Totally new to forum, sort of new to bac

[StuckinLA]

Totally new to forum, sort of new to bac

A 28 year old male presents to the ED complaining of difficulty breathing and rapid heart rate. Patient admits a history of anxiety and heavy alcohol use. Patient also admits to taking extremely large doses of an unprescribed medication. Patient insists this is a "cure" for alcoholism but patient admits to alcohol use today, but says it is below his norm.

Which of the following is the best treatment for this patient?

A) Follow standard of care for alcohol-related emergency

B) No treatment. Patient's symptoms are anxiety-related. Observe patient and discharge

C) The patient is a danger to himself and must not be allowed to continue taking large doses of unprescribed medication. Discontinue medication and hold patient for 72 hour involuntary psychiatric evaluation.

D) Maybe give a f*ck and take a look at the research on the medication that the patient has brought with him to the ED. Think rationally about it and go from there, which is kind of what he naively thought you might do in the first place, or else he probably wouldn't have come to the ED in the first place since you clearly aren't going to help him.


NE, if you could go ahead and slip that into a nursing textbook I'd appreciate it.

Man, you do have a lot on your plate! First, congratulations on the house. Seriously. If I remember correctly I saw some posts about waiting around in limbo waiting to find the perfect house in the perfect spot, and I take it you found just that if you bought a place. Yeah, I know the mortgage is intimidating, but it's worth it. Some people take out loans that big just to go to law school--you get a house that will make you very happy every day, they get a horrible career that slowly ruins their lives and crushes any shred of human decency left in them. My mother is a lawyer, so I'm speaking from a tiny bit of experience...

Anyway, that's just to say it feels like a huge deal and life-altering commitment right now, but in a year you won't even remember the size of the mortgage. You'll just be making monthly payments, not really thinking about it, and the house will be so much a part of you that you won't really even think about that, either. You'll just be happy in a background-way that you're there.

Your rationale for nursing school struck a chord with me and made me smile. I can relate to career-schooling for reasons besides getting the career at the end. It's kind of why I became a medic. Reading way too much Hemingway and realized one day I'd never seen anyone die. So I went out and fixed that. But seriously, it's awesome that you are learning about, and taking control of, the things that make you tick and the things that you're (we're) doing to tick a little differently.

Focus on the goal. Focus on the goal. Starting to get drunk at night again. Focus on the goal.

:l back at you.

[COSGringo]

Totally new to forum, sort of new to bac

I think it all depends on the doctor.
I don't believe there's a handbook out there. About the only standard is the hippocratic oath.

[Ne/Neva Eva]

Totally new to forum, sort of new to bac

Nice. I appreciate the multiple choice format, too. Make it really interesting though, and throw in another option that sounds like it might be right, just to mess with 'em. Loved that about my last biology professor... grrr.

And don't forget the finale! Change out of scrubs, pick up a case of cheap wine on your way home, and feel sorry for the fucker while you drown your every day super-stressed super-ego in a bottle. Lotso docs got what we got.

But I'm not actually that cynical. Peeps don't know what to do with us. It's not their fault, exactly. The system is broke. (feck. I wish the system was actually broke. Then there might be impetus for change. Addiction medicine is HIGHLY lucrative. For the docs that opt into the system. For the docs that don't, they generally don't make a lot of money. How many rich drunks do you know?

The handbook...it's on the agenda, COS. We tried to get one going around here, but it got lost in the shuffle. It IS a great idea.

My focus is fuzzy and I skipped my math class for the second day. Not good. I'm going to go break a sweat and see if tomorrow is better. Or maybe even later today.

Your focus, LA, might just be to keep taking the pills. They work. Drink, don't drink...I'm not sure it matters. (Though I know it sucks. Sorry.)

How much are you taking, and for how long?

[Ne/Neva Eva]

Totally new to forum, sort of new to bac

PS. It's not the mortgage. We were paying more in rent! (I'm a very practical kinda chick without the booze. And I really, really don't want to work for a living. :H)

It's not the right house. It's just the right house for right now. Love the one you're with...

Welcome back, COS! Missed you!

