Drugs – Niche-Me…

Doctor messes up.

I’m… well… very angry. If I could get this guy fired and reported to some agency to keep him from prescribing medications, I would. Darn straight! 

This “doctor” (He’s a PA-C. I don’t even know what that is. I know what a PA is. What’s the “C”? Crackpot?) Okay, back to why I’m so angry. 

Last time I saw this guy, let’s call him JH, he was reciting out loud what medications he was sending electronically to the pharmacy for a refill. As he was reading them, he said, “Lamotrigine–” To which I said, quite firmly, “No, that’s not one you fill. You’ve never filled that. S fills that.”

The guy’s never ordered this for me. Why would he? This is my mental health person’s job. He’s NEVER filled this for me. (I know I’m repeating myself. I’m hoping the Universe or something will smack him.) He does Oxycodone, Lyrica, and the one for restless legs. He’s my pain mgmt prescriber. (This should be scaring you.)

“Do NOT fill that drug.”

I was so mad. The pharmacy told me to call his office and inform them of the mistake. So, I did. No one would talk to me. I was sent to his PA’s voice mail. No one ever called back. 

I also called my mental health clinic and left another message, this time for them. I wanted them to be aware of the problem. A floater nurse called me back pretty quickly. We were on the phone about 18 minutes. She had no idea what the heck was going on. Eventually, about 2 minutes before I needed to leave to go to her actual building to see my counselor, she let me go. 

You know what the result of that conversation was? She concluded that my regular MP (med provider) had been weening me off Ritalin and that now I should have stopped taking it completely. 

I responded the only way I could – “Yeeeeessss?” I mean, what if she found out that I was still taking them? I was already getting paranoid at this point so I didn’t know what to say. I’m really am supposed to be taking it. My counselor (L) and I had just decided that I needed to ask to have it increased!

When I got to see L, he told me that he’d already gotten the email telling him what had happened. I told him about the Ritalin issue. He looked at my chart and immediately said that it was clear that I was was supposed to be on it. In fact, I was supposed to be taking the two pills. 

Sigh. So, now I have too much Lamotrigine and no Ritilan. I’m angry. 

This morning we took my Emotional Support doggie to the vet. She vomited blood right after vomiting on my bed. Thankfully, she’s going to be okay!

I’m stressed and weary. 

Angry. Stressed. Weary. Sigh

Idiots

My Millennials help me now. I have three. They help monitor my meds. The one that lives with me fills my medication box thingies. The second one lives down the street and comes by to visit and help out pretty often. The youngest is married and about to graduate from the same university that I did. 

I will not be killed by people who value my life so little that they cannot take the time, or get help, to read my chart properly or return my phone calls. 

I have managed all the stress from raising kids. I have not killed myself. I won’t be killed by these morons. I will protect myself. I will stand and not let stupid people sneak up on me. I fight with myself every day and I survive. I will survive these people too. 

Mel Robbins (I think it’s her) says that at the end of the day there will be no White Knight riding in to save you. No one is going to rescue you. You have to do it yourself.

There are frequent times when I can’t do this for myself, but today, this week, this moment, I can. I’m protecting myself. I’m going to do what I can to make certain that the people responsible for these screw-ups, won’t be able to do it so easily again. 

I’m pissed off. I haven’t killed myself. I’m not about to let incompetent medical professionals kill me. 

This is MY day. I will live it MY way. I will not let ANYONE take it from me. Not ever. 

Opioid Dependence and Mental Illness

Pile of pills

I’m not an addict. I’m not! I’m mentally ill. I have Bipolar Disorder. I also suffer from chronic pain in my lower back.

My primary care doctor (PC… PCD? Uhh… let’s go with MD) had been prescribing me oxycodone for the server and persistent (chronic) pain that I’ve had for years. After being active and doing something super strenuous like gardening for 15 minutes I think I’m dying. I’m exaggerating of course, but when I work as hard as Atlas does while holding up the world my eyes leak, I whimper and sit down. Sometimes I end up laying on the floor. The floor is such a very bad idea. If I straighten my legs my whimpering becomes desperate and I realize I’m crying. If I forget myself and straighten my legs I’m done. I can’t move. The pain paralyzes me.

I’m NOT an addict.

When I can think again, I try to find my phone. If I can’t find it right away I feel the panic rising and it triggers thoughts and emotions I thought I’d had under control.

This last time I thought I was managing my mania and depression (mixed state, rapid cycling) pretty well. I haven’t bought piles and piles of books on ducks or Oprah or how to be an astronaut. Honestly, I really haven’t. But please, don’t ask me what I’m thinking about. Also, I’ve been able to get out of bed AND wake-up in the morning and even go for walks. My depression skips through the dandelions with the mania comingling into a mixed state, which is always confusing.

