Quote :

"I haven't taken any prescription drug in the last 10 years."

you might when you graduate and have access to the safe in the pharmacy

[Edited on February 11, 2008 at 9:24 PM. Reason : asdf]

2/11/2008 9:23:43 PM

i still have 10 pills of hydrocodone that i was given when i shattered my elbow...i never used them because the pain wasn't as bad as they pretended it would be and i figured i'd just man up and get over it instead of popping pills

aside from that, i was given percocet when the break actually happened and they were straightening it for the x-ray, and then i was given morphine once when i had a piece of fiberglass go completely through my hand (now those are some cool pictures)

morphine was fun

2/12/2008 4:03:04 PM

I'd like to see them

2/12/2008 4:13:45 PM

let me know if they don't show up...i was teaching archery at a camp one summer and they were (obviously) using old fiberglass arrows...this one shattered when i shot it and i didn't even notice it through my hand until i saw part of it land 10 feet in front of me

it didn't hurt, and so i refused to go to the emergency room until after they had taken pictures...it STILL didn't hurt until they cut off the ends and then used pliers to pull it out (that was when they gave me morphine, though it wore off waaaaaay too quickly)

i have a small scar, and sometimes that part of hand will itch (the doctor said that my body would probably push tiny bits of fiberglass out for several years, and that it would irritate the nerve endings now and then)...all in all, it was interesting





[Edited on February 12, 2008 at 5:04 PM. Reason : .]

2/12/2008 5:00:35 PM

thats pretty awesome looking - did the fiberglass make the inside of your hand itch, or was it just painful?

2/12/2008 5:04:28 PM

oh hell haha

2/12/2008 5:04:58 PM

^^ nothing hurt until they yanked it out...it took three large male orderlies to hold me down (one for each shoulder and one for my legs)...since fiberglass is inert and very flexible in small strings, it didn't really hurt the inside...but i could feel it moving across the bone it had slid in next to, and that drove me batshit crazy

[Edited on February 12, 2008 at 5:06 PM. Reason : .]

2/12/2008 5:06:32 PM

lawl hahaha @ arrow, gg.

Quote :

"Self-medicating is never a good idea. just follow the rx and it should do you good."

it is when you are proficient in pharmacokinetics and have extensive medical background. also, it was my doctor's idea, not mine. but yes, it's a bad idea for the average person to self medicate and/or deviate from the script.



someone mentioned sleep apnea - etco2/o2 sats didn't show any apneas but the EEG did confirm that i was only in REM sleep for like an hour a night.

the thing with this particular dextroamphetamine is that it's a prodrug... it's got an amino acid (i forget which one) attached to it so it has to be hydrolized in the liver before it becomes active. with this being said, one would assume that the efficacy of the drug is directly related to enzyme efficiency. maybe my liver just sucks and i can't break this shit down fast at all. even if there were some other reason for my fatigue, amphetamines are amphetamines... that shit will affect anyone... dopamine doesn't care about shit. of course... there could be something wrong with the catecholamine receptors in mah brain... idk.

because of that, i'm thinking about switching to adderall... the XR has the mixed salts so they adsorb at different rates, plus it's just straight amphetamine, no hepatic impairment at all. we shall see. if that doesn't cut it, then there's something seriously fucked up with my brain.


as far as the fatigue goes: i wake up in the morning and feel like i haven't slept at all. i go to work and can't concentrate on the simplest tasks because it feels like i am incapable of cognition. walking short distances makes my muscles ache for no reason whatsoever. i get to class and i hear what is being said but it's like my brain can't learn any of it...

to overgeneralize, it feels as if my higher brain functions just don't want to work... at all.

i think i do genuinely have some form of ADHD, and that alone would be managable... but couple that with the fatigue, and it's a bit more than i can take.

2/12/2008 10:40:57 PM

Quote :

"it is when you are proficient in pharmacokinetics and have extensive medical background."

please enlighten us here with what PK class you've taken and what your extensive medical background entails beside your EMS days.

