Doctor’s Orders

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If you’re in treatment, there’s a pretty good chance you’ve come into contact with a number of health professionals. With both physical and psychological problems, I’ve been to over a bajillion doctors, pharmacists, nurses, NPs, PAs, specialists, etc, and that’s a conservative number. Some of them have been incredible, amazing people who quite literally have saved my life. I’ve had my therapist since age eight, and I’ve had my psychiatrist for over six years. They are both amazing people, and I can’t imagine how I got along without them. I also have a couple favorite pharmacists, three stomach specialists, an endocrinologist, an OB/GYN, a PCP, and have been to a cardiologist and ENT.

And then there are others that I hope go through the same trauma they put me through. I’ve had an NP try to prescribe me a drug I’m allergic to, someone who never responded to a crisis situation when I had to be hospitalized (my mom had to wait outside his office to even talk to him), an over zealous NP who had me on every medication under the sun, among so many other “professionals” who made my life harder during a time where I was at my worst.

Ok, so what was the point of that story? It can be very difficult to navigate a world of doctors, acronyms, pain, appointments, waiting, medications, and frustration. This becomes even worse when you’re already sick. I have a few things that help me when it comes to the world of healthcare.

1. I take notes on the backs of their business cards. These can be little notes like “friendly,” “kind,” “efficient,” or “cold.” This works especially well with people who I don’t encounter all the time, like pharmacists or people in a practice. This helps me remember which professionals I like and why.

2. I don’t waste time on doctors I don’t like. I’ve spent so much time trying to work with doctors who weren’t willing to work with me. Now, I try to find people who take the time to explain my conditions and treatments. I also look for doctors who aren’t too “gung-ho” about strange tests and treatments.

3. I set aside a lot of “padding” time around appointments. This has saved my ass on a number of occasions. For example, at the last two doctor’s appointments I’ve had, the doctor has been over an hour late. That’s just how it goes. There’s no point in being angry or frustrated about it. However, if I’ve scheduled appointments back-to-back, I’m going to be stressing about being late, and I’ll rush through my appointment. I know that when meeting the doctor, I have to be fully present to take part in my treatment. I need to have the time to ask the right questions and remember the answers. It’s not always easy to find this amount of time, and I’ve had to make sacrifices at work to make sure I have this padding. However, I’ve found that the reduction of time-related stress has been invaluable in the treatment process.

4. Allow yourself to debrief and, if necessary, grieve. There’s a lot of information to take in at appointments. Sometimes you get good news, sometimes you get bad news, and sometimes you’re left with more questions than answers. Whatever the case, I find debriefing very helpful. Sometimes I text my family/friends after my appointment. Sometimes I don’t want to talk to anyone and instead get a coffee by myself. Sometimes I go to back to work. Sometimes I spend an hour wondering how I can have a “pseudo” syndrome.

Sometimes, treatment can be as much of a process as having the illness itself. However, with enough practice, discretion, and luck, it eventually becomes an inconvenient habit.

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Drug Scheduling

Note: This information is only valid in the United States. In addition, I’m not a doctor, lawyer, or have any sort of important credentials. Always check with an authority in your area if you have any questions.

Today, I want to talk about controlled substances and drug scheduling. Like many with mental illness, I take a few controlled substances. I take both a stimulant for ADHD (Schedule II) and a sedative (Schedule IV) for anxiety. Both drugs are highly regulated, which makes it hard to obtain them (even legally!). In addition, there are a lot of special rules surrounding scheduled drugs.

So, what are these classifications? This is from the DEA’s website:

 

Schedule I

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Schedule I drugs are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence.

Some examples of Schedule I drugs are:

    • Heroin
    • LSD
    • Marijuana (cannabis)
    • MDMA
    • Peyote

 

Schedule II

Schedule II drugs, substances, or chemicals are defined as drugs with a high potential for abuse, less abuse potential than Schedule I drugs, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous.

Some examples of Schedule II drugs are:

    • Cocaine
    • Methamphetamine
    • Methadone
    • Demerol
    • OxyContin
    • Fentanyl
    • Adderall & Ritalin

 

Schedule III

Schedule III drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. Schedule III drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV.

Some examples of Schedule III drugs are:

    • Vicodin
    • Tylenol with codeine
    • Ketamine
    • Anabolic Steroids
    • Testosterone

 

Schedule IV

Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence.

Some examples of Schedule IV drugs are:

    • Xanax
    • Soma
    • Darvon
    • Darvocet
    • Valium
    • Ativan
    • Ambien

Schedule V

Schedule V drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes.

Some examples of Schedule V drugs are:

    • Robitussin AC
    • Lomotil
    • Motofen
    • Lyrica
    • Parepectolin

 

Travel

States have their own laws about handling controlled substances, including filling the prescriptions, driving with them on your person, and traveling. For example, if you’re in New York, you must have your medication in its original container. In Texas, there have even been accounts of people being questioned and arrested for having unmarked medication. In other states, all you need is proof of a prescription.

