telling my p-doc...

I have a p-doc appointment next week. I do not want to tell him that I intentionally discontinued Geodon because I need to be med compliant for the court case. I want to suggest to him that we try me without Geodon and I want him to go along with my plan. I also want him to prescribe Wellbutrin in place of Prozac because I gained weight on Zyprexa and Wellbutrin might help me lose it again. Finally, I am out of Zyprexa and want a PRN prescription for emergency sleep, either Zyprexa or Seroquel. I also want him to see my neuropsych report. Finally, I need to tell him that Topamax did not work out for me.

That is a whole lot to ask during one appointment.

Here is my plan, and I will probably fax it to him because that would be more organized (he has read my faxed letters in the past). Does it sound convincing?

-- When I went to Moscow, I used Zyprexa 10 - 15 mg to force sleep on the plane and to overcome the jet lag. Both ways - back and forth. It worked beautifully. It was my best trip, in terms of the ease of switching time zones. Zyprexa is not in my chart because I had leftovers from a different county.

-- I caught a cold in Moscow and was very congested, which interfered with my sleep and Elavil did not work. I had to use Zyprexa. Zyprexa made me sleep even while congested.

-- As a result, I continuously used Zyprexa for many days and gained weight - you know how it happens.

-- Prozac works well as an AD but might be causing a little hand tremor. I would like to try Wellbutrin instead, because I have heard that it might help with the weight loss efforts. If it does not work, we will go back to Prozac.

-- I could not tolerate Topamax. I even reduced the dose to the bare minimum and still could not tolerate it. I actually did not have the most frequent side effects you warned me about. Instead, I had: dizziness, nausea, anorgasmia, and a general malaise. I hated it. Plus, while it did diminish the frequency of migraines, it actually provoked a few migraines because I was not drinking enough fluids due to nausea and was skipping meals, both migraine triggers for me. So please remove this prescription.

-- I did not take Geodon while I was taking Zyprexa, for obvious reasons. I was surprised to find out that my skin did not break out. I forgot to pack my Tazorac and normally skipping a single night of Tazorac would result in a break-out. Nope, I had absolutely clear skin. I figured that I had acne due to Geodon and not Lithium. Lithium is not to blame!

-- My latest neuropsych results show nothing on Axis I. This includes Schizoaffective. I thought back to the time when Risperdal was prescribed to me, to be replaced by Geodon later as I had Parkinson-like symptoms on Risperdal. My ex husband insisted that I had schizophrenia/thought disorder and he still thinks that. I believed him. I in turn insisted on an AP, and my then doctor was resistant, thinking that Lithium should be enough. She asked me what I hoped to obtain from an AP. I said "clearer thoughts". She reluctantly prescribed Risperdal. Later, doctors disagreed with the schizoaffective dx and thought that it was just bp, but the AP prescription traveled along with me from doctor to doctor. And I want to question it now - in my whole life I had 4 hallucinations total and nothing after 2011; I had hallucinations while being in episodes. Lithium prevents episodes. I want to try a good Lithium-AD combo without Geodon. Plus, as of this month I will no longer have free mental health care and Geodon costs hundreds of dollars while Lithium costs less than 10 dollars. I do know by now what mania is and I do have enough of Geodon at home to start taking it if Lithium turns out to be insufficient. Let us try it!

-- I want a one-time prescription of an emergency PRN sleep medicine, just in case I get a cold again and get congested to the point when Elavil stops working. What would you recommend - low dose Seroquel or Zyprexa again? I want less weight gain, obviously.

-- Thank you very much, I know it is a whole lot of things to handle during one appointment.

A very well put together document. Hope the doc reads it and goes through each item with you during your appt.

Best wishes and good luck!

I wouldn't suggest lying to your pdoc about the geodon. You need to be truthful with your doctor.

Thank you! He does read and he remembers long quotes! He is amazing - he looks so young that you would not believe that he is an MD and married, too.

I cannot do that - I need a record of compliance. It is a legal matter. He might in the future be required to give me a note saying that I have been compliant. There are two things related to compliance - the objective Lithium levels which will be fine because I am continuing on Lithium, and the record of my refilling the prescriptions. If Geodon were cheap, I could just continue refilling the prescriptions and not taking the medicine, but Geodon costs hundreds of dollars a month.

I wouldn't say that wellbutrin and Prozac are interchangeable. You're already having interactions (ie you did with topamax) and I would anticipate them with wellbutrin, as I find it the most physically stressful of the 3 meds. Prozac being the least.

You beat me to the punch, I was going to make a similar comment. Prozac addresses serotonin and Wellbutrin addresses dopamine. Although they are both AD's different people respond better to one or the other. Some people are on both because they don't have a lot of overlap.

How often do you get to see pdoc? Is it possible to split this agenda into 2 sessions? I think this might overwhelm him and something really important to you might get lost. Also, making many changes at once makes it very unclear what is doing what.

Good luck!
EJ

I agree with Hankster. You are talking about two different drugs. As I posted on your other thread, I take both wellbutrin and zoloft. You should not have to give up the prozac unless it is not effective for you. If Wellbutrin helps your depression, that's great, but you can't just consider it for only weight loss possibilities.
Bluemountains

I understand your concerns about your Med-compliance/Stability for your divorce case.

One thing I think you need to be mindful of is you have stopped and starte d many meds in the past 3 months or so .. Geodon , Topomax and wanting to change out Prozac for Wellbutrin, taking Zypreza more often it sounds like. Wanting to change your med for ones that are cheaper makes sense as long as they work for you.

