Penalty for Early Withdrawal

The majority of doctors are very good at prescribing medication. The pharmaceutical rep saunters into his or her office with a slick sales pitch and a briefcase full of samples and brochures, and the doctor starts prescribing.

The problem lies in getting you off of that medication. When you've been taking something that knits its way into your central nervous system, like an antidepressant or many other anticonvulsant or anti-anxiety medications, you can't simply stop. You need to “taper down,” which is gradually taking a lower and lower dose until you are completely weaned off.

The dosage, and the length of time you need to taper down, depends on how long you have been taking the medication, the medication itself, and how sensitive your system is. Mine, evidently, is as sensitive as the trigger hairs of a man-eating plant. Every time I've tried to stop the medication–seems like no matter how long I've been on it–I experience the consequences. A fibromyalgia flare, a killer headache, swollen ankles, nausea, dizziness, insomnia… I've been there.

Now I'm here again. I did some research after my osteoporosis diagnosis (sounds like the next title of a Tom Clancy book… The Osteoporosis Diagnosis) and found that several of my fibromyalgia medications interfere with calcium absorption, which interferes with building new bone cells. My doctor didn't tell me that. It wasn't in the little flyer that comes with the medication. I had to go research that myself. So I figured I would start divesting myself of these scourges, one pill at a time. I started with one that I thought I could knock off fairly easily… an anticonvulsant/mood stabilizer that acted as a bit of a muscle relaxant and really wasn't doing anything for my moods. I figured I would do the smart thing and taper down–by one half of a pill a week. It seemed prudent to me, workable, and it wasn't really noticing too much of an ill effect, save for little bits of irritability here and there. Nothing I couldn't handle with some deep breathing or a whiff of lavender oil or a spray of Rescue Remedy.

Then I made my mistake. I skipped the last week of tapering because I grew too impatient. And I went into withdrawal. It was nasty. I've had worse, but this was pretty bizarre. Headaches, check. Dizziness, check. Hot flashes and mental confusion, oh my God. I couldn't feel my knees. Seriously, they were numb. So was most of my body. All my muscles tightened up as if they were a wool sweater I'd thrown in the dryer. Some of them twitched in bizarre patterns and at bizarre times. I became uneasy about going out in public, for fear that people would think I was having a seizure.

I got over that last problem, because I was not about to stay in the house the entire time it would take my body to stop freaking out–I kept telling myself that this was only a temporary condition–and I would get over it.

But I didn't seem to be getting any better. I called my doctor, who didn't know what to do because she wasn't familiar with the medication. Really? This is the doctor who prescribes it for me, and she doesn't know? Shouldn't somebody know? The pharmaceutical company that developed it? No, all they'll tell you is not to stop taking your medication abruptly without consulting your doctor or else you might experience the following withdrawal symptoms, which they are nice enough to list. Shouldn't somebody know how to help you get through this? Anything you can do with diet, meditation, exercise? No, my doctor said nothing would help other than time. Or, if the symptoms went on after five or six days, I could go back on the medication at the dose I was taking when I quit, stay on that for a week or two, and then have her prescribe a lower dosage and wean down from there.

I'm back on at my last dosage, and next week will begin further weaning. Hopefully, I'll have an easier time.

Next time your doctor suggests a medication, ask what will happen when and if you need to stop taking it. Odds are he or she won't know. Perhaps your pharmacist will.

Have any of you had a problem stopping a medication? How long did it take you to get over it?

I Have Osteoporosis. Now What?

Those of you who read my posts regularly know how dedicated I am to improving my health and well-being. And all those things doctors and women’s magazines recommend I do to preserve bone mass and set myself up for healthy aging? I do them. I’ve been pretty active for most of my adult life, walking and doing other weight-bearing exercises. I eat well, take the appropriate supplements and, despite the small handful of health problems I’m already facing, manage to get the most out of my days.

So what do I get as my reward? Osteoporosis.

