Opinions - Swim and the Doctor

[fiveleggedrat]

Swim will be visiting an internist next week for stress/anxiety issues.

Swim is a very stressed, paranoid person who self medicates with mostly tramadol and marijuana, and anything he can get his hands on. He knows and likes benzos as well.

Swim's family member made the appointment for him. He has been talking about going to the doctor regarding severe insomnia and bad sleeping habits, and generic anxiety stuff. Recently that member found him vomiting after getting opiate nausea, and is convinced he is vomiting from stress (he hides his drug use, which is very hard.)

Swim wants to know what this internist could possibly prescribe him for sleeping/anxiety problems, and what, if anything, would increase his chances of getting something without sounding like a drug user/abuser, and a partial liar. Swim believes there is no way he could get opiates for anxiety, and will at best get some benzo. Also, how does swim ask his doctor for something he knows will work, for example, 1mg alprazolam, which for him is equal to about 6mg lorazepam, the thing he fears being prescribed. Lorazepam is far too long acting for him (2 days on a single dose). Addiction is not an issue for him, he is very strong willed with drugs, and has good experience with varied GABA drugs. He also plans on using for needed, as opposed to taking like directed (3 times daily?! Nonsense!)

As always, sorry if this has been answered, Swim did UTFSE, and Swim believes this to be the correct forum, as it mostly relates to benzos. Thanks everyone. Let the sarcastic flaming begin

[staples]

Originally Posted by fiveleggedrat

Swim will be visiting an internist next week for stress/anxiety issues.

Swim is a very stressed, paranoid person who self medicates with mostly tramadol and marijuana, and anything he can get his hands on. He knows and likes benzos as well.

Swim's family member made the appointment for him. He has been talking about going to the doctor regarding severe insomnia and bad sleeping habits, and generic anxiety stuff. Recently that member found him vomiting after getting opiate nausea, and is convinced he is vomiting from stress (he hides his drug use, which is very hard.)

Now this is a tricky introduction to the problem; it seems to me that the drug use would only make the stress/anxiety/paranoia worse overall. But then it doesn't sound like SWIY is interested in treating that problem (yet?). My suggestion would be to nip it in the bud instead of focusing on what is otherwise fun for SWIY immediately.

Originally Posted by fiveleggedrat

Swim wants to know what this internist could possibly prescribe him for sleeping/anxiety problems, and what, if anything, would increase his chances of getting something without sounding like a drug user/abuser, and a partial liar.

The simple answer is: don't lie. At least SWIY shouldn't lie about his drug use. Many doctors understand that people self-medicate and if they respond well (which includes a lack of addictive behavior) to a certain medication/prescribed substance, then that may indicate to the doctor that with his oversight, the medication in question may indeed be the right medication for SWIY.

Of course, doctors also have their own opinions and may not want to give SWIY a certain medication right away. But then what if SWIY experiences side effects or doesn't receive therapeutic effects at all? Then it's time to try something else--in this case, SWIY should understand that patience is very important.

But again, is it really worth it in the long run? At what point does SWIY tell his doctor the real truth--that he's not taking the medication as directed and now has bigger problems? You should realize that after enough sessions, SWIY's actual progress will differ from SWIY's reported progress more and more significantly and it will become harder and harder to maintain the facade.

Originally Posted by fiveleggedrat

Swim believes there is no way he could get opiates for anxiety, and will at best get some benzo.

Probably, or buspirone (Buspar), or an SSRI+benzo, depends on the doctor and the specific problem. SWIY may get nothing but talk therapy.

Originally Posted by fiveleggedrat

Also, how does swim ask his doctor for something he knows will work, for example, 1mg alprazolam, which for him is equal to about 6mg lorazepam, the thing he fears being prescribed. Lorazepam is far too long acting for him (2 days on a single dose).

Let the doctor find out which medication works for SWIY. If SWIY doesn't do well on Lorazepam, why would the doctor try to keep SWIY on it?

Originally Posted by fiveleggedrat

Addiction is not an issue for him, he is very strong willed with drugs, and has good experience with varied GABA drugs. He also plans on using for needed, as opposed to taking like directed (3 times daily?! Nonsense!)

That the drugs are GABAergic is not enough to say whether SWIY will or will not have a problem.

Why wouldn't SWIY be prescribed as much as he needs? (why doesn't "as needed" = "as directed"?). I'm not sure if you are saying that 3 times/day is too much for SWIY, and I'm a little confused as to where you are getting that number if SWIY hasn't seen a doctor yet...

I love your avatar.

