Question:

I was wondering if anyone could help me.  My best friend has asthma, and got it as a reaction to the whooping cough vaccine when he was 3. His doctors put him on steroids when he was 16, which really messed up his metabolism.  He is currently on Flovent and Berotec.  He has been overweight ever since.  This situation, besides other factors, is really getting him down.  I don’t have asthma, and don’t have this weight problem.  Can anyone give any hints as to how to support him?   I want to be his friend, but it gets difficult at times to understand his feeling so worthless when he is such a nice guy. I appreciate any comments!! Lisa L.

Lisa Sometimes, it’s hard for us asthmatics to cope with the condition – it seems so unjust that we can’t control our breathing, something which is so fundamental, and something which other people take for granted. What doesn’t help is that some people find asthma funny – I’ve lost count of the times people have started laughing because I needed to use my inhaler in public. Honestly, you’d think I was about to relieve myself in the street, the way some people looked at me !! I don’t let it upset me now – the inhaler’s there for my benefit, not their entertainment. As I put it in a previous posting: DON’T LET OTHER IGNORANT BASTARDS CONTROL YOUR LIFE BY MAKING YOU FEEL UNCOMFORTABLE OR EMBARASSED ABOUT IT.

If they can’t accept that I am an asthmatic, and that I have to use regular meds to stabilise my condition, that’s their problem, not mine. I can sympathise with him about being overweight – my asthma is mainly exercise-induced, and I’ve never found a conventional or alternative treatment (breathing exercises included !) that can keep it under decent control whilst exercising. How to support him ? * Try to learn more about the condition, and treatments available.   By posting here, you’ve made a good start. The FAQ’s were posted   earlier this week, so you should have copies. If not, see the HTML   version at http://www.radix.net/~mwg/asthma-gen.html * Don’t wrap him up in cotton wool !!!   Most us don’t want sympathy, we just want to be better understood. * Don’t make an issue of his weight.   That’s the worst thing you can do.   My folks do that, even though they know the difficulties I have   with exercise, and it is SO annoying ! * Be there for him when he’s feeling down.   Let him know that you care – don’t assume that he knows that.   Being unable to breathe can be extremely distressing, if he has   an attack while you’re around, try to help him stay calm. Obviously, I can’t provide any medical advice, but it may be worth asking your own doctor for more information on the condition generally – that way, you might have a better idea of what he’s going through. It sounds like you really do care about your friend, especially as you’re making an effort to try to understand his condition. I hope that what I’ve said, and what I’m sure that other people will say, will be of some use to you. Feel free to mail me if you’ve got any further questions. Good luck ! Chris — Chris King               | Advice given here should NOT be used as a substitute

Response:

I was wondering if anyone could help me.  My best friend has asthma, and got it as a reaction to the whooping cough vaccine when he was 3.   His doctors put him on steroids when he was 16, which really messed up his metabolism.  He is currently on Flovent and Berotec.  He has been overweight ever since.  This situation, besides other factors, is really getting him down.  I don’t have asthma, and don’t have this weight problem.  Can anyone give any hints as to how to support him?   I want to be his friend, but it gets difficult at times to understand his feeling so worthless when he is such a nice guy. I appreciate any comments!! Lisa L.

Response:

Question:

I have another question about peak flows. I was diagnosed 14 months ago and, despite many different meds, my peak flows have not really budged. And, based on the charts, I’m 100 below where I should be. So how reliable are they? And why aren’t my meds working? (BTW — Just given another new med today!) The charts are only a rough approximation based on height, sex, and age. Other variables include race, chest size, etc. Your Peak Flow is what is measured when asthma is under control, after using a bronchodilator at mid-day. Your peak flow is not supposed to increase; the asthma drugs keep your lung function in the Green Zone (80% of PB).

Sorry, I was referring to Personal Best peak flow here. Personel Best numbers are not expected to increase, but if your typical peak flow is <80% of personal best, it indicates asthma is not controlled. To determine Personal Best peak flow, it may be necessary to give a burst dose of prednisone to quickly control the asthma. – Hide quoted text — Show quoted text – If asthma meds are not working, it raises doubts about the asthma diagnosis. Asthma is diagnosed using lung function tests. Lung function is measured before and after giving an inhaled bronchodilator like albuterol; a 12% improvement tends to confirm an asthma diagnosis. In difficult cases, a 2nd lung test may be given, called a methacholine challenge. Asthma is a reversible disease. If lung function is not reversible, it raises suspicions of COPD. Ellis

Response:

I have had asthma for 15 years and was told about a month ago that my asthma is not under control at all.  I was on Beclovent but now I take Serevent, Flovent, and Salbutamol. I now only use Ventolin about three times a week instead of 3-4 times a day like before. I monitor my peak flows everyday and have noticed that even when I feel that I am having an asthma attack (short of breath, tight chest, coughing) my peak flows usually don’t drop very much and sometimes don’t drop at all.  Are peak flows really a good way to tell how much distress you are in?  Does it work better for some people and not for others? My doctor always determines the severity of my attacks by having me blow once on the peak flow meter.  The problem is that sometimes my peak flows are good but I’m still not feeling great.  I have read a lot on asthma but I still have no answers to this (forgot to ask my doctor that last time I was in).   Sometimes I have wondered if it is all in my head when my peak flows are good and I’m still having problems breathing, but I know that that is ridiculous.  Any insights on this would be greatly appreciated. Meghan (new to this list) Before you buy.

Response:

I have another question about peak flows. I was diagnosed 14 months ago and, despite many different meds, my peak flows have not really budged. And, based on the charts, I’m 100 below where I should be. So how reliable are they? And why aren’t my meds working? (BTW — Just given another new med today!)

Response:

not everyone fits into the charts.  The charts are based upon an average individual with average non-disease oriented lungs.  The charts are averaged based upon size and age however. therefore, your norm will be unique to you.  If it is not budging upward then you may well be at your personal best and all future measurements will be based upon that number. Scooby RCP, EMT-P Perinatal-Pediatric Respiratory Specialist This mail is a natural product.  The slight variations in spelling and grammar enhance its individual character and beauty and in no way are to be considered flaws or defects.

Response:

I have another question about peak flows. I was diagnosed 14 months ago and, despite many different meds, my peak flows have not really budged. And, based on the charts, I’m 100 below where I should be. So how reliable are they? And why aren’t my meds working? (BTW — Just given another new med today!)

The charts are only a rough approximation based on height, sex, and age. Other variables include race, chest size, etc. Your Peak Flow is what is measured when asthma is under control, after using a bronchodilator at mid-day. Your peak flow is not supposed to increase; the asthma drugs keep your lung function in the Green Zone (80% of PB). If asthma meds are not working, it raises doubts about the asthma diagnosis. Asthma is diagnosed using lung function tests. Lung function is measured before and after giving an inhaled bronchodilator like albuterol; a 12% improvement tends to confirm an asthma diagnosis. In difficult cases, a 2nd lung test may be given, called a methacholine challenge. Asthma is a reversible disease. If lung function is not reversible, it raises suspicions of COPD. Ellis

Response:

Question:

Thanks to all who responded on my Tilade problem-especially Bill Ellis Fleemore.  I have my medication on the way-thank goodness.  Seems like my mail-order pharmacy had the medicine discontinued when all that happened was another company had bought out the originial manufacturers.  After calling the new manufacturer, they called the pharmacy and sent the Tilade to them.  I had been trying to reduce my Tilade without much success and was really wondering just how I was going to do without any.  My doctor had tried to take me off of it 3 yrs ago to no avail so both he and I were quite concerned that my asthma was going to get out of control again.  Now I don’t have to worry about that!- Pam in TN

Response:

Judy- I can certainly say that I did not expect to here my mail order pharmacy to say that Tilade is no longer available either.  With the help of Ellis in this group, I was able to talk to the manufacturer today and found out that they have temporary stopped the old formula and are waiting for a new one that has already passed trials in Europe.  So it looks like that the new version will be available in the US but they could not give me a definite date.  So I am still looking for some of the old stuff and they are also helping me out there too. I have one canister left so I hope that I can get something worked out within 17 days before this one runs out.- Pam in TN

Response:

I found out this week that one of my mainstay medications is no longer available in the US thanks to that darn little law that was passed earlier regarding the propellants used in the inhalers.  Well, my Tilade has bit the dust-along with my treatment plan that has had me in control since 1993!  My plan was 2 puffs of Tilade 3 times a day and 2 sprays twice a day of FLovent 220.  My pulmonary physician has told me that we will have to try to find another plan that will work since there is no substitution on the market for the Tilade. Pam in TN

– The drug manufacturers have enough CFC’s to last for several years.   There should not be a problem getting Tilade if you check with a few pharmacies.  We have plenty of it in New York. Wellington S. Tichenor, M. D. 642 Park Avenue New York, New York 212 517 6611 Visit our website at: http://www.sinuses.com Sinusitis: A Treatment Plan that Works for Asthma and Allergy too Any information read here should not be viewed as medical advice, as individual medical problems must be addressed by your physician. If you are looking for a physician and cannot get to New York City, please see the FAQ page.

Response:

I have to admit that I need to grumble a little bit and felt like here was the place to do it.  I found out this week that one of my mainstay medications is no longer available in the US thanks to that darn little law that was passed earlier regarding the propellants used in the inhalers.  Well, my Tilade has bit the dust-along with my treatment plan that has had me in control since 1993!  My plan was 2 puffs of Tilade 3 times a day and 2 sprays twice a day of FLovent 220.  My pulmonary physician has told me that we will have to try to find another plan that will work since there is no substitution on the market for the Tilade. Until now, I never realized that my health would be at the hands of someone that knows absolutely nothing about me or my disease-just the "bottom" line boardroom tactics.  It is frustrating enough to have to deal with the uncertainties of the disease but I was always comfortable knowing that my medications were keeping it under control.  Now I have to go back to sqare one again- Pam in TN

Response:

Dosn’t Tilade and Intal have the same propellant ? So if one has been chucked shouldn’t the other one follow suit ? But I was under the understanding this was not going to happen until suitable replacements were available.

Response:

I found out this week that one of my mainstay medications is no longer available in the US thanks to that darn little law that was passed earlier regarding the propellants used in the inhalers.  Well, my Tilade has bit the dust-along with my treatment plan that has had me in control since 1993!  My plan was 2 puffs of Tilade 3 times a day and 2 sprays twice a day of FLovent 220.  My pulmonary physician has told me that we will have to try to find another plan that will work since there is no substitution on the market for the Tilade.

