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just want your input from what you all know about lamictal rashes. i know there can be many looks/kinds...some are no biggie and go away and some are lethal.

so can someone maybe tell me should i worry...i woke up this morning after being on this med since early december, just went to 50 mg a week and a half ago from 25 mg. was doing fine...then down/tired the past week. ok so i woke up this morning to this rash on my neck, itchy and looking like a sunburn or a heat rash, mostly. neck felt raw. i went braless most of the day thinking it was heat related as it was worse where my bra/bra straps were. i had worn it to bed as i nurse my son...so i'm wondering if maybe this isn't anything to worry about. sigh...

i called my pRN and she said to go to 25 mg til our appt which isn't til the 8th. i don't WANT to go to 25 mg. should i see a dr. tomorrow to rule this out as a big deal? what would you recommend and what's your experience, those of you who've got a rash from lamictal and those who know about the lamictal rashes?

thanks. it seems to have chilled out but...SHOULD i be worried here??? oh i used my mothers hand lotion yesterday and am wondering if maybe it stayed on despite my wasshing my hands yesterday and maybe i rubbed my neck/chest and it got irritated from the chemicals??? rashes are so hard to dx...................hmmm.well we shall see what its like tomorrow. i have no fever or other symptoms although my dust allergies were going bonkers yesterday too-was staying at where my mothers staying and the pillows are old down pillows which probably have loads of dust mite poop in them...and real old mattress i'm sure...its a spare bedroom of her boyfs parents house...maybe its just a dust allergy reaction? i have never had this happen before though from dust allergies...hmmm.

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After the last discussion, did you NOT contact your GP?

Why? I mean, what the hell?

Next thing: if you're this worried about the rashes, why the hell wouldn't you go back to 25 mg til the 8th?

You called your psyNP.

She triaged your symptoms.

She gave you a course of action.

As the patient, you're now obligated to follow that.

That's how this works. You ask for a phone consult; you then abide by the phone consult instructions, unless you are then physically seen by someone who can gather more thorough information.

You don't get to wish-wash through and say, oh, gee, I don't like these phone consult instructions, I find them inconvenient. If someone shows the trust in you to phone triage you and then recommend a course of action, rather than just turfing you to the ER, then you don't blow her off.

It's till Jan. 8. That's 7 days away, and not 7 full days at that. Maybe there's a cancellation list in case something opens up earlier.

If you're not going to follow her phone instructions, you had best call her back and explain that so that she can adequately explain your risks and document it in your chart.

And this is not the place to seek support for a decision to subvert your provider's recommendations.

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she was vague. she did't say see my gp and she said go back down. i don't want to go back down...i've come too far and if this is helping me in the long run i don't wnat to go back down, damnit!!! i also do not respect everything dr's say. they often are talking out of the asses. she didn't say STOP the meds or GO BACK down. she suggested, said 'if you want...'. she didn't sound concerned. she thinks i'm the type that needs some 'hand holding' and wants it and wants it now. well she is kind of right but truly, this rash scared me and i thought she'd be more helpful/avail to at least fucking see my rash. you'd think they'd be more caring/concerned. i swear its all about money most of the time. i can't afford to pay her to see her before the 8th (she is 125 a pop for 15 mins). i'll go see the damn gp tomorrow....................

After the last discussion, did you NOT contact your GP?

Why? I mean, what the hell?

Next thing: if you're this worried about the rashes, why the hell wouldn't you go back to 25 mg til the 8th?

You called your psyNP.

She triaged your symptoms.

She gave you a course of action.

As the patient, you're now obligated to follow that.

That's how this works. You ask for a phone consult; you then abide by the phone consult instructions, unless you are then physically seen by someone who can gather more thorough information.

You don't get to wish-wash through and say, oh, gee, I don't like these phone consult instructions, I find them inconvenient. If someone shows the trust in you to phone triage you and then recommend a course of action, rather than just turfing you to the ER, then you don't blow her off.

It's till Jan. 8. That's 7 days away, and not 7 full days at that. Maybe there's a cancellation list in case something opens up earlier.

If you're not going to follow her phone instructions, you had best call her back and explain that so that she can adequately explain your risks and document it in your chart.

And this is not the place to seek support for a decision to subvert your provider's recommendations.

