A case of Ativan addiction and more.

[Guest guest]

Hello,

 

I need some help working with a patient who has been on Ativan for 20+ years, originally prescribed for a panic disorder.

She's 50 years old and came in yesterday for help with withdrawing from Codeine and Vicodan which she has been taking for back pain off and on for the last 10 years. She went cold turkey about 10 days ago and has felt weak, unstable, depressed, occasional racing heart and a heaviness in her chest since. Since going off she is only able to sleep for an hour or so with the help of large amounts of Ativan. At night she finds herself restless and agitated. She has used acupuncture to withdraw from Codeine and Ativan before and has found it helpful but didn't continue treatment because of communication problems with a Chinese practitioner. She has been an inpatient at an addiction facility before but refuses to go back.

She has also been put on Klonopin in the last month which she has been on before.

 

Urinary: frequent clear urination with dribbling

Digestion, bowels: has had diarrhea since going off the narcotics, no appetite but drinks a can or 2 of slimfast every day.

Gyn: menopause at age 44

General:Feels warm since withdrawal started but usually feels cold.

 

Observation: An extremely thin woman (an obsessiver runner) with a pale complexion and dark circles under her eyes. Talks very fast but makes sense. Very analytical and obsessively aware of her own thoughts.

Tongue: Very swollen, slightly pale with a red tip. Deep crack just at the tip. Thick grey coating. Moisture is ok except for wetness at the tip.

Pulse:Slippery, forceful and spinning in both cun/inch positions. Deep and very thin in all other positions except the left chi/cubit which was practically nonexistent.

 

Whether or not I treat her with herbs will depend on how comfortable I can get with understanding her case. Right now, I am not so sure as to how I should proceed, not having any experience with treating narcotic withdrawal and long term benzodiazapine addiction. I don't know how to interpret the information she presents, how much f it is withdrawal syndrome and how much of it is Ativan addiction. Should I just treat what I see with herbs and keep a close eye on her? Or should I acknowledge my fledgling status and not mess with herbs and her?

 

Part of why I am writing is that I remember Z'ev talking about serotonin reuptake inhibitors inhibiting the jing of the brain and creating a phlegm-fluid accumulation above and vacuity below. This is what I am seeing with this patient. Now, Ativan is not an SRI and although I don't understand it's pharmacological action I do know that it is involved in modifying GABA receptor sites in the brain, another knid of messing with jing up there. Her panic attacks from way back when, sound like they were of the phlegmy type(stuporous on the outside, yet flying back and forth to hell on the inside),so she may have a history of this sort of pattern before Ativan came on the scene.

My dx looks like this for now: Phlegm accumulation in the upper jiao. K yin/yang xu with deficiency heat. Heart and Kidney not communicating. (Sp xu)

If I were to pursue herbs, I was thinking along the idea of ban xia bai zhu tian ma tang plus tian wang bu xin dan.

I am grateful for any insight that you may have.

 

Kristin Wisgirda

[Guest guest]

Kristin,

Your dx sounds pretty accurate. I would definately use a modification of

tian wang bu xin dan and then tonify spleen and clear damp and phlegm

with a liu jun zi tang mod added. Herbs will help her greatly. When you

find your thinking confounded by western dx's and issues, use TCM!!

Don't hold back just because you are new at this. Use what you've

learned so far and then learn more. Make sure you put some shi chang pu

in the rx as well for phlegm blocking her heart orifices but be careful

with it and yuan zhi at 1st as they are fairly warm.

 

 

Mark