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Harm Reduction Questions for an MD?

Sweet he's back :)

I've got a question for you. Is there any major risk from mixing oxycodone with DXM? Say about 10-20mg oxycodone and about 200-400mg DXM. Not necessarily right at the same time but I got the urge to dex and haven't done it in forever but I also have some oxycodone I'd probably take earlier in the day then the DXM at night. I'm pretty experienced with the oxycodone. Used to have a huge tolerance but took a long break and these days 10-20mgs gets me high.
 
^ those types of questions can easily be answered in the BDD social and info booth or just searching through the archives. I think there are more pressing and community-benefiting questions Dr. Sim can direct the energy he is graciously donating towards.

Also, Doctor, though I personally am not in need of a consult, is it alright if I watch? I could throw on a lab coat and we could tell your patients that I am a student if it would make them more comfortable.

...or if you do not already have a peep hole installed, I could contract tentram to provide us with one.
 
In your personal opinion djism, if a patient wants to go on a benzodiazepine long term for anxiety related problems because nothing else has worked for him, do you think it would be a good idea ? And also is it something that I can upright ask my doctor ? I plan to talk to my doctor about going back on xanax Tuesday and also as a more long term medication.

My anxiety is crippling in social situations. I get lots of depersonalization (where I just feel extremely off and feel like I looked manic, crazy or sketchy to people in public) randomly and always feel like people are watching what I'm doing and commenting about it. This effects my school work and my ability to pay attention in my college classes. I'm constantly readjusting myself and feel uncomfortable sitting in a chair for extended periods of time. It's extremely annoying to say the least. I also sometimes randomly experience panic attack like symptoms while just sitting at home, including random stabbing chest pains and a general feeling of pressure on my chest. This goes away by readjusting how I'm laying or sitting, or usually stretching. It will usually come back randomly though until I move again. (I ALWAYS experience this specific anxiety problem when I smoke weed, so I rarely smoke anymore). They worry me though and make me paranoid something is wrong with my heart or at any moment I'm going to experience a heart attack. I know it's anxiety though since fidgeting makes the uncomfortable feelings subside. Of course I take stimulants regularly, like every couple weeks, sometimes more, and I know those definitely don't help my anxiety as comedowns can be filled with a heart beat that shakes my shirt and random palpitations, but even without them my anxiety remains the same. I haven't seen the doctor in around 6 months or so. The last time I had a refill for xanax was around then. It was fantastic to have around for my anxiety. I was supposed to take it as needed, up to 3x daily. I was however prescribed the lowest dosage, 0.25mg, and it wasn't very affective at that dosage. I found myself taking upwards of 1mg to really get any anxiolytic effects when experience high anxiety and my prescription would always run out much to fast. I didn't always take it daily either.

So there's really two things I'm going to discuss with my doctor on Tuesday. Making xanax a more long term dosage so I know I have refills, and also upping to dosage because what was prescribed was effective, but only above my suggested dosage.
 
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Hatrix, in my personal experience (im going to interject here), your doc will be more receptive (as was mine) to Xanax XR as a long-term benzo therapy. It'll be better for you in the long-term as well. If you're truly in it for the anxiolytic, and not for the abuse of the drug (not saying you are), then you'll also be receptive to the XR formula. It will eliminate the up/down and is better on your tolerance IMO. Im on .5mg XR BID and am smitten. I don't feel a dose dump, rather a nice even plateau of relief.
 
Hey Saw bones, :)

When you find the time I would be interested to hear if people with past concussions/mild TBI should avoid certain popular classes of drugs or take extra precautions while using.

I've suffered with post-concussion symptoms for going on a decade now. Even get the constant head pains in certain spots (not headaches). I ended up getting way out there on opiates (amoung other things) because of it.

