Honey's supportive doctor

I talked with Honey's PCP a while ago on the phone.
I am always impressed with the time she gives Honey and I both on the phone and in the office. I never feel like I am wasting her time nor do I feel like she is thinking that I need to stop telling her (PCP) what I need.
I had a couple goals concerning our conversation.

First, I wanted to update her as to what is going on (that we had not started reducing, that Honey was still trying to transition from tablets to liquid (while maintaining "stability"), and wanted her to know that Honey is just now feeling completely "normal" since the TEVA form of sertraline experience. I told her that I thought "Honey must be pretty sensitive to this medication". I feel if I say this (instead of saying the drug/poison "sucks" and is killing people) that I will not put her on the defensive and still have her seeing that my ideas about tapering really slow and cautiously is best for "Honey".
That goal met.

Second goal was to express my concern over transitioning to the liquid and shared with her my "information" regarding the possibility that the liquid might also trigger withdrawal symptoms (like the TEVA did for Honey) and that I wanted to transition slowly (from tablet to liquid) as well as keep her on at least 12.5mg of the tablet while decreasing the liquid.
Goal met-- she probably thinks I am nuts, but she said she definitely was okay with that and would continue to write refills for both the liquid and tablets as long as needed- would I just keep her updated- I almost thought it sounded like she meant "Keep educating her on this process".

Third goal: Ask PCP if she would write a note for school to inform school of Honey's diagnosis and let them know that she was having medications adjusted and the adjustments might cause physical and psychological symptoms. This is what I asked her to write (or something along those lines)-- we will see what we get. I also asked if she would be willing to help out as needed as far as school goes and she said "Certainly".
third goal met (haven't seen the note yet, but anything at this point from her that informs school of her diagnosis and med changes and knowing that PCP will back us as needed is all I need to get things started with school.
I feel like I accomplished something.

Honey continues to do well. We have started daily documentation as far as dosage, Honey's moods and any physical symptoms- so we will have a good baseline to go by when we start reducing and making poison (med) changes as far as form (tablet to liquid). This is our plan for now:

Currently (for the past 10 days 3/10- 3/19) she is taking 37.5mg Zoloft - 12mg liquid (.6ml) and 25mg tablet.
Starting tomorrow 3/20 she will take ¾ of a 25mg tablet (18.75mg) and 19mg liquid (.95ml) She will continue this for 10 days (until 3/29) as long as there are no withdrawal symptoms.
At that point (on 3/30- Thursday) we will try ½ tablet (12.5mg) and 25mg liquid (1.25ml). After 10 days (starting 4/9) on this ratio of tablet to liquid, I would like to start reducing the liquid (as long as she is baseline). We will reduce at 5% (actually just a bit more) of the total dose of 37.5 (actually reducing 2mg/.1ml). We plan to have her stay at this dose until she feels baseline or better. (at least 2 weeks on this dosage) and will reduce from there as tolerated.
I plan to keep her on 12.5mg of the tablet (½ tablet) as she reduces the liquid. I will have to worry about making a transition with the remainder of the tablet later. (Once she has reduced a good deal of the liquid)

I have never felt this way before... like a pioneer? I feel like Honey and I are creating a map. We can talk to other pioneers, who have been this way before, but their map might be different or maybe they have not been "here" before. Weird. I dont like being here and I dont like being here without a proven map. Honey hates it. But in a way (?) it is actually empowering (?) (I am sure I will take this "empowering" thing back)
It is also weird trusting my gut to this degree. Trusting it over science and mainstream practice. I am proud of my intuition/gut and proud that I listened, as it knew to go slow with the liquid, even before I understood that there might actually be theory behind it (might bring about withdrawal symptoms??- theory/thought)

Uchenna Agu (as in Uchenna and Joyce from Amazing Race All-Stars (yes, I watch)) said something on last night's episode that I loved. I dont have his exact words but it went something like this: By not trusting your instinct/gut/intuition, you are basically telling God or the Universe that He (God) is wrong. Like I said, I got his exact words wrong, but I think I got the gist of it correct. I am going to look for his exact words, because they were great.

Possible problems switching from Zoloft tablets to Zoloft liquid concentrate- I wonder if I could be any more confused?

I have some new concerns (what's new??)- this time with a potential problem switching from sertraline in tablet form to liquid form. I am learning that there is a possibility of moderate to severe withdrawal symptoms( something like what Honey experienced with the TEVA form of sertraline or worse). So, a couple of ideas/questions/plan of action that I am pondering.

First, being that Greenstone (pharmaceuticals) is a subsidiary of Pfizer, ***what are the chances of Greenstone sertraline being identical (inactive ingredients as well) to the Pfizer Zoloft tablet? I think they are identical, aside from the Greenstone version not having “Zoloft” printed on them. The colors and shape are the same for at least the 25 and 50mg tablets, I guess I have not seen a 100mg of either. (The U.S. government requires that the drug look different so it won't be mistaken for the original. This prevents fraud.)

***So, I have to imagine that the reason Honey had problems with the TEVA version of sertraline could have something to do with inactive ingredients?

***So then, I have to imagine that the reason she may have problems with Zoloft liquid could be the same issue? Different inactive ingredients?

