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Pnurse + Pdoc Suck!


Loon-A-TiK

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they both suck donkey dong because they missed a very, very important fact about lamictal and birth control.

it states, on page 42 of the PI for Lamictal, that minipills (no estrogen) do not require the doubling of the dose like pills containing estrogen.

they told me that they did require the dose being doubled, and kept me on my high dose. they even increased it to 500 when i was depressed!

no wonder i'm having lamictal side effects now. i shouldn't be taking so much. i'm sure my blood lamictal levels are through the roof.

when i asked that question, you'd think that they would have been able to answer me correctly. that would be a normal question, considering that many women take the pill and also take lamictal. what if all their "mini-pill" patients are on this high dose?

i'm going to march into his office with page 42, with the noted sections highlighted, and ask why i'm on this high dose. this could be bad.

i know i'm not supposed to play with my own meds, but i felt like because it is sunday and my pdoc isn't in the office, that i have every right to start lowering my dose. i went from 400 (i was already rebelling and taking 400and not 500) down to 300, and plan to stay there for awhile and drop to 200, a reasonable level.

oh dear god do they suck!

my uncle is an experienced pharmacist and he told me i wouldn't need the extra lamictal. if he knew that, then why didn't my treatment team? BECAUSE THEY SUCK.

i'm thinking of revisiting my huge pdoc bills from my old (but totally awesome) pdoc to see if i can pay them down/get some forgiveness and start going back to him. i feel like, even though my treatment is free, my health was endangered by lack of research. i knew something was wrong so read the PI through. isn't that something a health care provider should know, especially one dealing wtih this med constantly? it is such a widely RXed med! OMG- think of all the women on non-estrogen birth control who are taking huge doses of lamictal at that clinic!

do you think i should go back to my old pdoc, if they'll take me?

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By all means start WWIII over this!

If you are going to go back to your old pdoc, why bother even mentioning this to your current docs? It serves no purpose to even bring it up with them. Walk out the door without a word and don't look back.

If you are going to remain with your current docs, then accusing them of incompetence, railing at them and generally pissing them off will not endear you to them, nor improve your care.

At least they erred on the direction of safety from a bc perspective. You did the right thing by checking with a pharmacist, who gave you the correct answer. So, practically the system worked and you got the right result.

The world of meds is a lot more complicated. Since the early 1980's the number of psych meds alone has more than doubled. Just off the top of my head, there have been at least 3 generations of bc pills. Unfortunately, we don't have any one central coordinator for our health care who knows everything. So, we have parts of a team, and we have to be our own coordinator.

Good luck. a.m.

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i was suspecting lamictal overdose when i started getting weird leg cramps and vision problems. reading the PI sheet was enlightening.

ncc was saying something about that the last time i talked to her as well.

i'm erring on the side that my pdocs are full of it and that i need to make up on my past-due balance with my old pdoc so i can go back to him.

since the balance is actually in collections, i'm going to have to be really nice i think to get back into their good graces. but hey, i'm crazy and broke and they know that, so hopefully i'll be forgiven ;)

i'll have to tell my grandparents what happened at the clinic where i go so they will help me pay the balance and go to my old pdoc (if they'll have me back).

but money is money

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VE- do you mean would i have rather taken too little than too much? well, considering how wide of a therapituc range lamictal has and how it isn't that dangerous to take at 400-500mg, i'd most likely rather do that than be at an effective 100mg. would i relapse still taking risperdal and wellbutrin? i don't konw.

but i do know that my health care providers should have known, and if not sure, found out. i wasn't sure they were right, so i looked it up and sure enough...ultimately we're in charge of our own health care. but that doesn't mean i have to go to a place where they don't know what they're talking about.

i just made an appointment to see my pnurse for wednesday, so i can bring in page 42 and ask him about it. in the meantime, i'm also going to try to get into Dr. R's good graces again. i may be stuck where i am, he may not accept medicaid (but he's a pdoc, shouldn't they all?).

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Hi Loon,

I'd be furious too. Lamictal has such a huge range of nasty side effects, you'd think they'd do their research before prescribing it. I definitely think you should bring in page 42, but you might want to rethink the whole marching in and railing at them part. I'd bring it up sort of as a question - like, "hey - I was having these really weird symptoms so I did a little research and look what I found - what do you think?" That way you're educating them without accusing them of incompetence. Works all around. I don't agree with AM that you should just walk away if you're going back to your old pdoc. I think it's important to point out what you found so others don't have to suffer needlessly.