 Pam in TN I forwarded your post to Francis Adams, MD, author of the comprehensive asthma book ‘The Asthma Sourcebook’. Here is his response. "Dear Ellis: Tilade definitely has not been discontinued. I think you must be right that they are bringing out a new formulation, probably with HFA instead of CFC. That means that they won’t supply any more of the current formula and will hopefully ship the new one soon. In terms of finding the original formula, I think it depends on the individual pharmacy and what they have in stock.  I will try to find out more on Monday from the manufacturer. Good luck, Francis V. Adams, M.D." Here are some references to the manufacturer. Reference: http://www.rpr.rpna.com/  Rhone-Poulenc Rorer (mfgr of Tilade) http://www.prnewswire.com/cnoc/exec/menu?764050/ Company News Business Name                         Address                                                      Phone  Rhone-Poulenc Rorer  Incorporated                         500 Arcola Rd, Collegeville, PA                         19426-3930                                                      610-454-8000 Ellis

Response:

Question:

If Singulair doesn’t cause these deadly heart problems, why are they concerned with trying to unethically and illegally obtain the medical records of victims, to the point of harassing the victims’ doctors ?

Is that you Bruce?      X-Trace: nntp1.ba.best.com 920345515 204 206.86.233.5      Newsgroups: alt.support.asthma      As I had suspected, based on an investigation I did months ago, the      research done in Canada exonerating zafirlukast and Zeneca’s Accolate      from ANY responsibility in causing Churg-Strauss Syndrome has now been      proven to be false.      X-Trace: news.truenorth.com 916339707 5574 170.200.189.101 (14 Jan 1999 18:48:27 GMT)      Organization: True North      Newsgroups: alt.support.asthma      Is this the same standard pharmaceutical safety testing that allows      approved drugs to kill a minimum of 100,000, or at most 190,000, people      a year?      Why do you assume that if they cannot provide evidence that their      products are safe, that their customers are automatically risking their      lives? Could their medicines be based on a couple of thousand years of      use with few side effects? Or could they be killing 100,000 customers a      year?      How long has Singulair been on the market? How many people in this      newsgroup report side effects?      X-Trace: news.truenorth.com 906385984 581 170.200.189.101 (21 Sep 1998 13:53:04 GMT)      Organization: True North      Newsgroups: alt.support.asthma      After six weeks on Singulair I started getting more and more fatigued      every day until my prescription ran out  and I missed a couple of days.      I immediately felt better. So I started taking Singulair again and      getting fatigued again. After a more couple of tests of taking and not      taking Singulair I stopped. BTW it work well on my asthma.      Now I take Accolate and it makes me tired also, but only half as much. Send complaints about misuse of the Kosovo Privacy Project to: Or fill out the Anonymizer Help form:      https://www.anonymizer.com/3.0/help/support.cgi

Response:

If Singulair doesn’t cause these deadly heart problems, why are they concerned with trying to unethically and illegally obtain the medical records of victims, to the point of harassing the victims’ doctors ? Naysayers will claim they are so very concerned about the satey of their drug and "their" patients. Doctors are asked to fill out the "anonymous" questionnaire on toxic reactions to this new drug. How anonymous is it if they know who the patients’ doctors are to begin with ? This occurs AFTER the doctors comply: Merck engages in a campaign of telephone harassment of doctors three, even four times, trying to get these doctors to hand over their patients FULL medical histories, without the patient’s consent, and against the code of doctor-patient confidentiality and in violation of the law. Refusals don’t daunt Merck, the company continues to call the same doctors even after repeated refusals to violate their oaths. This message was sent through the Kosovo Privacy Project’s Anonymous Email page at <http://www.anonymizer.com/kosovo. This service was created to facilitate the safe reporting of information from within Kosovo and other troubled areas around the world. There is no way to identify the author. Anonymizer in no way endorses the contents of this message. Please do not reply to this message. It will not go back to the sender.

Response:

Question:

Frank can’t help it folks, poor thing.

– Hide quoted text — Show quoted text – I can answer these for you (A) What is a chiropractic subluxation? The potential injury caused by unnecessary spinal manipulation. (B) Can you identify one on a radiograph?  If not, what methods do you use to detect them?  How reliable are these methods? Only after a significant trauma.  Spiral CT scan is a very sensitive for delineating the extent of injury. (C) Can a subluxation cause visceral disease (a la Meric chart)? No (D) Can colic be treated chiropractically? No (E) Can a correcting a subluxation help in childhood ear infections? Not really

Response:

Kirk, sham manipulation is fatally flawed.

How can you be certain the sham manipulation is not having an effect by accident. If sham manipulation can be so successful then

why go to a chiropractor and pay good money? Why go to college to study this if anybody can

do it? The issue is knowing were and when to adjust. If the chiropractor understands what he is

doing then he must be able to make a sham treatment. If he doesn’t understand what he is doing then

why go to a chiropractor? Chris Noble

A key is whether or not the subject knows if it is a sham adjustment if one wishes to incorporate a placebo study. Before you buy.

Response:

 A sham could have some different effect that would blow the whole thing. Not very hard to understand.

– Hide quoted text — Show quoted text – Kirk, sham manipulation is fatally flawed.   How can you be certain the sham manipulation is not having an effect by accident. If sham manipulation can be so successful then why go to a chiropractor and pay good money? Why go to college to study this if anybody can do it? If the chiropractor understands what he is doing then he must be able to make a sham treatment. If he doesn’t understand what he is doing then why go to a chiropractor? Chris Noble

Response:

Kirk, sham manipulation is fatally flawed.   How can you be certain the sham manipulation is not having an effect by accident.

If sham manipulation can be so successful then why go to a chiropractor and pay good money? Why go to college to study this if anybody can do it? If the chiropractor understands what he is doing then he must be able to make a sham treatment. If he doesn’t understand what he is doing then why go to a chiropractor? Chris Noble

Response:

    Kirk, sham manipulation is fatally flawed.   How can you be certain the    sham manipulation is not having an effect by accident. If sham manipulation can be so successful then why go to a chiropractor and pay good money? Why go to college to study this if anybody can do it?

Chiro’s have developed techniques that work.   Their patients attest to this. Your sham treatment is neither defined or tested If the chiropractor understands what he is doing then he must be able to make a sham treatment.

 But no-one understands everything about any treatment.   He understands what he is doing works and he understands the basic philosophy behind it.   But he cannot guarantee that his approach is the only one that will work and that your sham treatment cannot possibly work. You want to use a sham treatment?   Prove it is ineffective first. If he doesn’t understand what he is doing then why go to a chiropractor?

Because they have developed successful treatments.   People go through it and say ‘It worked for me’ Until valid studies are done that is all we have to go on. You want a study?   Randomly select patients to consult MD’s or Chiro’s. Blindly evaluate the results.   Which group has a better response? If it’s the MD’s, then I’ll be quite happy to go to an MD first, and if that doesn’t work, go to the Chiro. If it’s the Chiro, then vice versa If it’s the same, then I’ll go to the one with the prettiest receptionist first<g Best wishes — John Bain UK TV Sound Director, magnotherapy user & distributor http://members.aol.com/JBainSI/Magnotherapy.html Surround Sound for Television

Response:

John I have to agree with your post and only wished that I was eloquent enough to have written it. — Dr. Roland R. Hicks Doctor of Chiropractic All good things come from above-down-inside-out Natural Alternative to Celebrex/Vioxx: http://drhicks.joint-pain.com/ Internet Marketing to Win: http://www.aboutimw.com/drhicks.html Nutrition Products and Information: http://freelife.com/Sites/drhicks/redir.cfm?page=/info/welcome/welcom… fm toll free (877) 791-8686

– Hide quoted text — Show quoted text –     Kirk, sham manipulation is fatally flawed.   How can you be certain the    sham manipulation is not having an effect by accident. Not really.  Because the intent of the sham arm of the intervention is to essentially keep the parents blinded, and mimic the conditions of the experimental intervention MINUS the part being investigated.  One could in ensure that a real manipulation is not performed, as long as the parents can’t tell. Not at all.   Just because the patients cannot tell the real treatment from the sham does not mean that the sham is ineffective. It’s like running a test on asprin and using paracetamol as a control. The patients might not be able to tell whether they had the treatment or the control, but the control would never be a placebo.     Comparitive studies are the only way to go until you can develop benchmarks    for the treatment. This, too, is not the case.  With a mere comparison study the conclusions that can be drawn are more prone to being erroneous. To determine if an adjustment (rather than just time spent with the patients, expectation bias, etc) is having an effect, a properly designed sham comparison is the only way to go.  Otherwise we are left with essentially useless studies like the one we are discussing now. Your studies are also useless.   Your controls are invalid.   You have no idea what effect the sham treatment might be having. Randomised comparison studies will show which treatment is more effective, as practised, on a random subject.   I don’t care about the mechanism at this stage, I just want to know which treatment is more effective.   This study will tell me.   It needs to be repeated with a range of practitioners to eliminate charismatic effects, but the results are meaningful.   It gives the odds of a successful outcome for any patient attending either of the two treatments. Controlled studies give us much more useful information than comparisons studies. Not when you do not know whether the sham has any effect.   And you don’t. Your anti-sham philosophy is simply yet another attempt to thwart scientific investigation of alternative modalities (like your arguments against sham acupuncture).  Should we now throw out all negative placebo controlled trials because we can never know if the inert placebo is having some magical, homeopathic, or unknown effect? This is essentially what you are saying if you extend your argument. Not in the slightest.   Unless you can say you totally understand how the therapy works, you cannot say whether the sham treatment has any effect. It must contain enough elements of the treatment to fool the subjects. Inert placebos can be varied to see if there is any difference.   Completely different issue. If you wish to use a sham treatment as a placebo, you must first prove it is ineffective.   How are you going to do that?   Try it against another sham treatment and choose the least effective? No, sham treatments have their place, but cannot be used to prove or disprove a therapy.   All it can prove is that the real treatment is not significantly better than the sham.   Now prove that the sham treatment is ineffective and I’ll listen. Best wishes — John Bain UK TV Sound Director, magnotherapy user & distributor http://members.aol.com/JBainSI/Magnotherapy.html Surround Sound for Television

Response:

    Kirk, sham manipulation is fatally flawed.   How can you be certain the    sham manipulation is not having an effect by accident. Not really.  Because the intent of the sham arm of the intervention is to essentially keep the parents blinded, and mimic the conditions of the experimental intervention MINUS the part being investigated.  One could in ensure that a real manipulation is not performed, as long as the parents can’t tell.  

