Wednesday, August 17, 2011

The Tao of a Ticked Off, Manic Woman Who Isn't Being Heard, Part 46.

Among my many delightful neuroses, I have Post-Traumatic Stress Disorder (PTSD) and Generalized Anxiety Disorder (GAD). Unmedicated for that, I'm edgy, irritable, sweaty, my heart races even more than normally (with a pulse in the mid 100's), shaky, unable to concentrate, I sleep very little and am up at 5am, and I bite the heads off of everyone, leaving them in my fucked up wake.

For the last year and a half, I've been on Estazolam for anxiety and insomnia. My family doctor prescribed it after a week during which I'd been up for 36 consecutive hours, couldn't sleep and was literally hallucinating. I was seeing double of everyone.

Estazolam is part of the category of drugs called benzodiazapines, or "Benzos," which calm the central nervous system and regulate the body's fight-or-flight response. They work wonders for people with GAD and PTSD. After the hell I was going through with my ex-boyfriend, my family doctor increased the dose from 1mg at bedtime to 1 mg twice a day and a 2mg pill to take at bedtime. Beautiful. I was sleeping soundly, my condition was under control, and I was doing very, very well.

The family doctor graduated her residency in June, writing me 5 months' worth of Estazolam upon her exit, to keep the therapy as-is. I have no fucking clue why, after all that time, she decided to call my shrink and ask him if it was ok that I was on benzos given that they can cause chemical dependency.

All of my doctors know my addiction history. I am very open about it. The fact remains, however, that I've been a more than responsible patient with my benzos and have taken them BY THE BOOK, not abusing them whatsoever. Dr. K immediately said "No way, that treatment's not appropriate for her, cancel her refills." The clueless new family doctor, a 2nd year resident, who was assigned to me (thank you, Public Aid, for the legion of fucktards I have to see as PCP's) agreed with him blindly, and despite me telling her that I was symptomatic with insomnia again, told me to take it up with Dr. K. Dr. K Rx'd a THIRD antidepressant, which didn't help, and told me to take the issue up with the family doc who was prescribing the Estazolam.

Enter mental fucking pinball back and forth with doctors as I rationed my dwindling supply of Estazolam as best I could without going into full-blown withdrawal. Anyone who knows anything about pharmacology knows that benzo withdrawal is even more brutal than narcotic withdrawal, and that you can't just cut a patient off those meds without a safe, controlled, 10% dosage decrease over the course of at least a month.
It's basic drug knowledge. My Tatus wouldn't help me (he's just the cardio guy and I honestly felt horrible asking him for an Rx), my shrink wouldn't help me, and my young family doctor (who's only met me in person once) essentially said I was up shit's creek and take it up with Dr. K. Dr. K's brilliant idea this morning was to admit me into rapid detox from the benzos, which only serves to cause more severe withdrawal symptoms and is overall a poor idea. I told Dr. K that I have a job to do and a son to raise and that he could go fuck himself.

I have to be on bipolar meds for the rest of my life to stay sane and stable. What's the big fucking deal if I have to be on benzos my whole life to calm the crazies? What's the fucking difference?

Blew in another call to the family doc, who agreed to Rx me a week's worth at the sustained dose of 4 mg a day, with a follow up appt next Wednesday. By then I will have seen my new PCP, who is smart, compassionate and knows my body chemistry quite well. I have every confidence, since I've proven to him in the past that I take my drugs responsibly, that he'll keep me on Estazolam long-term. His drug policies are stringent: you have to sign a written, witnessed contract that you won't pharmacy-shop, that you'll keep all your controlled substances at the same pharmacy, that you have to bring your pills in for him to count at every visit, all reasonable requirements for anyone on long-term controlled substances. He, in turn, promises in the contract not to cut you off your meds abruptly, and understands that physical dependency and psychological dependency are two different things. His contract vows that he will likewise be responsible in his treatment of your conditions if you are compliant with the contract. That's invaluable and a great idea. So rock-n-roll.

I'm not sure why the communication between all the doctors got so fucked up. I'm an admittedly complicated patient with a lot going on in my body. So for now I will stay treated for the week, and we'll see how next week pans out. Surely someone will eventually actually listen to me as a patient. A responsible patient who is struggling right now.

The first rule of physicians is what, "First, do no harm." Well, abruptly cutting off benzos IS doing the patient harm. So let's avoid that, shall we? If the doctors want to all get technical about this situation, worthy of mention is the fact that I NEVER gave the family doctor permission to talk to Dr. K. in the first place. I didn't sign a privacy waiver enabling them to mutually discuss my therapy. If they want to play hardball, I have no qualms about throwing HIPAA in their faces and suing the shit out of both the shrink and the family practice for blatantly violating my privacy as a patient. I'm that ticked off.

My young son just told me yet again, "Settle down, you crazy bitch." Truer words were never spoken.

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