. But you don't think Emsam caused anxiety? That is my biggest fear. My anxiety was high and now it is very terrible thanks to the hospital.
Sorry to hear you also had a bad hospital experience. The weird part of my experience was I think they were actually trying to help me. But my God, threatening an anxious person and yelling at them doesn't help! I went without food! They never followed through on not giving me meds but I definitely went without food. I think these people went to the Josef Mengele School of Psychiatry. Panicking was definitely not okay with any of the staff here, except maybe the social workers. They were very kind frankly and were the only reason I got some meals. But the rest of the staff did not care, would not talk to me, comfort me in any way, give me new tools to cope, call the doctor when I was having an 8 hour panic attack or throw water on me if I was on fire. It was not a safe environment for anyone I don't think.
Very scary.
Thanks for the support, FB. Have you restarted Emsam? I just wish I knew what I could expect...
Is it only at higher doses that it affects blood pressure? I already have low blood pressure, another thing that worries me.
Man, I tried so hard to get help and start some new meds somewhere I felt safe. That did not happen. I'm on my own.
Posted by floatingbridge on July 2, 2011, at 23:02:54
In reply to Re: Encouragement - Emsam, posted by lepus on July 2, 2011, at 21:15:10
Lepus, I don't know why more people don't understand that certain behaviors around anxious people are the very opposite of helpful :-/ Recently I came across a list on an anxiety disorder clinic site about how to talk to someone experiencing panic, and I have been wanting to make wallet cards to just hand it out to some of the people in my life, esp the ones who had entertained
the idea that hospitalization was a good idea for me.Take whatever time you need if you decide to try emsam, o.k. I didn't even want to take my first xanax today--and I have been on it before :-/
So, the only care I took about cutting my
patch was using the same scissors and leaving those scissors with the box in my med cabinet. I am pretty indifferent to germs--that's just me. I didn't think it was important because it is an transdermal that was going to sit on my arm. I was mindful to cut the patch 'lengthwise' against the peel back flap so every piece I could peel back w/o digging
in w/ finger nails. The directions say to avoid touching the sticky part--like applying a bandaid. I was washed my hands after application because they advise that--no accidental transfer to eyes or mouth. I really forgot I was wearing it.After about two-three days I felt a little funny, enough to contact some babblers by babblemail who reassured me this was start up. It was true for me and resolved within hours.
I have also taken the patch off and had slow but immediate decrease in effect, if that is helpful to know.
Are you in contact with the doctor who gave you the samples? Do you have a go-to medication for anxiety if it arises? I think I needed an extra dose of xanax during those transitory start ups.
For me, it reduced anxiety somewhat (not cure it). Maybe my response was atypical. I was very apprehensive about starting, too :-/
Keep posting if it helping.
Oh. The patched can peel up or come kinda off. The directions say just put on a new one. This happened a number of times. I freaked (of course) but long story short, I replaced the patch as directed w/o incident. Hope this is helpful.
> Hi FB,
>
> I have samples of Emsam right here. One is even open from when I was going to apply it this morning. I think maybe I needed a day off to recuperate after the hospital fiasco. I think my muscles were clenched for about 48 hours straight. I'm feeling it today.
>
> Okay, so I will cut the patch. Any scissors will do or do I have to sterilize them? Wash them after I assume?
>
> How did you feel on so little of the patch? Of course you were having the thyroid problems. But you don't think Emsam caused anxiety? That is my biggest fear. My anxiety was high and now it is very terrible thanks to the hospital.
>
> Sorry to hear you also had a bad hospital experience. The weird part of my experience was I think they were actually trying to help me. But my God, threatening an anxious person and yelling at them doesn't help! I went without food! They never followed through on not giving me meds but I definitely went without food. I think these people went to the Josef Mengele School of Psychiatry. Panicking was definitely not okay with any of the staff here, except maybe the social workers. They were very kind frankly and were the only reason I got some meals. But the rest of the staff did not care, would not talk to me, comfort me in any way, give me new tools to cope, call the doctor when I was having an 8 hour panic attack or throw water on me if I was on fire. It was not a safe environment for anyone I don't think.
>
> Very scary.
>
> Thanks for the support, FB. Have you restarted Emsam? I just wish I knew what I could expect...
>
> Is it only at higher doses that it affects blood pressure? I already have low blood pressure, another thing that worries me.
