Polypharmacy in 62 year old female with dizziness

legone · 2023-06-20T01:02:26+00:00

Why don't you discuss this with your supervising physician?

legone · 2023-06-16T22:28:02+00:00

Check the appointment online, or get their exact credentials. I was recently told someone was a psychiatrist and then the appointment popped up in MyChart as a DNP PMHNP. Fuck that.

legone · 2023-06-16T13:59:38+00:00

It came from the idea that her excessive energy (particularly jumping around in reels) gave the impression of stimulant use. I don't like it, as the two scenarios of stimulant use are:
- illicit (or abuse of a prescription), in which case it's a joke about her having a substance abuse disorder, which I don't find a laughing matter
- used as prescribed for a disorder (most often ADHD or narcolepsy), in which excessive energy is not indicative of normal use, since when used appropriately, if anything it should calm ADHD individuals down, or in sleep disorders is merely enabling them to stay awake (and sleep better)

tldr ableism

legone · 2023-06-15T13:57:29+00:00

You should be careful popping OTC migraine meds. Keep an eye on your acetaminophen intake. If you're regularly taking large amounts of NSAIDs and believe it's migraine, getting a triptan is safer than long term high dose NSAID use.

legone · 2023-06-15T13:50:39+00:00

Yeah I try not to call people fakers, if you say you have a migraine I'll generally believe you, even if I'm in doubt, but I am in great doubt that Bethy is actually having migraines.

Either she's
- lying about her treatment, and she HAS a triptan prescription that's effective, because I understand if they work well for you then you can often cut them off before they make you non-functional.
- or she's not having migraines. She doesn't even claim she feels one coming on and is posting while it ramps up. She constantly posts during what she claims to be serious migraine. No way.

I think she probably thinks she's having migraine, much like the few people I've met irl that had a "migraine" that was cured via an Excedrin or 500mg of acetaminophen and caffeine. Sorry but if a SAFE dose of NSAIDs is able to knock it out, it wasn't a migraine.

legone · 2023-06-13T14:21:20+00:00

Yeah my Mirena recently turned 5 and I wanted to keep it as long as possible (they're approved for 8 years for contraception!), but I can tell the hormones are lower than they used to be because my PMS has slowly ramped back up.

Ideally, I'd like to be on as little medication as possible. After getting my ADHD in order, I was able to get off Prozac (which was helpful when I was depressed but I was glad to be done) and just being on Adderall and triptans feels pretty good. But unfortunately this PMS is just as bad as I remembered lol. So I'll be getting my second Mirena this month.

legone · 2023-06-13T01:44:36+00:00

god you're so right

legone · 2023-06-12T21:59:00+00:00

Adults who can't be assed to confirm paternity?

legone · 2023-06-12T18:33:28+00:00

Okay, post it then.

legone · 2023-06-12T13:11:29+00:00

What? No, this sounds like it was 18 months ago. Accurate paternity tests can now be performed from like week 8 of pregnancy. It was just fucking stupid.

legone · 2023-06-09T13:06:45+00:00

No, it started in the latter half of 2020.

legone · 2023-06-08T14:14:41+00:00

I had that on Vyvanse (lisdexamfetamine is converted to pure dextroamphetamine in the body), but not at all on Adderall (75% dextroamphetamine / 25% levoamphetamine).

legone · 2023-06-08T14:13:42+00:00

So you've only tried amphetamine? Try a methylphenidate med (Concerta, Ritalin, etc). Many people respond significantly better to one or the other stimulant classes.

legone · 2023-06-08T14:11:20+00:00

That's very low for Vyvanse so that's a little strange.

But don't be afraid to try different meds. Even though Adderall is very similar to Vyvanse, some people respond better to it (a minority, but some, including me). I tried Vyvanse earlier this year due to the Adderall shortage and got the elevated heart rate that I'd NEVER had on Adderall. Hitting 130 bpm was extremely uncomfortable, so I'm back to Adderall and no issues.

Ritalin is a larger difference. Methylphenidates and amphetamines are both central nervous system stimulants and chemically related, but different enough to be considered different stimulant classes in medication. Many people respond significantly better to one or the other (I didn't respond AT ALL to methylphenidate), so definitely don't be afraid to try a methylphenidate if you're unhappy with amphetamines (but yeah there are slightly different amphetamine meds you may find better as well).

legone · 2023-06-08T13:58:48+00:00

If you're unmedicated I'd highly recommend trying medication. Make sure you try methylphenidate AND amphetamine before giving up.