“But this is something elderly people get,” I thought to myself this morning, as my gynecologist told me the values of my recent bone density test over the phone, which meant I had osteoporosis of the spine and severe osteopenia of the hips. And I’m not even fifty. Hell. I’m not even forty-nine. This can’t be happening, I thought. Besides, my mother had already told me that heredity was a big factor, so I didn’t have to worry on that score.

“I’ve got the hipbones of a twenty-year-old,” my seventy-something mother said.

Apparently I’ve inherited my bone structure from my father’s side of the family.

The next step, the gyn told me, was a Vitamin D test. Among other functions, Vitamin D is vital to helping your body use calcium and boron and other trace minerals to build bone. I’ve tested chronically low in the past and have taken several rounds of prescription megadoses. Then she recommended I take one of the more popular osteoporosis drugs, and gave me the names.

I had the blood draw for the D test a few hours ago.

I’ll gladly take another prescription for Vitamin D. Heck, I’ll take those big green pills once a week until the end of time if that means my levels go back up again.

The drugs, I’m more reluctant to take.

It’s funny how the constellations of info come together sometimes. Last week, when I went to the chiropractor, I told him I took a bone density scan. He’s a pretty out-there, holistic-health kind of guy, which I like, and nearly every time I go we have a spirited discussion about some issue of health and well-being. He’s been my source for many of the blog posts I’ve written for PNN. He also likes to educate and entertain his patients with his “article of the week,” usually something he’s found on the web about the evils of the pharmaceutical industry or that it’s in everyone’s best interest to see their chiropractors as often as possible.

Ironically, last week’s article was about how horrible osteoporosis drugs are for you, and how one study showed that taken long-term, they can actually lead to thigh fractures (and femurs are the strongest bones in the body.) The chiro explained that these drugs (the bisphosphonate drugs like Fosamax, Actonel and Boniva) eventually kill off the cells that promote bone repair. You get denser bones, he told me, but they also get more brittle. He also said he wasn’t for any medical test whose sole purpose is to recommend or rule out the “need” for a medication.

When I got home from my visit, I was going to write another blog about this issue, and the article, but I got busy and put it off.

Ironically, as I sit down this afternoon, nervous and wondering what the diagnosis will mean to my life, the article sits on the stand next to my computer.

“Osteoporosis Drug Found to CAUSE Leg Fractures,” the headline reads. And after outlining the evils of these drugs (despite Sally Field’s endorsement), he lists ten steps to better bone health. All of which I already do.

So once again, I become the poster child for my health challenges, a cautionary tale. If you don’t already, consider adding these steps to your lifestyle for healthier bones:

1. Eat your veggies. Buy as organic as your budget allows. Does the idea of vegetables make you cringe? Try juices instead.

2. Ditch the processed foods. ‘Nuff said.

3. Already hopped on that omega-3 bandwagon? You know, the essential fatty acids found in cold water, oily fishies and fish oil capsules? (There are other sources for vegetarians, like flax seed and walnuts.) Don’t forget to balance these out with omega-6 oils as well (soy, canola, safflower and peanut oils) and get them as unrefined and unprocessed as possible.)

4. Avoid gluten as much as possible. Some studies have implicated gluten (a protein found in wheat, rye, barley, oats and anything made from these grains) in decreasing bone density.

5. Avoid sugar and sodas. Sodas, and especially colas, can deplete your bones of calcium.

6. Steroids (like prednisone, cortisone and some asthma medications) can increase your risk of getting osteoporosis.

7. Getting your Vitamin K? This vitamin works alone with calcium and Vitamin D to preserve bone mass. This can be found in kale, one of my favorite foods, as well as many other green leafies like spinach and turnip greens. Consider a supplement if you’re not eating your veggies.

8. Vitamin D. Vitamin D. Vitamin D. Supplement if you don’t regularly eat oily fish like salmon or herring, or get out into the sun (without sunblock). Ask your doctor how much D (and sun exposure) you should take, as the research is constantly, it seems, upping these levels.