[Edited on February 12, 2008 at 11:15 PM. Reason : .]

2/12/2008 11:12:09 PM

oh lawd.

listen, i know i haven't gone to pharmacy school. i never said that. i see that you are in one currently, good job - it's an important profession. i am not trying to imply in any way, shape, or form that my knowledge and experience is equivalent to a degree in pharmacology.

pharmacology and, specifically, pharmacokinetics, has always been an interest of mine, and i usually research just about every drug i come across, whether it be that of my patient or mine. that, plus a working knowledge of physiological processes and mechanisms and a good grasp of organic chemistry, is enough for my needs. i like to know how things work.

people always discount the knowledge of EMS providers. people think that we are merely ambulance drivers. this is incorrect. take one look at our formulary and you will see why.

the above, along with the copy of the PDR sitting on my desk, is enough to figure out simple dosing.

i wouldn't do it if i wasn't sure i knew what i was doing and how it will most likely affect the condition in question.

i don't feel like arguing, so i won't say any more.



[Edited on February 12, 2008 at 11:43 PM. Reason : and to think, i KNEW someone would have something to say about that, lawl.]

2/12/2008 11:40:58 PM

also, my proficiency in pharmacology is not the issue at hand here

2/12/2008 11:49:34 PM

Quote :

"even if there were some other reason for my fatigue, amphetamines are amphetamines... that shit will affect anyone... dopamine doesn't care about shit. of course... there could be something wrong with the catecholamine receptors in mah brain... idk. "

If you have an underlying symptom that is causing a shortage of dopamine and noradrenaline in the brain, you're not going to get any effects from taking amphetamines even at severely high doses. Also, if you're taking a pro-drug and you built up a tolerance to it, increasing the dosage is not going to increase how fast your body can create the active drug enzymatically. You should have mentioned that you were taking a pro-drug in your first post, because that does make a difference. Taking 140mg of a pro-drug doesn't sound out or reason; taking 140mg of d-amphetamine makes you sound like a meth addict in training.

Also, your logic about being able to use drugs safely because you work with doctors is dangerous. There have been plenty of people who started using drugs for legitimate medical reasons only to end up with serious addiction problems.

[Edited on February 14, 2008 at 5:35 PM. Reason : clarification]

2/14/2008 5:33:07 PM

Quote :

"in REM sleep for like an hour a night."

i don't know a lot about this field... but that seems like quite a problem.

what's a normal amount?

2/14/2008 5:36:53 PM

hey evan...have you read up on vyvanse? I was under the impression that it wasn't supposed to give you as much of the "wired" feeling like other amphetamines. I don't know if that's because it's a prodrug or whatever, but if you're looking for something to wake you up, that might not be the right drug.

2/14/2008 5:49:31 PM

Quote :

"Also, if you're taking a pro-drug and you built up a tolerance to it, increasing the dosage is not going to increase how fast your body can create the active drug enzymatically. You should have mentioned that you were taking a pro-drug in your first post, because that does make a difference. Taking 140mg of a pro-drug doesn't sound out or reason; taking 140mg of d-amphetamine makes you sound like a meth addict in training."

i know this. i even said something to this effect a couple of posts up about the rate of hydrolysis in the liver. those who would have the knowledge to help me would most likely know or be able to figure out that vyvanse is a prodrug. 140mg of vyvanse gets hydrolyzed into around 60-70mg active dextroamphetamine, on average.

Quote :

"Also, your logic about being able to use drugs safely because you work with doctors is dangerous. There have been plenty of people who started using drugs for legitimate medical reasons only to end up with serious addiction problems."

i never said that it was because i work with doctors. read the post. i'm not an idiot.

Quote :

"i don't know a lot about this field... but that seems like quite a problem. what's a normal amount?"

lawl yeah

normal people get around 2 hours. it's not just the amount, though. it's how i sleep. i spend most of the night in stage 1, quickly advance through the stages, spend a couple of minutes in REM sleep, and then go back out.