So what should you do? Well, the safest thing would be to always keep it in its original container. I would also recommend that process if you’re traveling by airplane, especially internationally. While the TSA doesn’t mandate this, other countries might. In addition, you should obtain proof of your prescription and a valid ID (driver’s license, passport, military ID, etc).

But is this practical? For me, no. I take many pills a day, and I’d have to constantly carry a backpack if I needed them all in their original containers (granted, this is really only important for narcotics, but I like to exaggerate). When I travel, I keep my controlled substances in their original containers. I only have three, so it’s not a big deal. For the others, I keep them in a day-by-day pill box. I’ve never had any problems, and I’ve flown both domestically and internationally.

 

At Home

Generally, I just keep everything I need during the day in a pillbox in my purse. If I don’t need it during the day or in an emergency, I leave it at home. Every Sunday, I sort all of my pills into my pill boxes. If I empty a pill bottle, I disguise the name and Rx on the bottle using a security stamp like this one. Then, I recycle the bottles. When it comes to controlled substances, you definitely want to protect your identity. One, people can steal your identity, and two, they know that you have narcotics in your house and might try to rob you.

 

Around Friends

I try not to make it a point to discuss what meds I take. For one, it tends to alienate others, and for two, I’d rather not put people in the position that they know what medication I take. For example, my friend has bipolar disorder, and she takes a mild sedative. She had previously told people that she was prescribed that particular medication. Later, she found that someone had gone through her purse and stolen most of the pills from her pill bottle. You never know what people are going to do, so it’s probably best not to tempt them.

So, what can you do? Well, try to keep your pills as close to your as possible when you go out. You could also lock them in a small bag. Or, disguise them in a container that doesn’t look like a pill bottle (I use a contact lens case). Note: You probably shouldn’t do this if you live in NY. If you live in a group setting, such as a dorm room, hide them somewhere or invest in a small safe or lockable toolbox.

 

Using ASL

Clean Brains ASL ChartSometimes, I find myself unable to communicate or find words. For some reason, however, I can still use sign language. It might just be me, but in any event, I suggest it because you might find it useful as well. You can learn a few signs (such as the ones for medicine, emergency, hungry, thirsty, help, etc.) and teach them to people in your support network. That way, you can communicate without having to physically speak.

I’ve created a printable chart of the basic fingerspelling signs and the signs I feel are most helpful. You can print these papers and give them to friends and family as quick references. You can also buy the book The Perigee Visual Dictionary of Signing by Rod R. Butterworth. It’s the one that I personally find most useful (and believe me- I’ve seen a lot of them!).

Download Clean Brains ASL Chart

Download Clean Brains ASL Fingerspelling

Timing is Everything

Experiment with your medication time frames. [NOTE: Please consult with your doctor first to make sure this is ok.] For example, I’m on two doses of a stimulant that decreases my appetite, so I try to time lunch between them. I take my sedating night medications (such as antidepressants and antipsychotics) at night, generally around 10:30pm. I’m in bed by 11:00pm, and hopefully asleep around 11:30-11:45. If I take them earlier, I notice that I’m more likely to want to eat. If I take them too late, I’ll be groggy the next morning. For me, a 15 minute bracket of time can make all the difference. Now that I’ve established times that work for me, I set reminders on my Fitbit to make sure I fit in that 15 minute window.

Fitbit

I use a health monitoring app and wristband called Fitbit. While I use the device mainly for health concerns, one feature that I really like for mental health hygiene is the vibration alarm. You can set the alarm to go off at any time, and it’ll silently alert you using a quiet and peaceful vibration.

I used the alarm function to remind me to take pills, change activities, perform tasks, go to meetings, etc.

Copy Your Meds

DoctorKeep a detailed list of your medications, what they treat, and how often you take them. You can use an app (such as Health Vault) or keep a handwritten list with you. Make multiple copies of the list and keep a few with you so you can give them to doctors, family members, etc when you need to. I find this method especially helpful with medications I take PRN.

If You’re on Medication

MedicationDon’t run out! Most pharmacies will allow you to purchase more than one script at a time if you explain to them that you won’t be able to get back in time to refill your next one.

Ask your doctor for some sample packs with your scripts. Save these. So if you find yourself in the situation that your meds have run out and you are too unwell to go to the doctor or pharmacy you have backups. A lot of pharmacies will happily keep your scripts on file and for a small fee send out your meds when you are getting low – especially online businesses.

Hallucinations

I’ve found that the best way to lessen my auditory hallucinations is to always listen to music or television. Whether I’m at work, at home, or even falling asleep, I alway have something on. I find that my brain attaches voices and sounds to the TV or music and I don’t notice them as much. This works better when combined with medication to tone down the hallucinations.