Millie

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Just keep in mind that the info in the PI sheets isn't always accurate. The motive in writing PI sheets is often financial. It's to sell a product and to protect the drug company from liability. It's half advertising. The clinical experience of the physician is often worth a lot more. You should at least ask them and not just assume that the PI sheet is the be all end all of data.

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Not that I don't trust the docs but... I always ALWAYS talk to the pharmacist about my meds because that is all he does, it is all he knows. I mean interactions, chemistry, side effects and shit are his life. He does't have to deal with dianosises and all the other stuff. You're right, the pi's have other agendas, but I know that my pharmacist knows the shit on the shit I am taking. For example topamax and the pill. Depending on who you listen to (doc, pi) is how intence the risks are. My pharmacist actually had the study effectiveness rates, at dose x the effectiveness of the pill decreased by y% and so on. It was the only accurate info that I had so that i could make a decision about changing birth control Hello....can you say you people could really be fucking up my life??????? I don't think that they (doc's) do it on purpose, its what they have access to compared to what the pharmacist does. Anyway, thats just a suggestion, its woked out well for me. Feel better..

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so i'll do this:

1. i'll take in page 42 and ask about it, and if they have any clinical experience with it, adn "hey, look what i found!"---> great plan

2. always ask a pharmicist and be wary of what my doctors tell me. true mitten, they work with drugs all the time and that's all they know.

since i've started on the 300 for the past few days i haven't had those horrible cramps in my legs and wrists.

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Just here to echo that the doctors do not know everything. I had experienced tachycardia (rapid heart beat) from taking too much risperdal and mentioned it to the pdoc. She thought nothing of it. I read in the PI sheet that it is a toxic effect of Risperdal. So I lowered the dose. A lot of problems went away. I too was angry that the Pdoc would not know this. Unfortunately my pharmacist always says to talk to a doctor when I ask him about symptoms and drug reactions.

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my uncle, thankfully, is never afraid to assert his opinion, and is open with his belief that while doctors know how to diagnose patients, they're not the pharmacy experts like he and his staff. he'll tell me when he thinks something isn't right. he knew about this issue, but i believed my pdoc, because after all, my pdoc holds rank over a guy with a master's in pharmacy, but from now on i'll believe my uncle. he loves me and will tell me outright if he doesn't know, and will look it up.

it is too bad that your pharmacist either lacks confidence or doesn't want to be sued, so refers you to your pdoc. isn't that what pharmacists are for, to answer questions about your medication?

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No loon, not even pharmacists know everything about the pills they roll.

They may know the chemistry and pharmacokinetics, but they don't know the clinical applications that an MD knows.

If anyone expects perfection and omniscient knowledge from either Pdocs, GP's or pharmacists then you are surely diluded and will be disappointed in every professional you deal with. If you want to blame them for every mistake, error, misunderstanding or less than total knowledge then you will spend the rest of your life bad mouthing and suing them.j

Get real. These are the most highly educated people in our society. They are concientious and do a damn good job. You don't have enough money to pay for, nor do the doctors have unlimited time to give you perfect medical care by researching every therapy, every medication, every time they pull out the Rx pad.

harumph.

a.m.

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If anyone expects perfection and omniscient knowledge from either Pdocs, GP's or pharmacists then you are surely diluded and will be disappointed in every professional you deal with. If you want to blame them for every mistake, error, misunderstanding or less than total knowledge then you will spend the rest of your life bad mouthing and suing them.j

a.m.

Too right. I'll tell you a little story of what happened to me the other day. I'd asked my pdoc to put me back on WB (not normally prescribed here so it seems). Went back to the same pharmacy I got it from last year the only pharmacy that can specially order it from overseas. Well I went in with my script, the pdoc had written "Bupropion" on the script. When the script was ready, they came to me with a box of ZYBAN, an antismoking medication which happens to contain Bupropion. I thought, what the f**k!!! What is this. I don't care if it contains the same chemical in it, but I am NOT going to take any antismoking pills, I don't even smoke!

I had to explain to her what I was meant to get, and for them to look it up in their records as I'd had it last year, and that I wanted the same stuff as I got back then.

I always GRRRR when professionals don't do their job properly. Ok I'm a perfectionist, and ok I realise they don't know it all. If I do thorough research myself online, of course I'm going to pick up things that the average pharmacist or doctor doesn't know.

