Wednesday, June 19, 2013

New Meds? Old Ones No Longer Working?

First of all, yet another apology for the long time(s) between posts. I don't have an excuse my friends, so just imagine the "German Boy" standing before you, head bowed and taking whatever verbal punishment (well-deserved, I agree) there is in store for me. Just imagine yourselves as the editors and myself as one of your staff who hasn't turned in an article in months, and that should explain how I see this whole situation..........


You, as "Perry White" are standing behind your desk - the cigar smoke so 
dense one can only see a vague outline as any proof that it is really you - not 
a good sign.

                                     Captain Kirk's nipples, Craig!!!! Where have you been - at home with
                                     your fingers up your ass???? 
                 Stammering, I try to answer but am interrupted angrily by you.

                                                   BILL (LOW AND CONTRITE VOICE)

                                      Well, sir, you see, uh, it's like this. Um, I was like, ah.....


                                      Never mind! It's a rhetorical question! You know - rhetorical?
                                      Like your life has been????? Never mind, just sit down, shut up and
                                      listen. Oh, and take notes! You remember those, right? Notes???

Well my friends, there you have it: I am apologetic and contrite. I am also SINCERE - evidenced
by me writing screenplay-style, something I haven't done since the turn of the last century. From beginning
to end: 28 minutes. At my college, the University of West Georgia, the last student would have left
the room 20 minutes ago.

But let's talk about why I've dropped into such a lackadaisical lifestyle: tolerance. Short answer is there is
no short answer.

So what I would like to do is list my meds, their dosages and write a "Readers Digest" version of tolerances of each one. I use "condensed version", because I want to keep the information as concise and simple as I can and, because IANAD ("I am not a doctor" in web-speak), I also need to keep from speaking like one. Please allow a small chuckle to pass through your lips now, thank you.

Let's begin with Cymbalta 60 mg. once a day. Cymbalta was prescribed as an anti-depressant and anti-inflammatory, so this one also helps with my rheumatoid arthritis.

In speaking with Janet at Eli Lilly®, I found out that there is "no research to support evidence that doses greater than 60 mg provide any added benefit." What this says to me is they don't know if one can build up a tolerance and it'll be up to your own doc to decide if that is what's happening and where to take you from there. There's also no known antidote, so if you're thinking that it's not working at a current dose don't pop a handful thinking to jump-start it. Conversely, do not just stop taking it. Very dangerous and can lead to certain death. (Dr. Moe: .... "Dr. Curly, are we sure this patient has passed?" ...... Dr. Curly: "Why soitenly  we're sure! Right, Dr. Larry?"......Dr. Larry: "Either that, or very short of breath, Dr. Curly.") ....Nyuk, nyuk, nyuk. Long story short, expect to "go shopping" for a new anti-depressant if you and "Dr. Feelgood" decide you've reached the end of the line with Cymbalta.

I also take Bupropion (aka Welbutrin) SR (sustained release) 150 mg, once a day. Now this anti-depressant is more "flexible" than the previous one because of the many varied dosages. The web is overflowing with praise for this AD, and you'll find tales of  "The Honeymoon Effect" - that place where and when it "kicks in". After 6-8 weeks, you'll one day get "hit" with a sort of "fake high", which lasts a couple or three days (hence "the honeymoon") after which it will stabilize itself and do what it was made for: keep you mentally healthy and on an even keel, so to speak. From there on out, you and your physician will work together to find your maintenance dosage.

As far as building up a tolerance for Welbutrin, there are two schools of thought: yes you do and no you don't. I'm not being a smart-ass when I say that.  My opinion on the "naws'" position is because it comes in so many strengths and functions, the drug is very easy to work with if you or your doc feels you've reached your tolerance limit. The "yeahs" don't need to state their positions, and here's why I believe that: Keeping in mind that IANAD, I think some of those folks might have missed a dose or two. When that happened, they knew it right away because it can make you feel like shit very quickly. It's kinda like blood pressure medicine in that way, so don't miss a dose or let yourself run out. Because of economics, I weaned myself from 300 to 150mg, but in retrospect, I wish I hadn't. 300 mg was my maintenance dose and I can sure feel the difference. Next appointment, I'm going to ask to go back to its original strength.

Last but not least is Lamotrigine (aka Lamictal) 200 mg, once a day.  Lamotrigine is primarily an anti-convulsant used to treat epilepsy, but has also proven its efficacy in delaying mood swings caused by bi-polarism (manic depression or what I like to call "the booga-booga disease").

To get to the point: does Lamotrogine stop working after a certain time period? The answer is not that simple because there are so many outside factors, such as diet, which can slow or eliminate its efficacy. One's own body can determine if it works or not. Remember that it is an anti-convulsant, and so must be closely monitored and its dosage titrated to the individual.

I just spent 45 minutes educating myself about this drug, and it scares me that I knew so little about it after having  taken it 4 years now. It will be a priority the next time I visit my PCP, Dr. Battle, to ask for a specific blood test called a Lamictal Level to be drawn to see where I'm at with this stuff.

A quick word about side effects, drug interactions, overdosing, and why didn't I write about them?, etc.: Should you pay attention to these? "Oh, HELL YES!", says I. There are just sooooo many, and again, IANAD, that there's no way I'm going to include them in this blog. Go to Amazon and find yourself a Nurses' Drug Handbook and keep it handy. It's a reference book no home should be without.

Almost forgot to tell you about one of the many side effects of Lamotrigine and it's ironic as hell: MEMORY LOSS.

Even though this is about the drugs I am taking (and there are more, folks!), I hope you found this interesting and maybe even a little educational. The days of going to the doc, picking up a scrip having it filled and taking it as prescribed are over. You've got to become a part of your own patient chart and educate yourself.
Heard this one? The song is used as a tv commercial for a popular car!

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