Reputation Comments on this post:

=]

[fiveleggedrat]

Thanks, it's a shot of Swim's baby puppy not too long ago. MinPin/Chi Mix

Swim would say he wants to legitimize his drug behavior with a prescription that relates to solving the problem without being considered "drug use" to any but swim.

Swim worries that any mention of drug use would instantly end up with a wasted trip. Hear of it happening too often.

The mention to GABA drugs refers to the fact Swim would not be introduced into unfamiliar territory, which would be risky when being handed potentially large amounts of drugs.

The last bit about as need refers to a family member's script of Ativan (Lorazepam) 1mg 90/month. It says to take one tablet three times daily. Swim cannot understand how constantly being under the influence of a drug would be helpful for more than a few days when the body gets tolerant and the dose will have to go up, increasing addiction likelihood.

For both pain and anxiety, Swim always medicates as needed, not blanket treatment.

[staples]

Originally Posted by fiveleggedrat

Thanks, it's a shot of Swim's baby puppy not too long ago. MinPin/Chi Mix

Swim would say he wants to legitimize his drug behavior with a prescription that relates to solving the problem without being considered "drug use" to any but swim.

Swim worries that any mention of drug use would instantly end up with a wasted trip. Hear of it happening too often.

I don't think it's the simple fact that the patient admits to drug use that the doctor decided not to prescribe something where he would have in any other case. The bottom line is: as the patient, SWIY wants the doctor's help, the doctor wants SWIY to be honest because then he can best help SWIY. You say SWIY doesn't have any issues with drug dependence/addiction and so I don't see why a doctor, having considered all of this, would hold any strong opinion against drug therapy.

Originally Posted by fiveleggedrat

The mention to GABA drugs refers to the fact Swim would not be introduced into unfamiliar territory, which would be risky when being handed potentially large amounts of drugs.

Right, well, my point was that this isn't necessarily true. For example, benzodiazepines indirectly affect GABA transmission and indeed if there were a deficiency of GABA, taking a benzo wouldn't do anything. Other GABAergic drugs may work directly on GABA receptors and will likely produce some drastically different mental effects. So, just be careful with such assumptions, is what I"m trying to say.

Originally Posted by fiveleggedrat

The last bit about as need refers to a family member's script of Ativan (Lorazepam) 1mg 90/month. It says to take one tablet three times daily. Swim cannot understand how constantly being under the influence of a drug would be helpful for more than a few days when the body gets tolerant and the dose will have to go up, increasing addiction likelihood.

Again, it depends on the doctor and the specific problem. I was on 30x0.5 mg lorazepam per month for about 2 years and then asked my doctor to decrease the dosage to 10x0.5mg per month. I haven't built up a significant tolerance and it works great when I need it.

[Richard_smoker]

um...just a fyi...if you go in there and expect to get ANYTHING that is even REMOTELY CONTROLLED SUBSTANCE, he will forever label you as a drug-seeker.

you need to understand that this is a mutual relationship that you are developing beginning day 1.

he/she will need to look you over from head to toe, check your heart rate, blood pressure, ask you a million questions about all your organ systems, etc...if you're smart, then you will think of this as PAGE 1 of CHAPTER 1 of "5leggedrats medical treatment/history with Dr. So&so."

if you think about seeing your dr for the first time like it is akin to visiting the toy store and picking out what beanie baby you want, you will be very very disappointed...and i doubt that you will ever be able to mend this relationship if page 1; chapter 1 consists of "i want xanax. i don't like lorazepam because it lasts too long, etc etc"

I can tell you right now what's going to happen.

if the dr. doesn't find something PHYSICALLY WRONG with you--good sign, ie everything looks ok, so far...then they will probably determine that your anxiety and insomnia will be best approached FIRST with a prescription for a LOW-DOSE SSRI or MAYBE MAYBE Buspirone.

Again. If you want to fuck everything up, then complain about not getting whatever you really wanted.