Not at all.   Just because the patients cannot tell the real treatment from the sham does not mean that the sham is ineffective. It’s like running a test on asprin and using paracetamol as a control.   The patients might not be able to tell whether they had the treatment or the control, but the control would never be a placebo.     Comparitive studies are the only way to go until you can develop benchmarks    for the treatment. This, too, is not the case.  With a mere comparison study the conclusions that can be drawn are more prone to being erroneous. To determine if an adjustment (rather than just time spent with the patients, expectation bias, etc) is having an effect, a properly designed sham comparison is the only way to go.  Otherwise we are left with essentially useless studies like the one we are discussing now.

Your studies are also useless.   Your controls are invalid.   You have no idea what effect the sham treatment might be having. Randomised comparison studies will show which treatment is more effective, as practised, on a random subject.   I don’t care about the mechanism at this stage, I just want to know which treatment is more effective.   This study will tell me.   It needs to be repeated with a range of practitioners to eliminate charismatic effects, but the results are meaningful.   It gives the odds of a successful outcome for any patient attending either of the two treatments. Controlled studies give us much more useful information than comparisons studies.

Not when you do not know whether the sham has any effect.   And you don’t. Your anti-sham philosophy is simply yet another attempt to thwart scientific investigation of alternative modalities (like your arguments against sham acupuncture).  Should we now throw out all negative placebo controlled trials because we can never know if the inert placebo is having some magical, homeopathic, or unknown effect? This is essentially what you are saying if you extend your argument.

Not in the slightest.   Unless you can say you totally understand how the therapy works, you cannot say whether the sham treatment has any effect.   It must contain enough elements of the treatment to fool the subjects.   Inert placebos can be varied to see if there is any difference.   Completely different issue. If you wish to use a sham treatment as a placebo, you must first prove it is ineffective.   How are you going to do that?   Try it against another sham treatment and choose the least effective? No, sham treatments have their place, but cannot be used to prove or disprove a therapy.   All it can prove is that the real treatment is not significantly better than the sham.   Now prove that the sham treatment is ineffective and I’ll listen. Best wishes — John Bain UK TV Sound Director, magnotherapy user & distributor http://members.aol.com/JBainSI/Magnotherapy.html Surround Sound for Television

Response:

Suppose it is simply the child’s karma to be (eventually) free of Colic.  How can we be sure the adjustment, sham adjustment, or other method is not stealing the credit owed to Karma.

Why Andrew, have you done more reading about Karma and are prepared to discuss it now? Here’s the question you kept avoiding all those months ago. Given 100 subjects for a trial,  can we assume that each carries the same Karmic burden Yes or No. If yes, please give your reasons.  When you answer this we can go onto the next question. Best wishes — John Bain UK TV Sound Director, magnotherapy user & distributor http://members.aol.com/JBainSI/Magnotherapy.html Surround Sound for Television

Response:

I understand the need to control variables and the attempted use of sham adjustments to control those variables AMAP. The question of variables does not just enter the control side but also the treatment side of a study.  For example, are all the patients treated with manipulation going to get the same adjustment or the adjustment that is determined to be necessary to correct the dysfunction(subluxation/fixation/restriction).  The reason I bring up this point is because if there is a rotational fixation of the joint then a lateral flexion impulse may or may not correct the fixation and therefore may skew the results to the side of ineffectiveness of the procedure. When it comes to testing a physical medicine the variables are endless.  Not to say that testing should not be done but there must be a global understanding that there are multiple variables that can not be controlled. — Dr. Roland R. Hicks Doctor of Chiropractic All good things come from above-down-inside-out Natural Alternative to Celebrex/Vioxx: http://drhicks.joint-pain.com/ Internet Marketing to Win: http://www.aboutimw.com/drhicks.html Nutrition Products and Information: http://freelife.com/Sites/drhicks/redir.cfm?page=/info/welcome/welcom… fm toll free (877) 791-8686

– Hide quoted text — Show quoted text – Might not be a bad idea to look at all such trials, and shine today’s knowledge on them. I think one might find many old truths to no longer be so. And some to be so. There is much info out there which strongly suggests that we are effected on many subtle levels. By not taking that into account, we can only have faulty or inaccurate information. Surly someone would try to eliminate as many variables as possible. To not do so would, at best , be not worthy of trust. The problem was that the study design compared chiropractic manipulation to administration of a drug.  This is not a true controlled trial, but rather a comparison trial (although JMPT still referred to it as placebo controlled and single blinded). The investigators should have had a manipulation group and a sham group. Kirk, sham manipulation is fatally flawed.   How can you be certain the sham manipulation is not having an effect by accident. Not really.  Because the intent of the sham arm of the intervention is to essentially keep the parents blinded, and mimic the conditions of the experimental intervention MINUS the part being investigated.  One could in ensure that a real manipulation is not performed, as long as the parents can’t tell. Comparitive studies are the only way to go until you can develop benchmarks for the treatment. This, too, is not the case.  With a mere comparison study the conclusions that can be drawn are more prone to being erroneous. To determine if an adjustment (rather than just time spent with the patients, expectation bias, etc) is having an effect, a properly designed sham comparison is the only way to go.  Otherwise we are left with essentially useless studies like the one we are discussing now. Controlled studies give us much more useful information than comparisons studies.  Your anti-sham philosophy is simply yet another attempt to thwart scientific investigation of alternative modalities (like your arguments against sham acupuncture).  Should we now throw out all negative placebo controlled trials because we can never know if the inert placebo is having some magical, homeopathic, or unknown effect? This is essentially what you are saying if you extend your argument. — Kirk Kolas Ontario Veterinary College Class of 2002

Response:

I am not sold on the art of "sham" adjustments.  If there is any joint movement it will have some affect on the joint complex. — Dr. Roland R. Hicks Doctor of Chiropractic All good things come from above-down-inside-out Natural Alternative to Celebrex/Vioxx: http://drhicks.joint-pain.com/ Internet Marketing to Win: http://www.aboutimw.com/drhicks.html Nutrition Products and Information: http://freelife.com/Sites/drhicks/redir.cfm?page=/info/welcome/welcom… fm toll free (877) 791-8686

– Hide quoted text — Show quoted text – "The one study did show that there was a reported improvement but since it was the mothers who reported the improvement the research was not definitive. Who should you ask if a baby’s colic is better?  I think the study is flawed since the measurement is strictly subjective and I hope that they can come up with a more structured study.  Colic is not easily quantified or classified." —- The problem with the design of this study was not really a problem with the measurement of "hours of crying".  This is a reasonable outcome measure, considering "colic" is operationally defined as increased hours of crying. The problem was that the study design compared chiropractic manipulation to administration of a drug.  This is not a true controlled trial, but rather a comparison trial (although JMPT still referred to it as placebo controlled and single blinded). The investigators should have had a manipulation group and a sham group. This way, the parents could be kept in the dark with respect to whether or not their child truly received an adjustment.  By comparing the outcomes of these two groups, the investigators could control for all those other factors that may be at play (e.g. expectation bias, handling of the child, increased time with the parents, etc…) I found it curious that JMPT also referred to the study as single blinded.  In my view it was not even single blinded because the "blinding" referred to the person evaluating the colic diary.  The outcome measure was simply total hours crying, so the diary evaluator, I presume, is simply adding up some numbers.  Blinding this individual is advantageous, but nothing to write home about.  Blinding the evaluators (the parents) is paramount. Nevertheless I have seen this rather poorly designed study touted in some forums.  I’d like to see it done properly with sham manipulation. I have never seen infant adjustments in person, but the couple of instances I have seen it on video, the "adjustments" were so subtle that I fear the investigators would have a hard time devising a convincing "sham" manipulation without actually replicating the adjustment arm of the study. And to end on a completely biased note: most pediatric adjustments look like sham adjustments to me in the first place. — Kirk Kolas Ontario Veterinary College Class of 2002

Response:

The problem was that the study design compared chiropractic manipulation to administration of a drug.  This is not a true controlled trial, but rather a comparison trial (although JMPT still referred to it as placebo controlled and single blinded). The investigators should have had a manipulation group and a sham group. Kirk, sham manipulation is fatally flawed.   How can you be certain the sham manipulation is not having an effect by accident.

Not really.  Because the intent of the sham arm of the intervention is to essentially keep the parents blinded, and mimic the conditions of the experimental intervention MINUS the part being investigated.  One could in ensure that a real manipulation is not performed, as long as the parents can’t tell.   Comparitive studies are the only way to go until you can develop benchmarks for the treatment.

This, too, is not the case.  With a mere comparison study the conclusions that can be drawn are more prone to being erroneous. To determine if an adjustment (rather than just time spent with the patients, expectation bias, etc) is having an effect, a properly designed sham comparison is the only way to go.  Otherwise we are left with essentially useless studies like the one we are discussing now. Controlled studies give us much more useful information than comparisons studies.  Your anti-sham philosophy is simply yet another attempt to thwart scientific investigation of alternative modalities (like your arguments against sham acupuncture).  Should we now throw out all negative placebo controlled trials because we can never know if the inert placebo is having some magical, homeopathic, or unknown effect? This is essentially what you are saying if you extend your argument. — Kirk Kolas Ontario Veterinary College Class of 2002

Response:

 Might not be a bad idea to look at all such trials, and shine today’s knowledge on them. I think one might find many old truths to no longer be so. And some to be so. There is much info out there which strongly suggests that we are effected on many subtle levels. By not taking that into account, we can only have faulty or inaccurate information. Surly someone would try to eliminate as many variables as possible. To not do so would, at best , be not worthy of trust.

