ADHD and fibromyalgia and nortriptyline

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Yesterday I finally met with a new psychiatrist (having lost access to my previous one back in, oh, March), with the intention of figuring out what to try next in terms of ADHD medication.

As a recap, the first medication I tried (Concerta) just made me irritable and gave me tachycardia, and the second one I tried (Adderall) worked really well for my brain but also made my blood pressure skyrocket.

Anyway, on Tuesday I had also met with my pain doc and the decision we came to was that we should try increasing the nortriptyline again, since 20mg is doing something but not enough, and I couldn’t really remember why I felt like 30 was too much. He wants me to target 40-50mg for my eventual long-term dosage.

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The sorry state of medication reminder software

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I use an app called Medisafe to give me my medication reminders. It’s useful because it tracks my doses and also tracks how much I have left so I know when to order refills and so on. I’ve been using it for years.

Unfortunately it has a critical problem in that it only sends three easy-to-miss reminders spaced ten minutes apart with no way of configuring it. So often I’ll end up taking my medication a few hours later than the scheduled time, because I head to bed and notice the pending reminder that I meant to fulfill.

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Balance

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So, in anticipation of my new job starting next week I’m trying to figure out what the right balance of medications should be for my various neurological issues, and I’m not sure where the balance point should be. I’m mostly thinking out loud here, but I am going to try to walk through it and maybe folks with more experience can comment, or something.

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Adderall pluses and minuses

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So, on the plus side, Adderall XR has been helping me quite a lot with my focus and executive functioning.

On the minus side, I’m having several of the unpleasant side effects: greatly increased blood pressure, numb toes, migraines/nausea (starting yesterday or so), and constipation.

I was really hoping I finally found something that works for me. Maybe I should stop taking it for a couple days and see how I feel. Because right now I just feel bad.

First day on Adderall XR

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So after Concerta turned out to be not a great fit for me I stopped taking it, and decided to wait until my next psychiatrist appointment to try something new.

That appointment was on Wednesday, and the psychiatrist decided that Adderall XR (10mg/day) would be the next logical thing to try. The prescription arrived yesterday (Kaiser’s mail-order pharmacy works fast!) and so I took my first dose this morning.

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Gabapentin, day 1

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So, yesterday I finally got my prescription for gabapentin/Neurontin, as another attempt at managing my fibro symptoms. Took my first dose at 9 PM, and felt very tired and dizzy by 11 PM. Then still managed to not fall asleep until around 3 AM (I was definitely wide awake at 2, and my smart bed thing says I didn’t fall asleep until 3 so that seems believable).

I slept pretty okay although I had vivid dreams about unpleasant stuff, as always seems to be the case when my neurochemistry is being tampered with.

Woke up at 8 AM, couldn’t actually peel myself out of bed until half past 9, and I felt wobbly/dizzy/tired all day.

Pain was okay in the morning, but at 2:40 PM or so I had a flareup. It cleared up with a snack, though, and I kinda-sorta managed to get some actual work done, ish.

Went home at 6, had dinner, not sure where the past two hours went but I’m really tired and sleepy right now and also flaring like a matroncopulator, and it’s time for my next dose. Maybe I’ll sleep better/longer tonight and feel better tomorrow.

Nortriptylene day 4

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Are these updates getting annoying? I figure that the point of having a blog is to be able to do bloggy stuff again, and if people only want to subscribe to Bigger Things they can subscribe to the category-specific feeds on my site or whatever. Or they can skip/skim these entries.

Anyway.

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Day 2 of Nortriptylene

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I took my first dose Monday night, and I had some incredibly intense dreams, and I was very aware that I was dreaming but kept on switching between like six different parallel threads, and was also very aware of my various apnea events. I was sort of awake and asleep at the same time and wasn’t really sure what was a dream and what was reality.

All day Tuesday I was drowsy and in a fog, and did absolutely nothing with my day except basic things around my home. Fortunately, it was also a day off because of the snowpocalypse.

I was kind of worried that my second day on it would be much the same, but aside from feeling vaguely like I was stoned all morning, I made it to work just fine (although I was in sort of a zombie mode on my way there), and then during the day I actually had a fairly productive day. In particular, I finally looked into modernizing the lab’s website (which was originally running Movable Type, just like this one), and realized that a quick-ish path forward would be to use Publ. However, the lab’s site had a lot more hackiness with templates and layout than my own one did, and I quickly came to the conclusion that the best path forward would be to finally implement better support for pure-HTML entries – so I did.

So far I’m not finding any major reduction in my pain levels (and if anything I’m noticing the pain I do have much more acutely) but I mean I’m only at the starting taper dose.

I’m getting a couple of cavities filled tomorrow. I’m not looking forward to finding out how that interacts with this current mental state.

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