Any advice you could give would be really apperciated. I do plan on getting to a GP at some point in the next few months btw so no worries ;)
 
Djism, I'm a 49 year old woman with a few health problems. I had a transient ischemic attack a couple months ago. At the hospital, they ran loads of tests which didn't show any lasting damage. I have hypertension, cholesterol is 241 and triglycerides 121. I'm about 20 pounds overweight and have to work at getting healthy. But I didn't expect my bloodwork to come out so abnormal. I havn't used drugs in years but the concern was there since I was formerly an IV drug user (with sharing needles) and alcoholic. The hepatitis B test came out negative.

The concern the doctor had was elevated liver enzymes. The ammonia test came up 56 (reference range 9-33) A few numbers came up a bit high but the ones that trouble me are under general chemistries and I need help interpreting how bad it really is. One is ALT - SGPT: 239 (reference range 9-52 units) The other is AST - SGOT: 188 (reference range 14-36 units) I'm just reading the lab results and medical reports. It's just a reference note that these numbers are in the high range. The doctor didn't really tell me anything upon being released. I have no insurance to see a regular physician but this is nagging at me. Maybe I'm getting worked up over nothing. Can you help determine if this is severe? If it was, wouldn't they tell me?
 
ReversiblePulpitis said:
Hatrix, in my personal experience (im going to interject here), your doc will be more receptive (as was mine) to Xanax XR as a long-term benzo therapy. It'll be better for you in the long-term as well. If you're truly in it for the anxiolytic, and not for the abuse of the drug (not saying you are), then you'll also be receptive to the XR formula. It will eliminate the up/down and is better on your tolerance IMO. Im on .5mg XR BID and am smitten. I don't feel a dose dump, rather a nice even plateau of relief.
Click to expand...

I forgot about Xanax XR. I will definitely have to bring that up as an option. Thanks!
 
T. calderone


Just to respond to this in the meantime before you have an actual doctor to over this with you. I'm not a doctor but am a second year medical student. Your liver enzymes are def elevated and certainly need to be further explored, but just know that liver enzymes are VERY sensitive. I've many times seen enzymes 20 to 30X above the reference range. So while yours are elevated, they aren't relatively that high. I must stress again though, you should have follow ups as they are certainly above the normal reference range.




The concern the doctor had was elevated liver enzymes. The ammonia test came up 56 (reference range 9-33) A few numbers came up a bit high but the ones that trouble me are under general chemistries and I need help interpreting how bad it really is. One is ALT - SGPT: 239 (reference range 9-52 units) The other is AST - SGOT: 188 (reference range 14-36 units) I'm just reading the lab results and medical reports. It's just a reference note that these numbers are in the high range. The doctor didn't really tell me anything upon being released. I have no insurance to see a regular physician but this is nagging at me. Maybe I'm getting worked up over nothing. Can you help determine if this is severe? If it was, wouldn't they tell me?[/QUOTE]
 
Cane2theLeft said:
...or if you do not already have a peep hole installed, I could contract tentram to provide us with one.
Click to expand...

you don't think the building was built around a high-tech security system? i sit at the admin office all day with a free peep show and flirt with the patients. dj and i both being great looking aussies naturally attract all the 20-30 year old good looking women and yummy mummies.

and you know how we take their temperature.
 
hi there - i'd love to ask you a couple of questions regarding patients coming in if you wouldn't mind?

have you encountered many drug-seeking individuals and how do you deal with them? what is the most commonly searched for and seeked out drug in the doctors room? is it for adhd medication or is it the good old opiates..?
 
I have "adult add", (diagnosed when I was 32 - I could have been a brain surgeon if it was treated when I was a kid), I was prescribed Ritalin.
Ritalin is the only medication for ADD/ADHD available in my country, thats it, no Adderall, dexedrine, etc. At that stage of my life I was using crystal methamphetamine recreationally/self medicating (orally), and Ritalin be damned.
Obviously the crystal got out of hand after a few YEARS, and I stopped using it due to financial reasons.
I stopped about 3½ years ago.

Before the ADD diagnoses I went through (in this order - sertraline, fluoxetine, venlafaxine, paroxetine and citalopram), they did nothing, and the effexor was terrible.
Then the ADD diagnoses, Ritalin, and the Meth (which was the only thing I could feel working - so I gave up on the Ritalin).
When I quit Meth I wasn't keen on taking Ritalin as it just strung me out or didn't work at all.