– Hide quoted text — Show quoted text – The problem was that the study design compared chiropractic manipulation to administration of a drug.  This is not a true controlled trial, but rather a comparison trial (although JMPT still referred to it as placebo controlled and single blinded). The investigators should have had a manipulation group and a sham group. Kirk, sham manipulation is fatally flawed.   How can you be certain the sham manipulation is not having an effect by accident. Not really.  Because the intent of the sham arm of the intervention is to essentially keep the parents blinded, and mimic the conditions of the experimental intervention MINUS the part being investigated.  One could in ensure that a real manipulation is not performed, as long as the parents can’t tell. Comparitive studies are the only way to go until you can develop benchmarks for the treatment. This, too, is not the case.  With a mere comparison study the conclusions that can be drawn are more prone to being erroneous. To determine if an adjustment (rather than just time spent with the patients, expectation bias, etc) is having an effect, a properly designed sham comparison is the only way to go.  Otherwise we are left with essentially useless studies like the one we are discussing now. Controlled studies give us much more useful information than comparisons studies.  Your anti-sham philosophy is simply yet another attempt to thwart scientific investigation of alternative modalities (like your arguments against sham acupuncture).  Should we now throw out all negative placebo controlled trials because we can never know if the inert placebo is having some magical, homeopathic, or unknown effect? This is essentially what you are saying if you extend your argument. — Kirk Kolas Ontario Veterinary College Class of 2002

Response:

The problem was that the study design compared chiropractic manipulation to administration of a drug.  This is not a true controlled trial, but rather a comparison trial (although JMPT still referred to it as placebo controlled and single blinded).   The investigators should have had a manipulation group and a sham group.

Kirk, sham manipulation is fatally flawed.   How can you be certain the sham manipulation is not having an effect by accident. It’s like using a random drug off the shelves as a placebo, you have no idea what its effects will be on the participants in this study. Comparitive studies are the only way to go until you can develop benchmarks for the treatment. Best wishes — John Bain UK TV Sound Director, magnotherapy user & distributor http://members.aol.com/JBainSI/Magnotherapy.html Surround Sound for Television

Response:

John, Suppose it is simply the child’s karma to be (eventually) free of Colic.  How can we be sure the adjustment, sham adjustment, or other method is not stealing the credit owed to Karma. – Hide quoted text — Show quoted text – The problem was that the study design compared chiropractic manipulation to administration of a drug.  This is not a true controlled trial, but rather a comparison trial (although JMPT still referred to it as placebo controlled and single blinded). The investigators should have had a manipulation group and a sham group. Kirk, sham manipulation is fatally flawed.   How can you be certain the sham manipulation is not having an effect by accident. It’s like using a random drug off the shelves as a placebo, you have no idea what its effects will be on the participants in this study. Comparitive studies are the only way to go until you can develop benchmarks for the treatment. Best wishes — John Bain UK TV Sound Director, magnotherapy user & distributor http://members.aol.com/JBainSI/Magnotherapy.html Surround Sound for Television

Before you buy.

Response:

"The one study did show that there was a reported improvement but since it was the mothers who reported the improvement the research was not definitive. Who should you ask if a baby’s colic is better?  I think the study is flawed since the measurement is strictly subjective and I hope that they can come up with a more structured study.  Colic is not easily quantified or classified."   —- The problem with the design of this study was not really a problem with the measurement of "hours of crying".  This is a reasonable outcome measure, considering "colic" is operationally defined as increased hours of crying. The problem was that the study design compared chiropractic manipulation to administration of a drug.  This is not a true controlled trial, but rather a comparison trial (although JMPT still referred to it as placebo controlled and single blinded).   The investigators should have had a manipulation group and a sham group. This way, the parents could be kept in the dark with respect to whether or not their child truly received an adjustment.  By comparing the outcomes of these two groups, the investigators could control for all those other factors that may be at play (e.g. expectation bias, handling of the child, increased time with the parents, etc…) I found it curious that JMPT also referred to the study as single blinded.  In my view it was not even single blinded because the "blinding" referred to the person evaluating the colic diary.  The outcome measure was simply total hours crying, so the diary evaluator, I presume, is simply adding up some numbers.  Blinding this individual is advantageous, but nothing to write home about.  Blinding the evaluators (the parents) is paramount. Nevertheless I have seen this rather poorly designed study touted in some forums.  I’d like to see it done properly with sham manipulation. I have never seen infant adjustments in person, but the couple of instances I have seen it on video, the "adjustments" were so subtle that I fear the investigators would have a hard time devising a convincing "sham" manipulation without actually replicating the adjustment arm of the study. And to end on a completely biased note: most pediatric adjustments look like sham adjustments to me in the first place.   — Kirk Kolas Ontario Veterinary College Class of 2002

Response:

"Chiropractors are nervous system specialists with a focus on orthopedics. In other words, chiropractors are concerned with mechanical stressors on the nervous system. The nervous system controls all of the blood vessels in the body (via the sympathetic division of the autonomic nervous system). Every tissue in the body needs a healthy blood supply (for nourishment and waste removal). This blood supply is predicated upon having blood vessels functioning properly. Sympathetic innervation causes vasoconstriction (narrows arteries and arterioles), and thus diminishes the blood supply to an area. Profound reduction in blood supply results in hypoxia (decreased oxygen supply). This results in an ischemic condition, resulting in cellular death, and possible necrosis of the tissue. And thus, the functional integrity of the tissue is compromised." "A man may be a fool and not know it – but not if he is married." H.L. Mencken http://www.lifehousemusic.com/lh_music.html catchytune. says me.

Response:

– Dr. Roland R. Hicks Doctor of Chiropractic All good things come from above-down-inside-out Natural Alternative to Celebrex/Vioxx: http://drhicks.joint-pain.com/ Internet Marketing to Win: http://www.aboutimw.com/drhicks.html Nutrition Products and Information: http://freelife.com/Sites/drhicks/redir.cfm?page=/info/welcome/welcom… fm toll free (877) 791-8686

Here are some starter questions: (A) What is a chiropractic subluxation?

Atlas gave a good explanation, however I like to use common language to describet a subluxtion.  It is first and foremost the main object of a theory which attempts to explain what a chiropractor treats.  It is not proven for if it was it would not be a theory.  A subluxation in chiropractic terms is an abnormal positon or movement of the spinal bones/joints which cause a change in the function of the nervous system and to the extent that the nervous system is affected so the subjects health is affected.  Simply put a subluxation is anything which can cause negative effects on the nervous system and related to the structure of the body.  As Atlas stated that there are many causes of subluxations from injury, stress, metabolic, ect. (B) Can you identify one on a radiograph?  If not, what methods do you use to detect them?  How reliable are these methods?

There are instances in which the structural facet of a subluxation may be viewed on xray.  Since a subluxation is biomechanical, structural and neurological in origin one can not see the neurological or biomechanical aspects of a subluxation on a xray. Just as one cannot see the funtion of the sciatic nerve on a pelvic xray.  I propose a scenario to better understand the above explanation.  In my practice, I have the opportunity to see patients with disc degeneration on a daily basis.  These people come in with discs that have degenerated and thinned.  When the disc thins the bones(vertebrae) come closer together.  This caused the facet joints in the back of the spine to also come closer together(imburcate).  When these joints come closer together their biomechanics change and they are prone to Jamming upon extension movements or movements which cause an increase in the normal lumbar curve(lordosis).  Can you see these changes in the normal static Xrays?  yes Can you see the biomechanical changes on the xray? no biomechanical findings cannot be seen on a static test. Can you correlate your findings to the history and examination and predict the outcome of care? yes (C) Can a subluxation cause visceral disease (a la Meric chart)?

What is the Meric chart? A person can have a viscerosomatic reflex like having an upset stomach cause overall body weakness and malaise. A person can have a somatovisceral reflex like having hit one’s thumb with a hammer can cause stomach upset. A person can have a psychosomatic reflex in which they think they are sick and therefore they feel general muscle weakness and malaise. A person can have a somatopsychologica reflex in which the are hurt physically and it sets up the flight/fight reaction. This is the long way of answering the question asked.  Yes, a subluxation can be a cause of a visceral disease/condition/symptom.  The reverse is also part of the "subluxation theory" a visceral condition can reflex to the spine and cause pain and subluxation symptoms of the spine.  Ie. gall bladder causing pain in the right intrascapular region.  Cramping and lumbar muscle spasms and pain associated with painful menses in women are good examples of viscerosomatic reflexes.  The nerves travel both ways. (D) Can colic be treated chiropractically?

There is some clinical evidence that spinal manipulation can reduce the severity of colic however I believe the jury is still out on that one and more studies should be performed.  The one study did show that there was a reported improvement but since it was the mothers who reported the improvement the research was not definitive. Who should you ask if a baby’s colic is better?  I think the study is flawed since the measurement is strictly subjective and I hope that they can come up with a more structured study.  Colic is not easily quantified or classified.  Plus those little rug rats can’t comunicate other than crying or not crying.  My boy was diagnosed with a viral syndrome(possibly meningitis) when he was two months old.  We were up all night and went to the ER at 4AM due to his condition.  The only thing that would calm him was gentle motion of his hips and sacrum. Why? GOT ME.  The lumbar puncture was inconclusive.  I was explained by our pediatrician that just because you dip your hand into a barrel of pickles and don’t grab a pickle doesn’t mean that there are not pickles in there. We had to assume that the child had meningitis and treat it as such. (E) Can a correcting a subluxation help in childhood ear infections?

In my clinical experience, I would have to say emphatically YES.  Does it cure infections? NO I have treated approximately 20-30 children with chronic ear infections over the past 10 years and of those treated, in my observation 80-90% showed improvement in their condition.  Was it just the adjustments?  I doubt it.  I make sure that my patients keep on the medicinal regimine recommended by their medical doctor and simply try to improve the function of the cervical spine. I also try to make dietary changes for the child.  Do I understand the exact mechanism? NO  What my treatments are designed to do is increase drainage of the sinuses and aid in the drainage of the eustacian tube.  If there is restriction of motion in the upper neck causing reduce lymphatic drainage then this may be a factor in the condition.  My son has had chronic ear infections since he was one year old.  He has allergies and that plays a big role in his chronic infections.  I do gentle neck adjustments and skull craniopathy to aid in his congestion to clear his sinuses and have him on antibiotics only when an infection is present. The explanations provided are in no way complete and are for the purposes of presenting my experience.  If you have questions about the areas discussed or are unclear of what I was attempting to explain please ask me to clarify those areas. – Hide quoted text — Show quoted text – I have heard different chiropractors answer these questions differently.  We all know how a "Straight" chiropractor would answer them.  What do you think? — Kirk Kolas Ontario Veterinary College Class of 2002

Response:

If you have a question about chiropractic ask away.  I am not the ultimate expert but I may be able to help you none the less. If you had been to a chiropractor and had a question about the visit, rumors, theory, testing or even the question that you think others will think you are stupid to ask.  I’m on this newsgroup for enjoyment and if I can help another while I’m having fun then I’ve killed two birds with one stone. — Dr. Roland R. Hicks Doctor of Chiropractic All good things come from above-down-inside-out Natural Alternative to Celebrex/Vioxx: http://drhicks.joint-pain.com/ Internet Marketing to Win: http://www.aboutimw.com/drhicks.html Nutrition Products and Information http://freelife.com/Sites/drhicks/redir.cfm?page=/info/welcome/welcom… fm toll free (877) 791-8686

Response:

If you have a question about chiropractic ask away.  I am not the ultimate expert but I may be able to help you none the less.

