seeing doctor tomorrow need some advice

Hi, I'm seeing my doctor tomorrow who reluctantly prescribed me diazepam to help crossover from lorazepam. He wants me to come in to check on me. I initially showed him pages from the Ashton manual and he rather casually dismissed it. He wanted me to take a very aggressive plan, to totally switch over to 5mg diazepam twice daily from my 2mg of lz daily. Needless to say I couldn't follow his plan, I tried it for one day and the withdrawal was miserable.

 

So I'm wondering if anyone has advice on how to choose my words to explain to him that I couldn't follow his plan. Thanks.

 

 

Hi akossofi,

 

It might be helpful for someone reading this thread to refer back to your other thread to get an idea of where you're at.  http://www.benzobuddies.org/forum/index.php?topic=25231.msg380911#msg380911

 

We discussed the fact that your Dr didn't give you enough Valium to make the crossover, when you say you were miserable what are you referring to?  Was it symptoms or sedation? 

 

I'm not sure I understand what you need, do you want to talk to your Dr about the fact that the equivalency's need to be correct or that the Valium needs to be introduced slowly in order to remain functional?  Have you done any tapering since you saw him last, or have you continued to take your normal 2 mg dose?

 

Below is some information from the Ashton Manual about the slow introduction of Valium and why it's necessary.

 

 

A second factor to bear in mind is that the various benzodiazepines, though broadly similar, have slightly different profiles of action. For example, lorazepam (Ativan) seems to have less hypnotic activity than diazepam (probably because it is shorter acting). Thus if someone on, say, 2mg Ativan three times a day is directly switched to 60mg diazepam (the equivalent dose for anxiety) he is liable to become extremely sleepy, but if he is switched suddenly onto a much smaller dose of diazepam, he will probably get withdrawal symptoms. Making the changeover one dose (or part of dose) at a time avoids this difficulty and also helps to find the equivalent dosage for that individual. It is also helpful to make the first substitution in the night-time dose, and the substitution may not always need to be complete. For example, if the evening dose was 2mg Ativan, this could in some cases be changed to 1 mg Ativan plus 8mg diazepam. A full substitution for the dropped 1 mg of Ativan would have been 10mg diazepam. However, the patient may actually sleep well on this combination and he will have already made a dosage reduction - a first step in withdrawal. (Examples of step-wise substitutions are given in the schedules at the end of this chapter.)

 

http://www.benzo.org.uk/manual/bzcha02.htm

Hi, thanks for the response. I just wanted some advice on how to handle a difficult doctor. I'm doing very well following the ashton plan which he casually dismissed. I was just looking for a diplomatic way to tell him that I couldn't follow his plan because I got very bad withdrawal. I was hoping perhaps someone here had already been in this situation or someone with great finesse could advise me on how to handle this prickly pear as I am dependent upon him for my prescription to diazepam. Thanks again.

 

Here's the plan I've been following, tomorrow I start on week three and I feel pretty good.

 

Week 1

am dose = 1mg L

pm dose = .5mg L + 5mg D

 

Week 2

am dose = .5mg L + 5mg D

pm dose = .5mg L + 5mg D

 

Week 3

am dose = .5mg L + 5mg D

pm dose = 10mg D

 

Week 4

am dose = 10mg D

pm dose = 10mg D

My advice would be to explain to him that the equivalency is not correct for the crossover, and again show him the ashton manual or other resources that show the equivalency needed for valium.

 

I will tell you that I had to see three doctors before I found one that would agree to help me, so in the end that might be what you have to do. Doctors are stubborn sometimes, or more often just not educated well enough in regards to benzo w/d.

 

Just let your doctor know that you would feel comfortable following the equivalency outlined in the ashton, but don't be confrontational. It might also help if you show him your suggested taper schedule in writing to give him some idea of what you are wanting to do.

 

As bad as it sounds, the most important thing is not to do anything that might cause him to abruptly discontinue your prescriptions as this could leave you with no choice but to c/t. When you say 'doctor' is it a GP or a psychiatrist?

 

Jeff M.

also,  as he is a physician, he must understand the difference of the short vs the long acting benzo and such.  A gentle reminder may help him.....  It takes a bit of time for the crossover and the valium to build up to cover the interdose stuff of the short acting. Do what you need to do to get what you will need, even extra to stockpile so you can accomplish your goal. He sounds like he is covering his a**, but needs a reminder that you need to get off this drug in a safe and humane manner...... Good luck. 

Thanks floydhead86 and fairrobin for the encouragement and advice.

 

My doctor's a psychiatrist. He says he also works in a drug rehab. I wonder about being his patient there, he's so aggressive and closed minded.

 

I did an intake interview at a different rehab center and the counselor was just wonderful. He asked me a lot of questions and came to understand my true desire to get off this drug. He totally understood benzo's mind numbing effects and the withdrawal symptoms. But unfortunately the place was way too expensive for me to afford.

I hope you'll be able to work it out with your Dr, they don't seem to like being questioned, or told their business.  As others have suggested, treading lightly seems to be the best way to work around egos, sad isn't it?

Hi, thanks everybody my doctor visit went well. I showed him the plan I have been following and he was surprisingly supportive. He even wrote me another prescription to make sure I had enough for a slow taper! 

Excellent news Akossofi! 

Hi, thanks everybody my doctor visit went well. I showed him the plan I have been following and he was surprisingly supportive. He even wrote me another prescription to make sure I had enough for a slow taper! 

 

 

Yay, awesome.  I am so happy! Now onward for you and no looking back!!!

That's great news Akossofi. It's always a relief when you find a doctor willing to work with you. Good luck with your crossover and your taper!

 

Jeff M.