Sometimes I kinda feel that I'm "self medicating" because I tell my pdoc what med and what dose I want to be on, not the other way around. At least in the case of my current stint on Wellbutrin.

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Yes pharmacists do know plenty about medication interactions but I don't think they can comment too much on symptoms or regarding medications being the cause because there needs to be an assessment, diagnosis etc... I do agree that it is wise to check with different professionals and that there are going be times when your psychiatrist will know more than the pharmacist and vice versa. It can't hurt to check things out with an additional professional. Knowledge is power. Though us patients are the most knowledgeable regarding our own bodies and how things are affecting us. I think my Pdoc assumed my heart beating rapidly was due to anxiety. She wanted to medicate away the other symptoms of drug toxicity and that did not sit well with me. I don't like to take additional meds to coverup side effects.

Edit to add: Duh, I just remembered that my pharmacist's wife (also a pharmie) gave me a piece of paper, to give to my doctor, regarding info that Risperdal and some antid's (synergistic when taking two together) can cause prolonged QT intervals. Meaning they could affect the heart - prolonged QT intervals can lead to complications causing fainting or worse. So heads up if you are fainting check it out. I'm not mentioning this to say if, or if not, tachycardia is a symptom of this. Yeah for pharmacists.

So many hospitalizations and med complications could be avoided if more patients were aware of the medications they take, what they look like, etc. Most people don't even know what they were taking a year ago (especially in the elderly population).

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No loon, not even pharmacists know everything about the pills they roll.

They may know the chemistry and pharmacokinetics, but they don't know the clinical applications that an MD knows.

If anyone expects perfection and omniscient knowledge from either Pdocs, GP's or pharmacists then you are surely diluded and will be disappointed in every professional you deal with. If you want to blame them for every mistake, error, misunderstanding or less than total knowledge then you will spend the rest of your life bad mouthing and suing them.j

Get real. These are the most highly educated people in our society. They are concientious and do a damn good job. You don't have enough money to pay for, nor do the doctors have unlimited time to give you perfect medical care by researching every therapy, every medication, every time they pull out the Rx pad.

harumph.

a.m.

Ok, um, probably not my business and definitely a threadjack, but it's posts like this that keep me away from here. Whatever happened to good old common courtesy? It's deluded, by the way, not diluded.

Millie

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Sorry Millie,

I was deluded.

I am a stickler for spelling, and I am on Lithium and Lamictal which often means I don't know what I'm spelling.

I'm sorry if you don't care for the discourse. My increasing frustration is with people who are unrealistic in their expectations.

a.m.

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Sorry Millie,

I was deluded.

I am a stickler for spelling, and I am on Lithium and Lamictal which often means I don't know what I'm spelling.

I'm sorry if you don't care for the discourse. My increasing frustration is with people who are unrealistic in their expectations.

a.m.

Wow. Thanks. That was incredibly civil! I understand your frustration. I was being pissy about the deluded vs diluded thing. It was obviously a typo.

As for you, Mr Courtesy is Socially Relative - SHUT UP!! ;)

Ok, Loon, I apologize for the threadjack. Just shooting my mouth off as usual. Carry on.

Millie

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By all means start WWIII over this!

If you are going to go back to your old pdoc, why bother even mentioning this to your current docs? It serves no purpose to even bring it up with them. Walk out the door without a word and don't look back.

If you are going to remain with your current docs, then accusing them of incompetence, railing at them and generally pissing them off will not endear you to them, nor improve your care.

At least they erred on the direction of safety from a bc perspective. You did the right thing by checking with a pharmacist, who gave you the correct answer. So, practically the system worked and you got the right result.

The world of meds is a lot more complicated. Since the early 1980's the number of psych meds alone has more than doubled. Just off the top of my head, there have been at least 3 generations of bc pills. Unfortunately, we don't have any one central coordinator for our health care who knows everything. So, we have parts of a team, and we have to be our own coordinator.

Good luck. a.m.

ths is your quote, right after my opening to the thread.

have you changed your mind? ;)

not an issue millie!

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Loon:

this is your quote, right after my opening to the thread.

have you changed your mind? ;)

No, absolutely not. If you insist on blowing up at your doctors and accusing them of incompetence you will only hurt yourself and find yourself increasingly unable to find anyone willing to treat you.

a.m.

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