So a new Dr thought he would try Dothiepin - and I really didn't want to go through the whole A/D thing again.
Obviously Desoxyn would be the right treatment, but not in this part of the world.
After 2 years I feel like I am in the exact same state mentally, financially and socially as when I started the tricyclic. I tell my Dr that I don't feel it working and as a last resort maybe I could try mirtazapine as I have heard positive reports about it.
He said that the "weight gain" side-effect wasn't worth it and that I am doing fine on the Dothiepin.
I know that weight gain from mirtazapine is a very common side effect.

So my question finally is ....... would mirtazapine be out of the question because of weight gain (I don't have weight issues) and if that is my final option - or do you have the answer or advice to point me in the right direction? (Which, in my mind, would be to move to the USA and get my F'ing dexosyn and start living my life again?).

Purely from a medication point of view, would trying mirtazapine be that bad?
 
T. Calderone said:
Djism, I'm a 49 year old woman with a few health problems. I had a transient ischemic attack a couple months ago. At the hospital, they ran loads of tests which didn't show any lasting damage. I have hypertension, cholesterol is 241 and triglycerides 121. I'm about 20 pounds overweight and have to work at getting healthy. But I didn't expect my bloodwork to come out so abnormal. I havn't used drugs in years but the concern was there since I was formerly an IV drug user (with sharing needles) and alcoholic. The hepatitis B test came out negative.

The concern the doctor had was elevated liver enzymes. The ammonia test came up 56 (reference range 9-33) A few numbers came up a bit high but the ones that trouble me are under general chemistries and I need help interpreting how bad it really is. One is ALT - SGPT: 239 (reference range 9-52 units) The other is AST - SGOT: 188 (reference range 14-36 units) I'm just reading the lab results and medical reports. It's just a reference note that these numbers are in the high range. The doctor didn't really tell me anything upon being released. I have no insurance to see a regular physician but this is nagging at me. Maybe I'm getting worked up over nothing. Can you help determine if this is severe? If it was, wouldn't they tell me?
Click to expand...

I am not an MD. Well, not yet anyways. I've been a practicing paramedic for many years, and intend to attend medical school as soon as i can. Anyways, to answer your questions.

I would hope your hepatitis b came back negative since you should of received vaccines for this as a child in a 3 part booster series. Unless you meant, hep c, in which case good. Although it can take up to a year to show on tests and after the date of exposure.

In regards to your liver enzyme being elevated, many things can cause this. From medications taken for conditions to liver failure. But hold up, don't worry, liver enzymes are very sensitive and angry cells. I've personally seen 20-30 fold those ranges. I believe someone else advised this, but it is important to do follow ups with your attending physician, I believe he may do more labs over the course of time to determine more information. This isn't really something that can be diagnosed with 1 lab panel over the Internet. Moreover, remember these are AVERAGE references of everyone, your normal may be an outlier.

TL; DR

Don't worry too much. Be sure to do follow ups with your primary care or attending physician to determine the cause and treatment if one is even needed.

-Viral
 
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last time i got my oxycodone i didn't shoot up any more than i usually do maybe a little less but i got really bad twitches one so bad i fell and hit my head on the corner of a desk does anyone know why this could have happened to me
 
Bambooshoot said:
Hey, great to have you around! Okay I'm a IV heroin user, I was wondering what the common health problems would befor an addict. For example shot immune system or low blood pressure when in withdrawal. Basically I want to know how to separate common problems an addict will have from other health problems..
Click to expand...

I'm assuming IV heroin use here...
So much comes down to cleanliness of IV technique. Do it properly (ie rotate sites, use swabs, only use needles once) and issues are rare. And on the other side of the coin we have outcomes like those in my Case Studies thread. Of course the risk of ODing on H is the big issue. I imagine you can be a functional opioid addict however (cf a meth addict... functional is not possible w/o sleep)
Please clarify if youre asking about medical issues pertaining to 1) using heroin or 2) W/D from opioids
 
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