I’m not an addict.

After many months of giving me a legal way to get my the Oxycodone I take for pain legally, and for free. The label on the bottle says I’m to take the little unassuming pills three times a day. They are 20 mg. Currently, I’ve convinced the assistant fellow at the pain clinic to reduce my Oxycodone to 20 mg twice a day.

I’m not an addict.

I’m mentally ill. I have Bipolar Disorder, ADHD, chronic pain, and other stuff.

I was referred to a pain chronic clinic… ah… chronic pain clinic, where my Oxycodone prescription was reissued. A five-minute verbal probe, that’s what it took for the doctor to determine whether or not I needed the narcotic. We didn’t talk about Bipolar Disorder or any potential interactions the Oxycodone might have with drugs that are meant to manage my wild emotions or tame my fantastic panic attacks. I’m not certain she has any record of my current medications. She asked questions, and I quickly tailored my answers to fit what I thought she was waiting to hear. She made a few notes on a paper as small as her palm. I wondered if she was actually making notes that she could refer to later. She thought for a few seconds and then wrote the prescription. I sighed in relief.

I’m not an addict.

A while later, like over a year or maybe two, I’m still taking the narcotic. The clinic has new owners and staff. They no longer asked me questions. Sometimes they required a urine test. Then, they stopped asking me anything at all. We spent my appointment chatting. I started asking if we could please try to figure out what was causing the pain and try to deal with it by correcting the problem. I wanted the pain to stop.

They didn’t listen. They wrote the prescription without hesitation.

I’m telling you, I’m not an addict.

My mental health drug dispenser began paying attention after I updated her about my drugs and included Oxycodone in the list. She stopped talking about whether or not my meds were working to stabilize my moods and started talking about “Black box” warnings.

She had my attention. I started to panic.

At the time I had over five medical people prescribing medications. They didn’t know what the other office prescribed me. They relied on me to tell them the truth. I didn’t have to tell anyone I was taking Oxycodone. That got me thinking.

I’m not an addict.

Later…

I’m still asking the medical folks to figure out the cause of my chronic lower back pain. I’m still not getting results. I’m getting way too much Oxycodone every bloody month.

Because I can, I’ve been researching my of collages of illnesses, disorders, and psychological malfunctions.

Ah ha! Black box warning. Do NOT take anti-anxiety medication (benzine’s) – death may result.

Oxycodone 20 mg

I recently saw Dr. T, my very superior knee surgeon. He saw the condition of my spine when he was looking at the x-rays of my hips. He was making certain that my persistent knee pain, post second replacement, wasn’t being caused by anything running amock in my hips. He was eliminating any possible cause of my knee pain before he even considering using surgery to further correct the inept effort Dr. B made the initial knee replacement. Dr. B successfully replaced my knee, but that’s where the project ended.

It sucked. My leg from the knee down, well, it kind of turned the wrong way.

Dr. T corrected the first replacement. He tried to minimize the damage his surgery could do while trying not to blow up my entire joint… okay, the joint that was already gone.

Dr. T showed me the x-rays he’d just had taken and explained where and why he left Dr. B’s “efforts,” while replacing the replacement. A month ago we tried a shot to relieve the pain and keep from having to have surgery again.

Nope. I’ve had no relief from the pain. In fact, my brain was overjoyed and thought that my knee was doing awesome. Holy cow! I should NOT have knelt down like that! Looks like surgery is probably what our next conversation will be about. I’ll need to be on pain medication again…. I intend to be off Oxycodine ASAP. I would really like to have some kind of painkiller to take after surgery – assuming I have it. Always be prepared! Sigh…

I’m not an addict.

After my constant complaining about my back pain that happens every time, I do regular human type activities involving the lower back. I’ve finally had x-rays of my back taken. Holy heck. Next stop is at a spine doctor.

The online personal information provided by my medical organization includes this: Opioid Dependence.

My chronic pain clinic instructs me to continue taking the Oxycodone. I haven’t been able to identify any specific relief from the pain in a long time. I have never felt any “fun” results from taking it. It has never made me feel sleepy.

I have found that taking Oxycodone at bedtime with the medication I take for Restless Legs Syndrome (RLS) helps me to get to sleep and not wake up in agony caused by the RLS.

Am I an addict?

“Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety). Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.”*

I’m mentally ill. In my opinion taking any medication, especially one that alters my brain chemistry (opioids do this), should be thought about and discussed with other medical personnel who are also responsible for my continued living – and to live my best life.