Quote :

"hey evan...have you read up on vyvanse? I was under the impression that it wasn't supposed to give you as much of the "wired" feeling like other amphetamines. I don't know if that's because it's a prodrug or whatever, but if you're looking for something to wake you up, that might not be the right drug."

yep, it doesn't do that because it's a prodrug. adderall and the like are active already. vyvanse has to pass through the liver first to lop off the amino acid (i think it's tyrosine, i can't remember though) to make the active molecule. because of this, the active amphetamine doesn't hit your system all at once; rather, it's adsorbed gradually as your liver breaks it down.

the general problem with adderall is that it doesn't last very long. the XR variant contains different salts that adsorb at different rates, but this can only help so much. i'm going to give it a shot, but i'm not very optimistic.

2/14/2008 9:52:50 PM

you said you tried cymbalta right?


how long did you give it to work before you gave up on it.


you may have a total neurological origin to this problem, but some of it could very well be psychosomatic....the psyche is a powerful thing.


since cymbalta works with dopamine and norepi receptors it might help with the muscle aches.
and it does have an effect on overall fatigue


and honestly since you are not getting sleep you are at a huge risk for depression. if you dont have the energy to even get thru your day you definitely dont have enough reserve to cope with any stress in your life. one of the first things a shrink will do is prescribe sleep aids because if you cant sleep you cant get better...yakety shmakety etc

get back on an antidepressant and stick with it this time.

its not going to be the cure, but it will probably be an important piece in what will probably be a very complicated puzzle.


when you are trying to go to sleep, do you have racing thoughts, or just wish that your brain would STFU? or do you just pass out right away?

2/14/2008 10:06:03 PM

if he's not sleeping well, Cymbalta will only make it worse. That drug is notorious for causing insomnia.

2/14/2008 10:54:54 PM

yes, it is.

i'm thinking about trying wellbutrin... no documented hx of insomnia, affects both dopamine and norepinephrine reuptake... seems like it should fit in nicely.

we'll see.

2/14/2008 10:59:46 PM

Quote :

"how long did you give it to work before you gave up on it."

bout 2 weeks or so, that was the first one i tried.

Quote :

"you may have a total neurological origin to this problem, but some of it could very well be psychosomatic....the psyche is a powerful thing."

ja, i know :\

Quote :

"since cymbalta works with dopamine and norepi receptors it might help with the muscle aches. and it does have an effect on overall fatigue"

i thought it was an SNRI?

Quote :

"and honestly since you are not getting sleep you are at a huge risk for depression. if you dont have the energy to even get thru your day you definitely dont have enough reserve to cope with any stress in your life. one of the first things a shrink will do is prescribe sleep aids because if you cant sleep you cant get better...yakety shmakety etc"

yeah sleep aids unfortunately don't do anything - once i'm asleep, i stay asleep, and sleep ~8 hrs, but i don't SLEEP. :\

Quote :

"when you are trying to go to sleep, do you have racing thoughts, or just wish that your brain would STFU? or do you just pass out right away?"

racing thoughts until i concentrate on thinking about nothing at all, then i usually fall asleep soon after

2/14/2008 11:06:51 PM

Have you thought about taking benzos to try to help you sleep more soundly?

2/14/2008 11:08:03 PM

I have no medical or pharmacological background, but I really think that if you're having the same lapse in response after a few days with multiple medications, for multiple problems, across multiple different categories of drugs that work in totally different ways, the odds are pretty significant that this is a psychosomatic issue.

I realize this isn't what you want to hear, because it's easier to cope with and treat and still feel good about yourself if you can blame your problems on chemistry and imbalances. And when you just say "Yah, maybe " when brainysmurf and others with medical backgrounds suggest that, it seems like you might suspect the same but just don't want it to be true. It's one thing to easily dismiss internet assholes whose kneejerk reaction is to flame you for being lazy or wishy-washy and tell you to focus more or kill yourself. But when people with medical knowledge are suggesting it could all be a placebo effect, you really ought to bring that possibility up with your doctor, or see if talking to a therapist might help at least as much as the drugs have.