If you're smart, you will smile and thank him/her for letting you come to him because you didn't have a doctor otherwise...cross your fingers & say I hope this works! Ask the dr exactly what to expect, any side effects? is there a chance that i will feel better begining THIS AFTERNOON!??? ask about interactions with food. ask about long-term side-effects. make sure that he knows that you take OTC advil or tylenol SOMETIMES for your muscle pains/headaches (or whatever), make absolutely sure that there won't be ANY INTERACTIONS between this medication and that. Ask if you need to take the pills on an empty stomach or a full stomach. Ask if he's ever had anyone get unexplained illnesses like cancer or leukemia or WORSENING anxiety with THIS drug that he's presribing. ask will this make me just FEEL LESS ANXIOUS or will it just kinda work in the background...and essentially PREVENT you from ever getting another panick attack?? when he says, WHAT THE FUCK??, then you need to explain the difference between just being nervous and A PANIC ATTACK (i.e. public speaking, how it makes your voice tremble, how you start breathing fast, how your hand shakes, how you think you might be having a heart attack, etc etc...and ask if it would be bad for you if you took an EXTRA pill right before you had to get up on stage and give a talk in front of other people, since you get so un-nerved that you'd just about do ANYTHING to make that terrible panicky feeling go away!

others to ask: will this make me sleepy as soon as i take it? should i try taking it closer to bedtime since i can't sleep? even ask, "HOW LONG SHOULD I GIVE THIS MEDICINE TO WORK?" etc. etc. etc.

Now, if the medication works, then great. if it doesn't, then you just reschedule for another appointment! this would be chapter 2 of yours & your doc's BOOK! SEE!?? Then you can explain what the drug did or didn't do for you. explain if you're still having sleep problems or anxiety or whatever.

don't make it too complicated for the poor doc. either the meds he wrote for worked or they didn't. HE WILL JUST TRY AND GO UP ON THE DOSE...if you're smart, you will again, say "thank you. I'll try it! I hope this works!"--maybe this time with a little less confidence...

But GO HOME, TRY IT, if it doesn't work, then SCHEDULE ANOTHER APPOINTMENT!!

This is how Doctors like to be treated.

You must understand that they were NOT trained to cater to self-medicating patients. they were trained to take a problem and attempt to SOLVE THAT PROBLEM. For whatever reason, right or wrong, most of them DO NOT like to be told how to go about solving your problems. But, with that in mind, if you will be patient (a patient patient), and JUST DO EXACTLY WHAT HE TELLS YOU TO DO, you will often find that they will keep trying other remedies until your problem(s) are taken care of! it's not that doctors WON'T prescribe benzos for anxiety and insomnia....it's just that (since they're looking out for YOUR SAFETY and YOUR BEST-INTERESTS), they won't prescribe them to you when something else with less sides would work for your problem, and they won't prescribe them to you WHEN YOU WALK THRU THEIR DOOR, ASKING FOR THEM BY NAME!

just please don't insult their intelligence by treating them like a 1-stop-shop for pills. Remember that it's a relationship. Treat them like they know EVERYTHING about something you know NOTHING.

-DICK

Reputation Comments on this post:

	Well thought out response.
	=]
	Great post

[fiveleggedrat]

Thank you, Swim agrees very much so with your post.

Swim agrees for sure about asking for things, and to Swim, this is about creating a pharmacological profile of having anxiety issues. He was thinking that the whole relationship thing would work pretty close. Swim appreciates hearing things that confirm his suspicions. Also on making the doctor feel like that.

Thanks everyone, this thread has been very productive so far

[Lobsang]

The best way to get drugs from a physician is to say that one never has used drugs or even drinks. And then telling the doctor that one is fearful of addicition. Putting the doctor on the defensive. meaning tha one wants to get the doctore defending the fact that a drug is nor addictive. And also when the doctor asks one their occupation it is best to ell them that they are in their current occupation but working on getting into Jimmy Swaggart's Bible College to be a minister.

[Panthers007]

Originally Posted by Lobsang

T best to ell them that they are in their current occupation but working on getting into Jimmy Swaggart's Bible College to be a minister.

No - then he'll think you're a pervert and send you off to be tested for VD. Bongo lays the case on the table and speaks moleculer science to the doctor. If the doctor doesn't like this, Bongo leaves him/her there sputtering. Usually he gets what is needed. And that's the end of that. Bongo has learned that honesty is the best medicine. However, Bongo is never looking for drugs to get high on.

[Lobsang]

Originally Posted by Panthers007

No - then he'll think you're a pervert and send you off to be tested for VD. Bongo lays the case on the table and speaks moleculer science to the doctor. If the doctor doesn't like this, Bongo leaves him/her there sputtering. Usually he gets what is needed. And that's the end of that. Bongo has learned that honesty is the best medicine. However, Bongo is never looking for drugs to get high on.

Well the thing is that as far as getting drugs to get high on eusually has to manipulate the physician. Telling a doctor that one takes recreational drugs is a red flag if one wants drugs that can be used for recreation. But it depends of course on the doctor. Now years ago it was easy ti fine a doc who knew the game and would give you what ever you desired. But not andy more. The DEA has really cracked down.