Here are some starter questions: (A) What is a chiropractic subluxation? (B) Can you identify one on a radiograph?  If not, what methods do you use to detect them?  How reliable are these methods? (C) Can a subluxation cause visceral disease (a la Meric chart)? (D) Can colic be treated chiropractically? (E) Can a correcting a subluxation help in childhood ear infections? I have heard different chiropractors answer these questions differently.  We all know how a "Straight" chiropractor would answer them.  What do you think? — Kirk Kolas Ontario Veterinary College Class of 2002

Response:

I can answer these for you (A) What is a chiropractic subluxation?

The potential injury caused by unnecessary spinal manipulation. (B) Can you identify one on a radiograph?  If not, what methods do you use to detect them?  How reliable are these methods?

Only after a significant trauma.  Spiral CT scan is a very sensitive for delineating the extent of injury. (C) Can a subluxation cause visceral disease (a la Meric chart)?

No (D) Can colic be treated chiropractically?

No (E) Can a correcting a subluxation help in childhood ear infections?

Not really

Response:

(A) What is a chiropractic subluxation?

If you asked a medical doctor and a chiropractor to define a subluxation, you would get two different answers. The medical profession defines a subluxation as: "A partial or incomplete dislocation."  (From Taber’s Cyclopedic Medical Dictionary).      The Chiropractic profession has a different definition (and thus – meaning) for a subluxation. Specifically, a subluxation is an articular lesion which has the following components: 1. Abnormal movement or position of a bone. (Kinesiopathology). In the spine, this could be at the intersegmental level (meaning one vertebra and the vertebra above and below it). Or it could be at the global level (meaning the posture). 2. Abnormal tissue. (Histopathology):  This includes nerves, muscle, ligaments, tendons, adipose tissue, fascia, lymphatics, blood vessels, etc.      Kinesiopathology is composed of rotations and translations. Histopathology is caused by deformations of the tissues [Davis' Law of soft tissues, Wolff's Law of hard tissues]. What causes a subluxation? Subluxations are caused by one of three things:      1. Trauma (Physical stress)      2. Thoughts (Emotional stress)      3. Toxins (Chemical stress) Is a Subluxation the cause of all disease?      There is no one cause for all disease.  If there was, we would have probably found it by now. There are numerous causes for disease. One thing which needs to be stressed at this point is that the human body was designed to be healthy. The body has an innate ability to repair itself from injury, and to fight off pathogens. We were not designed to have to rely on pills, potions, and powders to resolve the majority of our problems.      Chiropractors are nervous system specialists with a focus on orthopedics. In other words, chiropractors are concerned with mechanical stressors on the nervous system. The nervous system controls all of the blood vessels in the body (via the sympathetic division of the autonomic nervous system). Every tissue in the body needs a healthy blood supply (for nourishment and waste removal). This blood supply is predicated upon having blood vessels functioning properly. Sympathetic innervation causes vasoconstriction (narrows arteries and arterioles), and thus diminishes the blood supply to an area. Profound reduction in blood supply results in hypoxia (decreased oxygen supply). This results in an ischemic condition, resulting in cellular death, and possible necrosis of the tissue. And thus, the functional integrity of the tissue is compromised.      Chiropractors do not treat disease. They find and remove subluxations. However, if the subluxation is the cause of the disease, then by removing the subluxation, you are effectively resolving the problem. (B) Can you identify one on a radiograph?  If not, what methods do you use to detect them?  How reliable are these methods?

        The Chiropractic definition of a subluxation involves mechanical, biochemical, and neurophysiological components. Of these, the mechanical component is visible on an x-ray. The neurological, and physiological components are not visible on an x-ray. Chiropractors study x-ray films with line drawing analysis. And with these, they can take precise measurements to determine if the bone(s) are subluxated.      Your chiropractor will only order an x-ray if he/she feels it is necessary. Precautions are used to ensure that you are exposed to the absolutely minimum possible radioation dose. These include lead shielding, high speed films, collimation, and screens. (C) Can a subluxation cause visceral disease (a la Meric chart)?

        Chiropractic has but one purpose. And that is to find and remove subluxations. If the subluxation is the cause of the dis-ease in the body, then it logically follows that by removing the subluxation (the cause), then you’re going to remove the dis-ease (the effect).      However, the subluxation is not the root of every health care problem. There are many reasons why people get sick. Interestingly enough, Chiropractic could help boost the immune system of the patient, so that their own innate immunity is stronger, and the body is better able to rid itself of the disease process. See: http://www.geocities.com/cbpdoc/neuroimmune.html (D) Can colic be treated chiropractically?

        Only if the colic is caused by vertebral subluxation. (E) Can a correcting a subluxation help in childhood ear infections?

        Only if the ear infections are caused by vertebral subluxation. I have heard different chiropractors answer these questions differently.  We all know how a "Straight" chiropractor would answer them.  What do you think?

        Now you know.

Response:

Question:

After about 7 months on Paxil, I started becoming very depressed.  My pdoc reduced the dosage and I was better, but then the pa’s started to get worse again.  When she increased the Paxil, the depression returned.  So now I’m off Paxil.  Actually, I wish the depression hadn’t happened, I was doing pretty good on Paxil for a while. Peg

Response:

 Hi Lynne, The SSRIs can induce or exacerbate movement disorders (possibly related to their effects on dopamine). I had a temporary increase in my restless legs syndrome (RLS) after a Zoloft increase which resolved after a Zoloft dose reduction. Zoloft has more effect on dopamine reuptake than any of the other SSRIs, and thus may cause these problems more frequently than other SSRIs. Bruxism (teeth grinding) can be brought on by an SSRI. A temporary reduction in your Paxil dose may resolve this problem, as may the addition of certain meds (Bromocriptine for one, I think). It’s also possible you’re exeriencing Paxil "poop out" with lessening of anti-aNXIETY EFFECTS AND NEED A DOSAGE ADJUSTMENT OR AUGMENTATION with another med. Good luck, Chip P.s. if I were in your situation I think I would try a reduction in Paxil dose and see if the teethgrinding improved. I have been taking Paxil for a year and a half and have suddenly developed what I think may be new side effects to the medicine. I was wondering if anyone else has had a side effect pop up after being on the medicine for quite awhile?. I am suddenly more nervous, anxious and generally stressed for no known reason. I have developed jaw clenching and have to wear a mouth guard at night. My jaw and neck also get tight during the day. I have had other side effects like insomnia all the way along, but not this new "tension" stuff. Thanks for any help or insight. Lynne

Response:

So your saying everyone is not entitled their own opinion?  Kiss my ass. Xanman — Depressed?  Anxious?  http://members.tripod.com/Xanman22/index.html Xanland – http://www.geocities.com/SoHo/Gallery/9098/ Xanland – A little insanity in an sane wolf.

– Hide quoted text — Show quoted text – Not good to share with the group.  Some people have done great on paxil. I for one don’t want to read what bad things can happen.  Remember, every med reacts differently with everyone. What kind of support is this group for then? You should not share bad experiences with meds? How about bad emotional phases, are they "allowed"? Nonsense. This is a support group, and in order to get support, we have to share the good with the bad. If somebody is in distress because they are unsure what to think of a med they are taking, why should they not ask others about it? It was not a "all meds are evil" mail after all. Skreee http://members.xoom.com/Skreee/James/JamesMason.html

Response:

I have been taking Paxil for a year and a half and have suddenly developed what I think may be new side effects to the medicine.  I was wondering if anyone else has had a side effect pop up after being on the medicine for quite awhile?.  I am suddenly more nervous, anxious and generally stressed for no known reason.  I have developed jaw clenching and have to wear a mouth guard at night.  My jaw and neck also get tight during the day.  I have had other side effects like insomnia all the way along, but not this new "tension" stuff.  Thanks for any help or insight.  Lynne

Response:

Not good to share with the group.  Some people have done great on paxil.  I for one don’t want to read what bad things can happen.  Remember, every med reacts differently with everyone. Xanman — Depressed?  Anxious?  http://members.tripod.com/Xanman22/index.html Xanland – http://www.geocities.com/SoHo/Gallery/9098/ Xanland – A little insanity in an sane wolf.

– Hide quoted text — Show quoted text – I have been taking Paxil for a year and a half and have suddenly developed what I think may be new side effects to the medicine.  I was wondering if anyone else has had a side effect pop up after being on the medicine for quite awhile?.  I am suddenly more nervous, anxious and generally stressed for no known reason.  I have developed jaw clenching and have to wear a mouth guard at night.  My jaw and neck also get tight during the day.  I have had other side effects like insomnia all the way along, but not this new "tension" stuff.  Thanks for any help or insight.  Lynne

Response:

My jaw and neck also get tight during the day.  I have had other side effects like insomnia all the way along, but not this new "tension" stuff.