Am I an addict?

No.

I have Opioid Dependence.

Dependence. I can live with that, but look, let’s get rid of that too. Okay?

{I have Bipolar Disorder. I’m a little manic now. I’m using it to write and post while I can. So, for now, I will post often because tomorrow, I may be depressed and unable to say what’s on my mind. I may not have anything on my mind.}

* https://ghr.nlm.nih.gov/condition/opioid-addiction

Insidious Black Box

I apologize for the length of this post. Please consider reading the entire post. It’s very important. Your life could depend upon it. (Robin)

Emotionmasks insane faces

I take two medications that I considered to have a Black Box warning. They both depress breathing. Together they can stop my breathing altogether… There are other dangers.

I have chronic pain with Bipolar Disorder and Generalized Anxiety. I am prescribed both Oxycodone and Clonazepam by two different providers. They both know that I take both medications.

I see a pain management specialist for my pain. I have for some time now. To be treated there, I have had to sign a contract that governs my behavior with regards to taking pain medications, I have to take a pee test every time I go in and they count my pills every time as well.

My med provider handles my Clonazepam prescription for anxiety. I suffer from extreme anxiety. Sometimes I feel like my brain is going to explode. Recently, this woman, who is the 4th or 5th provider I’ve had since I started going to this clinic, told me that I’m more likely to kill myself because of anxiety rather than depression. I was always told that a depressed person was more likely to commit suicide when they started to feel better. When they started feeling better, they finally would have the energy to follow through with their suicidal inclinations. Apparently, there is more to it than that.

My counselor and every med provider I’ve had is intimately aware of my massive anxiety and my inability to get it under control. We’ve tried all the counseling type of solutions including Cognitive Behavioral Therapy (talk therapy), mindfulness and other techniques. I’ve not had success with any of them.

My med provider is content for me to only take Lamotrigine, which is primarily to treat my Bipolar Disorder depression symptoms, and not to take anything other than Clonazepam for anxiety. From talking to her, it appears that this is primarily to treat the depressive symptoms that I experience. I have not been able to get any of the med providers who have treated me to give me anything for anxiety other than Clonazepam.

She, my med provider, told me at our second meeting, that people with anxiety are more likely to commit suicide than people with depression. Since I suffer primarily from anxiety, you would think someone would have warned me of this. I understand now why I feel so self-destructive while I’m exploding with anxiety.

She has told me that her goal is to get me off the Clonazepam completely. Now that I’m taking my runaway anxiety and the real chance I will kill myself because of it more seriously, I’m also taking the mix of these two medications seriously. I always have, but my frantic response to my anxiety has created a situation where I’m so afraid of what might happen if I stop taking the drug for anxiety.

I’ve always felt like I’m most insane when my anxiety is at its peak.

I understand that long-term opioid use for chronic pain is not the most effective way to treat it. I’ve wanted to find a different solution for a long time. My pain management provider doesn’t offer other alternatives than pain medications.

I normally don’t want to die. I’ve always had urges that are normally short in duration towards it, but I haven’t had times when I sit there with my bottle of Oxycodone ready to take it all. But, I could.

I’ve never told any of my mental health caregivers that I have suicidal thoughts. I know that my community does not have good facilities to treat acute mental health emergencies. I don’t want to become one of those people who is shuffled into a hospital emergency room with a guard sitting outside my little room. That’s what they do. I have first-hand knowledge of this.

So what’s the answer? Do I chance dying in my sleep? Or do I chance ending my life while I’m awake? Both are real dangers.

I’ve decided to deal with my feelings of self-destruction now. With the danger of the two medications and my new understanding the relationship between anxiety and suicide, I have promised my family that I will talk to my counselor on Wednesday when I see him. I will admit that I think about suicide. That’s a huge step for me.

I’m afraid. Admitting how I’ve been feeling for years is like admitting that I can’t control the one area of dealing with my mental health that I always felt I could say I didn’t have a problem with. I’ll finally be admitting I have no control over my depression or my anxiety in relationship to staying alive.

As I say, I don’t want to die. When my anxiety runs away I cannot always control myself. I can become violent and destructive. I break down and cannot function. I become paralyzed yet also hysterical.

Yesterday I talked to my mother and all three of my kids and admitted the truth to them. My youngest who is a psych major at the same university that I attend (so is her partner) said she had been wondering if that was a problem for me. They all agree that they would rather I call them than I call a suicide line. I’ll talk to my therapist about that.