Many years ago in my old neighborhood there was a doctor. Dr S. Now Dr S was a very very good doctor. But then after his son died he lost all desire for legitamate medicine and began to be a drug seller. At any time of day there was a line outside his office with all kinds of "questionable" people from other towns. Dr Santnor had a body guard and they had a guard dog in the office. At night when Dr S would be comming home the local kids hanging on the street corner would clap and cheer and raise their beers in salute to Dr S as he would drive by.

Now gradually the local pharmacies refused to fill his prescriptions. Except for the one that was owned by his brother.

Now my friend went to Dr S wanting some pills. But he did not know the name of the pills. So Dr S actuall handed him the PDR and told him to look through the pictures of pills and fine the one he wanted. Once another friend who was a regual custor of the doctor went to purchase his prescription. But Dr S would not oblige him. Dr Santnor had an x ray machine. He told my friend that he needed a full set of skull x rays to find out what pills he needed. It was a real scam. Despite all of this Dr S never lost his license. He retired and moved away.

Them there was Dr. K. Now he would sell prescriptions. But he was a very good doctor. But if you were a person he felyt had potentiol in life he would not sell you. He would deny you and treat you as a normal doctor would. He had this strange idea that there were "good" people in the world and "bad" people. And he did not care about the "bad" people so he would sell them drugs. Once my friend went to him and wanted 2q prescriptions. One for uppers and one for downers. Dr K wrote both scripts and as he handed them to my friend he said' You wana go up or you wana go down...But just don't take these two prescriptions to the same drug store"

[fiveleggedrat]

Swim just got back from his doctor. Swim thinks you will all like to hear what happened.

Swim went in complaining of chronic insomnia, chronic stress, chronic anxiety, social phobias, reoccurring nausea, and maybe a few other small things. Swim is probably slightly exaggerating his problems to said doctor, but Swim is trying to get sympathy and working medicine. To not complain much would be to him like breaking a bone and walking away with Ibuprofen 800's which don't work: pointless.

Right out the gate, doctor says, more or less, "BENZOS BAD!!! TAKE "MOOD REGULATORS!" Swim is 100 percent sure he means SSRI or SNRI's. Both do not work for Swim, he has used them before without a doctor and found no useful effects. He said Swim (Who is Age 19, Male) is too young to be having sleep/anxiety problems, and too young to be put on anxyolitics. He clearly said "I do not believe in things like alprazolam, lorazepam, those are not good, etc"

Swim has a referral to a psychiatrist and a gastroentologist.

Swim lied and said he NEVER used/uses drugs, smokes, or drinks. Swim knows if he even mentioned pot, he would have been labeled a drug freak. What a joke. Swim knows several benzos that would help his stress/anxiety, as they occur sporadically, and are not needing constant medication. That's ok useless doctor, Swim will keep buying his alprazolam 2mg bars from someone he knows and using .5mg-1mg for his breakthrough stress.

Swim will not be put on SSRI or SNRI's. They make Swim sick as a motherfucker. Swim experimented with them before for curiosity's sake, but can he tell his doctor this? No.

Swim's mother has a doctor who hands her anything she asks for. Swim will have to keep looking for a more intelligent doctor. She was getting lorazepam, hydromorphone, propoxyphene, promethazine, and was offered many other stronger, higher dose things but refuses stronger treatment usually.

Honestly, Swim wants to walk into a doctor and be prescribed at least 1 amphetamine, methamphetamine, at least 2 opioids, one being morphine derived and one codeine derived, medical MJ, Modafinil (cant remember substance name), at least 2 benzos (rarer ones), a strong muscle relaxer, GHB (if he lived in europe, he believes it is prescribed for alcohol addiction), and pretty much anything else he can think of.

Now, realistically, Swim would be content with one strong opioid for his neuropathic back pain, and one less common yet decent strength benzo for sleep and anxiety. The rest he can deal without getting

Swim himself is unsure of his ratio of actual needing medication, and his desire to get free (Swim has insurance) drugs. Swim thinks it is about probably evenly split. At least Swim knows what to expect, unlike bad situations like people on high dose pain meds for months only to suddenly get off having no idea what to expect or what will happen. If Swim did not know drugs well, he would not even think of trying to take advantage of a doctor.

Swim would also walk into the doctor and talk pharmacology with him, if only he had more doctors covered by his insurance and could see more possibly. He cannot pay out of pocket, therefore, cannot afford to see 10 doctors just to find one who will prescribe Swim a useful substance.