>
> Man, I tried so hard to get help and start some new meds somewhere I felt safe. That did not happen. I'm on my own.
Posted by Phillipa on July 3, 2011, at 0:19:29
In reply to Encouragement - Emsam, posted by lepus on July 2, 2011, at 13:36:16
Lepus it's been a good 15 years since I nursed on a psych floor. I am totally appalled at your experience and apologize for what has happened to the profession. It just wasn't like that when I worked there. We had time to care and talk to the patients often. I'm so sorry by what happened to you. I do think you might want to report this to adminstration. And as FB said take you time and recover first. Love Phillipa
Posted by lepus on July 3, 2011, at 11:35:41
In reply to Re: Encouragement - Emsam » lepus, posted by Phillipa on July 3, 2011, at 0:19:29
> Lepus it's been a good 15 years since I nursed on a psych floor. I am totally appalled at your experience and apologize for what has happened to the profession. It just wasn't like that when I worked there. We had time to care and talk to the patients often. I'm so sorry by what happened to you. I do think you might want to report this to adminstration. And as FB said take you time and recover first. Love Phillipa
Thanks, Phillipa. The administration will definitely be getting a letter. I think I might call the local mental health advocacy group and NAMI as well.
Things have definitely changed for the worse. It seems like psychiatry is sliding backwards as other medical fields make giant strides forwards. I guess it all comes down to money and how many people they can afford to staff. The night I was having the awful panic attack, the nurse yelled at me to not use the call button because there were only two people on staff. Okay, well I'm sorry you're short staffed but I'm still having a massive problem here...sorry it is inconveniencing you.
Posted by floatingbridge on July 3, 2011, at 12:10:43
In reply to Re: Encouragement - Emsam » lepus, posted by floatingbridge on July 2, 2011, at 23:02:54
Umm. I didn't see your questions about blood pressure.
I felt the emsam start up was slow, which was good for me
My blood pressure is low. But I did not have any problems on emsam like maoi's and going from lying down to standing. No more than usual, maybe less, because I *slowly* started to feel a little better physically.
I had exacerbated sleep problems. Some here have said that resolves. Insomnia has always been big for me, and my doc did not give me proper sleep support :-/ so I am off right now. I would say, only speaking from my experience, a sleep plan in place, just in case is a good idea.
There was no other side effect for me besides sleep. It seemed *gentle* to me.
I only went as far as the 6mg patch.
You say you are alone. Will you let me know if you are in touch with a doctor, at least by phone? Thanks.
Posted by lepus on July 3, 2011, at 14:59:15
In reply to Re: Encouragement - Emsam » floatingbridge, posted by floatingbridge on July 3, 2011, at 12:10:43
Yes, my doctor is available by phone. She gave me her personal cell number.
The patch has landed...on my arm. It's about a fourth of a patch. Hard to divide it up evenly, especially when the sides are rounded. So, I have a rectangular shaped patch on my upper arm.
And I'm nervous as heck. I'm trying to work on some stuff for school to keep my mind off it but I know every twitch is going to send me into panic. This is so ridiculous. I long for the old me. I thought medications could be fun. They were also a shot at feeling so much better. I guess this one is too but too many times starting the medication has meant feeling even worse.
Thank you for all your help, FB. Let's hope this is a solution to this long nightmare.
I will keep remembering you thought it was gentle. I need gentle so desperately.
Posted by lepus on July 3, 2011, at 15:57:26
In reply to Re: Encouragement - Emsam, posted by lepus on July 3, 2011, at 14:59:15
Ugh. Had an anxiety bump about 50 minutes after putting the patch on. I am fighting through it. Probably psychological, right? I mean it is a 1/4th of a patch!
Posted by floatingbridge on July 3, 2011, at 16:34:46
In reply to Re: Encouragement - Emsam, posted by lepus on July 3, 2011, at 15:57:26
Well, like I said, I had to 911 some babblers here when I started up. So you can post to this thread at the very least or babblemail me if you want 24/7. I imagine others here don't mind, either. I got alot of support.
I think I really get the hyper vigilance piece and the onset of anxiety for any/no reason.
That all said, I don't know if this med will work for you, but in the general scheme of medicines and as a consumer :-) I think of emsam as gentle. That's why it doesn't really always rate around here as a good AD for some folks.
You're going to be o.k. I am very glad you have your doc's cell. I would think she wouldn't prescribe it if she thought it was a danger. She's probably knows how med sensitive you can be.