Hello, I am experiencing this too.  I have to mentally remind myself to loosen my jaw.  I did not think it was because of the paxil though, but who knows.  I get the insomnia occasionally, but to cope with that I switch to taking the pill in the morning for a few days and that seems to fix it.  I don’t know what to think about the jaw clenching, but do not feel it is serious enough to stop the paxil. Take Care, Amy Jo

Response:

HI Lynne, I have the same symptoms of jaw clenching, I know how unpleasant it can be. I had a mouth guard many years ago (at the time we thought it was TMJ).  The guard doesn’t fit any more so now I am getting a partial upper plate (if the damn Dentist would just call me back).  I do relaxation exercises to help me relaxe those clenched muscles.  Oh BTW, I don’t take Paxil. Cathy — P.H.O.B.I.A. People Helping Others Become Independent Again Off-line Self Help Support Group, NJ http://community.nj.com/cc/phobia Anxiety Treatment Options http://www.members.tripod.com/~PhobiaGroup/index.html

– Hide quoted text — Show quoted text – I have been taking Paxil for a year and a half and have suddenly developed what I think may be new side effects to the medicine.  I was wondering if anyone else has had a side effect pop up after being on the medicine for quite awhile?.  I am suddenly more nervous, anxious and generally stressed for no known reason.  I have developed jaw clenching and have to wear a mouth guard at night.  My jaw and neck also get tight during the day.  I have had other side effects like insomnia all the way along, but not this new "tension" stuff.  Thanks for any help or insight.  Lynne

Response:

I have been taking Paxil for a year and a half and have suddenly developed what I think may be new side effects to the medicine.  I was wondering if anyone else has had a side effect pop up after being on the medicine for quite awhile?.  I am suddenly more nervous, anxious and generally stressed for no known reason.  I have developed jaw clenching and have to wear a mouth guard at night.  My jaw and neck also get tight during the day.  I have had other side effects like insomnia all the way along, but not this new "tension" stuff.  Thanks for any help or insight.  Lynne

Dear Lynn, You really should talk to your doctor about how poorly you are feeling. IMO…..it sounds like the Paxil dose you are on is not as effective as it was and you are experiencing a increase in your anxiety. There was recently a thread on SSRI anti-depressants and jaw clenching, it could be a side-effect of Paxil. Jaw clenching is also a symptom of anxiety, and you seem to be living with alot of tension and anxiety right now. You need to talk to your doctor, treatment might include increasing your paxil dose, or augmenting it with another med. Also, have you ever looked into CBT? P.S.  It wouldn`t hurt to have a good checkup with your doctor to rule out any physical causes of these symptoms. Take care. Jackie

Response:

I have been taking Paxil for a year and a half and have suddenly developed what I think may be new side effects to the medicine.  I was wondering if anyone else has had a side effect pop up after being on the medicine for quite awhile?

I feel like some of the effects have really come and gone.  I’ve had almost all of them, it seems, but few have lasted the whole time so far. But how I think about it right now is that they are all tolerable except for weight gain.  And that’s interesting, because I know that without the drug I would totally be in fear of all of them.

Response:

Paxil definitely causes some people to involuntarily clench their jaws and/or grind their teeth (bruxism). I had my dentist custom-make a nighttime mouth guard for me, and that has helped a lot… I was getting a very sore TMJ (temporomandibular joint or something like that — where your jaw hinges to your head, just below your ear) from grinding my teeth all night. I still grind my teeth sometimes during the day but try to prevent it by reminding myself all the time. If it doesn’t look too silly, or when you’re alone, try sticking just the tip of your tongue between your teeth so you won’t bite down or clench! (You can do this with your mouth closed.) So far I’ve cracked two molars, loosened a canine tooth, and scraped the enamel off the tops of my front teeth — all from this newly intensified teeth-grinding since I’ve been on Paxil (one year plus two months). But for me — IT’s WORTH IT! Paxil has worked too well for my panic and depression for me to consider discontinuing it; I’ll stick with my mouth guard and other tricks to try and save my teeth.  :-) – Anne —

Response:

Question:

Any anxious/depressed nurses out there? I recently graduated nursing school and started my first ever LPN job. Although I’ve been on various SSRIs (currently Zoloft) the old anxiety and depression which I thought had subsided several years ago are coming back with a vengeance!  I’m afraid I’m going to screw up, get a bad review, or even get fired or lose my license! Diana B.

Hi Diana, welcome to ASAP, If every nurse with a anxiety disorder was fired, then most hospitals would need to close. For some reason(s) the medical profession generally, and nurses in particular, seem to have more than their fair share of anxiety and depression sufferers. Probably, all  due to those difficult to please patients, although I am of course an exception!    :-^) Take care Ian

Response:

If every nurse with a anxiety disorder was fired, then most hospitals would need to close. For some reason(s) the medical profession generally, and nurses in particular, seem to have more than their fair share of anxiety and depression sufferers. Probably, all  due to those difficult to please patients, although I am of course an exception!    :-^) Take care Ian

In my experience the worst patients, are male patients. Especially in the 45 to 50 age bracket. <G They are demanding, obnoxious and can not handle any pain. I would give up peroxide just to see what kind of patient you are, Ian. ~~ When I was in the hospital having surgery, this one night there was this person screaming all night, it was the most blood-curdling screams I had ever heard. I couldn`t take it any more, and asked one of the nurses what was wrong. With a "giggle", she said it was the man down the hall passing a tiny ole kidney baby…….You guys are such babies<VBG. *Her*

Response:

Any anxious/depressed nurses out there? I recently graduated nursing school and started my first ever LPN job. Although I’ve been on various SSRIs (currently Zoloft) the old anxiety and depression which I thought had subsided several years ago are coming back with a vengeance!  I’m afraid I’m going to screw up, get a bad review, or even get fired or lose my license! Diana B. The JerZ Fox Money doesn’t buy happiness. Poverty doesn’t buy anything.

Response:

Any anxious/depressed nurses out there? I recently graduated nursing school and started my first ever LPN job. Although I’ve been on various SSRIs (currently Zoloft) the old anxiety and depression which I thought had subsided several years ago are coming back with a vengeance!  I’m afraid I’m going to screw up, get a bad review, or even get fired or lose my license! Diana B.

Hi Diana, Welcome to ASAP! I am a LPN also, but I am not working due to PD.  I do understand how difficult it is to do your job while being very anxious and panicky. When I was working in a nursing home, I was the medication and treatment nurse. Medications were quite difficult to dispense while in a anxiety state. My worse fear was I would make a medication error and hurt someone. I had no idea what was wrong with me, but you do know what you are dealing with. Seek help immediately, before this gets out of control. I would first go to your MD and get a good checkup just to make sure nothing physical is causing it. If everything checks out, get to a psych doctor ASAP. It is time to either up the Zoloft dose, or think about a med change. A script for a benzo would also help. I would also suggest Cognitive Behavioral therapy, if you haven`t done this before. You need to be taught some coping tools for those anxious moments at work. And CBT can do that. You can`t get fired or lose your license because you suffer from a anxiety disorder. Making errors while really anxious is always a possibility, that is why you need to deal with this now, and aggressively, this will not go away on its own. I really do sympathize with you, I do know what you are going through. Hope things work out, and keep in touch<g Jackie ~~Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence~~

Response:

Question:

Thanks to everyone who responded.  It really does make me feel better to read such supportive comments.   No more AOL….. Thanks again! Peace, Dan

Response:

I’d like to introduce myself.  I’m a twenty six year old male, and I’ve read this newsgroup on and off for the last couple years.   Also, I’d like some feedback on my medication.  First, though, my history with panic disorder…  Ever since I was a little kid I’ve had trouble with panic attacks.  In Little League, I was a nervous wreck before games because I thought I might have an attack.  (Of course at the time I didn’t know what they were, and was afraid to tell anyone.)  I quit the basketball team because I thought I was prone to PAs at night, particularly in the lighting of a gymnasium.  These were textbook panic attacks I was having (and worrying about having!) – most of the symptoms, and they’d last about fifteen minutes or so. I had a pretty normal childhood otherwise.  By the time I reached high school, I considered the PAs a thing of the past, something I’d luckily outgrown.  I made it through college without really giving panic attacks any thought. Then — about three years ago (I’d been out of college almost a year), I was going through a somewhat stressful time in my life, trying to figure out my future, looking for a career I cared about, etc.  I had *the* worst panic attack I’d ever had, and the reason it was so bad was because it seemed to not go away.  Without exaggeration, I can honestly say that I felt like I was having a panic attack for two months.  I had no idea what was going on, and grew very depressed.  I was living with my girlfriend, who was supportive as she could be, but she was the only person I told.  This was a very dark, scary time in my life.  Things lightened up a bit when I finally told my mom.  She knew someone who’d had a problem that sounded similar.  Soon, I moved back home.  I met with my mom’s friend, who gave me several books to read (Kernodle, Sheehan, Reid, Weekes), which I read with a frenzy.  She also recommended a psychiatrist, who helped me through medication.  This was a summer of healing for me.  We found a medication combination – 5 mg per day of Xanax, 1mg per day Klonopin, and 150 mg per day Zoloft.  I had tried Imipramine, but it made me feel even more anxious, as though I were about to have a PA at any time. Anyway, this dosage took awhile to reach, but it was the dosage that worked for me.  I also read and practiced many of the self-help techniques such as deep relaxation, breathing exercises, meditation, stopping negative thought patterns, et al.  It took awhile, but I got better.  I finally felt some joy in life again.  Since then, I’ve stayed at the same dosages of the medications, with few side effects, and feel very good.  I’ve had panic attacks begin, but the combination of the medication and learning not to fear the attack enables me to take a deep breath and let it go.  My life isn’t perfect, but I feel sane. I’ve moved away from my parents house, and owe them a HUGE debt of gratitude for letting me free-load for a year as I got better.  It took me awhile to get a job, because I had an immense fear of being stuck somewhere for eight hours. I wasn’t afraid to go out – I was afraid, though, to *have* to be in one place.  When I finally started working, it was a huge step in my recovery.   So, I’m curious what your thoughts are on my medication.  Sometimes I feel a bit guilty, like I should try to taper off the meds.  Other times, I’m perfectly content to stay on them the rest of my life.  I haven’t built up a tolerance for the Xanax, so that’s not a problem.  My doctor mentions tapering every time I see her, which is every three months, but lately I’ve been in so many transitional stages in my life, I just haven’t felt ready to mess with the medication.  (First I moved away from home – far away, actually – and then I got married to the girlfriend who’d been so supportive when I first got sick, and now we have a three month old baby boy….I’d call all that "transitional".)   That’s my story, and I’m curious what you all have to say about my medication. I know the dosages are pretty high, but I also know that quality of life is not something to take for granted. Peace, Dan "Is a dream a lie if it don’t come true  Or is it something worse?"              - Bruce Springsteen

Response:

