synergy

Evils of Trileptal

We had the day off, but due to a scheduling error at the psychiatrist's office, we spent the entire afternoon running around. But things worked out in the end. Original plan had been the see Dr. X in the morning and then have haircuts and visit with a friend in the afternoon. Well, Dr. X's office called yesterday and they had moved the appointment to the afternoon without telling us. Second time this has happened. Last time, they deleted the appointment entirely. Fortunately, the front desk people are good and know us well, so they accepted that it was their fault. Any case, hair cuts had to be moved up and we had less time to visit with the friend, but still. . . .

K pointed out to the front desk people and her doctor that patients, especially psychiatric patients, will immediately assume that they made a mistake in the appointment time and it can be very disheartening. This time K had them write down the time on a card to ensure that there is written, not just electronic, evidence of the scheduled time. We'll see in September.

K is still sick with her cold, though she's moving around more today than yesterday. So Dr. X wasn't fully convinced that she was doing well and checked in with me to verify. As usual, I was there with K. It makes things easier when I attend the Dr. X appointments. I know what's happening with her treatment and I can offer details that she may overlook or forget. Dr. X appears to prefer it as well. The three of us have developed a very good relationship over the past 2.5 years. I never went with K to see him before she began to struggle with the depression post-heart attack.

Any case, one of the meds in K's cocktail is trileptal. It's used to combat the noise in her brain and calm her episodes of rage. Normally, she takes 150 mg once a day, and twice a day, if needed. Ever since the job situation has escalated, she's been taking it twice a day to combat the omnipresent rage. It has proven to be extremely effective for her.

Well, she happened to mention to Dr. X that she has a rash on her hands that she believes may be connected to the trileptal. She's had it for at least six months, but it has started to spread, since she has regularly increased the dose to 300 mg/day. Apparently, there is fear of the Stevens-Johnson rash, which is the same as the rash, which may be brought on by use of lamictal. K was pulled off lamictal, because she was showing signs of a rash and Dr. X wasn't willing to take the risk that it might be serious rash.

At no time had anyone mentioned to us that Trileptal was a possible source of the Stevens-Johnson rash. Dr. X was ready to take away K's trileptal prescription and bodily search her for any pills that she might have with her. K was fighting back pointing out that she certainly doesn't want to have to change meds, while going through the stress of transitioning to a new job.

I brokered a compromise by having K agree to see a dermatologist and Dr. X would give her another prescription for trileptal. That satisfied K, though Dr. X was not completely thrilled. He made K promise to go immediately to the dermatologist and call him with the results of the visit. He tried to convince himself that he was worrying too much, but it was evident that he remained very concerned. He screwed up writing the prescription and had to write it a second time.

The other interesting thing he asked her was if she really wanted to lose weight. I guess there is another medication, similar to trileptal, which will help patients lose weight. The downsides are that (and this is a direct quote) you lose a few IQ points. Apparently it impacts short-term memory and your ability to find the right words. Dr. X said that doctors frequently say you lose weight on the drug, because you are too dumb to find food. K turned down his offer for this prescription.

I could tell that she was tempted, but ECT and the aftermath of losing her short-term memory and being unable to write and read were very traumatic for her. I wondered if the side effects would be worse for her due to the previous loss of short term memory. Both of us are fully convinced that some permanent damage was done to her brain by the ECT. Dr. X reassured her that it wouldn't be nearly as bad, but she figured the job situation required her to be as intelligent as possible. As for weight loss, once she recovers from her cold, she'll be joining me at the gym in the mornings at 5 am.


No big plans for the weekend, which is good as K needs some time to recover from her cold. Next weekend is Pride, so we might actually go out and do some things. K's not enthusiastic, but I'll work on convincing her.

I'm pleased that there were no changes from today's visit. We didn't expect any. Dr. X requested that K work on reducing the amount of ambien she's using. Right now, she uses every night during the week, and he would like her to cut back. The job situation has been taking a toll, and it should be easier for her once she's placed. She had hoped to find out today as to where she's going, but no e-mails have come through yet. Dr. X's attack on trileptal had us a bit concerned, but we'll keep an eye on the rash and hope that he is worrying needlessly.

posted by synergy @ 4:48 PM