I have tried to learn to practice mindfulness several times in the past. I never fully committed to it. Mindfulness was just part of the learning experience in one of my classes I just finished. It’s time for me to review the materials I have about it, I have lots. I need to try to learn how to harness it’s potential in earnest this time. My life depends upon it.

I have a particular fear: I’m terrified of my anxiety. I know what it does to me. I sometimes feel the insidious devil of insanity creeping through my mind trying to take over, and it literally shreds my mind.

If you have any Black Box warnings for medication yourself, please take it seriously. Now that I am self-aware of my true situation I’m ready to find a way to deal with my symptoms.

 

My main medications:

Chronic Pain – Oxycodone / Nucynta

Anxiety / PTSD – Clonazepam / Benzodiazepines

Bipolar Disorder / Depression – Lamotrigine

 

Oxycodone – Warnings

“To make sure this medicine is safe for you, tell your doctor if you have:

  • a history of drug abuse, alcohol addiction, or mental illness
  • if you use a sedative like Valium (diazepam, alprazolam, lorazepam, Ativan, Klonopin, Restoril, Tranxene, Versed, Xanax, and others)”

https://www.drugs.com/oxycodone.html

Clonazepam – Warnings

Risks from Concomitant Use with Opioids
Use of benzodiazepines, including Clonazepam, and opioids may result in profound sedation, respiratory depression, coma, and death. Because of these risks, reserve concomitant prescribing of benzodiazepines and opioids for use in patients for whom alternative treatment options are inadequate.

Observational studies have demonstrated that concomitant use of opioid analgesics and benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. If a decision is made to prescribe Clonazepam concomitantly with opioids, prescribe the lowest effective dosages and minimum durations of concomitant use, and follow patients closely for signs and symptoms of respiratory depression and sedation.
(The above Warning is taken from: https://www.drugs.com/pro/clonazepam.html)
Concomitant: (synonyms: attendant, accompanying, associated, related, connected)

Lamotrigine – Warnings

To make sure lamotrigine is safe for you, tell your doctor if you have:

  • A history of depression or suicidal thoughts or actions
  • Some people have thoughts about suicide while taking this medicine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

https://www.drugs.com/mtm/lamotrigine.html

Nucynta – Side Effects for Health Care Professionals

Psychiatric – Common (1% to 10%): Insomnia, confusion, abnormal dreams, anxiety, depression, irritability, nervousness, drug withdrawal syndrome, restlessness, sleep disorder, hallucination, depressed mood.
https://www.drugs.com/sfx/nucynta-side-effects.html

 

Benzodiazepines

Benzodiazepines may be used in the treatment of anxiety, panic disorder, seizures, or sleep disorders.
https://www.drugs.com/drug-class/benzodiazepines.html

 

Bipolar – Changing Meds Again

My title “Changing Meds Again” isn’t meant to be a negative statement. It is a part and a way of life for some people. People like myself.

I have many, many issues in the weave that is ME so please do not take what I say about myself and my plans (treatment and such) and assume they will work, or not, for you. They may, but that’s between your med provider and you.

Anyway. I’m at the point where my med provider (this time we’ll call her Toni) Toni, has put me on a “don’t argue, come see me every two weeks until this is straightened out.” schedule. Actually she told me something about my nerves and getting them to calm down. ;0)

Today I started Lyrica for FM. I’ve been waiting for 6 months for this to make it through insurance. (There’s that word again.) Speaking of nerves, it should help quiet a great many of mine I look forward to the possibilities.

Also, in the morning I start back on Wellbutrin. I was on it years ago and it seems like a good thing to try again.

Toni: “Are you depressed?”
Me: “When? Like right now?”
Toni: “All the time. Over all the things, would you say you are mostly happy or mostly sad?”
Me: Hemming an hawing… “Like all the time?”
Toni: gives me a look of ‘honestly, you silently scream depression creating irritation’
Me: regretfully admitting “Okay, yes, depressed. I didn’t want to admit that.”
Toni: “Because it confuses you being a mixed Bipolar?”
Me: “Yes!”
Toni: “Because you’re a manic depressive.”
Me: “Yes!!”

I’m on wellbutrin. I start taking it tomorrow (Thursday) morning. We shall see.We shall see.

Heres my medication list for Bipolar and other mental alphabet soup:
Lamictal
Latuda
Wellbutrin
Diazepam
Lyrica (not directly in the list, but a major player in my new “list”)
Oxycodone  (not directly in the list, but a major player in my new “list”)

I fired my counselor. Talked to the head guy of counseling assignments. I explained the problem. She is only 4 years practicing while I need someone who can handle me. All of me. From the head to the toe… toes. From my head to my toes. Eh. From Arthritis and FM, to Bipolar and ADHD, from chronic pain to degenerative disk disease/arthritis in spine. I need someone who can help me focus and go through my day still being me but maybe being more experienced and work in biofeedback, mindfulness and neuroplasticity. With my medications I think this is the next logical step.