***So, then, I have to wonder if her chances of being successful with the liquid (without serious withdrawal symptoms) might be increased if she remained on a bit of the tablet?
(Looking back at the TEVA experience, when she first started the TEVA setraline, Honey was taking ½ of a 50mg TEVA tablet and ¼ (12.5mg) of a 50mg Greenstone sertraline tablet, because I had a number of ¼ tablets remaining of the Greenstone. Once I ran out of the Greenstone ¼ tablets, she was taking just the TEVA, it was really then a matter of days (5?) before we noticed the withdrawal symptoms that continued to increase until back on the greenstone)

I guess I am going to continue on with going to liquid, but will keep her on at least 12.5mg of the tablet (using a slow change-over to get to that point). I will do this over time and see how she does and will in no way hesitate to go back to where she is now. At that point (going back to just tablets), I would wait until school was out for the summer and work it that way.
My plan at this time (actually in a few days/this coming Monday - going to give the current liquid/tablet ratio 10 days) is to go to ¾ 25mg tablet (18.75mg) and 18.75mg liquid (Honey is currently taking 25mg tablet and 12.5mg liquid) and she how she does and without hesitation, if withdrawal begins to look like the TEVA withdrawal, I will reinstate the previous setup (what she is taking now). IF all goes okay, (after several days (10) of feeling baseline) I will again try to take a ¼ tablet away and replace it with liquid. I am thinking if she can successfully get down to just a ½ 25mg tablet with the remainder being liquid, and is stable and ready, we will start reducing the liquid (and keep the ½ tablet (12.5mg) in place. Then, I can decide what to do later about the 12.5mg tablet.
I spent the entire night thinking this through. I did not sleep. This is all making me just about lose my mind
Honey continues to do well and she has noticed that her problems with concentration have decrease to just about “normal for her”.
I realize all of what I am talking about above are my own theories and could have nothing to do with fact. I know there is a strong possibility that I will be wrong. I know we could just as easily wait for school to be out to start this process- but Honey wants to press forward. I will try it as long as Honey is for the most part symptom free. (All the more reason to get myself together and get a note from PCP and talk with school counselor/possibly school Principal.

Things are settling down...

Well, I do think things are starting to settle down a bit.
Honey appears and says that she is feeling much better
(since the withdrawal problem caused by the Teva form of sertraline).
She appears more grounded, less irritable and anxious. She continues to have muscle pain and her concentration might be a bit messed up? Sleep continues to be an issue, but I think it will be a huge issue until she is free from the Zoloft.
And I feel a sense of relief and a sense of peace, like I can let go of this a little bit (in a way)
I know now that she is on the right road.
She has what she needs as far as the right medication (read also as poison)
in the oral concentrate Zoloft.
She has her doctors understanding, backing and support.
She has gained some personal confidence in this journey.
She has gained some personal knowledge in her situation that she didn't have before.
We have started the transition to the liquid (from the tablet) in a slow process.
She will be off and running soon!
I know I need to start taking better care of me.
Doing more than existing to get her through another day of this mess.
I know that when I am feeling less than good, I am less than good to Honey, Tootsie and all the rest.
Stephany reminds me that this is my journey.
I may be walking alongside Honey in her journey, but I have a journey too.
I want to celebrate my journey

yep, it was withdrawal, yep- got the script for liquid zoloft :) :)

Well, 7 hours after taking her 37.5mg dose of REAL zoloft, Honey is back to her stable self. Irritablity way down, anxiety way down. I cant wait to see how she sleeps tonight since for the past several days, dreams have been dramatic and vivid and waking her up frequently. For two weeks she has been in withdrawal and we just couldn't figure out what was wrong.

Sertraline under the Teva label should be investigated. This drug should not be used as an equal to Pfizer/Greenstone sertraline. It took me a visit to 3 different pharmacies before I found one that carried Greenstone (vs. Teva)

I was so proud of Honey today. We have been talking over (Honey and I) what the goals of the Dr. visit were, what we wanted to share, what we would share if necessary, what we would accept from the doctor and what we would refuse.
Honey presented "her case", presented a review of previous withdrawal (late Aug 06 - started back on sertraline Nov 06 and dosage bumped up Jan 07 (to help with symptoms that seemed to be withdrawal symptoms from previous Zoloft use of 50mg), presented a summary of WHY she wanted off the drug and presented our researched plan for tapering safely.
Honey ROCKED! She did all of this while she was basically "freaking out" due to withdrawal symptoms. She finally had to sit down/lay back on a bench in our final pharmacy. The pharmacist got a dose for Honey immediately. A literal few hours later and she was feeling so much better.

Dr. gave Honey a script for 2 weeks worth of tablets.
She also gave Honey the script for liquid Zoloft.
We decided that Honey would stabilize on the tablets for a couple days, then go to tablets and liquid and gradually go to just liquid. WHY? I dont know- I just feel like we should. Actually, I think I received a helpful, anonymous email from a dear helper who suggested not going straight to the liquid, but to make a gradual change. Who knows, but it seems safer to me and dr. had no problem with it.
Glad the day is over. I am so glad to have solved the withdrawal issue, so proud of Honey- being her own advocate today (I know it something she will be proud of for a while) and so glad we got the liquid :)