[StuckinLA]

Totally new to forum, sort of new to bac

Hey COS, just having a bit of fun and letting off steam. I'm writing real test questions right now and they're making me want to die.

I started bac in early March. Went up following Dr. L's schedule that was posted here in some thread I can't remember. Got up to 150 fairly easily, but started drinking again and got really freaked out and dropped into the 130s to try to avoid the afternoon sleepiness without totally giving up. Stayed there for 3 weeks? 4?

Decided that I've come this far, so there's no sense quitting now. Going up by 12.5 every 5-7 days (25 mg cut in 1/2, so the awkward number). Currently at 200, going up again Wednesday or Thursday.

I'm trying to hang in there and stay the course. And having a lot of doubts, too. When not drinking--well, you've seen my posts. When drinking it's weird--I don't really feel a happy buzz, I just suddenly notice that my balance is really off and that must mean I'm drunk. Then I have mild-to-moderate anxiety and pass out.

Problem is, in 2 weeks I start teaching a summer class and it's going to be intense. I mean, a serious workload and I'm going to have to be on the ball all the time for 6 weeks--and the titration schedule/doses don't seem to fit with what I'm going to need to do.

But goddamnit I don't want to turn back when I've come so far. I've noticed a few nights where I was relatively unfazed by alcohol, even having a few drinks and not caring about continuing. Even my "heavy" drinking nights now are nowhere near my heavy drinking nights of the past.

[COSGringo]

Totally new to forum, sort of new to bac

Well if you are 200 you are up there that's for sure. I got to 260 and got really sick. Went down to 230 and interestingly hit my switch then. I am at 220 now. Sounds like you have a good regimen now.
It will be tough if you have to teach I would think. Maybe stay at where you are at so you get can through that period.
If you can handle the somnolence then go for it. Maybe some energy drinks. Sadly that's how I get through it but it works for me. Maybe not others.

[StuckinLA]

Totally new to forum, sort of new to bac

Crisis of faith time, again.

At 200/day. Got the zoned-out, going to fade straight away into oblivion, tiredness while working on the laptop in the afternoon. I simply cannot keep this up and teach. In my infinite wisdom, when I got home I worked out a schedule to drop slowly over the next month to somewhere around 75/day.

But now I don't know. Just going to 180ish seemed to help a lot. But my head is in a fog and I don't quite know which way is up, or forward, or whatever. My writing/reading/work is nonexistent. It's been nonexistent since I got sober for those 2 months.

I'm drinking nightly, probably less than I was before, and not having cravings in the morning so I'm not worried about a bender, though I can't imagine booze leaving the picture entirely--as silly as it is, abstinence was never my goal.

So I have options. Stick around in the 180s and see if things level out, then probably try to push upwards. OR, I could go down into the LDB range, maybe 50-75/day and get naltrexone from the pdoc I saw last week. Maybe take him up on the gabapentin as well, but there's no way I'm taking an SSRI.

I know, I'm stupid to think that going down on bac when I'm already drinking more again is a good idea. But maybe if the SEs improve I won't have all the insomnia/anxiety, and throw TSM into the mix... Maybe I'll get back to feeling more like me?

Ugh. Thoughts?

[COSGringo]

Totally new to forum, sort of new to bac

Well it's just one person's opinion and it's just my opinion. I am not a doctor and I don't have to teach a class.

I would say stay at 180 for a while. It might even take you to another level. One just doesn't know.
I hate to suggest this but I have to do it myself as I sit in front of about 4 monitors and about 6 computers. Energy drinks or lots of strong tea helps. I don't get nerved out like I once did as I stopped caffeine all together a long time ago prior to going on bac. That keeps me going.

Also, how are you sleeping? Most people need a solid 6 or more hours. If you are not getting that (I have plenty of those nights where I don't) then you need to find a way to fix that. You can try natural or medicinal. I won't push my ideas on that unless you really want them.

Try as hard as you can to at least limit how many drinks you have. I realize the point of the bac is to do that for you but you will feel much better if you do that. The SE's will go down and you can titrate back up easier. If you are going to binge at least wait until you don't have responsibilities the next day.