It is hard enough to find medications that take care of the symptoms. If these meds work for you, then you have achieved your goal and I would not try to change them right now, just to get your life back in shape while you are still feeling well.  Make sure your doc. informs you about all possible side effects, but basically I wouldn’t touch a thing for as long as possible if you find a set of meds that really work for you. Dr.S. There are no false alarms http://www.algy.com/pdi – Hide quoted text — Show quoted text -(SYMKTB) writes: I’d like to introduce myself.  I’m a twenty six year old male, and I’ve read this newsgroup on and off for the last couple years.   Also, I’d like some feedback on my medication.  First, though, my history with panic disorder…  Ever since I was a little kid I’ve had trouble with panic attacks.  In Little League, I was a nervous wreck before games because I thought I might have an attack.  (Of course at the time I didn’t know what they were, and was afraid to tell anyone.)  I quit the basketball team because I thought I was prone to PAs at night, particularly in the lighting of a gymnasium.  These were textbook panic attacks I was having (and worrying about having!) – most of the symptoms, and they’d last about fifteen minutes or so. I had a pretty normal childhood otherwise.  By the time I reached high school, I considered the PAs a thing of the past, something I’d luckily outgrown.  I made it through college without really giving panic attacks any thought. Then — about three years ago (I’d been out of college almost a year), I was going through a somewhat stressful time in my life, trying to figure out my future, looking for a career I cared about, etc.  I had *the* worst panic attack I’d ever had, and the reason it was so bad was because it seemed to not go away.  Without exaggeration, I can honestly say that I felt like I was having a panic attack for two months.  I had no idea what was going on, and grew very depressed.  I was living with my girlfriend, who was supportive as she could be, but she was the only person I told.  This was a very dark, scary time in my life.  Things lightened up a bit when I finally told my mom.  She knew someone who’d had a problem that sounded similar.  Soon, I moved back home.  I met with my mom’s friend, who gave me several books to read (Kernodle, Sheehan, Reid, Weekes), which I read with a frenzy.  She also recommended a psychiatrist, who helped me through medication.  This was a summer of healing for me.  We found a medication combination – 5 mg per day of Xanax, 1mg per day Klonopin, and 150 mg per day Zoloft.  I had tried Imipramine, but it made me feel even more anxious, as though I were about to have a PA at any time. Anyway, this dosage took awhile to reach, but it was the dosage that worked for me.  I also read and practiced many of the self-help techniques such as deep relaxation, breathing exercises, meditation, stopping negative thought patterns, et al.  It took awhile, but I got better.  I finally felt some joy in life again.  Since then, I’ve stayed at the same dosages of the medications, with few side effects, and feel very good.  I’ve had panic attacks begin, but the combination of the medication and learning not to fear the attack enables me to take a deep breath and let it go.  My life isn’t perfect, but I feel sane. I’ve moved away from my parents house, and owe them a HUGE debt of gratitude for letting me free-load for a year as I got better.  It took me awhile to get a job, because I had an immense fear of being stuck somewhere for eight hours. I wasn’t afraid to go out – I was afraid, though, to *have* to be in one place. When I finally started working, it was a huge step in my recovery.   So, I’m curious what your thoughts are on my medication.  Sometimes I feel a bit guilty, like I should try to taper off the meds.  Other times, I’m perfectly content to stay on them the rest of my life.  I haven’t built up a tolerance for the Xanax, so that’s not a problem.  My doctor mentions tapering every time I see her, which is every three months, but lately I’ve been in so many transitional stages in my life, I just haven’t felt ready to mess with the medication.  (First I moved away from home – far away, actually – and then I got married to the girlfriend who’d been so supportive when I first got sick, and now we have a three month old baby boy….I’d call all that "transitional".)   That’s my story, and I’m curious what you all have to say about my medication. I know the dosages are pretty high, but I also know that quality of life is not something to take for granted. Peace, Dan "Is a dream a lie if it don’t come true Or is it something worse?"             – Bruce Springsteen

Response:

SYMKTB schreef: – Hide quoted text — Show quoted text – < snipped life story for space  We found a medication combination – 5 mg per day of Xanax, 1mg per day Klonopin, and 150 mg per day Zoloft. with few side effects, and feel very good.  I’ve had panic attacks begin, but the combination of the medication and learning not to fear the attack enables me to take a deep breath and let it go.  My life isn’t perfect, but I feel sane. So, I’m curious what your thoughts are on my medication.  Sometimes I feel a bit guilty, like I should try to taper off the meds.  Other times, I’m perfectly content to stay on them the rest of my life.  I haven’t built up a tolerance for the Xanax, so that’s not a problem.  My doctor mentions tapering every time I see her, which is every three months, but lately I’ve been in so many transitional stages in my life, I just haven’t felt ready to mess with the medication.  (First I moved away from home – far away, actually – and then I got married to the girlfriend who’d been so supportive when I first got sick, and now we have a three month old baby boy….I’d call all that "transitional".) That’s my story, and I’m curious what you all have to say about my medication. I know the dosages are pretty high, but I also know that quality of life is not something to take for granted. Peace, Dan

Hi Dan! Good to hear you’re doing so much better. It seems you have a nice family and your parents seem to have an OK son who will surely be a great father himself. It’s a kind of success story which is always inspirational and it seems there is much warmth around you. About the meds: it’s a lot of benzodiazepine but if it works, it works and if you don’t notice side effects like motor or cognitive impairment I wouldn’t worry about it. The combo of SSRI and benzo is a common one and the Zoloft dose is not unusually high. I’m happy that it works for you the way it does. If and when you feel like it you can always experiment with reducing the Xanax dosage but if it turns out that need 5 mgs that’s fine too IMO. Philip – Hide quoted text — Show quoted text – "Is a dream a lie if it don’t come true  Or is it something worse?"              - Bruce Springsteen

Response:

We found a medication combination – 5 mg per day of Xanax, 1mg per day Klonopin, and 150 mg per day Zoloft…… I’ve stayed at the same dosages of the medications, with few side effects, and feel very good.  I’ve had panic attacks begin, but the combination of the medication and learning not to fear the attack enables me to take a deep breath and let it go.  My life isn’t perfect, but I feel sane.

This is great you have had such support and found a combo that works for you and given you back your life. So, I’m curious what your thoughts are on my medication.  Sometimes I feel a bit guilty, like I should try to taper off the meds.  Other times, I’m perfectly content to stay on them the rest of my life.  I haven’t built up a tolerance for the Xanax, so that’s not a problem.

My first reaction is – if it ain’t broken, why fix it?  I think many of us get to a point we feel we can do this without meds and you are certainly free to try and lower your doses and see what happens.  I did that once and found I didn’t need as much K as I was taking.  Went a little lower and found I had pushed it too far.  Anyways,  I don’t know why you feel guilty, as IMO, there is no need to.  Better to be on meds and functioning than a suffering *warrior*.  Plus you have already been there and know what it is like. My doctor mentions tapering every time I see her, which is every three months, but lately I’ve been in so many transitional stages in my life, I just haven’t felt ready to mess with the medication

An excellent reason for NOT making changes at this time.  If you do want to try that….I hope you will do it at a time when life is relatively stable and nonchaotic – and having a new baby sure doesn’t seem the time.  Congrats by the way.  :) That’s my story, and I’m curious what you all have to say about my medication. I know the dosages are pretty high, but I also know that quality of life is not something to take for granted.

Dan…I think you just answered your own question.  Dosages are irrelevent – all that matters is what works for the individual.  Alot to be said for that quality of life thing. Best wishes… Gwen

Response:

(SYMKTB) writes: That’s my story, and I’m curious what you all have to say about my medication.

Hi Dan, good story. It gives people hope when they read that someone is doing well. I can’t give you much input on the meds. Please don’t ever feel guilty about taking the medication you need to control the PD. I suffered for years without them. I tried going to therapy and CBT  but nothing ever worked for me.  I’m considering asking my Dr about taking Klonopin. I’ve taken Xanax .5 mg PRN for the past 2 years. I’ve had PD since I was a child as well, but it was only 2 years ago that I decided to go to a Dr and ask for medication. You’re fortunate to have a supporting family and spouse. It’s much easier to deal with your PD if you know someone actually "believes" what’s going on. My husband always thought I was "making it up" until he saw our (at the time 4 yr old) daughter going through a PA. First he started to yell at her, then he saw the fear on her little face and said,"my God, what’s wrong with her?" Of course, I knew what was happening to her and told him. Then he felt awful for all those years of actually yelling at me to "knock off the bullsh*t" during my PA’s. Now whenever he witnesses one, he comes close to tears and tries everything he can to help. I can really relate to your comment on not being afraid to go out, but  being afraid of *having* to be somewhere for 8 hours. I have to return to work as soon as my daughter starts school, and I know I can only handle a few hours a day. That’s why I’m thinking about the Klonopin. I’m sure you’ll get a lot of helpful information from your post. I really learn a lot from here as long as I skip over the useless "wars" that go on. I don’t post here that often myself, but , what prompted me to was to congratulate you on your new baby boy!  And that I see you are a fellow BOSS fan! good luck with the little 3 month old "transition"!! (that’s a biggie isn’t it? LOL!) adp

Response:

Question:

- Hide quoted text — Show quoted text – After a pretty severe crash last week (cutting and all), I’m working my way back out.  But it seems like I’m climbing up a gravel cliff-little things seem to push me back down again.  I have no idea where the top is, but it’s a lot harder to get out each time I crash. My therapist thinks there’s something I’m not telling her, and my PDoc keeps upping my Zoloft dose.  He says that any other meds are a ’shot in the dark’ as to their effectiveness with me, and since Zoloft worked for me once (before I went off it-not recommended!), it should again, but I’m at double the dose now w/ no relief and the side effects are increasing. My wife is getting frustrated, since I’m such a burden when I crash, and it takes me *so* long to get back to ‘normal’.  She’s a rock, but after an episode, she tends to get a bit more upset with me since it builds up. At least I had one good realization while I was down: I felt that it *would* pass at some point.  That’s a first.  So score one for my sense of self-preservation. Thanks to all the asd’ers and grinchers that supported me last week.  I hope I didn’t bring you down. Mark "I was told that ‘Pain is just weakness escaping.’  Well, then I should be freakin’ Hercules by now."

