Dr. Levin's Titration Schedule

[GingerDust]

Dr. Levin's Titration Schedule

Me too hanging. If I space 20 even an hour apart it comes off better than trying to take 40 together. It's interesting that it could make such a difference.

[GingerDust]

Dr. Levin's Titration Schedule

If the good Dr. (?) P doesn't like it, perhaps he would be so good as to prescribe for people here the way Dr. L does. Put up or shut up.

[Road to Recovery]

Dr. Levin's Titration Schedule

Otter;1192385 wrote: I suspect the answer to this is quite simple in that prescribing Baclofen is outside Bill P.'s area of expertise so his insurance would not respond to any claims against him. He may have his ideas which is why he is getting in touch with Dr. L but that does not necessarily mean he knows how Dr. L prescribes.

The problem as I see it for Dr. L is that Baclofen is, it seems to me, a highly individual thing. Dr. L appears to be putting everyone on a one size fits all schedule. The Glasgow study which is on the Baclofen UK site, has concluded that dosages need to be tailored. Thi s study is supported by senior practitioners including the editor of the International Journal of Alcohol and Alcoholism, Jonathan Chick who has a D.Sc.

I think Dr. L is courting disaster if he is just handing out a titration schedule over the phone and charging for it. Doctors are obliged to take full histories from patients to avoid them coming back and making claims about them. I just think someone should point this out to him. I don't think the body of medical knowledge is such that he could actually be sued for negligence for this but a time will come when that may be the result of this sort of prescribing.

Otter, I dont know what your agenda is here but what you say makes no sense (IMO).
Everyone IS different yes but how would a doctor know exactly what each individual can handle in terms of SEs and titration schedule? If we are going to say they should know, than they should also be able to tell us at which dose we will hit the switch.
DRs all go by a guideline as to how much to perscribe for meds. They dont perscribe different levels of doses of meds to patients, they go with the doses that are commonplace in the medical profession. adjustments can be made if the patient isnt having a positive outcome with the med and it's dosage. Take antibiotics for instance, does each individual receive a different med and dose than everyone else - no there is a guideline. Obviously you dislike DR L and have a thing for Bill P...
Quit wasting people's time with your theories.
Obv

[redhead77]

Dr. Levin's Titration Schedule

Otter;1192385 wrote: I suspect the answer to this is quite simple in that prescribing Baclofen is outside Bill P.'s area of expertise so his insurance would not respond to any claims against him. He may have his ideas which is why he is getting in touch with Dr. L but that does not necessarily mean he knows how Dr. L prescribes.

The problem as I see it for Dr. L is that Baclofen is, it seems to me, a highly individual thing. Dr. L appears to be putting everyone on a one size fits all schedule. The Glasgow study which is on the Baclofen UK site, has concluded that dosages need to be tailored. Thi s study is supported by senior practitioners including the editor of the International Journal of Alcohol and Alcoholism, Jonathan Chick who has a D.Sc.

I think Dr. L is courting disaster if he is just handing out a titration schedule over the phone and charging for it. Doctors are obliged to take full histories from patients to avoid them coming back and making claims about them. I just think someone should point this out to him. I don't think the body of medical knowledge is such that he could actually be sued for negligence for this but a time will come when that may be the result of this sort of prescribing.

I apologize in advance LoOp. I don't know how to quote something from one thread on a different thread, and I think this is important. I can't ignore it.

I suspect the answer to this is not "quite simple". Docs in this country have wide prescriptive power, and I doubt it just relates to insurance reimbursement. As a matter of fact, when you say HDB would be out of his area of expertise (some might say scope of practice), it is out of most docs area of expertise. The people who prescribe HDB on a regular basis are neurologists. They are prescribing this for MS patients. So, people prescribing this for addiction are doing so off-label. The front line responders who treat alcoholism, such as the internal med docs and the psychiatrists, likely have little experience or knowledge of HDB. And few studies written in peer reviewed journals to base their decision to prescribe or not prescribe. Which brings your whole claim that it's negligent to not prescribe bac off-label for addiction to a screeching halt (IMO). More on that later, and somewhere else.

Dr L is prescribing off-label. If he is most comfortable going with a slow titration with everyone, then I don't blame him. I will say, as his patient for 8-9 months, he does not stick to his 3 times a day spiel, and whatever else he tells people at first. I take my medicine 5 times a day. He's on board. He helps me adjust things to best suit me.

And he doesn't always charge Otter. How much do you read around here? He isn't worried about getting reimbursed.

I do hope Bill P gives Dr L a call. And not because he's pissed off. He should have called prior to telling his patient to adjust his medication from what his prescribing doctor told him. A courtesy call if nothing less. He should have let Dr L know he didn't agree and why, and then told him he would now be prescribing for said patient. He shouldn't be telling a patient to change their dosing when the script is under another docs name. It's unprofessional to say the least. And it does make me wonder...

[GingerDust]

Dr. Levin's Titration Schedule

redhead77;1192724 wrote: He shouldn't be telling a patient to change their dosing when the script is under another docs name. It's unprofessional to say the least. And it does make me wonder...