Do you have a panic med? Klonopin?
Anytime, Lepus. You're o.k.
:-)
fb
Posted by Lepus on July 3, 2011, at 17:07:54
In reply to Re: Encouragement - Emsam » lepus, posted by floatingbridge on July 3, 2011, at 16:34:46
I do have a panic med. I have both Klinopin and Ativan. I think I even have an old bottle of Xanax around ere somewhere. I think I have a med cabinet to knock out a horse. Luckily I'm not suicidal.
I'm undecided about babblemail. I feel it is good to have a record of the experience that might help others but then I might also need to talk to you more personally. Ugh. I just need my hand held through this.
Right now I'm a bit sleepy and irritable. Been doing accounting homework, so not sure if it is a side effect of the med or the homework!
Thank you, FB. Your kindness is very appreciated.
Posted by lepus on July 3, 2011, at 18:37:55
In reply to Re: Encouragement - Emsam, posted by Lepus on July 3, 2011, at 17:07:54
How does this patch work anyway? Does the medicine enter the bloodstream at a continuous rate, cross the blood brain barrier and then do its magic? I wonder if what I felt was the meds crossing the BBB?
It does make me feel a bit better knowing I could stop the drug just by ripping off the patch, but then I'm not sure that is how it works.
Posted by floatingbridge on July 3, 2011, at 18:57:57
In reply to Re: Encouragement - Emsam, posted by lepus on July 3, 2011, at 18:37:55
> How does this patch work anyway? Does the medicine enter the bloodstream at a continuous rate, cross the blood brain barrier and then do its magic? I wonder if what I felt was the meds crossing the BBB?
Well, it is supposed to enter continuously. The BBB is over my head. :-/
Exposure to hot water (a shower is o.k.), excessive heat from a heating pad *directly on the patch*, or a blazing hot prolonged exposure to sun (which sounds awful to me) can speed the delivery. I experienced this only after I went into a hot tub and heated pool like
a dodo bird. But again, the intensity remitted. The response in my own case was delayed, not immediate. So it took me a few minutes to think back and say, hmmm, it was the pool. Like 12-24 hours later. Everyone is different.Likewise, removing the patch. It will *slowly* tone it down. But I think that's good for me because I do best with slow ascent and descent. But let's say I felt like I could feel the descent begin within the hour, and that was enough to reassure me. Me and a xanax :-/
>
> It does make me feel a bit better knowing I could stop the drug just by ripping off the patch, but then I'm not sure that is how it works.
Posted by lepus on July 3, 2011, at 19:30:08
In reply to Re: Encouragement - Emsam » lepus, posted by floatingbridge on July 3, 2011, at 18:57:57
I think the psychological response to knowing the patch is off might be enough to calm frayed nerves. Well, at least for me. I really don't know anymore how much of my reactions are actually reactions or are me being a Nervous Nelly.
I do sunbathe since I have low Vit D levels. I hope that won't be a problem. I don't do it in excessive heat but I do get right in the light.
With most drugs you know their half life, how long they take to kick in, how long they'll be in your system, etc. I don't see any of that info for Emsam? Does anyone else? Scott?
Posted by lepus on July 3, 2011, at 19:37:52
In reply to Re: Encouragement - Emsam, posted by lepus on July 3, 2011, at 19:30:08
Found the half life. It is about 18 to 25 hours. Long...
Posted by Phillipa on July 3, 2011, at 20:49:40
In reply to Re: Encouragement - Emsam, posted by lepus on July 3, 2011, at 19:37:52
I feel as you that it's comforting to know you can see the actual patch gone and know that slowly the med is leaving your system. And that it does bypass gastrointestional system and hepatic first pass. Phillipa
Posted by lepus on July 3, 2011, at 22:51:40
In reply to Re: Encouragement - Emsam » lepus, posted by Phillipa on July 3, 2011, at 20:49:40
> I feel as you that it's comforting to know you can see the actual patch gone and know that slowly the med is leaving your system. And that it does bypass gastrointestional system and hepatic first pass. Phillipa
Right. Even though I know it isn't going to leave my system immediately should I have an issue, there is a certain psychological comfort in tearing off the patch and pitching it.