 Mark, *Any* med is a shot in the dark.  The fact that Zoloft worked once, doesn’t mean it will work forever for you.  Since the side effects seem to be increasing and the Zoloft isn’t working, maybe it’s time to try something else.  You’re paying the pdoc for help, insist that you get it. chuck

Response:

After a pretty severe crash last week (cutting and all), I’m working my way back out.  But it seems like I’m climbing up a gravel cliff-little things seem to push me back down again.  I have no idea where the top is, but it’s a lot harder to get out each time I crash. My therapist thinks there’s something I’m not telling her, and my PDoc keeps upping my Zoloft dose.  He says that any other meds are a ’shot in the dark’ as to their effectiveness with me, and since Zoloft worked for me once (before I went off it-not recommended!), it should again, but I’m at double the dose now w/ no relief and the side effects are increasing. My wife is getting frustrated, since I’m such a burden when I crash, and it takes me *so* long to get back to ‘normal’.  She’s a rock, but after an episode, she tends to get a bit more upset with me since it builds up. At least I had one good realization while I was down: I felt that it *would* pass at some point.  That’s a first.  So score one for my sense of self-preservation. Thanks to all the asd’ers and grinchers that supported me last week.  I hope I didn’t bring you down. Mark "I was told that ‘Pain is just weakness escaping.’  Well, then I should be freakin’ Hercules by now."

Response:

Question:

WebfootVA schreef: – Hide quoted text — Show quoted text – BTW, though you said you take it at night.  Do you eat dinner late or do you take it with a snack?  If I started to eat my dinner at 9pm I would not only have bad indigestion, I’d probably weigh about 10 pounds more than I do now! Hi Iris, I do both.  I used to eat late dinners when I worked until 9pm so I could eat with my husband in the past.  For me, this was never a big deal.  I either eat a very light dinner at 5pm with my kids and a big snack later on, or I just have a late dinner, but I always eat before the meds. I also work out 5-6 times a week in the mornings at the gym as I’ve tended to gain weight with any of the meds in the past and I didn’t want to go that route again.  It also helps a lot with the everyday stress and gives me exposure to the rapid heart rate….rapid breathing symptoms, which I’m hoping will eventually help me prevent relapse once this goes into remission again. take care, Lene Well, I’ll probably have to take it in the morning then, or at least with my dinner around 7pm.  If I eat much later, I feel queasy when I go to bed. I need to start working out again.  I don’t have a weight problem but I am noticing a growing flab problem!  Exercise was my salvation when I had PA’s 10 years ago, but now I’ve developed a bit of a phobia–also, I suspect tied to the rapid heart rate, sweating, etc. BTW, the doc wants me to start out on 25 mg for a week then increase to 50mg where I’ll stay if the drug is successful.  Is 25 mg a low enough dose to start? Should I ask him for a lower dose?  I only weigh about 112, although I have a friend who doesn’t even tip the scales at 100 lbs and she started at 50 mg with no problem. Ever more questions. Iris —

  Iris, I feel your doctor knows about your fear of meds (which I recognize completely) and therefore starts your medication on a very low dose indeed. You should have no problems taking this at any time of the day. And: the proof of the pudding is in the eating. Try it and do it asap because you’ve been torturing yourself for too long now. Just do it! You’ll survive. Just as I did, so many times now (and still fraking out over every new med but having learnt to take it. If I can do it, you certainly can! I wish you knew me better to discover how true this is… Philip Peters

Response:

– Hide quoted text — Show quoted text – WebfootVA schreef: BTW, though you said you take it at night.  Do you eat dinner late or do you take it with a snack?  If I started to eat my dinner at 9pm I would not only have bad indigestion, I’d probably weigh about 10 pounds more than I do now! Hi Iris, I do both.  I used to eat late dinners when I worked until 9pm so I could eat with my husband in the past.  For me, this was never a big deal.  I either eat a very light dinner at 5pm with my kids and a big snack later on, or I just have a late dinner, but I always eat before the meds. I also work out 5-6 times a week in the mornings at the gym as I’ve tended to gain weight with any of the meds in the past and I didn’t want to go that route again.  It also helps a lot with the everyday stress and gives me exposure to the rapid heart rate….rapid breathing symptoms, which I’m hoping will eventually help me prevent relapse once this goes into remission again. take care, Lene Well, I’ll probably have to take it in the morning then, or at least with my dinner around 7pm.  If I eat much later, I feel queasy when I go to bed. I need to start working out again.  I don’t have a weight problem but I am noticing a growing flab problem!  Exercise was my salvation when I had PA’s 10 years ago, but now I’ve developed a bit of a phobia–also, I suspect tied to the rapid heart rate, sweating, etc. BTW, the doc wants me to start out on 25 mg for a week then increase to 50mg where I’ll stay if the drug is successful.  Is 25 mg a low enough dose to start? Should I ask him for a lower dose?  I only weigh about 112, although I have a friend who doesn’t even tip the scales at 100 lbs and she started at 50 mg with no problem. Ever more questions. Iris —   Iris, I feel your doctor knows about your fear of meds (which I recognize completely) and therefore starts your medication on a very low dose indeed. You should have no problems taking this at any time of the day. And: the proof of the pudding is in the eating. Try it and do it asap because you’ve been torturing yourself for too long now. Just do it! You’ll survive. Just as I did, so many times now (and still fraking out over every new med but having learnt to take it. If I can do it, you certainly can! I wish you knew me better to discover how true this is… Philip Peters

Philip: What a nice reply!  I’m going to print it out and tape it to the mirror, ’cause I’ve decided I’m going to start tonight! Iris (hoping to be successful…) —

Response:

– Hide quoted text — Show quoted text – BTW, though you said you take it at night.  Do you eat dinner late or do you take it with a snack?  If I started to eat my dinner at 9pm I would not only have bad indigestion, I’d probably weigh about 10 pounds more than I do now! Hi Iris, I do both.  I used to eat late dinners when I worked until 9pm so I could eat with my husband in the past.  For me, this was never a big deal.  I either eat a very light dinner at 5pm with my kids and a big snack later on, or I just have a late dinner, but I always eat before the meds. I also work out 5-6 times a week in the mornings at the gym as I’ve tended to gain weight with any of the meds in the past and I didn’t want to go that route again.  It also helps a lot with the everyday stress and gives me exposure to the rapid heart rate….rapid breathing symptoms, which I’m hoping will eventually help me prevent relapse once this goes into remission again. take care, Lene

Well, I’ll probably have to take it in the morning then, or at least with my dinner around 7pm.  If I eat much later, I feel queasy when I go to bed. I need to start working out again.  I don’t have a weight problem but I am noticing a growing flab problem!  Exercise was my salvation when I had PA’s 10 years ago, but now I’ve developed a bit of a phobia–also, I suspect tied to the rapid heart rate, sweating, etc. BTW, the doc wants me to start out on 25 mg for a week then increase to 50mg where I’ll stay if the drug is successful.  Is 25 mg a low enough dose to start? Should I ask him for a lower dose?  I only weigh about 112, although I have a friend who doesn’t even tip the scales at 100 lbs and she started at 50 mg with no problem. Ever more questions. Iris —

Response:

BTW, though you said you take it at night.  Do you eat dinner late or do you take it with a snack?  If I started to eat my dinner at 9pm I would not only have bad indigestion, I’d probably weigh about 10 pounds more than I do now! Hi Iris,

I do both.  I used to eat late dinners when I worked until 9pm so I could eat with my husband in the past.  For me, this was never a big deal.  I either eat a very light dinner at 5pm with my kids and a big snack later on, or I just have a late dinner, but I always eat before the meds. I also work out 5-6 times a week in the mornings at the gym as I’ve tended to gain weight with any of the meds in the past and I didn’t want to go that route again.  It also helps a lot with the everyday stress and gives me exposure to the rapid heart rate….rapid breathing symptoms, which I’m hoping will eventually help me prevent relapse once this goes into remission again. take care, Lene – Hide quoted text — Show quoted text –

Response:

Okay, after taking Zoloft for the first time last night, I felt so wired up today. How long are the side effects going to take? Why do some people have more side effects at first than others? PS make sure you eat with it.  I noticed a BIG difference in severity of side effects depending on whether I had a full stomache or not.

Good advice Lene.  I’m still working on starting my Zoloft (sigh…) and the reason I was leaning toward taking it at breakfast was to lessen the side effect possibility.  I’ve had this reaction with several other drugs. If I take them with food (if it’s an option), I always tolerate them better.  I’m not a scientist, but I think food slows the absorbtion rate, so your body can better adjust. BTW, though you said you take it at night.  Do you eat dinner late or do you take it with a snack?  If I started to eat my dinner at 9pm I would not only have bad indigestion, I’d probably weigh about 10 pounds more than I do now! Iris —

Response:

Okay, after taking Zoloft for the first time last night, I felt so wired up today. How long are the side effects going to take?

<snipped for space I’m not a doctor but I do believe that, while there is a possibility that you are experiencing a reaction to Zoloft, it’s an infinitessimal one. Most likely you have hyped yourself up over it with anticipation. ISTM a little too early for any reaction at all, good or bad… Sad to say, we anxiety types do this all too easily — Gary Cooper

Response:

Okay, after taking Zoloft for the first time last night, I felt so wired up today. How long are the side effects going to take? Why do some people have more side effects at first than others?

Side effects with zoloft at first are extremely common.  I’ve been on it for 10 weeks, My side effects lasted about four weeks.  However, my husband who is also on zoloft for chronic pain management had few side effects and none of the ones that I did.    I found that I had to work a bit with the time I took it, to manage the side effects better at first. Some people are just more sensitive to meds.  Myself included.  I usually have side effects to everything.  Try and keep in mind that that the side effects are a temporary situation and well worth getting through in order to give it a chance and see if this is the answer for you. PS make sure you eat with it.  I noticed a BIG difference in severity of side effects depending on whether I had a full stomache or not. take care Lene – Hide quoted text — Show quoted text –

Response:

Okay, after taking Zoloft for the first time last night, I felt so wired up today. How long are the side effects going to take? Why do some people have more side effects at first than others? Is it kind of a Riddlin effect.  Kids who take it and don’t need it tend to react to it differently and get hyped up.  and whereas kids who need the medication the most feel the effect immediately.    mmm.  in that case  is it true that if you’re feeling overanxious when initially using Zoloft   that you’re closer to healthy than you are sick?    just a hopeful thought

Response: