Sunday, February 24, 2008

Testosterone is a controlled substance. And so should it be.
Speaking of controlled substances, I have a doctor who's sort of driving me crazy with her cowgirl prescribing practices. A psychiatrist, to be more specific. I recently upped the dosage of one of my drugs, and haven't been doing spectacularly generally, moodwise, and as a result I've been pretty tired (intense training for the upcoming road race season probably hasn't been helping...walking up the stairs after my workout today, my calves were crying...). I mentioned this to her, in the casual way you mention things to your psychiatrist--"I think the new dosage is a little sedating, but I understand that will go away with time, and I'm just hanging out waiting for my body to adjust..." To which she replies, "If it's really bothering you, I could write you a prescription for ProVigil, and then you wouldn't be so sleepy."
Whoa. Back that train up into the station. What?
First of all, treating side effects from drug A with a whole new drug is something I'm not completely comfortable with. Sure, if I have to have chemo (God forbid) someday, some Zofran would not go amiss. But taking a sedating mood stabilizer, then adding a dash of modafinil to keep my head on straight so I can go to work? No. Try again. See what's behind door number 3, because you are not a winner this time.
Furthermore, modafinil is a controlled substance. It's not seriously hardcore, I mean, it's no MS Contin (how does she know so much about narcotics? you wonder. My uncle died when I was 18 after a protracted and painful battle with not one but two types of cancer. Somehow he won the "your life will turn to shit" lottery and over the course of 10 years developed a fibrosarcoma in his leg which was removed but metastasized--as we later learned--to his lung; and an unrelated adenocarcinoma of the lung that showed up shortly after the first metastases did. Did I mention he also had both his legs amputated above the knee because he developed diabetes but didn't control it? So, yes, he had lots and lots of drugs around. I remember visiting his house and literally seeing bottles--not drugstore vials, but glass dispensary-type bottles--of morphine sulfate sitting around) but it's a respectable Schedule IV, up there with your Ativan and Talwin.

Then there's my PCP, who offered to write for Tylenol #3 when I had that boil on my butt earlier this year. Huh? This is the same guy who once thought it would be a good idea to write for Fiorinal for my migraines (can't take triptans or ergotamines with SSRIs, I know, but surely he could have thought of something better than a Schedule II narcotic?). When I went to Cornell and told my doc there I sometimes got migraines, and took Fiorinal for them (though not often, because I don't like being knocked on my ass) I thought she was going to have a seizure. "That's a really bad idea," is all she said. So now when I feel the aura coming on, I just get into bed, have a handful of aspirin (ok, I'm kidding--seriously, an aspirin overdose can f*ck you up a lot worse than some narcotics can, mostly because there is no equivalent to Narcan for aspirin...) and try to sleep through it. Unless the guy upstairs is playing 'Wonderwall' on his guitar for the fifth time in a row, in which case I roll over, fire a few shots through the ceiling, and then try to sleep through it.

1 comment:

Anonymous said...

I'd kill for some Provigil for the fatigue of my mood stabilizers. Three years hasn't made that side effect go away nor has it made the bad memory, poor concentration, or general cognitive fuzz go away either. Be careful what you don't wish for...

P.S. The risk of Serotonin Toxicity Syndrome is still pretty remote even when you're taking an antidepressant and a triptan. It's another one of those warnings that sometimes gets blown way the fuck out of proportion (you only use triptans intermittantly!), kinda like the connection of BC pills, migraine, and stroke (if you're young, healthy, exercise, don't smoke, and have no family history, you're risk is already incredibly small, so doubling it isn't doing a whole lot!).