I know easier said then done. I just learned over time that the SE's were worse than any temporary pleasure I was getting from drinking a lot. Not saying abstain but limit it to say 4-5 drinks. I am not sure how much you were drinking before but that's about 1/3 of what I drank.

I think hang in there. Let us know how you are doing. If you must titrate down do it in steps and see how you feel.

Naltrexone might help a bit but I did not have much luck when I used it alone. I still drank maybe less but it made my stomach all messed up which ruined my foodie part of when I was in New Orleans. Bummer. Don't waste your time with Campral. That was a joke I think.

Good luck, the rough patches you have now will get better.

[Ne/Neva Eva]

Totally new to forum, sort of new to bac

Go. Up. Just go up. You will not regret it. Unlike going down.

If you need to go down before you hit your switch you can--and much more quickly than we talk about here.

Look. Here's the deal: climate around here about bac has changed. For the better in some ways. But sometimes you just gotta punt. Or go for the touchdown. Or whatever the correct sports analogy is for getting the job done. You've for what? A couple of weeks? Go for the goal. It is my opinion that indifference is worth just about everything you've got. And then it's done.

Gotta go to a funeral. Life is short LA. Just. Do. It.

[RedThread12]

Totally new to forum, sort of new to bac

Dear Stuck: (sorry, I'm smiling a little bit regarding the irony of your name and your current situation) I agree with Ne.

I've never been in exactly your situation, but SHE has . . . or at least, similarly. I took baclofen to save my life. I was drinking all day, every day. Looks as if you might be climbing out of that pit, as well. The question seems to be: temporary, sometimes extreme discomfort - or your life?

You've come quite a way. If you can, give ALL importance to coming out from under the relentless lash of drinking against your will. Keep on.

:l 's to you Ne. Your post should be preserved for posterity.

As well as many others, which I shall bring to the table forthwith.

[COSGringo]

Totally new to forum, sort of new to bac

Agreed, go for on 4th and 1. Hope you know American football.
Tough though when you are teaching classes.
If you have a time when you won't be in front of folks maybe really go for it then as long as that's not too far out.

[bleep]

Totally new to forum, sort of new to bac

One thing to think about is that if you follow the advice given, and then later go back down, you should find it much easier to cope with levels that are currently giving you problems.

That somnolence in front of a computer is horrific, the best thing I found was a short break. Even 20 seconds standing up and stretching can break it, and it goes away for a few minutes. Rinse and repeat. Just sitting still, I found it almost impossible to stay awake.

I'd also go up, for what it's worth.

[COSGringo]

Totally new to forum, sort of new to bac

Yes getting up from the computer is a good idea. TV really knocks me out for some reason. If I am not active in some way it's downhill quick.
Hope I can titrate down eventually.

[StuckinLA]

Totally new to forum, sort of new to bac

Remember all those days/weeks you just wanted to crawl into a bottle? For me, it's not just to escape, it's also giving voice to all that depressed, hopeless regret that's swimming around here. It always felt like there was a possibility the next day would be better. Sometimes, it really was better, and I knew I had to work super-hard to overcome the fucking up. But of course it never actually worked that way, and it clearly doesn't work any way anymore.

The idea of indifference makes me think of the last time I put a cat down. Poor thing was sick, and it had to be done, but man I wish I could've kept him around.

NE, Red, COS, Bleep, thank you. The football analogy is great, and not sure if you meant it like this, NE, but when you said punt it was totally calling me a bitch. And that was about the best thing you could do.

Onwards and upwards.

[Ne/Neva Eva]

Totally new to forum, sort of new to bac

Um, no. Rest assured that was not my intention. Needless to say I don't know a damn thing about sports, much less the analogies. (obviously.)

But I swear to you that half the reason that I made it through was because some of my closest confidantes were men, and they kept implying (at least I thought) that I was being a candy-ass girl, that it was all in my head and I would be god-damned if some man was going to make me feel like a wimp.

Of course, when I thought back on it after the fact then I was REALLY pissed. The SEs sucked. It was brutal. But they got me through it. assholes.

Whatever works. :H

:l