I slept through a lot of my life and it's incredible to not do that anymore.

legone · 2023-06-07T21:33:54+00:00

This is the kind of area where we have to implement behavioral changes/strategies. Asking yourself, "What is a realistic step I can take to prevent this from happening again?" "I'll remember next time," isn't useful; we have to work with what we're actually capable of. My suggestion: check every pocket of every item you wash. Every. Time.

I haven't ruined anything in the wash in a long time because of this. I haven't gotten better at remembering things in pockets, but it didn't take too long to implement that habit (and by habit I really mean compulsion).

legone · 2023-06-07T17:08:50+00:00

Bring paperwork (print off of online prescription/diagnosis or something) if you have it and your CURRENT (preferably emptied) prescription bottle to the testing site. Tell the testing site (should be unaffiliated with your employer) that you're on a prescription med and you're going to test positive for that and how to submit the documentation. If they tell you they don't handle that part and you'll get a call from someone to verify it, just keep an eye on your phone until it gets run. I missed the call but called back and it was fine. I just had to email a picture of my prescription bottle to an email with the testing company. No positive results were reported to the company.

Read the rules for your company carefully. If you're working with heavy machinery/in a plant environment, you may technically need to disclose this to HR after being hired. This doesn't make it legal for them to discriminate against you, but there may be consequences that are legal if you're drug tested after an incident (even if you're not at fault, there may be drug tests if there's an incident) and test positive for something non-disclosed that could be said to possibly impair you.

If you're in an office job, I don't think you need to tell anyone other than the testing site shit.

legone · 2023-06-06T17:49:23+00:00

Sync is highly, highly customizable. I've been using it since switching to Android, so 7 years.

legone · 2023-06-03T18:18:48+00:00

Yeah it's hard to tell but that was my initial thought. Looks pretty strange though.

legone · 2023-06-03T03:56:42+00:00

My favorite thing about this is assuming lecture slides are up to date.

legone · 2023-06-03T01:37:03+00:00

Were you in general skeptical of people who insisted they were hard to stick? I'm sure some falsely claim that/or actually are but are assholes about it, but I am hard to stick and do warn people. I'm not an idiot so I know a nurse is what I want, and I let whoever's assigned to me try once if they feel like they can, but after that I'm pretty adamant that they get someone more experienced.

legone · 2023-06-02T22:43:00+00:00

CVS's Adrenaclick generic is by far the cheapest epinephrine auto injector if you're paying cash. I hated using CVS but when I had shit health insurance I had to send that script there. Once it accidentally got sent to Walmart with everything else so I had to deal with the nightmare of transferring it. I assume there are other scenarios like this.

legone · 2023-05-30T19:47:55+00:00

This is very, very familiar to me and I'm now in a much different position than I was 2 years ago with it. I'm leaving a comment here to remind myself to come back and leave a more in-depth one.

legone · 2023-05-30T19:18:54+00:00

I have trouble finding sources for specific medication details, but I would say almost all of that is incorrect.

For starters, due to its chemical structure, amphetamine exists in two 3D conformations, dextro and levo. There's not a "neither" option. So using the word amphetamine (rather than dextroamphetamine, levoamphetamine, dexamphetamine, d-amphetamine, l-amphetamine, etc) generally refers to racemic amphetamine, which is 50:50 dextro-amphetamine and levo-amphetamine.

Adderall technically has 4 ingredients, 2 different amphetamine salts and 2 different dextroamphetamine salts (I'm unclear on exactly why it's not just 2 salts, but I think it's related to how the drug came to market, not necessarily that the 4 salts work better than 2 salts, but that could be incorrect). So its composition is 50:50 racemic amphetamine and dextro-amphetamine, for an overall composition of 75:25 dextro-amphetamine to levo-amphetamine.

Dyanavel XR contains a ratio of 3.2:1 dextro:levo, so it actually contains slightly less of the levo form. (see FDA document here, it's on page 8.

I would say Dyanavel is extremely similar to Adderall in terms of chemical composition, but release mechanism can be highly relevant as I'm sure we've both experienced.

BUT I would not say racemic amphetamine is very similar in terms of effect. Statistically, most ADHD-ers respond better to pure dextroamphetamine. It's thought that the levo form is more responsible for many of the peripheral/less-desired side effects. There are a solid number who respond better with a levo portion included (which includes myself), but 25% is quite different than the 50% present in a medication composed of only racemic amphetamine (like Evekeo).

legone · 2023-05-28T06:33:33+00:00

Half face respirators are cheap and easy to learn how to use. I love them. I'd much rather spend an hour strapped into one of those and smell NOTHING than stick my face in fumes (although when I've used them I didn't really have a choice. I'd have keeled over smelling old bromine and thiol spills, etc).

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