I personally see no reason to lie or omit facts when it comes to your T or Pdoc.. I would think something might slip out down the road and what do you do then? anyway just my opinion .

Good luck with whatever you decide.

I will wait with the Wellbutrin then and just mention going off Geodon. Prozac works perfectly well for me and the dose is low - but apparently I get a slight tremor from it. Not horrible though - not like with Depakote in the past.

Prozac was the first AD tried and it worked after something like 4 days. I later thought it was serendipity that my then p-doc guessed it right on the first try. Back when she prescribed it, I had no hope that it would work, but it did.

The thing is... if I stay on Prozac, then I would eventually (not now) be asking for WB as a diet pill (thanks Venus for calling a spade a spade). Would a p-doc allow that kind of use?

Zyprexa/Seroquel would both be meds that I have tried. I do remember sleeping soundly on Seroquel, but I do not remember whether I gained weight - life was too stressful back then to notice. That is why I was asking around for people's experiences. Zyprexa clearly causes weight gain. Even with using it for a week or so.

You mean that I might later forget about my "story" and he would then figure things out?

What if I tell him that when I packed Zyprexa for the trip, I forgot to pack Geodon just as a I forgot to pack Tazorac and, lo and behold, I found out that I did not break out and I did not have mania while off Geodon?

I think once you lie or omit things eventually they bite you in the *** ...

I think it's great that you have been stable being off Geodon. There is never a guarantee that you will or won't continue to stay stable of course. Hopefully you will. I think remaining stable is the most important thing right now with whole legal mess is ongoing.
I am sure asking your Pdoc about possible medications to look closer at in the future would be a perfectly normal discussion as Geodon is going to be very expensive for you to pay for.

Absolutely, I cannot be on expensive medications.

So should I just tell him that I cannot afford it and already discontinued? He knows that the only remaining AP option, Abilify, is out of consideration at 600 dollars a month.

There are three people no one should ever lie to:

1) Your lawyer,
2) Your priest or clergyman, and
3) Your psychiatrist.

Seriously, Hammie, you know you need to be honest with your pdoc, otherwise you're shooting yourself in the foot. He can't treat you properly if he doesn't have all of the ammunition, ya know?

FWIW, I've tried a couple of 'little white lies" with mine a couple of times too........it doesn't work, he knows me entirely too well and my facial expressions always rat me out. LOL

You ladies, the three of you, have convinced me. I will tell him the truth. But then I will not fax a letter for fear of creating a paper trail.

And will not even mention WB. The mean four kilos off a year reported in clinical studies are not worth the risk of turning wild manic and losing a chance to get a stable job.

I know what I will do. I will ask him to read my report and look at life history and go back to the drawing board and dx me anew, because my former doctors were influenced by the earlier doctors who in turn were influenced by me who in turn was influenced by ex. A contaminated chain of reactions. So he can start afresh and he is young and smart so he would enjoy it. I will fax the report ahead of the appointment for that.

I know nothing of Zyprexa, but I take Seroquel and have gained a ton of weight on it. My pdoc said that Seroquel is notorious for that, and you can gain a lot of weight even on a low dose. Just an FYI. Good luck and let us know how it goes hamster.

Zyprexa is miracle stuff and I wish I could've stayed on it, but it put almost 20 lbs on me within just a few weeks. Luckily I was able to lose it all plus some of the long-term weight when I went off the Z......now if I could just get my blood sugars down a few more points, life would be good again!

Yeah... Since I am not planning a lot of plane trips anytime soon, I will just buy a little marijuana as emergency sleep medicine... I can no longer afford it daily but just for those infrequent cases when Elavil is not enough. Marijuana does not make me gain weight. The only reason I essentially overused Zyprexa lately was due to marijuana being illegal outside of California...

Does your pdoc know about the MJ? I used to enjoy it myself, but it's not compatible with a nursing license in my state and I'm not about to risk what I worked so hard for, just to obtain a few moments of mellow. Although I have to admit, I really liked mellow.

I know your situation is different, but I also am heeding my pdoc's advice to stay away from it because he's seen clinical evidence that it makes bipolar worse, and Lord knows I don't need THAT.

P-doc just told me that LT use may increase anxiety and that was all in regards to MJ.

OK, now I have a killer argument for being off Geodon

High dose --> no orgasms
Medium dose --> flat orgasms without a whole body experience
Off --> powerful orgasms, back to normal

By the way, to give Z credit, it does nothing bad at all to me sexually.

I do not want to have a bottle of Zyprexa in my possession anymore. Sure it works wonders for sleep but I am now only one pound lighter than at my heaviest. That's it, no more Zyprexa. If I do not have it, I cannot take it, right?

I still have a stash of that, too......you know, just in case I CANNOT sleep or I freak out during a manic episode and can't get hold of my pdoc.

Then again, I still have about 50 Wellbutrin tablets that expired six months ago. I don't know why I've hung onto them this long, because I sure as heck can't take 'em!!

Oh, I know. Those bottles. I threw away the remaining few Topamax pills, and recycled the container. Yes, it is not the proper way to dispose of drugs, but heck, just a few pills.

Will be taking http://en.wikipedia.org/wiki/Clozapine for emergency sleep or to force sleep on a plane or to move swiftly through a jet lag. No weight gain. Heavy sweating, very uncomfortable, but it is better than the weight gain. I have a full bottle which should last for years. So this item is off the list.

I am incapable of throwing out medications of any sort ...one day I might just need them Must be because I worked in medical all my life.