I have not ripped it off though. Today has gone fairly smoothly, but then I'm on a baby amount. I hope dosage increases go smoothly as well. :fingers crossed:
Posted by Phillipa on July 4, 2011, at 0:26:36
In reply to Re: Encouragement - Emsam, posted by lepus on July 3, 2011, at 22:51:40
I feel that means a lot as once was going to try it and that was so comforting. Have a scientific mind and have to see to believe. Don't forget toe crossing also!!!! Phillipa
Posted by Lepus on July 4, 2011, at 4:06:07
In reply to Re: Encouragement - Emsam » lepus, posted by Phillipa on July 4, 2011, at 0:26:36
Think I might need to cross a few more things in the hopes this will work. Woke up to a nocturnal panic attack tonight. Not sure if it is due to the EMSAM or not. I have been having more of them lately.
Not happy. I feel like I'm being tortured lately. I just want it to end. Please.
Posted by floatingbridge on July 4, 2011, at 7:26:06
In reply to Re: Encouragement - Emsam, posted by Lepus on July 4, 2011, at 4:06:07
Lepus,
The nocturnal attacks appeared before emsam?
Do you ever write stuff down? Like took what when and symptoms like panic episodes? You probably do. It's a good tool and frees up my mind.
> Think I might need to cross a few more things in the hopes this will work. Woke up to a nocturnal panic attack tonight. Not sure if it is due to the EMSAM or not. I have been having more of them lately.
>
> Not happy. I feel like I'm being tortured lately. I just want it to end. Please.
Posted by Lepus on July 4, 2011, at 7:26:32
In reply to Re: Encouragement - Emsam, posted by Lepus on July 4, 2011, at 4:06:07
Patch is off. I just woke up again to ridiculous anxiety.
I don't understand. I was only on 1/4th of a patch. But this has to be more than mere coincidence now, surely? I'm a nervous wreck!
Now what...
Posted by floatingbridge on July 4, 2011, at 7:40:37
In reply to Re: Encouragement - Emsam, posted by Lepus on July 4, 2011, at 7:26:32
> Patch is off. I just woke up again to ridiculous anxiety.
>
> I don't understand. I was only on 1/4th of a patch. But this has to be more than mere coincidence now, surely? I'm a nervous wreck!
>
> Now what...Lepus, I'm sorry. Did you ever look at any of my multiple emsam threads? My patch was off and on countless times
:- / I know I drove everyone nuts. I felt nuts starting up.I don't want to tell you what to do. That wouldn't be right. Keep me posted if you will. I'll be here no matter what you decide.
Myself, I still wake early from some intense dream, but my sleep time is lengthening a bit. Today was 4:30 am. That's good for me.
Hang in there whatever you decide.
Posted by Lepus on July 4, 2011, at 8:01:51
In reply to Re: Encouragement - Emsam » Lepus, posted by floatingbridge on July 4, 2011, at 7:40:37
I do recall several of your start up threads. I thought the anxiety was mostly your thyroid though?
I don't think I can handle waking up every night to that kind of anxiety. I woke up twice in a panic!
I don't understand. I feel doomed now. I don't know what is left for me to try.
Posted by Lepus on July 4, 2011, at 8:12:35
In reply to Re: Encouragement - Emsam » Lepus, posted by floatingbridge on July 4, 2011, at 7:26:06
The nocturnal panic attacks were there before the EMSAM. I had an incident on Thursday when I was in the hospital. This attack felt different though. More difficulty breathing.
I am not a journaler and I regret it, especially since all my previous doctors seem to have retired or they won't release my records no matter how many times I request them and fill out the necessary forms. Seems they just don't even have them anymore. I don't know.
> Lepus,
> Z
> The nocturnal attacks appeared before emsam?
>
> Do you ever write stuff down? Like took what when and symptoms like panic episodes? You probably do. It's a good tool and frees up my mind.
>
>
> > Think I might need to cross a few more things in the hopes this will work. Woke up to a nocturnal panic attack tonight. Not sure if it is due to the EMSAM or not. I have been having more of them lately.
> >
> > Not happy. I feel like I'm being tortured lately. I just want it to end. Please.
>
>
Posted by floatingbridge on July 4, 2011, at 8:14:37
In reply to Re: Encouragement - Emsam, posted by Lepus on July 4, 2011, at 8:01:51
What kind of panic (symptoms) you experiencing?
And I'm curious when you started emsam. Yesterday (Sat) or Friday?
I was told I could take my patch off about an hour before bed.
I hope you don't feel pushed here. I'm just trying to listen and be steady.
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