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she was vague. she did't say see my gp and she said go back down. i don't want to go back down...i've come too far and if this is helping me in the long run i don't wnat to go back down, damnit!!! i also do not respect everything dr's say. they often are talking out of the asses.
It is the minority of this mind, that make it more difficult for the rest of us to get things as considerate, courteous, and CONVENIENT FOR THE PATIENT as phone consults. There is a fucking reason she is telling you that. It's not for shits and giggles, yanno.

wtf!

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she was vague. she did't say see my gp and she said go back down. i don't want to go back down...i've come too far and if this is helping me in the long run i don't wnat to go back down, damnit!!! i also do not respect everything dr's say. they often are talking out of the asses.
You're concerned you may have a horrific allergic reaction, which could manifest as a rash. But you won't follow up with your GP.

You're concerned you could have a horrific allergic reaction, which could manifest as a rash. But you won't tolerate a 7 day reduction in dose - for a medication that you might well be able to take for many years - to see if maybe a slower titration will resolve the problem. There are multiple reports on this board and others from people who did better with a slower dosing increase. Patience now can pay off for the long run. This is kind of the whole point of the titration process. That's why they don't just bang ya on in to Lamictal at 200 mg on day one.

Do you see why the priorities seem kind of odd here?

Reported fear of life threatening reaction; then no followup with GP; again, reported fear of life threatening reaction; then not complying with prescriber's instructions. Something's not matching up.

Given your recurring severe anxiety about rash, I'd think maybe a really, really slow titration would be a great idea to talk about with your psyNP.

You think doctors are often 'talking out of the asses.' You're letting your psyNP prescribe you a medication. You're taking it. I would suggest you don't take medication from ass-talkers, as a general rule. If your doc or NP is an ass-talker, move on.

She's showing you the respect of not thinking you're talking out of your ass when you give her a history, report symptoms, or call her with problems, or when you say you will follow through.

She evidently wasn't thinking you were talking out of your ass, so she could trust you to do what you committed to do. She didn't just send you to the ER where someone could look at you and could verify what was actually happening.

But you're blowing her off and picking and choosing through the instructions based on your whims.

Gee, and we wonder why so many offices just send all the patients to the ER and won't even try to phone triage.

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WHY are some of you being so fucking COLD to me?! all i am doing is asking your opinion...many of you have been there...and often i know these rashes are not a big deal. so i wanted to know what the lethal one(s) look like!!! i don't need you blasting me and cutting me down, for christs sake!!!!!!!!!!!!!

i have had one hell of a day watching 2 hellion kids. i do not need this right now. not at all. if you are in shitty moods and want to shit on someone, shit on someone else. WTF is right. wow.

she was vague. she did't say see my gp and she said go back down. i don't want to go back down...i've come too far and if this is helping me in the long run i don't wnat to go back down, damnit!!! i also do not respect everything dr's say. they often are talking out of the asses.
It is the minority of this mind, that make it more difficult for the rest of us to get things as considerate, courteous, and CONVENIENT FOR THE PATIENT as phone consults. There is a fucking reason she is telling you that. It's not for shits and giggles, yanno.

wtf!

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why, gee...and we wonder why any of us are on these boards...am i alone in my feelings re. my prescribers? i'm TRYING to trust in them but its awfully hard sometimes. maybe i don't make sense...believe me i confuse myself. this rash doesn't seem severe so that is why i haven't gone to ER or to my GP. she didn't seem that concerned (my pRN). i guess i'll leave MY business to MY business if i'm only going to get blasted on this fucking forum. i've had it with being treated like this here. i'm not fucking stupid and don't feel i ever deserved to be treated as so.

she was vague. she did't say see my gp and she said go back down. i don't want to go back down...i've come too far and if this is helping me in the long run i don't wnat to go back down, damnit!!! i also do not respect everything dr's say. they often are talking out of the asses.
You're concerned you may have a horrific allergic reaction, which could manifest as a rash. But you won't follow up with your GP.

You're concerned you could have a horrific allergic reaction, which could manifest as a rash. But you won't tolerate a 7 day reduction in dose - for a medication that you might well be able to take for many years - to see if maybe a slower titration will resolve the problem. There are multiple reports on this board and others from people who did better with a slower dosing increase. Patience now can pay off for the long run. This is kind of the whole point of the titration process. That's why they don't just bang ya on in to Lamictal at 200 mg on day one.

Do you see why the priorities seem kind of odd here?

Reported fear of life threatening reaction; then no followup with GP; again, reported fear of life threatening reaction; then not complying with prescriber's instructions. Something's not matching up.