Thoughts, oh wise DF'ers?

[staples]

Originally Posted by fiveleggedrat

Right out the gate, doctor says, more or less, "BENZOS BAD!!! TAKE "MOOD REGULATORS!" Swim is 100 percent sure he means SSRI or SNRI's. Both do not work for Swim, he has used them before without a doctor and found no useful effects. He said Swim (Who is Age 19, Male) is too young to be having sleep/anxiety problems, and too young to be put on anxyolitics. He clearly said "I do not believe in things like alprazolam, lorazepam, those are not good, etc"

lol, SWIY is not too young to be having sleep/anxiety problems. Not at all. Get a better doctor. Plenty of research (as well as SWIY's family history, it would seem) supports that benzodiazepines are effective (at least short term, and long-term in some cases) treatments for anxiety/insomnia, whether he "believes in them" or not.

Originally Posted by fiveleggedrat

Swim lied and said he NEVER used/uses drugs, smokes, or drinks. Swim knows if he even mentioned pot, he would have been labeled a drug freak. What a joke. Swim knows several benzos that would help his stress/anxiety, as they occur sporadically, and are not needing constant medication. That's ok useless doctor, Swim will keep buying his alprazolam 2mg bars from someone he knows and using .5mg-1mg for his breakthrough stress.

If you were a doctor, and someone came in and said "look, I have these anxiety problems and I've been struggling to treat it by illegally buying alprazolam. It works well, but obviously introduces many legal, moral, and potential health issues. What are my options?" why should you be disinclined to use drug treatment? Be honest with your doctor.

Originally Posted by fiveleggedrat

Swim will not be put on SSRI or SNRI's. They make Swim sick as a motherfucker. Swim experimented with them before for curiosity's sake, but can he tell his doctor this? No.

Er, SSRI's aren't recreational substances... do you really think SWIY has an adequate experience to say that no SSRI or SNRI will work for him?

They may not, this is true. But out of curiosity: which SS(N)RI's has SWIY tried? What was his regimen? It may be that feeling sick is only a side effect from the increase serotonin and would subside after 1-3 weeks. Not to mention, some of these drugs have a complex metabolism and really need to be taken at the direction of a doctor to rule them in or out as a treatment option.

Originally Posted by fiveleggedrat

Swim's mother has a doctor who hands her anything she asks for. Swim will have to keep looking for a more intelligent doctor. She was getting lorazepam, hydromorphone, propoxyphene, promethazine, and was offered many other stronger, higher dose things but refuses stronger treatment usually.

Why not go to her doctor? Certainly if he knows first-hand that such anxiety/insomnia issues run in the family and have responded well to benzos, he should consider that option?

Originally Posted by fiveleggedrat

Honestly, Swim wants to walk into a doctor and be prescribed at least 1 amphetamine, methamphetamine, at least 2 opioids, one being morphine derived and one codeine derived, medical MJ, Modafinil (cant remember substance name), at least 2 benzos (rarer ones), a strong muscle relaxer, GHB (if he lived in europe, he believes it is prescribed for alcohol addiction), and pretty much anything else he can think of.

Why? No responsible doctor would prescribe both amphetamine and methamphetamine, as well as two flavors of opiates and benzos... at least not without years of treatment to rule down to these options for SWIY specifically (which is difficult to imagine)....

Originally Posted by fiveleggedrat

Thoughts, oh wise DF'ers?

Personally, I think SWIY is being exceptionally unrealistic in what he's trying to get from the doctor... I don't really get wheather SWIY wants drugs therapeutically or recreationally or some combination of the two... certainly the fantasy SWIY has about his ideal prescriptions suggests more than just theraputic use...

does SWIY understand that it becomes very hard to use a drug theraputically if that drug isn't used theraputically all the time? It's also detrimental to the therapy overall... This isn't an issue of will, it's an issue of tolerance/dependence.

[Lobsang]

Honestly, Swim wants to walk into a doctor and be prescribed at least 1 amphetamine, methamphetamine, at least 2 opioids, one being morphine derived and one codeine derived, medical MJ, Modafinil (cant remember substance name), at least 2 benzos (rarer ones), a strong muscle relaxer, GHB (if he lived in europe, he believes it is prescribed for alcohol addiction), and pretty much anything else he can think of.

Yeah...I can see it now. The doctor says "This is serious. I am going to put you on methamphetamine, 2 differnt opiates, marijuana, 2 different benzos, a muscle relaxant and GHB...Oh and yes SWIM, is there anything else you think you might need?"