9. Move that body! Get stronger with light weights and do regular weight-bearing aerobic activity like jogging or power-walking. Note: swimming and cycling are great exercises, but they aren’t weight-bearing. If these are your go-to aerobic activities, ask your physical therapist, doctor or a trainer at your gym about adding some weight lifting to your repertoire.

10. Some studies show that taking natural progesterone can increase bone strength. Ask your doctor or compounding pharmacist.

So, here I sit, having done all the right things, without the results I’d hoped for. I repeat my own mantras, that I am not my diagnosis, I am not my disease, I am not my pain. Maybe after the news has sunk in, these strategies will become easier and will give me more faith. But right now, they just feel like empty words.

Boning up on the State of My Bones

As many of you know, I am currently what the medical establishment so charmingly calls “postmenopausal.” This comes with many of its own joys and some new responsibilities toward my health. According to the aforementioned medical establishment, I'm supposed to, like Sally Field, be worried about the state of my bones. There's a whole industry that has grown up around "women of a certain age" being frightened about falling and breaking a bone. Especially a hip.

We're supposed to be doing weight bearing exercises -- building our bones with power walking and weight lifting. We're supposed to get lots of calcium and, if our doctor advises, take the medication that the last pharmaceutical representative who visited his office told him about.

I never really worried about my bones before. There is no history of osteoporosis in my family, and although my grandmother broke her hip, she was quite advanced in age when it happened. Although I can't eat or drink dairy products, I've been taking the appropriate combination of supplements (calcium plus magnesium plus vitamin D) that are supposed to make up for that missing chunk in my food pyramid. I've always exercised, either jogging or walking or kicking it on the elliptical trainer. And I've been doing upper body weight lifting consistently for the past five years.

Yet I still want to have that bone density test. I want a number. I want to know that I'm okay. Yes, this has been drummed into me by my culture and the media, because, logically, why would I feel validated about getting a number?

I just want to know what I'm up against. I do have, well, not the classic risk factors, but some of the minor ones -- I've been a vegan on and off, I started menopause early, and I have difficulty absorbing nutrients from my digestive system.

But just try getting a bone density test out of your insurance company when you don't fit the guidelines. Yes, they will cover it, but only if I have a family history of osteoporosis or my doctor suspects I might have osteoporosis. But isn't it logical that after menopause, when our bones tend to thin, a test like this should be mandatory? That giving me a baseline figure while I can still do something about any potential bone loss would be much cheaper than waiting until I have osteoporosis or, find out that I do after having broken a bone?

So I thought I would get one at the health fair. Several women I have known told me that you can get one there free, but last year, I arrived too late and missed all the sign-ups. This year, I got in early enough, I had my test, and it was not good. The young woman who took my scan told me that I needed to call my doctor and get a full-on bone density test.

Maybe this will get my insurance company to finally cover it.

Meanwhile, there's nothing I can do. I'm concerned because I don't really know what this means, or if bone loss is reversible. I just know that I don't want to take another drug that has more side effects than benefits.

Have any of you tested positive for osteopenia or osteoporosis? If yes, is there a noninvasive treatment?

(Illustration by Eric Shalley.)

Thank You!

This is a belated but glorious "thank you" both to PNN for giving me the honor of being your "Health and Well-Being" featured author, and to all of my readers for, well, reading, and supporting me.

And that's one of the things I like best about writing for PNN - the supportive environment.

It's been shown that surrounding yourself with positive, supportive people - physically, and, as more studies are proving out - on the web as well - is great for your health. Social contact can reduce stress, provide important outlets during times of duress, and even help you live longer!

So, I raise a virtual glass (of sparkling apple juice) to our health-to our individual health, the health of our nation, and the health of our world.

To all of you writers, keep writing. To all of my readers, please keep reading-I welcome your comments with an open heart and an open mind. And maybe more of you will want to express yourself here as writers, too.

It's a good place to be.

Namaste.