Given your recurring severe anxiety about rash, I'd think maybe a really, really slow titration would be a great idea to talk about with your psyNP.

You think doctors are often 'talking out of the asses.' You're letting your psyNP prescribe you a medication. You're taking it. I would suggest you don't take medication from ass-talkers, as a general rule. If your doc or NP is an ass-talker, move on.

She's showing you the respect of not thinking you're talking out of your ass when you give her a history, report symptoms, or call her with problems, or when you say you will follow through.

She evidently wasn't thinking you were talking out of your ass, so she could trust you to do what you committed to do. She didn't just send you to the ER where someone could look at you and could verify what was actually happening.

But you're blowing her off and picking and choosing through the instructions based on your whims.

Gee, and we wonder why so many offices just send all the patients to the ER and won't even try to phone triage.

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WHY are some of you being so fucking COLD to me?! all i am doing is asking your opinion...many of you have been there...and often i know these rashes are not a big deal. so i wanted to know what the lethal one(s) look like!!! i don't need you blasting me and cutting me down, for christs sake!!!!!!!!!!!!!
Because, like a lot of others who blow in and blow out of here, you ASK what we think and then completely disregard.

I rely on a number of medical personnel on an ongoing basis, and most of them--not all--have been very helpful if not downright awesome. It annoys the shit out of me when people say, "Oh, my doctor told me to do this, but fuck her I don't want to because ALL doctors are assholes." Because while you're saying that, I'm patiently waiting to be seen, or trying to get through on the phone while they are wasting their breath with someone who has NO INTENTION of doing what they're told.

We ALL have to pay for that kind of mentality. And, frankly, I'm sick of it. Maybe you haven't sat in the ER long enough, or enough times to truly appreciate what a service your psyNP is providing to you. I HAVE.

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You may not be stupid, but you are doing stupid things, and people are pointing that out, not because they hate you but because this is a health support board and what you are doing is dangerous and unnecessary. We would like you to be mentally healthy, we would like you to not have to go off an effective medication due to a rash, and we'd like you to not potentially die from something that can be treated.

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well thank you resonance. that was more kindly put...

i appreciate that. i don't agree that i'm doind stupid things, though. but maybe i am. maybe its that 'ol self sabotager in me that i can't quite figure out before its all said and done and i'm like wtf. oh but i don't know if i even want to be that vulnerable on here anymore and share what is on my heart...or brain. i just don't know.

You may not be stupid, but you are doing stupid things, and people are pointing that out, not because they hate you but because this is a health support board and what you are doing is dangerous and unnecessary. We would like you to be mentally healthy, we would like you to not have to go off an effective medication due to a rash, and we'd like you to not potentially die from something that can be treated.
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she thinks i'm the type that needs some 'hand holding' and wants it and wants it now. well she is kind of right
Well, as evidenced by recent discussions, yes. That's not a criticism, MM, it's just a thing, y'know?

So that's why the really REALLY slow titration might be a good idea to talk about with her. Less panic for you, fewer visits for you, less drama for both of you. Really, think about it. Maybe stay at each dose for a good long month or more without a rash-scare - don't go up til you have 4 rash-free weeks. That can work really well. I rash out on everything, and this is what actually gets me through starting rash-y drugs.

but truly, this rash scared me and i thought she'd be more helpful/avail to at least fucking see my rash. you'd think they'd be more caring/concerned. i swear its all about money most of the time. i can't afford to pay her to see her before the 8th (she is 125 a pop for 15 mins). i'll go see the damn gp tomorrow
Your GP sees you for free? If so, that sounds like a totally rational person to see for your rash, eh?

She took your call about your rash.

She takes your emails.

She discussed with you that sometimes maybe your anxiety gets out of hand, and that maybe feeding into it would be a problem for you, and worked on problem-solving with you.

This doesn't sound uncaring or unconcerned.

WHY are some of you being so fucking COLD to me?! all i am doing is asking your opinion...many of you have been there...and often i know these rashes are not a big deal. so i wanted to know what the lethal one(s) look like!

this rash doesn't seem severe so that is why i haven't gone to ER or to my GP. she didn't seem that concerned (my pRN).

I'm not being cold. Or even shitty.

Now you're saying you often know these rashes are not a big deal. Good. Now you are normalizing them. Despite repeatedly asking about them.

I'm not going to play "feed the diagnostic anxiety" on this thread, or "but what about this particular lesion?" as a reassurance activity. You had a nice discussion of what the nasty stuff looks like before, and I think you know where that thread is.