I've been wondering too. What kind of doctor can't write a prescription for whatever they want, whether or not it's in their field of expertise? Are there situations where a doctor would be limited in that regard? I assume the patient is in the US since Dr. L is treating him? But Dr. P is not in the US . . . something stinks.

[SlipperyPete]

Dr. Levin's Titration Schedule

Road to Recovery;1192544 wrote: Otter, I dont know what your agenda is here but what you say makes no sense (IMO).

It first popped into my mind that Otter vehemently defends Phil Thomas, and is apparently not a fan of Dr. L.
I now just realized that Bill P defended Phil Thomas, and clearly is not a fan of Dr. L.

I told myself I wasn't ever gonna use this phrase, but "just sayin'."

[redhead77]

Dr. Levin's Titration Schedule

There would be drugs that a doctor couldn't/shouldn't prescribe. Chemotherapy would be one, if one wasn't an oncologist. He would probably be allowed to prescribe bac, but it might be noticed by his peers. I would think insurance should still reimburse, even if he has to code a certain way.

I couldn't blame him at this point for not wanting to prescribe. And I can't say for certain he hasn't taken over the prescriptive authority for said patient. He can tell us that. My point is, he shouldn't be changing titration schedules without first talking to the prescribing physician. This is my opinion, of course.

[GingerDust]

Dr. Levin's Titration Schedule

[QUOTE=redhead77;1192754]He would probably be allowed to prescribe bac, but it might be noticed by his peers. [quote]

Surely he prescribes for himself then.

I would think insurance should still reimburse, even if he has to code a certain way.

I would guess.

[redhead77]

Dr. Levin's Titration Schedule

Zen, Bill P said he recommended his patient to Dr L. So, the patient didn't come in for a stress test, for him to find out said patient was taking bac. I've been reading Bill P's posts for a while. To say he's a wild cannon doesn't quite cut it. I have seriously questioned many of his posts. I've just been quietly watching/reading. I do remember Cowgal. God rest her soul. I didn't know until later, but I've read what I could.

Sorry to hear about your bridge Zen. You seem to be in decent spirits considering. Good luck at the dentist tomorrow.

EDIT: Oops. Sorry, his exact word was referred. Same difference.

[Otter]

Dr. Levin's Titration Schedule

It is in how you define it. You could say baclofen does not cure alcoholism but it does cure a GHB deficit. But then, if it does cure that deficit and you are left with the other stuff over which you then have control as per the Brain Imaging video, then whatever is left is not an illness because you are, arguably drinking out of choice and not addiction/illness since you have a treatment for that. So, Baclofen does cure alcoholism after all because it puts you in a position that you are free from the craving illness and are left with your own free will. There you go.

[Otter]

Dr. Levin's Titration Schedule

Bombastic! Hey, no way, what ya mean by that. Come on, take that back. Jeez. What do you have to do around here.

[redhead77]

Dr. Levin's Titration Schedule

Hey Otter. I guess this is getting this thread bac on track as it directly relates to Dr L. Dr L explained to me that the mechanism of action of bac, is likely related to its ability to break the bond between BDNF (brain-derived neurotrophic factor) and GABA. It doesn't necessarily replace GABA in the addicted brain. BDNF and GABA link together and then you have an addicted brain. Bac comes in and undoes this mechanism and that is the point of indifference or the switch. He told me to think of it as a lock and key. I'm not sure if this is all of why bac works. I don't claim to be a scientist and I don't play one on tv! :H I have done a little research on BDNF and addiction. It seems to be a decent theory.

[GingerDust]

Dr. Levin's Titration Schedule

We need docs M and N. Then we would have L M N O P.

[Ne/Neva Eva]

Dr. Levin's Titration Schedule

Zenstyle;1193170 wrote:
So.... my point in case is.... is anyone going to acknowledge the side effects or is it just conceived to be an irritance that only the unlucky few suffer from?

hmmmm. Wait a second. My thread, my life, was completely dedicated to bac side effects for four months. From my first 5mg all the way up to 340mg when I couldn't count, couldn't sleep, heard voices and saw dead people. Or at least people my dog didn't see.

There is no denying SEs. Particularly under certain circumstances. Whether or not they are manageable is a completely different question.

There is also the question of taking baclofen completely differently than we do most commonly around here. Perhaps if there were people who shared their experience with Low Dose Bac it would help others who are taking Low Dose Bac.

Finally, there is the question of worth. Was it worth it for me? Are you kidding me? Four months! After a literal life time of battle, having tried everything, I'm free. To drink when I want. To not drink if I don't want. Not ever. There's more, of course, but I won't go on. It was worth it. It would have been worth it at twice the cost.

Ed, my husband, said he felt as though he was in a Cinderella Story. Someone slipped some magic in and gave him a whole new life. Unlike me, he is not prone to hyperbole OR fairy tales.

Side effects? They suck. Hardest thing I've ever done. I feel for every person looking for the goal. It's why I'm still here. I'm no deny-er. But let's fill in the full story. Ya' know? A tool like no other... And it's a secret. Still.

(If you're looking for someone to share experience about not being able to take bac, and still looking for a way out, there's always Bruunhilde.)

[Ne/Neva Eva]

Dr. Levin's Titration Schedule

Sunnyvalenting. Few SEs. Mid fifties.