If it turns out to be psychosomatic, remember that for those few days when you started on a new med, you performed much better. Even if you thought it was because of a pill, you were able to conquer it for a time, and you can do it again. Stay strong and all that warm fuzzy crap.

2/14/2008 11:31:49 PM

i know what you're saying

but i honestly don't think it's psychosomatic.

this didn't start until a couple of months ago.. and it just happened all of a sudden. nothing traumatic, saddening, depressing, etc. happened. i just woke up one morning and felt like i hadn't gone to bed, and it's gotten worse ever since.

my mind WANTS to do all the things that i used to do, but it seems like i don't have the energy to do them...

2/14/2008 11:42:36 PM

i have always wondered if people felt this way

Quote :

" 1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. 2. Often has trouble keeping attention on tasks or play activities. 3. Often does not seem to listen when spoken to directly. 4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). 5. Often has trouble organizing activities. 6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). 7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). 8. Is often easily distracted. 9. Is often forgetful in daily activities."

i thought i was the only one

2/14/2008 11:58:57 PM

Yup, same fucking thing happened to me.

Woke up one morning and I thought I had the flu. Tired, muscle aches, couldn't concentrate. Two years and over a dozen docs later I finally found one that MIGHT be able to get me back to near normal.

Really fucking annoying to be in grad school, read a paragraph of a journal article, and not be able to remember a damn word of it.

2/15/2008 12:11:23 AM

if you have trouble sleeping, benadryl does wonder for me.

2/15/2008 12:46:28 AM

I have problems reaching REM sleep, but diphenhydramine and doxylamine do nothing more than zombie me out without actually helping me reach REM sleep.

2/15/2008 9:03:03 AM

Quote :

"if you have trouble sleeping, benadryl does wonder for me."

believe me, i know, i give it to people all the time. lawl

and:

Quote :

"diphenhydramine and doxylamine do nothing more than zombie me out without actually helping me reach REM sleep."

2/15/2008 10:42:51 AM

Quote :

"Woke up one morning and I thought I had the flu. Tired, muscle aches, couldn't concentrate. Two years and over a dozen docs later I finally found one that MIGHT be able to get me back to near normal."

Have you had the gamut of tests run? Chronic fatigue? Fibro? Mono?

2/15/2008 10:49:33 AM

Yup, chronic fatigue syndrome. I have been tested for more diseases than most people knew existed. Right now I am on valcyte to see if it helps.

2/15/2008 11:14:36 AM

I take lexapro, remeron, and adderall daily and I don't feel "dirty" or "bad" for taking too many medications. Psychological problems aren't different then any other physical ailments. What are you going to do when you get older and have to start taking medications? Feel bad and let your heart disease run rampant? That's just silly, we're extremely fortunate to live in a day and age where we have the ability to treat so many diseases/disorders. Once you get over your pride issues, you'll find that sucking it up and treating your psychological problems will ultimately lead to a longer, happier life.

2/15/2008 3:49:19 PM

The problem is of course that a lot of diseases (ADHD) are over diagnosed and over prescribed. I agree it's great we can fix so many problems..but it's not great that a lot of people didn't t need the drugs they're on but are now addicted to them

2/15/2008 4:06:04 PM

^^I hope my pride never gets in the way of me taking huge doses of doctor prescribed oxycontin and klonopins.

2/15/2008 7:38:41 PM

Cure the symptoms, not the disease. Tis the American way.

2/17/2008 12:34:20 PM

The doctor's creed: If you not part of the solution, there's millions of dollars to be made by prolonging the problem.

2/17/2008 2:49:43 PM

be glad, or at least hope that its nothttp://en.wikipedia.org/wiki/Fatal_familial_insomnia


genetic prion disease

2/23/2008 7:27:56 AM

cliff note version plz

kkthxu

2/23/2008 5:17:34 PM

It's amazing how many here consider themselves to be experts on pharmacotherapy.

2/23/2008 5:26:09 PM

nobody ever said they were an expert.

2/24/2008 1:47:02 AM

words

2/24/2008 9:23:05 PM