Dermatologic diagnosis is really best undertaken in person.

am i alone in my feelings re. my prescribers? i'm TRYING to trust in them but its awfully hard sometimes.
Oh, gosh, no, you're not alone. But you're now writing a very different statement.

And if it's hard, that's something to work on them. That's a good thing to do here, actually.

i guess i'll leave MY business to MY business if i'm only going to get blasted on this fucking forum. i've had it with being treated like this here. i'm not fucking stupid and don't feel i ever deserved to be treated as so.
If all you want to see is blasting, MM, that's your choice or your interpretation. I just reviewed your posts and responses. I don't see a lot of blasting. I see some honest responses, but I don't see disrespect, I don't see attacks, and I don't see viciousness. If anything, I see a remarkable amount of patience. People seem to have been very respectful of the fact that you do have two children and are having a rough go of things.

As far as personal accountability and responsibility - yeah, I'm gonna call you on it if you call your provider for specific advice and then ignore it. I didn't say you were stupid. I said that you were irresponsible in this one area and that you were violating the patient/provider relationship. That's a different thing. Don't generalize from one to the other. Well, you can if you want to, but it seems to make you really upset, so I would try to avoid it.

You came on here looking for suggestions.

Here are mine.

Follow your psyNP's phone consult suggestions for now.

See your GP to put your mind at ease. Have him or her fax the visit note to your psyNP.

See your psyNP on 1/8 and talk to her about maybe a super slow titration like I described above. Remember: slow now can pay off big later. It's like the foundation for a house.

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I know you don't want to go down to the old dose. Who doesn't want to start feeling better asap? But by some criteria, your pRN is even being really generous by not stopping the med altogether. Here are some guidelines about rash on Lamictal from a website I've generally found helpful:

What are the signs of great risk? Here are the versions I've heard so far:

"Anything above the neck"

"Around or in the mouth"

"Soft tissues (like mucous membranes of mouth, nose, eyes -- including the membrane over the eye (conjunctiva), so a red, sore eye counts) (or the anus, also a mucous membrane, also counts)

"Anything on the face"

Obviously these all describe nearly the same area, but the "soft tissues" version is the most specific.

Three strategies for rash

Stop for any rash anywhere.

Have a dermatologist see the patient within 24-48 hours; hold the doses until seen.

Stop for any rash above the neck; for anything else, reduce the dose to the previous level, and hold it there until you can tell whether the rash is going away (if so, continue upward again but more slowly and/or by smaller steps; use Benadryl or topical Caladryl to control itching while you're waiting).

Obviously, this is just a website, just one MD's approach, certainly not advice for YOU from YOUR doctor. But it looks like a lot of people would have you stop Lamictal altogether for that neck rash, unless you could see a dermatologist right away. Compared to that, maybe going back down to 25 mg for a while isn't so bad?

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for ATTENTION? my god, susan. come on! i AM seeing my nurse and i AM taking in all the suggestions. i'm researching for petes sake. and of COURSE i'm not going to ignore this rash...

i don't appreciate being told i'm posting for no good reasons. i'm researching...always, researching. and i value all of your experiences and wisdom. i do not however value self righteousness or criticism.

go see a dermatologist, or, at least, your GP.

which is what has been suggested countless times on this thread and on others.

if you don't want to listen to your nurse and don't want to take any suggestions here, why expend any energy asking the questions? for attention? use your blog for those sorts of things. blogs are great for bitching and moaning just for the sake of bitching and moaning.

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i AM seeing my nurse and i AM taking in all the suggestions. i'm researching for petes sake. and of COURSE i'm not going to ignore this rash....
I don't think it's an automatic "of COURSE," MM. You were, a whapping great.... less than 1 day ago, saying you were going to blow off medical instructions. You hadn't followed up with GP after the last discussion. I can see how that would look like a history of ignoring the last rash, which would suggest risk of ignoring this rash.

But, hey, now you've changed the plan, and apparently you're planning to go follow up and actually have someone physically examine you to help you sort this out. Good deal.

i don't appreciate being told i'm posting for no good reasons. i'm researching...always, researching. and i value all of your experiences and wisdom. i do not however value self righteousness or criticism.
I believe that you don't appreciate those things.

As to not valuing self-righteousness or criticism... well. I believe our values are manifest in how we live. You simply have a strong sense of fairness and justice, it would seem, and you believe in speaking up when you think it's necessary.

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