Medications are not going to fix me. They will hopefully allow me to function without… you know don’t you? Without the craziness running what feels like all the rest of my life.

I need to be able to manage. I must be able to succeed and what I want to do.

Bucket list? That’s for babies. Try barrel mitigated by soup.

Be well my friend. More later. I’m going to begin answering questions some people have been asking. I hope it will be helpful.

Ciao

Bipolar – PENS & Oxycodone

I love pens. I really, really want to get one of those very expensive jobbies. I saw some in a gift boutique downtown Wednesday afternoon. They were 2013 models and at a bargain 50% off the normal $450 and $300. Oiy! Maybe not today. I’d love to get one for myself and one for my eldest daughter. We both love to write.

Writing can be a passionate thing. It is with me. Always with me I’m investing something of myself when I write whether it’s something blatantly obviously personal or if it’s something going on in my head that I want to talk about.

Right now I want to say something that I think is very important so sit up and read carefully. I’m putting this in terms of applying to myself so I know this from personal experience.

I have chronic pain. I have something wrong with my L4 and L5 disks, degenerative disks all the length of my spine, osteoarthritis, and fibromyalgia. I have a twice replaced right knee (replaced twice in two years, the first time it didn’t work) known as a TKR. I am 51 years old and I must say I do not appreciate needing to go to a pain management specialist and taking narcotics… every day.

I’ve been having what i can only label as nightmares now that I’m taking closer to the prescribed amount each day. (I also take Tramadol but that gives me migraines after a few days use). I don’t normally have nightmares. I was having trouble discerning reality fro dream when I would wake up in the morning.

Tonight I woke after another “nightmare” and remember something quite startling. When I was “incarcerated” in a facility to recover for my TKR the second time because my parents were moving and my kids wouldn’t be around to care for me giving me meds and such. It was a horrible experience. Besides generally feeling like I was incarcerated I was on Oxycodone at my maximum dosage every single time I could take it. The staff were only too happy to let me have it.

Unfortunately I had several nights in which I had terrifying and convincing hallucinations. It has taken me a long time to admit they didn’t really happen. Add to that, that I don’t remember my eldest daughter calling me daily from the MacDill Air Force base where she works as an air traffic controler. We live across the country from each other and that eats at my heart. We’ve always been close and the distance is difficult. But I don’t remember her calls and I know that bothers her. She took care of me during my first recovery and had to go through my even having two blood clots below my surgical knee. That was also a nightmare.

Last night and tonight I’ve been about at the level of Oxycodone that I was at in the rehabilitation center (read: nursing home) and I’ve started having hallucinations, not nightmares.

I suspect my use of pain medications is on the way down. We’ve tried a number of things and nothing seems to help.

I have an idea that I am sure will help. Ever hear of neuroplasticity? I’m sure you’ve heard of Luminosity, that’ s neuroplasticity. For me, this will mean using mindfulness to “remap” my brain and in doing so enable my actual brain structure to interpret pain differently. It won’t seem painful to me.  I guess I could put it like that without going into detail right now. I will soon though.

Neuroplasticity is becoming my key to dealing with my much of my troubles. Think of it, how awesome it will be to control my chronic pain, Bipolar, FM and OA… at least to a degree. Many advanced meditation practitioners are known to change their brains in a manner like the mindfulness I’ve mentioned.

Mindfulness. Neuroplasticity. How great to have the possibility of using these disciplines to help myself!

I’m not likely to be drug free… but I’ll get as far as I can.

I’ll talk about Mindfulness and Neuroplasticity in depth soon. They are very important disciplines that science backs up. I mean they are both proven scientifically to work in the areas I need. They impact many other things too.  After all, they are not confined to “topics” the brain considers. They do however, change the brain in ways we cannot comprehend considering the vast expanse, the last frontier as they say. At night I’ve taken to listening to Pandora. I searched and found a Mindfulness station to listen through the night. It’s playing right now. I finally decided to subscribe. Know why? The commercials were scaring me as I slept. Ew.

Watch your consumption of drugs like Oxycodone. You could have side affects you would think would anticipate.

Be cautious. Be ever vigilant.

Catch you later.I’m trying to stay awake for a while. Those hallucinations were getting very weird. Scary.

Robin